CDC Releases Recommendations for Flu Vaccine, Provides Assurances About Supply, USA

The US should have an adequate supply of flu vaccine for all residents who seek vaccinations this year, but physicians should first vaccinate high-risk individuals, such as Hurricane Katrina evacuees who have moved into shelters, federal health officials said on Wednesday,... USA Today reports (Szabo, USA Today, 9/15). CDC expects four suppliers to provide as many as 97 million doses of flu vaccine this year "to avoid the shortages that took place last year," the Los Angeles Times reports. CDC expects 60 million doses of flu vaccine from Sanofi Pasteur and eight million doses from GlaxoSmithKline, as well as three million doses of nasal-spray vaccine from MedImmune. In addition, CDC expects as many as 26 million doses of flu vaccine from Chiron, whose manufacturing facility in Britain was closed last year because of contamination concerns (Piller, Los Angeles Times, 9/15). The Chiron facility must pass a final FDA inspection before the company can distribute flu vaccine (Condon, Hartford Courant, 9/15). Flu vaccines this year protect against three major strains: the New Caledonia and Shanghai strains, which were in the vaccine last year, and the new California strain (Los Angeles Times, 9/15).

Guidelines
In the event that Chiron provides no doses of flu vaccine this year, the U.S. would have an adequate supply of the vaccine for 71 million residents (CQ HealthBeat, 9/14). Chiron spokesperson Alison Marquiss also said that the company could not begin to distribute flu vaccine until the end of September or early October (USA Today, 9/15). As a result of the continued uncertainty, CDC has asked physicians to delay flu vaccinations for lower-risk patients until Oct. 24. At a briefing in Washington, D.C., sponsored by the National Foundation for Infectious Diseases, CDC Director Julie Gerberding said that physicians should first provide flu vaccinations to adults older than age 65, children ages six months to 23 months, and individuals who live with or care for infants younger than age six months. Others who should receive flu vaccinations first include individuals with chronic conditions, nursing home residents and pregnant women (CQ HealthBeat, 9/14). Gerberding also said that elderly hurricane evacuees, as well as evacuees of all ages who have moved into shelters, should receive flu vaccinations first (AP/Las Vegas Sun, 9/14). According to the Times, outbreaks of flu are more likely in shelters because of crowding (Los Angeles Times, 9/15). Sanofi Pasteur plans to provide 200,000 of the first available flu vaccinations to hurricane evacuees who have moved into shelters (AP/Las Vegas Sun, 9/14). CDC has not made similar distribution recommendations for the MedImmune nasal-spray flu vaccine FluMist -- which is recommended only for healthy individuals ages five to 49, except for pregnant women (USA Today, 9/15). Jeanne Santoli, deputy director of immunization services at CDC, also recommended FluMist for health care workers (CQ HealthBeat, 9/14).

Comments
According to Gerberding, the CDC recommendations seek to allow adequate time to protect individuals most at risk for flu and help organizations schedule vaccine clinics (USA Today, 9/15). CMS Administrator Mark McClellan said, "The vaccine supply this year is expected to be very good, with over 90 million doses coming online in the weeks ahead" (Los Angeles Times, 9/15). McClellan added that CMS hopes to have 90% of nursing home residents vaccinated against flu (AP/Las Vegas Sun, 9/14). A proposed rule scheduled to take effect Oct. 1 would require all nursing homes that receive federal funds to provide residents with flu and bacterial pneumonia vaccinations (Ricks, Long Island Newsday, 9/15). In a press release, CMS officials said that only 65% of nursing home residents received flu vaccinations and only 38% received bacterial pneumonia vaccinations in 1999 (AP/Las Vegas Sun, 9/14). According to CQ HealthBeat, CMS has increased the average Medicare reimbursement rate for administration of flu vaccinations from $8 to $18. McClellan said, "With just one shot we can prevent many" of the deaths from flu in nursing homes (CQ HealthBeat, 9/14).


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