CDC urges clinicians to expect delays, plan for influenza vaccine
By Joan Unger, RN, MS, ARNP
and William T. Elliott, MD, FACP
Citing lower manufacturer capacity, the Centers for Disease Control and Prevention (CDC) in Atlanta urges health care providers to order their flu vaccines now.
The CDC warns nurses and doctors that the 2001-2002 flu vaccine may again be delayed and urges all health care providers to ensure that high-risk individuals are targeted for early prevention. Although the problem
is not expected to be as severe as last year, the Advisory Committee on Immunization Practices (ACIP) of the CDC recently released supplemental influenza recommendations. Emphasis will be placed on making the initial supply of influenza vaccine available to health care providers who serve persons in high-risk categories.
Providers who order late may delay their orders. ACIP asks manufacturers, distributors, and vendors to ensure that all providers who have placed orders receive some early-season vaccine, which makes it possible for them to vaccinate high-risk patients early. ACIP also suggests manufacturers delay vaccine distribution to sites primarily vaccinating healthy workers until November and that providers be informed of the amount and date of shipment so high-risk patients can be notified of the vaccine’s availability.
The CDC explains that this year’s delay is a result of a lower manufacturing capacity as the number of manufacturers has dropped from four to three. Still, the CDC predicts that 64% of the vaccine supply (49.8 million doses) will be available by the end of October, more than twice the amount available last October, with an additional 27.3 million doses available by November or December. The total supply, similar to 1999 and greater than in 2000, should be adequate by the end of November.
An important change found in the current ACIP recommendations extends the optimal time for vaccinating individuals at high risk from mid-November to the end of November. Vaccination rates typically peak in October or early November, whereas the disease itself peaks between December and March. However, in 15 of the last 19 years, peak influenza activity occurred between January and March, which indicates that flu vaccination in November, December, and even later is effective in most flu seasons. As a result, the CDC recommends that immunizations should continue into January if necessary and also suggests that to avoid missed opportunities, vaccine (if available) should be offered to high-risk persons when they are seen for routine care or are hospitalized in September.
• Nursing considerations.
The flu shot is the best protection you can give your patients against influenza and its complications. Numerous variables affect the severity of any flu season, many of which cannot be fully anticipated or prevented. Nurses can help protect their patients by arming themselves with the most current CDC information and by following the ACIP recommendations. It is especially important to do the following:
— Make sure you know who the high-risk target groups are, especially in children. (See Target Groups for Priority Influenza Vaccination, below.)
| Target Groups for Priority Influenza Vaccination |
|
People at High Risk of Complications:
• 65 years or older
• Those under 65 years of age with chronic illness,
• People of any age who reside in nursing homes
• Adults and children with chronic disorders of pul-
• Adults and children who have received medical
• Children and teen-agers, 6 months to 18 years,
• Women in the second or third trimester of preg-
• People between 50 and 64 years of age. This
People Who Can Transmit Influenza to Those
• Nurses, physicians and other persons in hospital
• Employees of nursing homes and chronic
• Employees of assisted living and other residences
• People who provide home care to people
• Household members, including children, living
Source: U.S. Department of Health and Human Services, Centers
|
— Identify high-risk patients for notification and target the vaccine available in September and October for those at increased risk for influenza complications and for health care workers.
— In November, begin offering vaccine to contacts of high-risk persons, healthy persons aged 50-64, and others wanting to reduce their risk for influenza.
— Continue vaccination through December and as long as vaccine is available.
The CDC says that minor illnesses with or without fever do not contraindicate the use of influenza vaccine, particularly among children with mild upper respiratory tract infection or allergic rhinitis. However, persons with acute febrile illness usually should not be vaccinated until their symptoms have abated.
Patients often have myriad questions about influenza vaccination. You can save time and avoid misunderstandings by offering printed information. Information regarding individual vaccine components can be found in package inserts from each manufacturer. Explain the following:
• Viruses in the vaccine are killed, so they cannot get influenza from the vaccine.
• Influenza viruses change from year to year, and each year’s vaccine is manufactured to be as effective as possible against the specific strain anticipated for the current year.
• It is still possible to contract flu from a virus that is not covered by the current vaccine, but vaccinated people who do contract influenza often have a milder case than those who did not get the vaccine. People sometimes mistake any illness with fever and cold symptoms for flu.
• Protection develops about two weeks after immunization and may last up to a year.
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