CDC refines flu vaccine message, works out allocation plan

Washington -- As physicians absorbed the news that flu vaccine would be in short supply this year, some fine-tuning of the vaccine delivery system was undertaken by local, state and federal health officials to ensure the smoothest possible journey through the upcoming flu season.

Some health departments made a mandate out of Centers for Disease Control and Prevention recommendations regarding who should receive vaccine. Anyone in Washington, D.C., who administers a flu shot to a child or adult not in a high-risk category could be charged with a misdemeanor and fined, according to an emergency rule that was to take effect on Oct. 16.

Immediate court proceedings faced anyone in New Mexico who administers vaccine to someone not in a high-priority category, according to an Oct. 7 public health order.

Meanwhile, Dept. of Health and Human Services Secretary Tommy Thompson urged all state attorneys general to check each report of price gouging involving the flu vaccine and to prosecute all those taking advantage of the vaccine shortage.

The AMA is urging all those distributing flu vaccine to give vaccinations on a priority basis to high risk patients -- in keeping with CDC guidelines.

When news broke on Oct. 5 that drug manufacturer Chiron would be unable to supply any vaccine for this year's flu season, Aventis Pasteur, the remaining manufacturer of injectable vaccine licensed for this country, still had about 22.4 million doses of vaccine on hand.

Those remaining doses will be allocated in two phases, according to a plan worked out by the CDC, Aventis and Chiron. The first phase of 14.2 million doses will be distributed over the next six to eight weeks through Aventis contracts directly to facilities -- such as hospitals, long-term care facilities and nursing homes serving high-risk populations -- and to physicians and other private health professionals who care for young children.

In addition, all preservative-free vaccine, all doses ordered via the Vaccines For Children program, the Veterans Administration and the Dept. of Defense will be delivered. Also, 50% of the non-VFC doses, preservative-containing doses ordered by state health departments through state or federal contracts with either Aventis or Chiron will be shipped.

Local health departments that ordered vaccine directly from a Chiron distributor will be part of the phase-two allocation. This second phase of about 8.2 million doses will begin shipping in the next few weeks and will be available to physicians and others who placed orders with Chiron.

A place on the waiting list

To ensure that a practice is considered for the phase-two allocation, the CDC recommends that physicians get in touch with their Chiron vaccine distributors and let them know that their practice needs the vaccine and how many high-risk patients are served.

The CDC, Aventis, and Chiron distributors are working collaboratively to determine the need for influenza vaccine that will not be addressed by the phase-one activities. If the local health department is facilitating vaccine reallocation, physicians should also notify local health authorities of their need in case vaccine does become available.

Practices with an excess supply of vaccine are asked to contact their local health departments that are working with the National Assn. of County and City Health Officials to reallocate local supplies.

Physicians who are unable to obtain vaccine or enough vaccine for all their high-risk patients should consider directing them to community-based clinics.

The CDC also made the following recommendations:

• The vaccination of doctors and other health care workers who have direct contact with patients is even more necessary than usual this year, as this will protect patients as well as cut work absences due to illness.
• FluMist, the nasal vaccine manufactured by MedImmune, is a good option for healthy people ages 5 to 49, including most physicians, nurses and other health care professionals. Only those who work with severely immunosuppressed patients, such as transplant patients, should refrain from using the live, attenuated influenza vaccine.
• Children younger than 9 who received one of the two recommended doses of vaccine last year only need to receive one flu shot this year. The series does not have to be restarted.
• Children who are at least 5 years old and healthy can receive either inactive or live attenuated vaccine, or a combination of the two, a recommendation that is at variance with the FluMist label.
• Vaccine for children should be administered on a first-come, first-served basis. Do not put a dose aside for a child's second shot.
• FluMist must be stored in the freezer at 5 degrees Fahrenheit or -15 degrees Celsius at all times. It should not be stored in a frost-free refrigerator because the defrost cycle will cause the temperature of the freezer to drop below those levels. Those without access to a manual-defrost refrigerator should request a special freezer box from the manufacturer that requires special preparation. When following the manufacturer's instructions, care must be taken that lowering the temperature in the freezer compartment does not cause the temperature in the refrigerated portion to fall below freezing, thus destroying the medications stored there.
• Do not halve the 0.5 mL dose of vaccine for patients older than 3, as any lesser amount has not been shown to provide protection.