CDC considers tapping European supply of flu vaccine

Dec 9, 2003 (CIDRAP News) – The federal government is considering buying influenza vaccine from a British company in an effort to remedy a possible shortage in the United States, the head of the Centers for Disease Control and Prevention (CDC) said today.

Julie Gerberding, MD, MPH, said Chiron Corp. has about a half million doses of flu vaccine in the United Kingdom that might be available. "That product is licensed in the US but not cleared for use because it hasn't gone through all the stages of approval," she said at a news briefing. "We're working with the FDA [Food and Drug Administration] and the company to see whether it would be safe to get that vaccine into the US in time to have any impact on this year's flu season."

The CDC has not yet determined how much of a vaccine shortage exists, Gerberding reported. "We are receiving some reports of shortages, but we are also receiving reports from many jurisdictions where there is no apparent shortage and people can still access vaccine," she said. The agency is working with state and local health departments, medical societies, and other groups to assess the supply.

Gerberding said the CDC is not moving to reserve the remaining vaccine doses for groups most at risk for severe flu complications, but she expressed a hope that those groups will have priority in places where the supply is running low. "We're certainly not restricting vaccine access to anyone at this point, but like all situations when there's a possible shortage, we want the people who need the vaccine the most to be first in line to receive it," she said.

Later she added, "Given the fact that at the local level there are clinicians who have access to limited supplies today, it only makes sense that they would put the emphasis on the people with advanced age or chronic medical conditions or the little children."

Any decisions about rationing flu vaccine, should it come to that, would be up to state or local health officials, Gerberding said in response to a question.

The demand for vaccine has been spurred this year by an early flu season and signs that it could be an unusually bad one. The CDC reported Dec 5 that the flu was widespread in 13 states and present in all but two jurisdictions, Massachusetts and Washington, DC. In addition, the vaccine appears to provide incomplete protection against the predominant flu strain so far this year, called A/Fujian, according to the CDC.

The two leading manufacturers of flu vaccine for the United States, Aventis Pasteur and Chiron, said last week that they had shipped all their doses to medical providers. However, about 4 million doses of the new intranasal vaccine, FluMist, are still available. FluMist is currently licensed only for healthy people between the ages of 5 and 49.

Gerberding noted that vaccine manufacturers have to estimate how many doses to make each year on the basis of the previous year's demand and other factors. The manufacturers made 95 million doses last year, and 12 million went unused and had to be thrown away, she said. So this year the companies made about 83 million doses. Because more people are seeking shots this year, "the manufacturers' estimate of the need for vaccine may have undershot the mark," she said. She added that it's too late to make more vaccine for this season, and trying to do so would cut into the supply for next year.

Gerberding revealed that public health officials considered including the A/Fujian strain in this year's vaccine but concluded that it might be impossible to produce it in time. The decision-makers, including the FDA, the American Medical Association, the World Health Organization, and others, "really kind of independently but simultaneously made the decision that it wouldn't be prudent to race to try to get the Fujian strain this year because it could jeopardize the whole vaccine production and we might start the year with no vaccine at all," she explained.

In other comments, Gerberding noted that four antiviral drugs are available for influenza. The drugs are mainly used to provide short-term protection for people who have been exposed to the flu in institutional settings and who have been vaccinated but are not yet protected by the vaccine. "We're investigating adding antivirals to our stockpile," but no decisions have been made, she said.

Gerberding also commented on reports that some flu cases in children are being complicated by drug-resistant strains of Staphylococcus aureus. An Associated Press report today quoted a CDC epidemiologist as saying that some children have died of influenza-related staphylococcal infections.

Gerberding said staphylococcal infections are often seen in influenza patients, and if staph organisms that are resistant to methicillin or other drugs are common in a community, "it's not surprising that that would be the kind of staph that would complicate influenza." However, she said she wasn't aware of recent documented cases.

See also:

Transcript of CDC news briefing
http://www.cdc.gov/media/transcripts/t031209.htm

Access to recorded Webcast of news briefing
http://www.videonewswire.com/cdc/

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