Flu Shots Scarce Even for Most Vulnerable

Only 55 million doses for 95 million people at risk

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HealthDay Reporter

THURSDAY, Oct. 7, 2004 (HealthDayNews) -- Federal health officials estimate that 94.9 million U.S. adults and children are at high risk for influenza and should be vaccinated.

This wasn't a huge problem last year, when 83.4 million flu doses were produced and 83.1 million dispensed.

This year, however, because Britain just suspended the license of a key U.S. flu vaccine maker, only about 55 million doses will be available, half of what is needed just for the most vulnerable.

While the U.S. Centers for Disease Control and Prevention is urging hospitals and other health-care providers to give flu-shot priority to high-risk individuals, including the elderly and small children, the numbers make it clear there just isn't enough to go around -- not for high-risk people, and especially not for healthy people.

CDC spokeswoman Karen Hunter said the CDC does not keep tabs on what percentage of people who get flu shots in a more typical year are healthy. But Maxim Health Services, which provides flu clinics to corporations, pharmacies and others, estimated that, in previous years, about 78 percent of those attending the flu clinics were high-risk.

Hunter said the agency hoped health officials across the country will save the shots for those who need them the most. "We're recommending that healthy folks defer to the high-risk group," she said. "It's important for people to understand that, for healthy people, the flu is uncomfortable, certainly, but it's not typically life-threatening. There are also other things people can do if they are not going to be able to get flu shots, such as washing your hands and, if you're sick, staying at home."

On Tuesday, Chiron Corp., which was under contract to make as many as 48 million doses of its vaccine, Fluvirin, announced it couldn't deliver any because of regulatory problems at its factory in Great Britain that led to its license suspension. Aventis Pasteur, the remaining supplier of flu shots, reportedly will be able to produce an additional 1 million doses, bringing its total for this flu season to about 55 million. The company has already distributed 30 million doses, according to the CDC.

Meanwhile, U.S. health officials met with British regulators Thursday to discuss the suspension of Chiron's license to produce flu vaccine at the company's Liverpool plant. And they planned to inspect the factory this weekend to see if any of the impounded vaccines could be salvaged, the Associated Press reported.

The purpose of the meeting was to see "where the disputes are and how we might be able to reconcile them, if at all possible," U.S. Health and Human Services Secretary Tommy Thompson said.

However, he added, "it does not look promising at this point, but we are going through all the procedures."

It is still not clear how the vaccine shortage will affect the coming flu season, or even whether talk of diluting the current supply is feasible.

"The implications could be huge [such as the 1918 pandemic], or much smaller. It really depends on the virulence of the virus and what percentage of the high-risk patients are infected," said Dr. Jeff Wiese, associate professor of medicine at Tulane University School of Medicine in New Orleans. "Undoubtedly, there will be an effect. The question is how big it will be."

Even in light of this crisis, CDC director Dr. Julie Gerberding has said that her agency would not force redistribution of flu supplies. That is "not a realistic strategy," she said Wednesday.

The CDC will, however, try to identify health-care providers that have extra vaccine to steer it towards areas with shortages. The agency also plans to set up a toll-free hotline so consumers can report shortages.

Otherwise, individual institutions are having to devise their own contingency plans.

"Some hospitals that placed their order with Aventis will receive their flu vaccine as ordered. How they distribute that will be up to them, so it is possible that some healthy people will receive the vaccine," Wiese said. "However, I would guess that hospitals and clinics that receive the vaccine will take the more responsible position of ensuring that the highest-risk patients [such as the elderly, people with co-morbid disease, and health-care providers] would receive the vaccine first."

Indeed, Maxim Health Services, which has received its supply of vaccine from Aventis, announced that it would be adhering to the just-revised CDC guidelines and would cancel all flu clinics at corporations, "as these sites serve a broader range of individuals, many of whom are not high-risk." In 2003, Maxim vaccinated more than 1.8 million people.

The company is "requiring people to sign forms verifying that they are high-risk," a company spokeswoman said.

Rite Aid Corp., one of Maxim's clients, confirmed that candidates for flu shots are being screened. "We're only giving immunizations to people who are high-risk," said Jody Cook, a spokeswoman for the pharmacy giant.

The Massachusetts Department of Public Health on Wednesday issued an advisory to doctors and hospitals telling them to halt clinics for the general public and urging them to restrict flu shots to those at high risk. The department said that 73 percent of the 462,000 doses of flu vaccine were supposed to have come from Chiron.

Health officials in Colorado, one of the hardest-hit states in the 2003-2004 flu season, will also be restricting the shots to the most vulnerable, according to the Rocky Mountain News.

Walgreens, meanwhile, has ordered its stores to restrict vaccinations to high-risk candidates, while CVS said it had suspended its flu clinics.

According to the San Francisco Chronicle, Chiron had already shipped 6 million doses of its vaccine to the United States before evidence of contamination was found. The doses had been waiting in a warehouse under a company-imposed "quarantine." Howard Pien, chief executive of Chiron, said all the Fluvirin doses will be destroyed, according to the Chronicle.

The revised CDC guidelines call for preference to be given to infants aged 6 to 23 months; adults 65 years and older; individuals aged 2 to 64 with underlying chronic medical conditions; all women who will be pregnant during flu season; residents of nursing homes and long-term care facilities; children 6 months to 18 years who are on chronic aspirin therapy; health-care workers involved in direct patient care; and out-of-home caregivers and household contacts of children under the age of 6 months.

More information

Visit the CDC for more on the flu and flu vaccinations.

SOURCES: Jeff Wiese M.D., associate professor of medicine, Tulane University School of Medicine, New Orleans; Jody Cook, spokeswoman, Rite Aid, Camp Hill, Penn.; Karen Hunter, spokeswoman, U.S. Centers for Disease Control and Prevention, Atlanta; Maxim Health Services, Columbia, Md.; Maxim statement; Oct. 7, 2004 San Francisco Chronicle, Rocky Mountain News

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