Influenza Vaccine Shortage Report

Contra Costa Health Services
October 12, 2004

On October 5, 2004, Contra Costa Health Services (CCHS) was notified that the influenza vaccine supply, which we were due to receive from the California State Health Department, purchased by the federal Centers for Disease Control, would not be available. The vaccine supply for the United States has been severely impacted due a manufacturing problem at Chiron Corporation.

Influenza typically impacts 5 to 20% of the population during the flu season. For most, the illness resolves rapidly. However, each year 200,000 persons are hospitalized for flu complications and there are over 30,000 flu related deaths each year. Older adults and persons with significant chronic disease account for over 90% of these deaths.

The Centers for Disease Control purchased the vaccine for distribution to Public Health from Chiron Corporation, which was to supply 44 million doses of flu vaccine to the country. This shortfall in vaccine will cause an inadequate supply of adult influenza vaccine in the United States for the 2004-2005 flu season. The U.S. uses approximately 100 million doses of flu vaccine each year.

The remaining 54 millions doses of adult flu vaccine, expected to be available in the United States for this flu season has been manufactured by Aventis-Pasteur. Of these doses, approximately 30 million doses have already been distributed. In addition, approximately 1.1 million doses of live attenuated vaccine (Flumist) manufactured by MedImmune will be available. The MedImmune vaccine is only for healthy adults under 50 years of age. MedImmune has now committed to manufacturing an additional 1 million doses.

CCHS is severely affected by this shortage. All vaccine to be used by Public Health Division was ordered through the Centers for Disease Control from Chiron. Each year, Contra Costa Regional Medical Center and Clinics (CCRMC) purchases a very limited amount of vaccine and receives an additional amount from the Public Health supply for indigent and high-risk individuals. This small amount of CCRMC purchased vaccine, from Aventis, is the total amount of vaccine available in Health Services this year.

In 2003 Contra Costa Public Health provided 21,500 doses of flu vaccine through Senior Drop-In clinics, to skilled nursing facilities and to other high-risk populations. 11,200 of these doses were provided to persons over 65 years of age. We anticipate having an adequate supply of vaccine for children.

To ensure that the limited supply of available flu vaccine is administered to the most vulnerable people throughout the State, the State of California Health Services Department has issued an Emergency Public Health Order directing health care providers to limit the provision of vaccine to those individuals in the high-risk categories identified by the Centers for Disease Control and Prevention. The order also states that providers should refrain from vaccinating healthy individuals not at high risk of serious illness or death from influenza.

Centers for Disease Control and Prevention (CDC) Priority Guidelines

The Centers for Disease Control and Prevention (CDC) has issued priority guidelines for administration of influenza vaccine this season. These groups are considered to be of equal importance and should get a flu vaccination: (List is from CDC)

Adults aged 65 years and older Even if you're in great health
All children aged 6-23 months Children younger than 2 years old have one of the highest rates of hospitalization from influenza
Adults and children with a chronic health condition - Like heart disease, diabetes, kidney disease, asthma, cancer, or HIV/AIDS
Women who will be pregnant during the influenza season - Flu season is typically November through March
Residents of nursing homes and long-term care facilities
Children aged 6 months-18 years on chronic aspirin therapy
Health care workers involved in direct patient care
Out-of-home caregivers and household contacts of children aged < 6 months

Persons who are not included in one of the high-risk groups described above should be informed about the urgent vaccine supply situation and should NOT get vaccinated.

Contra Costa Health Services Response

In response to the shortage of adult flu vaccine, Contra Costa Health Services has cancelled all of the Public Health adult drop-in flu clinics and issued a press release to notify the community. In addition, we are:

Tracking and publicizing availability of flu clinics in Contra Costa County
Coordinating with private companies offering flu vaccine clinics to ensure screening
Communicating with all local hospitals to determine available vaccine supplies
Surveying Contra Costa Health Plan community providers to begin to determine the community vaccine supply available
Updating web page (www.cchealth.org) and Public Health hotlines with information about flu clinics and prevention information (888-959-9911 and 313-6469)
Distributing information listing CDC priority groups to providers
Refining guidelines for CDC priority groups
Developing prevention messages for flu and distributing them
Discussing and coordinating the health response with health systems in other counties
Issuing a medical provider alert and advisory to physicians of provision of vaccine
Investigating possible sources of vaccine and staying updated on resources in the community for individuals at risk

Background

Influenza in the United States

Influenza viruses are spread from person to person primarily through the coughing and sneezing of infected persons. The incubation period is 1-4 days, with an average of 2 days. Influenza illnesses typically resolve after a limited number of days for the majority of persons. Influenza viruses cause disease among all age groups, and rates of infection are highest among children. However, rates of serious illness and death are highest among persons 65 years of age and over. Persons of any age who have medical conditions that place them at increased risk for complications from influenza are also at high risk. The primary prevention strategy has been vaccination of persons at risk.

Epidemics of influenza typically occur during the winter months in temperate regions. In the United States, approximately 5-20% of the population gets the flu, more than 200,000 people are hospitalized from flu complications, including pneumonia. Each year there are approximately 36,000 deaths per year in the United States during 1990-1999 during the months of flu activity. Older adults account for more than 90% of deaths attributed pneumonia and influenza.

Influenza Vaccine

There are two types of influenza vaccine available. The inactivated (i.e., killed virus) influenza vaccine is administered by injection and is known as the "flu shot." This vaccine is approved for use in people older than 6 months, including healthy people and people with chronic medical conditions. The second type of vaccine is the live attenuated influenza vaccine (LAIV), which is administered nasally (Flumist). This vaccine is recommended for healthy persons between the ages of 5 and 49 years of age. It should not be used by people with chronic medical conditions, pregnant women or others at risk of influenza-related complications.

Prevention of Influenza

In order to prevent the transmission of influenza viruses, Contra Costa Health Services recommends to all Contra Costa residents:

Wash your hands often with soap and warm water
Use tissue when you cough, sneeze or spit and dispose of the tissue in a covered trash bin
Keep your hands away from your face
Clean shared space more often such as phone receivers, keyboards, steering wheels and office equipment
Do not share personal items such as, forks, spoons, toothbrushes and towels
Avoid crowds during periods of flu activity
Avoid people who are sick with respiratory illnesses
Stay home when you are sick to avoid contact co-workers and friends