CDC launches late-season flu vaccination push

Nov 13, 2006 (CIDRAP News) – Although 77 million doses of seasonal influenza vaccine have already been delivered this fall, distribution delays have left some providers empty-handed, prompting the Centers for Disease Control and Prevention (CDC) to intensify its message on the benefits of late-season vaccination.

At a press conference today, the CDC announced the designation of the week after Thanksgiving as "National Influenza Vaccination Week." CDC Director Julie Gerberding, MD, MPH, said the aim is to raise awareness about seasonal flu vaccination and urge more Americans to be vaccinated in November, December, and later.

The CDC predicts that flu vaccine manufacturers will produce a record number of doses this year, between 110 and 115 million. Gerberding said the remaining doses will be shipped through November and into early December. She urged healthcare providers to make good use of the final deliveries of flu vaccine by scheduling extra clinics, extending clinic hours, and supporting mass vaccinations at sites such as retail stores.

L.J. Tan, PhD, director of infectious diseases for the American Medical Association (AMA), said many patients mistakenly believe that the only time to get vaccinated is before Thanksgiving. "This is a step toward shattering that myth," he told reporters. Administering the flu vaccine in November, December, January and beyond is consistent with federal Advisory Committee on Immunization Practices recommendations.

Gerberding said that though distributors try to provide at least partial fulfillment of all vaccine orders early in the season so that all providers can begin their vaccination activities, some providers are still having trouble getting their doses. "There are still mismatches between the need and supply in certain parts of the country," she said.

Because flu vaccine sales and distribution are handled by private companies, the CDC can't control the flow of the product to customers.

Don Williamson, MD, Alabama state health officer, said some public health agencies have adequate supplies of the vaccine, but others are struggling. He estimated that 40% to 45% of providers in Alabama have received their shipments and about 30% have their shipments of the children's vaccine.

Delays affect family physicians
Tan said that smaller providers, such as family practice physicians, are most likely to have been affected by distribution delays. "The biggest challenges are the chronically ill, high-risk patients that seek the vaccine from their family doctors in early October," he said. "If they can't get it, they go somewhere else. We want to encourage them to go back to their physicians."

Some AMA members have reported that the delays aren't as bad as last year, Tan said, adding that there's still room for improvement in the vaccine distribution system.

Gerberding said that despite the record number of doses this year, public health officials worry about supplies going unused. "We're trying to do everything we can to get every dose used," she said.

The CDC is starting to see some flu activity, but Gerberding said it is too early to say what the predominant strains are and how widespread and virulent they'll be. According to CDC tracking through Nov 4, Florida and Louisiana have local activity, and North Carolina is the only state showing regional activity.

In June, federal health officials recommended that toddlers aged 2 through 4 years be immunized against influenza each year, adding millions of people to the groups included in vaccination recommendations.

Children often miss second vaccine dose
In other flu immunization news, a report in the November issue of Pediatrics said that in a 3-year study, most children being immunized against flu for the first time did not receive the second dose recommended for optimal protection.

The CDC recommends that children aged 6 months to 9 years who have never received a flu shot should receive two doses of vaccine. Those who receive trivalent inactivated influenza vaccine (TIV) vaccine should have a booster 1 month or longer after the initial dose, before the onset of the flu season.

Researchers evaluated 125,928 children aged 6 months through 8 years who were members of health maintenance organizations participating in the Vaccine Safety Datalink project. The children received their first TIV dose in the 2001-02, 2002-03, or 2003-04 influenza season.

Compliance with the two-dose recommendation varied by age-group and influenza season. Among children younger than 2, the proportions who received their second dose were 44%, 54%, and 29% over the three seasons. In children older than 2, compliance was 15%, 24%, and 12% over the three seasons. Children were more likely to receive the recommended second dose if they received their first dose by mid November.

Researchers concluded that noncompliance with the two-dose TIV series could decrease the direct and indirect benefits of vaccination programs.

Jackson LA, Neuzil KM, Baggs J, et al. Compliance with the recommendations for two doses of trivalent inactivated influenza vaccine in children less than 9 years of age receiving influenza vaccine for the first time: a Vaccine Safety Datalink study. Pediatrics 2006;118(5) [Abstract]

See also:

CDC weekly influenza update
http://www.cdc.gov/flu/weekly/

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