CDC says flu shots should go to high-risk groups first

Dec 11, 2003 (CIDRAP News) – With influenza spreading rapidly and vaccine supplies running low, the Centers for Disease Control and Prevention (CDC) recommended today that people at high risk for flu complications should have priority for vaccination.

"Emphasis should be placed on targeting" vaccine to the high-risk groups, the CDC said in an alert issued today. Those groups include healthy children aged 6 to 23 months, people 65 years and older, pregnant women in their second or third trimester during the flu season, and anyone 2 years or older who has a chronic health condition.

Next in line for vaccination should be healthcare workers and other people who are in a position to spread the flu to those who are at high risk for complications, the CDC said. The agency also said healthy people between the ages of 5 and 49 should be encouraged to get the new intranasal vaccine, FluMist, which is approved only for that group. About 3.9 million doses of FluMist were available as of Dec 9, the CDC reports in the Dec 12 Morbidity and Mortality Weekly Report, released online today.

The agency reported today that flu was widespread in 24 states last week, up from 13 states a week earlier. The hard-hit states include most western states other than California, plus several in the Midwest, East, and South, according to the MMWR report. Most of the other states have regional or local outbreaks.

Reports of scattered flu vaccine shortages have emerged in the past week. The two major manufacturers of injectable vaccine, Aventis and Chiron, reported Dec 5 that they had exhausted their inventories, which totaled about 79 million doses combined.

Here are the CDC's new recommendations on vaccination, as listed in today's alert and in MMWR:

  • Emphasis should be placed on targeting trivalent inactivated vaccine to persons at high risk for complications from influenza: healthy children aged 6 to 23 months, adults aged 65 years or older, pregnant women in their second or third trimester during influenza season, and persons aged 2 years or older with underlying chronic conditions.
  • Persons at high risk should be encouraged to search locally for vaccine if their usual healthcare provider no longer has vaccine available.
  • All children at high risk, including those aged 6 to 23 months, who report for vaccination should be vaccinated with a first or second dose, depending on vaccination status. Doses should not be held in reserve to ensure that two doses will be available.
  • Next priority should be given to vaccinating those persons at greatest risk for transmission of disease to persons at high risk, including household contacts and healthcare workers.
  • Healthy persons aged 5 to 49 years should be encouraged to be vaccinated with intranasally administered live, attenuated influenza vaccine.
  • Decisions about vaccinating healthy persons, including adults aged 50 to 64 years, with inactivated influenza vaccine should be made on a case-by-case basis, depending on local disease activity, vaccine coverage, feasibility, and supply.
  • Health departments should work with their healthcare providers to reallocate influenza vaccine to healthcare providers in need when possible.

The CDC also issued the following recommendations on hygiene and the use of antiviral medications:

  • Good respiratory hygiene should be encouraged, including cleaning of hands, and staying at home when symptomatic with fever and respiratory illness.
  • Antiviral medications with specific activity against influenza A viruses should be considered either for treatment or chemoprophylaxis for influenza A, especially in persons at high risk for complications from influenza.

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