Abundance of flu shots may mean longer vaccine season

Washington -- Broaden the flu vaccination season -- starting in September if possible -- and keep giving the shots beyond Christmas, advised public health officials and medical society representatives at a recent meeting.

With an abundant vaccine supply expected for the upcoming flu season and additional manufacturers to help stabilize the supply, physicians should incorporate some new tactics to battle seasonal flu.

The calendar shouldn't run this show, concluded participants at the 2007 National Influenza Vaccine Summit held last month in Atlanta. The event, sponsored by the American Medical Association and the Centers for Disease Control and Prevention, occurs at least annually.

Early signs indicate that there could be 132 million doses available -- the most ever in a single season. So using it all and avoiding having to discard doses at the end of the season will require a plan.

The vaccine system's ongoing challenge during the past several years has centered on an uneven distribution system and too few manufacturers. With more firms entering the arena and researchers focusing on updating technology to produce vaccine more quickly, the challenge of getting the vaccine into patients will fall to physicians.

"The good news is that we will likely have an ample supply of vaccine, but the challenge will be to use it all and make sure that we don't waste any," said AMA President-elect Ron Davis, MD, who attended the summit.

Among the strategies discussed was the expansion of the vaccine season that traditionally had extended only from October to just before Thanksgiving.

"Physicians and other health care providers should not be fixated on a particular month or set of weeks in which to vaccinate," said Gina Mootrey, DO, MPH, a medical officer with the CDC's National Center for Immunization and Respiratory Diseases. "When they have the vaccine available, be it earlier or later in the season, they should use the vaccine."

Dr. Mootrey co-chaired the vaccine summit with Litjen Tan, PhD, the AMA's director of infectious disease, immunology and molecular medicine.

Physicians also should be more forceful in persuading patients to get vaccinated, Dr. Davis said. "Some physicians at the summit made the point that if they exhort patients to get the flu vaccine, only rarely would a patient refuse it."

A head start

An expanded vaccination season could even begin in August. Representatives from MedImmune, the company that produces the intranasal flu vaccine, FluMist, reported that its vaccine could be ready for shipment by late summer -- in time for back-to-school physicals.

"For that important category of patients, those ages 5 through 50, without any underlying illness, physicians and other health care providers who are using the nasal vaccine can actually start earlier," said William Schaffner, MD, chair of Vanderbilt University's Dept. of Preventive Medicine in Nashville, Tenn.

Dr. Schaffner had espoused the idea of a longer vaccination season last year in his role as the Infectious Diseases Society of America's liaison to the CDC's Advisory Committee on Immunization Practices. "I hope that this year people can begin to implement this," he said. "People should vaccinate into December and January and even beyond."

The entry into the market of more manufacturers also should help stabilize the vaccine supply, Dr. Mootrey said. There already are four manufacturers producing flu vaccine, up from only two a few years ago. A fifth, CSL Biotherapies, headquartered in Melbourne, Australia, has submitted an application with the Food and Drug Administration to supply vaccine for the upcoming U.S. season.

Among other issues addressed at the summit were the increasing number of state laws designed to govern immunization programs. The concern was that a patchwork of competing legislation further could complicate an already delicate system, said Andrew E. Van Ostrand, vice president for policy and research at the Health Industry Distributors Assn., a trade association based in Alexandria, Va., that represents medical product distributors.

The measures range from state purchasing and distribution proposals as well as priority distribution of vaccine to physicians and public health entities to regulating or eliminating the preservative thimerosal in vaccines. Several states have already enacted laws with such restrictions.

An abundant supply of thimerosal-free vaccine is available for those who want it, Dr. Schaffner said, but requiring that it be ordered could complicate procedures. Plus, it would be a more expensive option, since thimerosal-free vaccine is available only in single doses rather than in 10-dose vials, as is vaccine containing thimerosal, he noted.

Participants at the summit were urged to discuss with legislators the potential downside of such measures, Dr. Mootrey said.

The vaccine summit, begun in 2000, assembles all the stakeholders in the influenza vaccine field -- from physicians who order and administer the vaccine to the producers and distributors. The number of attendees has been increasing each year, Dr. Davis said. What began as a gathering of about 30 is now up to about 200.

"People are getting to know each other better each year," he said. Plus, it may be the only place such an opportunity exists. "I can't think of anything else like this."