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Update: Influenza Activity and Vaccine Availability -- United States, 1991-92

During the 1991-92 influenza season, widespread influenza-like illness (ILI) activity* was first reported in Louisiana for the week ending November 9, 1991, and in Mississippi the week ending November 16. Through November 30, six additional states (Alaska, Missouri, New York, North Carolina, Tennessee, and Texas) reported widespread activity; 13 (Alabama, Arkansas, California, Florida, Georgia, Indiana, Kansas, Kentucky, Minnesota, Nebraska, New Jersey, Ohio, and Pennsylvania) reported regional activity.

Influenza A outbreaks in schools this season have been previously reported (1). The first laboratory-confirmed influenza A(H3N2) outbreak in a nursing home occurred in mid-November in Cleveland, Ohio, and affected 46 (14%) of the 335 residents; nine (20%) of the ill residents were hospitalized for pneumonia or other complications of influenza A infection, and two (4%) died.

Based on CDC's 121-city mortality reporting system, 5.4% of reported deaths were associated with pneumonia and influenza for the week ending November 30--a level that remains below the seasonal baseline for this period. However, reports of increases in mortality associated with influenza tend to lag behind reports of increased influenza activity. Reported by: Participating state and territorial health department epidemiologists. EA Mortimer Jr, MD, Dept of Epidemiology and Biostatistics, J Fishman, MD, Dept of Medicine, Case Western Reserve School of Medicine, Cleveland; TJ Halpin, MD, State Epidemiologist, Ohio Dept of Health. WHO Collaborating Center for Surveillance, Epidemiology, and Control of Influenza, Influenza Br and Epidemiology Activity, Office of the Director, Div of Viral and Rickettsial Diseases, National Center for Infectious Diseases; Div of Immunization, National Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: Rates of morbidity and mortality in the Ohio nursing home outbreak are equal to or lower than those reported during influenza A(H3N2) outbreaks in previous years (2-4). Although influenza activity for 1991-92 has been reported earlier than in past seasons, the overall severity of influenza activity for this season cannot be predicted. However, because influenza A (H3N2) activity may be associated with excess mortality, health-care providers should continue efforts to vaccinate high-risk persons and their household members and caregivers (5,6).

The early influenza activity and resulting increase in demand for vaccine have raised questions regarding supply and distribution of influenza vaccine. Vaccine manufacturers produced and distributed 32 million doses of the 1991-92 influenza vaccine for civilian use, a 12.7% increase over doses produced during the 1990-91 season (CDC, unpublished data). Each year since 1985, 85% or more of influenza vaccine doses have been distributed to private physicians and health organizations, with the remainder being distributed to the public sector (federal, state, and local health departments and programs), resulting in wide variation in distribution and use of the vaccine (CDC, unpublished data). In response to reports of vaccine shortages in some areas, representatives of CDC, the Pharmaceutical Manufacturers Association, the Food and Drug Administration, and the companies that manufacture influenza vaccine are assessing vaccine supply, distribution, and the possibility of redistributing vaccine from areas of surplus to areas reporting a shortage.

Persons at increased risk for complications of influenza include those who are aged greater than or equal to 65 years; residents of chronic-care facilities; persons with chronic pulmonary (including asthma) or cardiovascular disorders; persons who require regular medical care or have been hospitalized because of chronic metabolic diseases (including diabetes), renal dysfunction, hemoglobinopathies, or immunosuppression (including that caused by medications and human immunodeficiency virus); and children and teenagers receiving long-term aspirin therapy (who may be at risk for developing Reye syndrome after influenza) (6). Although most publicly funded vaccination campaigns have been completed and most persons at high risk should have been vaccinated by December 1, the 1991-92 vaccine can be administered throughout the winter, and efforts to vaccinate high-risk persons and their contacts should be continued by health-care providers, especially private physicians, until influenza activity has begun to decline in the community. Amantadine may be used as an adjunct to vaccine, or alone if vaccine is contraindicated or unavailable, for prophylaxis against or treatment of influenza A infection, especially in high-risk persons (4,6).

References

  1. CDC. Update: influenza activity--United States, 1991-92. MMWR 1991;40:809-10.

  2. Arden NH, Patriarca PA, Fasano MB, et al. The roles of vaccination and amantadine prophylaxis in controlling an outbreak of influenza A(H3N2) in a nursing home. Arch Intern Med 1988;148:865-8.

  3. Goodman RA, Orenstein WA, Munro TF, et al. Impact of influenza A in a nursing home. JAMA 1982;247:1451-3.

  4. CDC. Control of influenza A outbreaks in nursing homes: amantadine as an adjunct to vaccine--Washington, 1989-90. MMWR 1991;40:841-4.

  5. CDC. Update: influenza--United States, 1989-90. MMWR 1990;39:157-9.

  6. ACIP. Prevention and control of influenza: recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR 1991;40(no. RR-6).

*Levels of ILI or culture-confirmed influenza activity are reported by state and territorial health department epidemiologists. Levels of activity are: 1) sporadic--sporadically occurring ILI or culture-confirmed influenza, with no outbreaks detected; 2) regional--outbreaks of ILI or culture-confirmed influenza in counties having a combined population of less than 50% of the state's total population; 3) widespread--outbreaks of ILI or culture-confirmed influenza in counties having a combined population of greater than or equal to 50% of the state's total population.

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