Flu shot season kicks off; increased supply expected

Washington -- As physicians, nurses and others pick up flu shot syringes and brace for the upcoming influenza season, they are being urged by national health organizations to give injections first to people in high-priority groups -- including themselves.

New to this risk category are people made homeless by Hurricane Katrina and now living in crowded shelters. They are also at the front of the line to receive any necessary catch-up vaccinations, since many lacked routine health care even before the hurricane struck.

But after Oct. 24, all comers should be provided the flu vaccine, said Centers for Disease Control and Prevention Director Julie Gerberding, MD, MPH.

"This year, to help ensure that people at highest risk for serious complications are vaccinated, we're making them a priority for the next six weeks," said Dr. Gerberding during a Sept. 14 briefing sponsored by the National Foundation for Infectious Diseases and the AMA's National Influenza Vaccine Summit.

If followed, that recommendation should help avoid a replay of last year's scenario in which elderly and other high-risk people waited in lines for hours to receive flu shots. The sudden halving of that season's supply when Chiron Corp. failed to produce its promised doses led to a supply-line nightmare for physicians and other health care professionals.

The hope this year is for a more orderly vaccine distribution process.

For one thing, there should be at least 71 million to 90 million doses of vaccine on hand, Dr. Gerberding said, compared with about 60 million last year.

Sanofi Pasteur is planning to produce 60 million of these, which it began shipping in August. Newly approved supplier GlaxoSmithKline expects to produce 8 million doses, and MedImmune, which makes the live attenuated intranasal vaccine, is planning to produce 3 million doses.

The MedImmune vaccine can be administered at any time to non-pregnant, healthy people ages 5 to 49 and is not subject to the priority recommendations.

In addition, Chiron expects to supply 18 million to 26 million doses of vaccine this year, having corrected the contamination problems encountered last year. At press time, however, the company still needed final Food and Drug Administration approval, and those doses weren't included in Dr. Gerberding's count.

Although there are still unknowns about the vaccine supply and the severity of this year's flu bug, "We know for sure that flu vaccine saves lives, hospitalizations, work productivity and the inconvenience that flu-like illnesses cause for so many people," she said.

Each year, 36,000 people die from the flu, and 200,000 are hospitalized.

Physicians: Immunize yourselves

Also speaking at the briefing, AMA Trustee Ardis D. Hoven, MD, made a special request to all physicians and other health care workers to "lead by example and get vaccinated against influenza." Generally, only about 40% of health care professionals receive the flu vaccine.

"The vaccine minimizes the chance of getting the flu and spreading it to others, and it cuts down on frustrating problems such as sick days away from work," Dr. Hoven noted.

She urged the employers of health care workers to consider making it as convenient as possible for them to receive the vaccine and to provide it at no charge. Workers should be reminded that they are protecting the health of their patients and family members by receiving the vaccine, she added.

Meanwhile, flu vaccination rates among children with underlying medical conditions such as asthma and diabetes remain alarmingly low, despite longstanding recommendations that they receive the vaccine, said Henry H. Bernstein, DO, member of the American Academy of Pediatricians' Committee on Infectious Diseases.

Only 38% of children with chronic illnesses received the flu vaccine last year, Dr. Bernstein said, the lowest rate for any recommended childhood immunization in the United States.

Older Americans are also an important target population.

Cynthia G. Whitney, MD, MPH, acting chief of the respiratory diseases branch at the CDC, stressed the importance of vaccination against pneumococcal disease for everyone 65 and older and for those of any age with an underlying medical condition.

Of the nearly 40,000 cases and more than 4,000 deaths from invasive pneumococcal disease each year in the United States, more than half occur among adults for whom the vaccine is recommended.

As an inducement to vaccinate older people, Mark McClellan, MD, PhD, administrator of the Centers for Medicare & Medicaid Services, noted that the payments for both the influenza and the pneumococcal vaccines have increased this year, and the administration fee for both has more than doubled since last year, with the national average now $18, up from $8.

Both diseases take a high toll among nursing home patients. With that in mind, CMS has proposed a rule requiring that all nursing home residents be vaccinated against influenza and pneumococcal disease, Dr. McClellan said.

Antivirals also can play an important supporting role in preventing and treating flu, said William Schaffner, MD, professor and chair of the Dept. of Preventive Medicine at Vanderbilt University School of Medicine in Nashville, Tenn.

For people allergic to eggs or for those unvaccinated for any reason, an antiviral can reduce the severity of the flu if taken within two days of exposure.