Amid flu vaccine delays, CDC offers to boost supply
Web site links available doses with those in need
As employee health professionals scrambled to cope with flu vaccine delays, the Centers for Disease Control and Prevention created a special Web site to link those needing more vaccine with sources of extra supply.
The site, which can be accessed through www. cdc.gov/nip, was designed not only to provide information on manufacturers and distributors but allow unused vaccine to be redirected to hospitals that need it.
CDC also has guaranteed the production of up to 9 million additional doses, which are to be available in December, to ensure that there will be no overall shortfall. Last year, 74 million of the 77 million doses produced were distributed. This year, CDC anticipates a total of 75 million doses.
However, the timing of those doses has wreaked havoc with hospitals’ campaigns to immunize health care workers and high-risk patients. Some hospitals received their usual flu vaccine orders nearly on time. Others were told that most of their shipment would arrive in November and December and that they should expect 10% to 15% less than they ordered.
"We were really trying to step up efforts this year [to immunize health care workers] and now it’s going to be much harder," says James Garb, MD, director of occupational health and safety at Baystate Health System in Springfield, MA, sharing the concerns of many in employee health. Garb expected to receive just 16% of his order in October, another 58% in November, and the remaining 26% in December.
Delays in production of the flu vaccine emerged earlier this year when growth of the A(H3N2) vaccine component proved more difficult than expected. Two manufacturers also had quality control issues to resolve with the Food and Drug Administration (FDA).
As a result, manufacturers had somewhat different production problems. Aventis Pasteur of Swiftwater, PA, began shipping vaccine in September and expected to continue shipments through the end of November, about a month behind schedule. Wyeth-Ayerst Laboratories in St. Davids, PA, expected to ship most of its 24 million doses in November and December.
Overall, the FDA estimated that 76% of the flu vaccine would be shipped by the end of November.
The Advisory Committee on Immunization Practices issued recommendations in October that called for giving priority to the highest risk patients and health care workers who cared for them. The expert panel also stressed that even immunizations given as late as December or January would likely prevent spread of influenza.
"In a review of the past 18 influenza seasons, peak activity occurred in January to March during 14 years," reported Walter Orenstein, director of the National Immunization Practices and assistant surgeon general. Allowing for two weeks between vaccination and full immunity, "vaccination even in December will be expected to have impact in most years."
Campaigns can continue into next year
In fact, vaccination campaigns can continue into the next year, according to Orenstein. "Influenza peaked in February and March in 10 of 18 years. Even vaccinations in January can prevent disease morbidity and mortality in most years."
Influenza experts gave the greatest priority for immunization to high-risk patients — those with medical conditions that place them at risk for complications due to influenza. But they made it clear that immunizing health care workers who care for those patients is an equally important task.
If there’s a shortfall at a hospital, "the first advice would be for these organizations to get additional vaccine as much as possible," says Keiji Fukuda, MD, MPH, chief of CDC’s influenza branch. "It really shouldn’t be an either/or situation. The target is to protect high-risk people. Vaccinating health care workers is a part of that strategy."
Influenza experts were uncertain what impact the delay would have on efforts to reach higher levels of immunization of health care workers. The 1997 National Health Interview Surveys found that 34% of health care workers received the influenza vaccine. Vaccination levels of 80% or above provide "herd immunity" in which the virus is unlikely to spread.
Lanier Park Hospital, a small hospital in Gainesville, GA, typically immunizes more than 70% of its staff involved in direct patient care. But this year, the hospital didn’t expect to receive any vaccine until late November, says Edward I. Galaid, MD, MPH, medical director of Lanier Park Occupational Health.
"Once the word started coming down that the vaccine was going to be delayed, the projections of when we were going to get our vaccine were later and later," he says.
While the hospital was prepared to administer vaccine as quickly as possible once it became available, Galaid also was looking into the use of antivirals to shorten the course of influenza for those health care workers who become sick.
"I think it’s a prudent strategy to consider, not knowing when the peak of the flu season is going to be this year," he says. "I know last year was particularly challenging in terms of staffing [during the influenza season]. The hospital is full, your census is up, then you have people who are sick. It’s a one-two punch."
As a part of that strategy, "I think we’re going to have to increase employee awareness of what the symptoms are of flu," Galaid says.
Ironically, the delay and fears of a shortage of flu vaccine may have given the immunization efforts an added boost of publicity. Some members of the ACIP panel noted that it’s human nature to want something that is in high demand.
Last year, Memorial Sloan Kettering Cancer Center in New York City used "flu deputies" in the hospital units to administer flu vaccines and raised immunization rates to about 40%. As the fall shipments of vaccine were delayed, Janet Eagan, RN, MPH, CIC, the infection control manager, made contingency plans to immunize staff in the highest risk units first. Meanwhile, hospital staff began asking when the vaccine would arrive. (She expected her order in early November.)
"People stop me in the hall now asking, When are you going to give it out?’ We’re going to try to use [the publicity] to our advantage," she says. "There’s a lot of press about it. A lot of people are concerned. I’m really hoping more people will be paying attention to [flu immunization] and will be ready to go when it gets here."
Eagan says she is glad she has an effective mechanism to immunize health care workers quickly. "I have a system in place, and everyone knows what to do. I will give them their flu kits — everything except the vaccine."
Implementing the "flu deputies" program last year puts her in a strong position, Eagan says. "It would be harder to start that program now without the vaccine here."
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