Doctors wary about flu vaccine deliveries

Supplies are supposed to be plentiful, but after several rough seasons, physicians are dubious.

By Victoria Stagg Elliott — Posted Oct. 9, 2006

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This year, Chuck Hofmann, MD, an internist in Baker City, Ore., is doing everything he can to ensure that he gets flu vaccine for his practice. After a few rough seasons when vaccine arrived late if at all, he's placed orders with several different companies, and he calls every week to track the progress.

"They all say it will come, but we will believe it when we see it," he said.

Influenza vaccine is supposed to be plentiful this year, but, like many others, Dr. Hofmann is still smarting from the supply disruptions of recent memory. This time around he's keeping his fingers crossed.

"We have not received anything yet, and they're not telling us when it's going to come," said Randy Rice, MD, a family physician in Moose Lake, Minn. "It makes me a little leery about what's going to happen."

On one hand, the big picture looks rosy. All manufacturers have been given the nod by the Food and Drug Administration, and, according to data collected by the Centers for Disease Control and Prevention, about 75 million doses should be distributed before the end of October. Another 25 million or possibly more will be available in November and December.

If production goes as expected, there may be more vaccine available before the end of October than in six out of the past seven seasons. Overall, more doses could be produced than ever before.

On the other hand, as of mid-September, many physicians did not yet have supplies. Quite a few had been told when to expect them, but many had not. To be fair, it is still early. The bulk of supplies are expected to be available this month.

Physician frustration

But while many wait with bated breath, some evidence exists that past supply disruptions may have had a systemic impact, undermining both doctors' overall interest in administering the shot and patients' interest in receiving it.

"Patients have developed a lackadaisical attitude," said Mark Olesnicky, MD, a general internist in Florham Park, N.J. "Many were unable to get the flu shot in past years. They figure, 'I didn't get sick; what the heck should I get a flu shot for?' I hope that we have plenty of flu vaccine, but I predict there's going to be quite a lot of vaccine left over."

Many physicians also are frustrated by the perception that orders by retail establishments receive preferential treatment in terms of fulfillment.

"I hope to get enough, but I don't think I will," said Anthony Battista, MD, a pediatrician in Mineola, N.Y. "It's all going to go to the retail outlets. Physicians are not getting priority."

Data have not supported this belief, although this issue has come up repeatedly at American Medical Association Annual Meetings. AMA policy states that an adequate number of doses of every manufacturer's vaccine supply should be sold directly to health care professionals who immunize high-priority patients. The AMA also co-sponsors the National Influenza Vaccine Summit with the CDC and has long worked at stabilizing supply.

Public health officials say that because physicians are more likely to order through distributors that have, in the past, been more likely to carry vaccine from manufacturers that have had problems, physicians also have been more likely to be affected by supply disruptions.

"Vaccine manufacturers and distributors do not favor providers or purchasers submitting large orders over those with small orders," said CDC spokesman Curtis Allen.

The CDC is warning that, particularly early in the season, the vaccine might not look like it's distributed equitably. "Some providers may appear to have more influenza vaccine than others, because there are multiple manufacturers, distributors and distribution channels -- each of which has different distribution plans and schedules," Allen said.

Those who give shots in these settings also counter that they have been affected by supply problems as well and that they also work to get vaccinations to those who are at high risk.

"Grocery stores are not offering the flu shot," said Stephen Allred, a nurse practitioner and clinical director of, a company that provides shots in retail venues as well as senior centers in Washington and Oregon. "They are offered by licensed nurses. We do screening for contraindications, and we follow the CDC recommendations. We hope everyone will have vaccine, because ultimately we all have the same goal to reduce the epidemic of flu."

But despite the fact that many physicians are skeptical that this season's flu vaccine will be as plentiful as public health officials predict, they also hope there actually will be as much vaccine as is promised.

"I hope we can just vaccinate everyone," said Bryan Picou, MD, a family physician in Natchitoches, La. "We encourage our patients to take it. It's crazy not to."

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Few asthmatic children get flu shots

Despite the fact that youngsters with asthma are recommended to receive an influenza vaccine every year, the majority do not, even if they had contact with the health care system while shots are available, says a study in the September Archives of Pediatrics & Adolescent Medicine.

Researchers analyzed administrative claims data from the Michigan Medicaid program and found that, in the 2001-02 season, nearly 17% of children with this condition got a flu shot. In the 2002-03 season, fewer than 22% were immunized. The authors also found that, of those who did not get the vaccine, more than two-thirds in each season had at least one doctor visit.

"If we were able to prevent even a small percentage of these missed opportunities, we could substantially increase the overall influenza vaccination rate among these children," said Kevin J. Dombkowski, DrPH, lead author and a member of the Child Health Evaluation and Research Unit in the Division of General Pediatrics at the University of Michigan Medical School in Ann Arbor.

This study is the latest to document low rates of flu vaccination among children with asthma, and some groups are taking steps to address this problem. The National Foundation for Infectious Diseases issued a report in August advocating that parents of children with asthma be informed year-round of the importance of an annual influenza shot and for clinics that care for these patients to target this population in their efforts to increase uptake.

"All children with asthma, regardless of its severity, should be protected with an annual influenza vaccine," said NFID president Carol Baker, MD.

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External links

National Influenza Vaccine Summit, co-sponsored by the American Medical Association and the Centers for Disease Control and Prevention (link)

American Lung Assn.'s Flu Clinic Locator (link)

Centers for Disease Control and Prevention on influenza (link)

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