High-Risk People Forgoing Flu Vaccine Despite Adequate Supplies, Surveys Find
The CDC's Advisory Committee on Immunization Practices on Friday will meet to consider easing its recommendations on who should receive flu vaccinations as a new survey finds that only 34.8% of high-risk residents were vaccinated and as health officials fear some doses might go unused, USA Today reports (Manning, USA Today, 12/17). A U.S. flu vaccine shortage developed in October when California-based Chiron 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 for flu shots continues. On Wednesday, HHS officials announced that the department will use part of a $220 million grant intended to fund children's vaccination programs to pay for doses of the German-made flu vaccine (California Healthline, 12/16).
According to a CDC telephone survey of 16,713 U.S. residents, among those in priority groups -- including adults ages 65 and older, people with chronic diseases, health care workers and children ages six months to 23 months -- elderly residents were the most likely to have received the vaccine at 51.1%, followed by 34.2% of health care workers and 19.3% of adults with chronic medical conditions. In addition, 36.6% of children ages six months to 23 months have received the vaccination (Manning, USA Today, 12/17). The survey also found that more than 23% of high-risk residents had tried but failed to get the 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. Additionally, the survey found that 37% of elderly residents and 54% with chronic diseases said they tried to get a shot but were unable to obtain a vaccine (Stein, Washington Post, 12/17). Last year, 54% of high-risk residents received vaccinations during the flu season (Piller, Los Angeles Times, 12/17).
CDC estimates that 185 million U.S. residents are in the high-risk group and expects that up to 50 million will seek a vaccine (Fox, Reuters/Boston Globe, 12/17). CDC Director Julie Gerberding said that according to a recent survey of state health departments, 82% of states have enough vaccine for residents in high-risk groups, and some have a surplus. She encouraged health care providers with supplies of unused flu shots to notify the CDC so the doses can be reallocated to regions where the shortages persist (Manning, USA Today, 12/17).
According to the Post, Gerberding acknowledged that some vaccine might not be used, but she added that it is better to have too much vaccine than to turn people away (Washington Post, 12/17). The advisory committee will discuss altering its recommendations about which groups should receive flu shots. At least 11 states already have eased restrictions to allow more residents to gain access to the vaccines.
Gerberding said many residents in high-risk groups may be unaware that there are sufficient supplies of the vaccine. Donna Cochrane, president of Onsite Health Service Providers in Atlanta, said the initial shortage of the shot "scared away a lot of people," adding, "They didn't want to take it away from somebody else or they thought they'd be penalized. People with chronic diseases, in high-risk categories, didn't get flu shots because they thought it was only for people 65 and older."
In addition to that confusion, public health scientists say a slow start to the flu season also could be a reason more residents are not seeking vaccines. Gregory Poland, a professor at Mayo Medical School and member of CDC's advisory committee, said, "When the shortage was announced, people panicked. But now there is no influenza activity, and they simply don't perceive themselves to be at risk" (McKenna, Wahlberg, Atlanta Journal-Constitution, 12/17). Gerberding said this year's flu season "is getting off to a slow start," with only New York state reporting widespread cases, but she also noted that "the most common time for the flu to peak is February" (Washington Post, 12/17).
Gerberding said, "People in high-risk groups have not gone out to get vaccinated. They're stepping aside, and that is not what we want them to be doing." She added, "We want people in the high-priority group to seek vaccine because we still have doses and there's still time to be vaccinated" (Atlanta Journal-Constitution, 12/17). William Schaffner of Vanderbilt University is in favor of easing the restrictions on those who are eligible for flu shots. He said, "We have vaccine now going begging. Vaccine left in the refrigerator cannot prevent disease. I would rather put a dose of vaccine into a young, healthy person than leave it in the refrigerator while I'm looking for the next priority person" (Manning, USA Today, 12/17).
Gary Kirk, chief of the immunization division for the Michigan Department of Community Health, said, "It's hard to tell if the public isn't interested or if providers are not getting orders into us as quickly as the want" (Anstett, Detroit Free Press, 12/17).
FDA last week sent a warning letter to Chiron, made public Thursday, that said inspectors in October found about 20 "significant objectionable conditions" at the Liverpool plant that could result in the company losing its license if not fixed. FDA also said the plan for correction Chiron submitted Nov. 13 was not adequate.
Chiron has until Dec. 31 to respond to the letter. Chiron spokesperson Alison Marquiss said the warning letter was "something of a formality because the company has already responded in detail" to the preliminary inspection report (Leinwand, USA Today, 12/17).