Notice to Readers: Updated Recommendations From the Advisory Committee on Immunization Practices in Response to Delays in Supply of Influenza Vaccine for the 2000--01 Season
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On July 14, CDC reported a substantial delay in the availability of a proportion of influenza vaccine for the 2000--01 season and the possibility of a vaccine shortage (1). Since then, resolution of manufacturing problems and improved yields of the influenza A (H3N2) vaccine component have averted a shortage. Although safe and effective influenza vaccine will be available in similar quantities as last year, much of the vaccine will be distributed later in the season than usual. This update provides information on the influenza vaccine supply situation and updated influenza vaccination recommendations by the Advisory Committee on Immunization Practices (ACIP) for the 2000--01 influenza season.
For the 1999--2000 influenza season, approximately 77 million doses of vaccine were distributed, of which 3 million doses were returned. On the basis of information pro vided by manufacturers, distribution of approximately 75 million doses is anticipated for the 2000--01 season, including 9 million doses that CDC has contracted with Aventis Pasteur (Swiftwater, Pennsylvania) to produce. Most vaccine doses usually become available to providers by October, with 99% of distributed doses available before December; this year, approximately 18 million doses are expected to be distributed in December.
The optimal time to administer influenza vaccine is October through mid-November (2) to assure that vaccination occurs before there is substantial influenza activity. In any influenza season, vaccine should continue to be offered after November to persons at high risk for influenza complications; this will be particularly important in this season in which vaccine delivery is delayed. The effectiveness of this approach is supported by surveillance data from the past 18 years, indicating that seasonal activity peaked four times in December, four times in January, seven times in February, and three times in March.
Vaccination of persons aged >65 years substantially reduces influenza morbidity and mortality. For each additional million elderly persons vaccinated, CDC estimates that approximately 900 deaths and 1300 hospitalizations would be averted during the average influenza season (CDC, unpublished data, 2000). The health impact of individual seasons can vary widely on the basis of the size of the susceptible population, the prevalence of influenza infections, the type and strain of the predominating virus(es), and the match between the vaccine strains and those circulating in the community. The primary goal of influenza vaccination is to prevent severe illness and death from influenza infection and its complications. Although the severity of influenza seasons varies, an annual average of approximately 20,000 deaths and 110,000 pneumonia and influenza (P&I) hospitalizations result from influenza infections (3--5). More than 18,000 (>90%) of these deaths and approximately 48,000 of the P&I hospitalizations per year occur among persons aged >65 years who are at highest risk for influenza-related complications.
Because of the potential health impact of delayed influenza vaccine availability, CDC and ACIP updated recommendations for the 2000--01 season. The goal of these recommendations is to minimize the adverse health impact of delays on high-risk persons. Minimizing the adverse impact on this group will require an effective response by the private and public sectors, including actions that have not been undertaken during past seasons.
Updated ACIP Recommendations for the 2000--01 Influenza Season
Persons at high risk for complications from influenza are:
Role of Health-Care Organizations and Health-Care Providers
ACIP encourages health-care organizations and providers to undertake special efforts to maximize influenza vaccine coverage among high-risk persons. Health-care organizations and medical providers that can identify elderly and high-risk patients from computerized administrative databases or clinical records should evaluate their capacity to send reminders directly to these patients. Reminder-recall systems have been proven effective in increasing vaccination coverage and are recommended by the Task Force on Community Preventive Services (8). In addition, ACIP recommends use of standing orders in long-term--care facilities and other settings (e.g., inpatient and outpatient facilities, managed-care organizations, assisted-living facilities, correctional facilities, adult workplaces, and home health-care agencies) to ensure the administration of recommended vaccinations for adults, including influenza vaccine (9). Assuring that elderly and high-risk patients receive vaccine before hospital discharge throughout the influenza season will provide protection for a large number of high-risk persons.
Role of State and Local Health Departments
State and local health departments can play a critical role in promoting vaccination of high-risk persons and in promoting ongoing vaccination through December and later. Because only a small proportion of influenza vaccine is delivered by the public sector, the greatest impact may be achieved through the formation of coalitions that include community and provider organizations to promote the strategies recommended by ACIP. Key coalition partners include professional societies, Health Care Financing Administration peer review organizations that have an existing focus on influenza vaccination through the National Pneumonia Project, and community groups that focus on high-risk populations. Many states already may have an active coalition for adult vaccination that could serve as a focus for state and local efforts. Health departments also can play a key role in disseminating timely and accurate local information on influenza activity and communicating local availability of vaccine to high-risk groups and monitoring and promoting vaccination of residents of long-term--care facilities.
Update on Use of Influenza Vaccine in Children
Early vaccination of young children with high-risk conditions is a priority because two doses of vaccine administered at least 1 month apart are recommended for children aged <9 years who are receiving influenza vaccine for the first time. Two influenza vaccines (Flushield, Wyeth Laboratories, Inc. [Marietta, Pennsylvania], and Fluzone® split, Aventis Pasteur, Inc.) are licensed and recommended for use in high-risk children aged >6 months. One other influenza vaccine, Fluvirin (Medeva Pharma Ltd., Leatherhead, England), is labeled in the United States for use only in persons aged >4 years because its efficacy in younger persons has not been demonstrated. Because Fluvirin is not indicated for children aged 6 months--3 years, providers should use other approved influenza vaccines for vaccination of children in this age group.
CDC will provide information material to assist state health departments and other organizations in their communication and education efforts. This material and updates on the influenza vaccine supply will be posted on CDC's World-Wide Web site, http://www.cdc.gov/nip. Additional information and assistance can be obtained by contacting CDC's National Immunization Program by e-mail, firstname.lastname@example.org, or the National Immunization Information Hotline, telephone (800) 232-2522.
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