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Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail. Notice to Readers: Delayed Supply of Influenza Vaccine and Adjunct ACIP Influenza Vaccine Recommendations for the 2000--01 Influenza SeasonAnnual vaccination against influenza is the primary means for minimizing serious adverse outcomes from influenza virus infections. These infections result in approximately 20,000 deaths and 110,000 hospitalizations per year in the United States (1). The amount of trivalent inactivated influenza vaccine produced for distribution in the United States has increased substantially; in 1999, four manufacturers produced a combined total of 80 to 85 million doses. For the 2000--01 influenza season in the United States, lower than anticipated production yields for this year's influenza A(H3N2) vaccine component and other manufacturing problems are expected to lead to a substantial delay in the distribution of influenza vaccine and possibly substantially fewer total doses of vaccine for distribution than last year. A more precise estimate of the vaccine supply will be available as production progresses during the summer. Because many vaccine providers currently are planning their fall vaccination activities, CDC and the Advisory Committee on Immunization Practices (ACIP) are issuing adjunct influenza vaccination recommendations beyond those made by ACIP on April 14, 2000 (1). The adjunct recommendations are specific to the 2000--01 influenza season. Adjunct Influenza Vaccine Use Recommendations for the 2000--01 Influenza Season
Use of Influenza Antiviral MedicationsThere are no new recommendations for the use of influenza antiviral drugs. The approved usage (i.e., for treatment or chemoprophylaxis), age group, dosage, route of administration, metabolism, and adverse reactions of these agents vary (1), and all of them require prescription by a physician. Influenza antiviral drugs are useful for controlling influenza outbreaks in specific and circumscribed situations, such as nursing homes. In addition, long-term antiviral chemoprophylaxis of high-risk institutionalized residents or some persons at high risk for complications from influenza might be indicated if vaccine either is unavailable, ineffective (e.g., severely immunocompromised persons), or contraindicated. However, these drugs are not a substitute for influenza vaccine. Even if an influenza vaccine shortage develops, CDC and ACIP do not support their routine and widespread use as chemoprophylaxis against influenza because this is an untested and expensive strategy that could result in large numbers of persons experiencing adverse effects. Additional DiscussionIn the United States, 70 to 76 million persons (approximately 35 million persons aged >65 years; 33 to 39 million persons aged <65 years with high-risk medical conditions; and 2 million pregnant women) are at high risk for serious complications from influenza infections, including hospitalizations and deaths. The expected delay in influenza vaccine distribution and a possible shortage for the 2000--01 influenza season has raised difficult questions of how to maximize protection against influenza for these persons. One complicating factor is that many vaccine providers must plan their fall vaccination activities now even though the vaccine supply is uncertain. Given the current situation, CDC and ACIP have issued modified recommendations for the 2000--01 season emphasizing the delay of organized influenza vaccine campaigns until November, the continuation of routine vaccination activities during regular health-care visits, and the development of provider-specific contingency plans in case a vaccine shortage should develop. There are additional important points worth emphasizing in addition to these main recommendations:
As new information becomes available, CDC and the Food and Drug Administration (FDA) will issue updates. In the meantime, ACIP and CDC request that persons and organizations planning to administer influenza vaccine, as well as members of the general public, join in these efforts to maximize protection of persons most likely to develop serious and life-threatening complications from influenza. FDA, CDC, ACIP, National Institutes of Health, and vaccine manufacturers will continue to work together to facilitate the availability of influenza vaccine for the upcoming season and to minimize the adverse impact of an influenza vaccine shortage if one should develop. If a substantial vaccine shortage appears imminent, or if the situation warrants, then CDC and ACIP will issue further recommendations. Reference
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