The December 17 MMWR reports on three separate surveys related to influenza and influenza vaccine.

The first report, “Estimated Influenza Vaccination Coverage Among Adults and Children” provides information on a survey that assesses the use of influenza vaccine and the primary reasons reported for not receiving vaccine. Beginning November 1, 2004, questions were added to the ongoing Behavioral Risk Factor Surveillance System (BRFSS) survey. This report analyzes data collected during December 1-11 on self-reported vaccination during September 1 – November 30, which indicated that persons in nonpriority groups had largely deferred vaccination and that, among unvaccinated adults in priority groups, one fourth tried to get vaccine but were unable to do so. Vaccination coverage was suboptimal for persons in all assessed priority groups.

In previous influenza seasons, the BRFSS survey included two questions on influenza vaccination coverage among adults: “During the past 12 months, have you had a flu shot?” and “During the past 12 months, have you had a flu vaccine that was sprayed in your nose?” Beginning November 1, the two influenza vaccination questions were also asked regarding a randomly selected child in the household. In addition, new questions for adults and children were asked to determine

1. the month and year of the most recent influenza vaccination and
2. whether persons were vaccinated for influenza during the 2003-04 influenza season,
3. the primary reason vaccination was not received and
4. whether the respondent (or a child in the household) was in one of the ACIP-designated priority groups for vaccination.

Among adults in all priority groups, 34.8% reported receiving an influenza vaccination during September 1-November 30, compared with 4.4% of adults aged 18-64 years who were not in a priority group. Among adults in priority groups who had not yet received influenza vaccine, 23.3% reported that they attempted to obtain vaccination but could not. A substantially greater proportion of children in priority groups received at least one influenza vaccination this season compared with other children; 36.6% of children aged 6-23 months and 26.8% of children aged 2-17 with high-risk conditions were vaccinated, compared with 8.9% of children aged 2-17 years with no high-risk condition.

The second report, “Experiences with Obtaining Influenza Vaccination Among Persons in Priority Groups During a Vaccine Shortage,” provides information on a survey that assessed what proportion of persons at increased risk for influenza complications had been vaccinated, what proportion sought vaccination but did not receive it because of the shortage, and what factors might be dissuading persons at high risk from seeking influenza vaccination. The survey was conducted by the Harvard School of Public Health, in collaboration with International Communications Research. The survey indicated that approximately 63% of persons aged 65 years or older and 46% of chronically ill adults who tried to get the influenza vaccine were able to do so. More than half of adults at high risk did not try to get the influenza vaccine. Reasons sated for not getting the vaccine included

1. waiting for more vaccine or believing because of shortages they could not get the vaccine,
2. believing that they were not at high risk for getting a serious case of influenza,
3. not believing that the vaccine would be effective in preventing them from getting influenza and
4. concerns that they could get influenza from the vaccine.

Of parents with children aged 6-23 months, 50% tried to get the vaccine for their child, 76% of those parents who tried to get the vaccine for their child reported that they were able to get the influenza vaccine and 24% reported that they were unable to do so. Reasons for not seeking the vaccine included

1. not believing their children were at risk for a serious case of influenza,
2. concern about the side effects,
3. being told by a health care provider that the child should not get the vaccine because of the shortages or because the child was not at high risk for having a serious case of influenza and
4. not believing that the influenza vaccine was effective.

The final report, “Experiences with Influenza-Like Illness and Attitudes Regarding Influenza Prevention,” provides information on attitudes related to prevention of influenza-like illness (ILI). In October 2003, CDC recommended that health-care facilities implement a Universal Respiratory Hygiene Strategy, including providing masks or facial tissues in waiting rooms to persons with respiratory symptoms. To gather information on ILI and attitudes regarding prevention of ILI, CDC and 11 Emerging Infections Programs conducted a random-digit-dialed telephone survey of noninstitutionalized U.S. civilian adults in February, 2004. This report summarizes the results of that survey, which determined that 43% of adults and 69% of children aged 6 months -17 years with ILI visited a health-care provider for the illness. Eight percent of adults with ILI reported having been asked by a health-care provider to wear a mask; 82% said they would wear a mask if requested. With the limited availability of influenza vaccine this season, the use of masks by persons with cough illnesses in health-care settings, a component of the Universal Respiratory Hygiene Strategy, might be a helpful and acceptable method for decreasing influenza transmission.

Because influenza activity peaks in February or later in most years, persons in priority groups should continue to seek vaccination. For more information on these reports visit www.cdc.gov/mmwr/ Additional influenza information and resources are available at http://www.cdc.gov/flu.

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HHS Purchases 1.2 Million Doses of Flu Vaccine
Earlier this month, The Department of Health and Human Services (HHS) announced that the Food and Drug Administration (FDA) has authorized the use of GlaxoSmithKline influenza vaccine, Fluarix, in the United States under an Investigational New Drug application. Additionally, HHS has reached an agreement with the company to purchase 1.2 million doses of the vaccine for distribution to areas most in need. This purchase is part of the Department’s ongoing effort to identify and make available additional influenza vaccine doses to protect the American public for this winter’s flu season. The doses of Fluarix vaccine are in addition to the existing supply of 61 million doses of licensed influenza vaccine, which includes about 58 million doses of Aventis injectable vaccine and 3 million doses of FluMist nasal spray.

Fluarix has not been licensed for use in the United States and will be administered under an Investigational New Drug application (IND). The Fluarix vaccine being purchased by HHS has been approved by the European equivalents of the Food and Drug Administration (FDA), but is considered an IND because it is not currently licensed by FDA. The IND allows the investigational use of Fluarix, and HHS is immediately purchasing 1.2 million doses that are available this month. GlaxoSmithKline (GSK) has agreed to make up to 4 million doses available under the IND.

Under an IND, patients who are offered the Fluarix vaccine must sign a form that provides important information and acknowledges that they are aware of the potential adverse effects associated with the investigational vaccine. Sponsors of INDs are required to monitor the use of the investigational product, maintain adequate records, control the supply of product, provide periodic reports to FDA regarding safety and other issues and make sure informed consent is obtained form individuals before receiving the vaccine. CDC will assist GSK with these activities.

Additionally, the federal government has purchased and stockpiled antiviral medicines to treat more than 7 million people. Supplies of antiviral medicines also exist in the private sector and manufacturers indicate that they have the ability to significantly ramp up production. All told, between existing stockpiles, private sector supplies and production capabilities, the FDA estimates there could be enough medicine to treat tens of millions of people through the heart of flu season.

U.S. Department of Health and Human Services and Ad Council Launch Flu Vaccine Campaign
Earlier this month, HHS and the Ad Council released a national public service advertising (PSA) campaign designed to provide Americans with critical information about flu vaccinations. The campaign asks Americans to “Give Others a Shot” if they are not in a priority group for the flu and provide simple tips to prevent the flu’s spread. The television, radio, and web PSAs encourage audiences to visit www.cdc.gov/flu or call CDC’s toll-free number, 1-800-CDC-INFO, to get more information on this year’s flu season and to see if they’re at high risk for the flu. The PSAs also provide practical steps to help prevent the spread of the flu, including:

• Avoid close contact with people who are sick.
• Keep your distance from others if you are sick.
• When possible, stay home from work, school and errands when you are sick, and don’t send your children to child care or school if they are sick.
• Cover your mouth and nose when coughing or sneezing.
• Clean your hands often.

The PSAs are being distributed up to 28,000 media outlets nationwide this week and will air and run in advertising time that is donated by the media.

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Vaccine Safety and Registries Community Workgroup Solicits Feedback on Recommendations for IIS and VAERS
The Vaccine Safety and Registries Committee (VASREC) Workgroup is sponsored by the American Immunization Registries Association (AIRA). It involves CDC, state and private registries/IIS and other partners. The VASREC Workgroup is soliciting reviews and comments of its recommendations captured in the document “Immunization Information System (IIS) – Vaccine Adverse Event Reporting System (VAERS) Collaboration for Vaccine Adverse Event Reporting.” The document is posted on the AIRA website at http://www.immregistries.org/docs/IIS-VAERS_Coll_Desc_06-25-2004_v2.doc. It provides a consensus-based description of activities and flows of information involving IIS data reporting to VAERS and is purposely technology neutral and written at the business/functional level. If you have comments or questions, please e-mail the VASREC Workgroup Chair, Warren Williams at wwilliams@cdc.gov. For more information on AIRA please visit http://www.immregistries.org.

CDC and State Testify Before Oklahoma Legislative Subcommittee
Dr. Melinda Wharton, Acting Deputy Director of the National Immunization Program and Don Blose, Chief of the Immunization Services Division of the Oklahoma Department of Health spoke at the November 10, 2004, meeting of the Oklahoma Legislature’s Appropriations and Budget Committee’s Subcommittee for Health and Social Services. The topic at the request of the subcommittee was vaccine safety and thimerosal. Dr. Wharton discussed the Institute of Medicine’s findings and the research that has taken place in regard to thimerosal with the subcommittee as well as the influenza vaccine shortage. The Immunization Program at CDC welcomes the opportunity to work with state health departments and to provide technical assistance to other state legislatures.

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Free Immunization-Related Brochures
For a limited time, the National Immunization Program has a number of immunization brochures available for health care professionals and consumers that can be ordered in large quantities. These brochures include topics such as VFC, Vaccine Safety, Schools, Registries and Traveler’s Health. Some Spanish resources are also available. Supplies are limited. Visit http://www.cdc.gov/nip/publications/default.htm and click on CDC Online Order Form. Additional resources are also listed. These resources are free of chare and there is no cost for shipping.

39th National Immunization Conference
The 39th National Immunization Conference is scheduled in Washington, DC, March 21-24, 2005 at the Washington Hilton and Towers. The goals of the Conference are to help participants provide comprehensive immunization coverage for all age groups and explore innovative strategies for developing programs, policy and research to promote immunization coverage for all age groups. For more information about the conference or to submit abstracts (due November 19) visit http://www.cdc.gov/nip/nic.

Job Openings within the National Immunization Program
NIP is committed to recruiting and hiring qualified candidates for a wide range of positions. Researchers, Medical Officers and Epidemiologists as well as other specialties are often needed to fill positions within NIP. We encourage all interested parties to apply for these jobs. For a current listing of positions available at NIP, please visit http://www.cdc.gov/hrmo/hrmo.htm. Once at the site, conduct a search for “National Immunization Program.”