US H1N1 vaccine delayed as cases and deaths rise

Oct 16, 2009 (CIDRAP News) – Production delays are cutting into federal pandemic vaccine–supply projections at a time when virus activity is widespread in 41 states and children's deaths are spiraling, the US Centers for Disease Control and Prevention (CDC) said today.

Since August, federal officials have predicted that 45 million pandemic vaccine doses would be available by mid October, but today the CDC said the total so far is 11.4 million.

The slow start is complicating the launch of pandemic flu vaccine campaigns for state and local public health departments as well as school districts. Some have postponed or cancelled events because they don't know when they will receive their vaccine supplies. For example, the Lawrence-Douglas County Health Department, based in Lawrence, Kansas, recently cancelled Oct 30 clinics at the fairgrounds and the University of Kansas because it wasn't sure when the vaccine would arrive.

Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases, said some manufacturers are reporting delays because antigen yields are lower than expected. She also said it takes time to conduct potency and purity tests on each lot of the vaccine.

"We are not cutting any corners. It's very important that this process be done safely and carefully," she stated.

Schuchat acknowledged the effect that the slower-than-expected trickle of pandemic vaccine is having on state health departments, and she warned that the next 2 weeks will be challenging. "We're all going to have to bear with the situation," she said, adding that supplies will likely become more plentiful by the end of October and into November.

States have ordered 8 million of the currently available doses, and half of it is injectable vaccine, Schuchat said, which is good news because it gives authorities more flexibility in delivering doses to some high-priority groups. Certain groups couldn't receive the very first doses, which were the live attenuated intranasal form of the vaccine, made by MedImmune, which is recommended only for healthy people aged 2 through 49 years.

Federal officials are also anxious about the slow start to pandemic vaccine distribution. "It's hard to see the illnesses rise," Schuchat said.

She acknowledged that the situation puts public health officials in a difficult position when communicating the vaccination message to members of the public, who are being urged to obtain the vaccine at a time when delays are hampering the launch of immunization campaigns.

The number of states reporting widespread activity is unprecedented for this time of year, she said. The percentage of doctor visits for influenza-like illnesses continues to rise and is well above the national baseline; for the first time this flu season the mortality rate from pneumonia and influenza has risen above the epidemic threshold.

"This is a very busy and difficult flu season," Schuchat said.

Ten more pediatric deaths were reported to the CDC over the past week, raising the number of fatal pandemic H1N1 cases in children to 86, she said. The number of deaths in September alone is more than the total for some entire flu seasons, Schuchat added. Since Aug 30, the CDC has received reports of 43 pediatric deaths; 38 have been confirmed as pandemic H1N1, and five are still undergoing subtyping.

About half (19) of those deaths occurred in teens, which appears to be a shift from earlier in the outbreak when most pediatric fatalities were in the youngest age-groups.

"These are very sobering statistics, and they're likely to increase," said Schuchat. Some of the young people had underlying conditions, but others did not.

Meanwhile, some sites are reporting shortages of seasonal flu vaccine, Schuchat noted. So far, 82 million doses have been distributed, which is 5 million more than the previous week. Federal officials have said they expect producers to make 114 million seasonal flu vaccine doses.

See also:

Lawrence-Douglas County Health Department Web site

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