CDC Advisory Committee Recommends Eased Guidelines on Priority for Flu Vaccinations
The CDC's Advisory Committee on Immunization Practices on Friday recommended that public health officials beginning Jan. 3 ease guidelines on who should receive priority for flu vaccinations to include people ages 50 to 64 and those in close contact with people in high-risk groups, the Washington Post reports. Existing recommendations giving highest priority to people ages 65 and over, children ages six months to 23 months, those with chronic diseases and health care workers will be preserved.
CDC officials in October established initial guidelines on who should receive priority for the vaccine in an attempt to reserve doses for those who could benefit most in the face of the unexpected national flu vaccine shortage (Stein, Washington Post, 12/18). The shortage emerged when California-based Chiron in October announced that the British Medicines and Healthcare Products Regulatory Agency suspended the manufacturing license of a Liverpool, England, facility that produces about half of the U.S. flu vaccine supply.
MHRA recently extended the suspension from January to April. Before the shortage, U.S. officials estimated that the country would have 100 million doses. France-based Aventis Pasteur supplied the United States with 58 million flu vaccine doses, and Maryland-based MedImmune provided about three million doses of the nasal-spray flu vaccine FluMist.
HHS officials earlier this month also agreed to import 1.2 million doses of GlaxoSmithKline's flu vaccine Fluarix, manufactured in Germany, after the vaccine received provisional FDA approval. U.S. officials could purchase an additional 2.8 million doses from GSK if demand continues (California Healthline, 12/17).
CDC typically accepts the committee's recommendations (AP/Wall Street Journal, 12/21). Although the recommendations are not mandatory, they are "extremely influential," according to the Los Angeles Times (Peterson, Los Angeles Times, 12/18).
The panel also recommended that health officials until Jan. 3 increase efforts to encourage all people at high risk for contracting the flu be vaccinated (Washington Post, 12/18). According to the AP/Wall Street Journal, "The move was prompted by worries that tens of thousands of doses of flu vaccine might go to waste" (AP/Wall Street Journal, 12/21).
The recommendations come as a recent CDC telephone survey of 16,713 U.S. residents found that only 34.8% of high-risk residents were vaccinated against the flu. The survey also found that more than 23% of high-risk residents had tried but failed to get the flu vaccine, 10% chose to forgo the shot in order to save it for others and 6.5% did not realize they were in the high-risk group. A separate survey by the Harvard School of Public Health found that 51% of elderly residents and 63% of those with chronic diseases had not tried to get a vaccine.
Last year, 54% of high-risk residents received vaccinations during the flu season. CDC officials have estimated that 185 million U.S. residents are in the high-risk group and they expect up to 50 million high-risk people to seek a vaccine.
At least 11 states already have eased guidelines to allow more residents to gain access to the vaccines (California Healthline, 12/17). In addition, at least 43 states have said they have enough flu vaccine to inoculate all high-risk state residents. CDC officials have distributed about 21 million doses of vaccine since the shortage was announced, and Aventis is producing an additional 3.5 million doses for this season to be distributed in January (Manning, USA Today, 12/20).
Health officials in Minnesota have alerted CDC officials that they do not need about 81,000 doses the agency had previously allocated for the state. Minnesota has about 60,000 doses of the vaccine remaining, according to state Health Commissioner Dianne Mandernach (Majeski, St. Paul Pioneer Press, 12/18). However, public health officials in New York state, North Carolina, Pennsylvania, Rhode Island and Washington, D.C., have said that they do not have enough vaccine to inoculate people designated as high-risk under CDC's previous guidelines (USA Today, 12/20).
CDC spokesperson Tom Skinner said that in total about seven states do not have enough vaccine for all residents in high-priority groups (Fahy, Pittsburgh Post-Gazette, 12/18). According to the New York Daily News, the recommendation to expand CDC guidelines "sparked a rush for vaccinations" in several states (Shin, New York Daily News, 12/18).
Jeanne Santoli of the CDC's National Immunization Program said CDC has been able to redistribute flu vaccine from areas with a surplus to other areas still in need. However, she added, "[M]y sense is the magnitude of vaccine we've gotten back will not be enough to meet the need of states that say they do not have enough." Santoli said, "The issue is [state officials] want vaccine now. If they wait until January" -- when additional does are expected to be available -- "they may not have takers" (USA Today, 12/20).
ACIP Chair Myron Levin of the University of Colorado School of Medicine said, "On the one hand, we don't want any [vaccine] to go to waste. On the other hand, we don't want to start using it all and have the high-risk (people) finally show up and not be able to get vaccine." He added, "The season has been slow to develop, and so they might not have seen a demand yet. We're still afraid we'll run out of vaccine. The prime emphasis is to make sure the high-risk individuals get vaccinated. We're going to make another push on that, and following that, we want to broaden it to make sure the excess vaccine that exists in certain areas is well-utilized" (Washington Post, 12/18).
CDC Director Julie Gerberding said, "In most communities we're still targeting vaccine to the people in the highest priority groups. The challenge is that in some places, health departments and private providers currently do not have enough demand from people in those priority groups. We don't want those doses to go to waste" (Peterson, Los Angeles Times, 12/18).
Some officials for the Association of Southeast Asian Nations on Monday in Singapore said that an avian flu pandemic is most likely to occur in Asia, would be transmitted by humans and could be more contagious than the SARS virus, the AP/Las Vegas Sun reports. ASEAN is comprised of officials from Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Vietnam. During the meeting, officials discussed methods to increase avian flu precautions and improved disease reporting among countries.
Francois Xavier-Meslin, World Health Organization coordinator for disease control, prevention and eradication, said, "We are getting closer [to a bird flu pandemic], but when it's going to happen, I don't know. If it happens, which is not yet proven, it's going to be worse than SARS. A full-blown flu virus, you can transmit easily to people in your family or people you work with. It is a very highly contagious disease compared to SARS."
Hans Wagner of the Food and Agriculture Organization said, "Asia is an area with very high poultry density, human density. Asia has always been a center of flu, so all these factors come together" (En-Lai, AP/Las Vegas Sun, 12/19).