On October 4, 2004 the Centers for Disease Control and Prevention (CDC) was notified by Chiron, a major manufacturer of flu vaccine, that none of its influenza vaccine would be available for distribution in the U.S. for the 2004-2005 flu season due to contamination issues. Chiron was to make 46-48 million doses for the U.S. That means that almost half of the nation’s flu vaccine will not be delivered this year. Now the CDC is recommending that only people in certain high-risk groups receive the vaccine..
Below, flu specialist Jim Campbell, M.D., discusses the shortage and its implications, and provides information on the new vaccination recommendations. Dr. Campbell is a specialist in pediatric infectious diseases at the University of Maryland Center for Vaccine Development and an assistant professor of pediatrics at the University of Maryland School of Medicine.
Why is there a shortage of the flu vaccine this season?
There are only two manufacturers of injectable influenza vaccine in the U.S. and each would have supplied approximately half of the doses. This year, one manufacturer cannot distribute any of its vaccine because of a problem at the production facility in which the vaccine vials became contaminated with a bacterium. That leaves the country with approximately half of the expected doses.
So how much flu vaccine will be available in the United States this season? Is there a shortage in hospitals, clinics?
Instead of approximately 100 million doses, there will be about 55 million doses. There is a shortage in all sectors of health care. The main determining factor for how short a particular hospital or clinic is on vaccine is the company from which it ordered vaccine.
How is the CDC attempting to re-distribute the vaccine?
The Centers for Disease Control and Prevention in Atlanta is working together with the manufacturers, vaccine experts, and health care providers to re-allocate the doses of vaccine not yet shipped or not yet used. These groups are finding the places where high-risk patients do not have access to vaccine, such as hospitals, and re-directing doses.
How many flu vaccine doses are available at the University of Maryland Medical Center?
According to the University of Maryland Medical Center, there are only approximately 300 doses available today, but the University is part of the re-allocation plan and hopes to receive additional doses before the start of the flu season.
Who will that be used for?
The Medical Center will be following the CDC guidelines to vaccinate high-risk patients and health care workers. It is hoped that the re-allocation will provide enough doses to vaccinate most high-risk people, but at this point, there are just too few doses available.
Where else can I get a vaccine?
Private and public clinics may have vaccine available, but should be following the CDC recommendations for vaccinating only high-risk people. Also, vaccine may be available at certain retail stores and pharmacies, again for high-risk people only.
Who should get vaccinated this season?
Due to the vaccine shortage, the CDC is changing its guidelines about who should get vaccinated this season. They say the existing flu vaccine supplies should be given to protect people who are at greatest risk from serious complications from the flu.
According to the CDC, everyone in this group be vaccinated:
Who should not receive a vaccination?
Healthy people 2 to 64 years of age should postpone or skip getting a flu shot this year so that available vaccine can go to those at greater risk for flu complications.
So if I'm not high-risk, what other medical alternatives are available? How can I prevent the flu?
The only alternatives available at this point are:
What else can be done to prevent the spread of flu?
Good respiratory hygiene including hand-washing, avoiding touching one's eyes, nose, and mouth, and avoiding people ill with respiratory symptoms, will help prevent the spread of flu. Always cover your nose and mouth with a tissue when you cough and sneeze, and make sure to wash your hands afterwards with soap and warm water, or an alcohol-based hand cleaner.
What about antiviral medications? I’ve heard they can be used to prevent the flu.
Three antiviral drugs (amantadine, rimantadine, and oseltamivir) are approved and commercially available for use in preventing flu. Those drugs can be used to prevent influenza and they do work in healthy people. But it is not usually recommended that healthy people use them, as a public health measure. They are usually only used as a preventive measure for people at risk of flu complications or at risk of giving the flu to people at high risk.
For example, people at risk who have not been vaccinated and the flu season is already underway in their area can start prophylactic antivirals at the time of vaccination to cover them until the vaccine induces antibody protection (about 2 weeks).
The other people who may benefit: the unimmunized who provide care to high-risk people, immunodeficient people who cannot mount an immune response to the vaccine, high-risk people with a contraindication to the vaccine (allergy to eggs, etc). These are the traditional groups for whom it's recommended.
With the vaccine potentially unavailable to many people who would normally get it, antivirals may partially fill this gap.
Who can be vaccinated with the nasal-spray flu vaccine, FluMist and who should not receive FluMist?
FluMist is available for healthy non-pregnant 5 to 49 year olds who do not have contact with people who have severely compromised immune systems.
Until further data is available to show the vaccine's safety and usefulness in people of other ages and people at risk, it cannot be recommended for them.
Is there any chance flu vaccine supply will increase this year?
The amount of time it takes to make new vaccine is too long to expect any significant increases in supply this year. The single manufacturer of injected flu vaccine available this year is going to increase production, but this increase will not nearly replace the doses unavailable due to the loss of the other company's contaminated vaccine.