A shot in the arm urged for flu vaccine programs

Washington -- The Infectious Diseases Society of America is recommending a range of actions to bolster the nation's efforts to prepare for a pandemic flu outbreak while simultaneously easing what IDSA terms a seasonal flu vaccine situation that suffers from an outdated manufacturing process and a flawed distribution system as well as vast numbers of unvaccinated physicians and other health care professionals.

The group urged that the strong messages regularly meted out to get a yearly shot be upgraded to a requirement for physicians and others in health care, albeit one that allows for written opt-outs on religious, philosophical or medical grounds.

"There is no better example of what we should do to prepare for a pandemic than to become extremely good at vaccinating health care workers and protecting patients when they come into health care facilities," said Andrew T. Pavia, MD, chair of IDSA's National and Global Public Health Committee, in announcing the group's recommendations Jan. 25.

Fewer than two in five physicians and other health care workers receive an annual shot, yet they provide care for the thousands of patients hospitalized each year with the flu. They well could spread the disease to family members and others in the community, IDSA said.

Such a vaccine mandate isn't new, Dr. Pavia noted. Physicians and others already are required to get hepatitis B vaccines, and those who work in children's hospitals are often required to be vaccinated against measles and varicella or they can't come to work.

Benefits all around

Sinking more money and effort into preparing for pandemic flu will provide more payback with improvements for annual flu, said Kathleen Maletic Neuzil, MD, MPH, chair of IDSA's Pandemic Influenza Task Force.

The problems surface each winter, she said. "Every year we hear about supply problems, shortages, delays, maldistribution. We hear about mismatches between influenza vaccines and the strains that are circulating."

Investment in pandemic preparation would be a win-win situation for the country, Dr. Neuzil added.

The group also urged the federal government to team with other countries to devise a master plan for developing, producing and distributing a pandemic flu vaccine. The new Biomedical Advanced Research and Development Authority, signed into law in late December 2006 and intended to provide incentives to pharmaceutical companies in the development of vaccines, would be a part of this larger project.

The IDSA also recommended:

• Devising plans to increase the public's uptake of seasonal flu vaccine to stabilize manufacturing capacity as well as decrease morbidity and mortality rates, which now stand at 226,000 hospitalized and 36,000 dead each year.
• Developing new antiviral and antibacterial drugs and stockpiling them to make sure there are enough on hand in the event of a pandemic.
• Building systems capable of responding to mass casualties.
• Improving the quality of diagnostic tools for flu and ensuring that they can be used not only in sophisticated labs but also in remote areas.
• Improving flu surveillance.
• Allocating sufficient funds for long-term planning and action.

Other public health groups also are focused on possible ways to smooth the annual flu vaccine system's difficulties. The National Influenza Vaccine Summit, an initiative co-sponsored by the American Medical Association and Centers for Disease Control and Prevention, brings together stakeholders on these topics.