CDC announces plan for sharing remaining flu vaccine

Nov 9, 2004 (CIDRAP News) – In an effort to spread the impact of the influenza vaccine shortage fairly, federal health officials today announced a plan to share most of the approximately 11 million remaining doses of injectable vaccine among states on the basis of need.

About 3.1 million doses will go to states and territories to fulfill orders they had placed before the vaccine shortage erupted last month, including orders with Chiron, whose entire production of 48 million doses was lost because of contamination concerns, the Centers for Disease Control and Prevention (CDC) announced.

"This process will ensure that 100% of public-sector orders from states will be fulfilled," regardless of where the orders were placed, CDC Director Julie Gerberding, MD, MPH, said during a teleconference this afternoon.

Another 7.2 million doses of vaccine will be apportioned to states over the next several weeks "on the basis of unmet high-priority needs," Gerberding said. "We're using a formula that state and local health officials have developed that asks, 'What is the gap between the number of high-priority people in the state and the number of doses already shipped?'"

Within each state, the state health officer will be responsible for determining where the doses will go, Gerberding said.

She said the CDC is holding back another 1.3 million doses of vaccine "to make sure we have some flexibility in case we develop an unexpected pediatric or adult situation where there was an urgent need."

The loss of the Chiron vaccine, amounting to nearly half of the total expected supply, left Aventis Pasteur as the only maker of injectable flu vaccine for the US market this season. The shortage prompted the CDC to recommend that vaccine be reserved for people at risk for serious flu complications, including 6- to 23-month-old babies, people over 65, those with chronic illness, pregnant women, healthcare workers, and other close contacts of vulnerable people.

In a news release, the CDC said Aventis had already shipped 33 million of its expected total of 58 million doses before the Chiron problem emerged. "The remaining 25 million doses have been allocated at a rate of about 3 million doses per week—or about 14 million doses—since Oct 11, under a joint distribution plan developed by CDC and Aventis." The remaining doses will be distributed through December and into January, the agency said.

In today's news conference, Dr. Mary Selecky, immediate past president of the Association of State and Territorial Health Officers (ASTHO), commented, "This new allocation will help us provide vaccine for people in the high-priority groups, but you have to remember that there's still not enough vaccine for everyone who needs it. The shortage can't be fixed at this point, but the plan will ensure that the vaccine is allocated in the fairest way possible."

Patrick M. Libbey, executive director of the National Association of City and County Health Officials, also expressed support for the allocation plan. "We see it as the best available solution for getting the vaccine to the people who need it most," he said.

The CDC also announced the debut of a 24-hour flu information hotline at 1-800-CDC-INFO, in English and Spanish, for healthcare personnel and the public. The number for the hearing-impaired is 1-800-243-7889.

People are encouraged to call the hotline for information about the flu and this year's flu season and to report when they can't find vaccine in their communities, the CDC said. Healthcare personnel can also use the number to report cases of flu or flu-like illness. Callers can listen to recorded messages on various topics and can switch to a live staff member to seek more information.

Libbey said people in search of a flu shot should call their own healthcare provider or their local health department. Gerberding added that if information isn't available from the local or state health department, people should call the CDC hotline.

In response to questions, Gerberding said the CDC probably will not make any recommendations this year about how to ration vaccine when there's not enough for all high-risk people in a local setting. "Right now the CDC perspective is we understand that state and local health officials are very capable of making these kinds of decisions," she said. "I don't think we're going to issue any formal recommendations about sub-prioritization this year, but it's something we might take into consideration in future years."

Gerberding also said that reduced-dose, intradermal flu shots are not the answer to the current shortage for high-risk groups. In two recent studies, injecting reduced doses of flu vaccine—20% or 40% of the normal dose—just under the skin surface worked as well as a standard intramuscular dose in adults up to age 60.

"This is a promising strategy that might make vaccine go farther, but it wasn't shown to be effective in people over 60 and probably won't be effective in people who need vaccine the most," she said. "It's not the solution for most of the high-priority population."

Gerberding also noted that flu is present in 29 states so far but is within the normal range for this time of year. In contract to last year at this time, no states have reported widespread cases, she said.

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