Notice to Readers: Delayed Influenza Vaccine Availability for
2001--02 Season and Supplemental Recommendations of the Advisory Committee
on Immunization Practices
Manufacturer projections of vaccine distribution for the 2001--02 influenza
season suggest that 49.8 million doses will be available for delivery by the end of
October 2001;* this is approximately 26 million fewer doses of influenza vaccine than
were available by the end of October 1999 (75.8 million doses) (Figure 1).
Manufacturers also project distribution of 27.3 million doses in November and December, bringing
the cumulative projected total to 77.1 million doses, which is greater than in 2000
(70.4) and comparable with 1999 (76.8). Predictions of monthly vaccine distribution vary
by manufacturer, and providers will probably receive vaccine on different schedules.
Because of the 2001--02 influenza season vaccine delay and the large number
of doses projected for distribution in November and December, the Advisory
Committee on Immunization Practices (ACIP) has developed supplemental recommendations.
The goals of these recommendations are 1) to prioritize and phase in using vaccine for
the 2001--02 influenza season to ensure that persons at greatest risk for severe
influenza and its complications and their health-care providers receive vaccine early in
the influenza season, and 2) to increase overall protection of those at greatest risk
for severe influenza and its complications as targeted in the
Healthy People 2010 objectives (1). Persons at high risk include those aged
>65 years; nursing home and other chronic-care facility residents; adults and children with chronic disorders of
the pulmonary and cardiovascular systems, including asthma; adults and children
who required regular medical follow-up or hospitalization during the preceding
year because of chronic metabolic diseases (including diabetes), renal
dysfunction, hemoglobinopathies, or immunosuppression, including that caused by medications
or human immunodeficiency virus; children and teenagers (aged 6 months--18
years) who receive long-term aspirin therapy; and women who will be in the second or
third trimester of pregnancy during the influenza season
(2). Achieving influenza vaccination goals will require the combined actions of vaccine providers; the
public; manufacturers, distributors, and vendors; and health departments and
other organizations providing vaccine.
ACIP Supplemental Recommendations for 2001--02 Influenza Season
Vaccine Providers
Providers should target vaccine available in September and October
to persons at increased risk for influenza complications and to
health-care workers. The optimal time for vaccinating high-risk persons is
October through November (2). To avoid missed opportunities, vaccine also should
be offered to high-risk persons when they access medical care in September,
if vaccine is available. Vaccinating high-risk persons early can be
facilitated through reminder and recall systems, in which such patients are
identified and encouraged to come into the office for a vaccination-only visit
(3). Additional information that may help providers implement a
reminder/recall system is available at http://www.cdc.gov/nip/flu.
Beginning in November, providers should offer vaccine to contacts of
high-risk persons, healthy persons aged 50--64 years, and any other
persons wanting to reduce their risk for influenza.
Providers should continue vaccinating patients, especially those at high
risk and in other target groups (2), in December and should continue as long
as there is influenza activity and vaccine is
available. To increase vaccination rates, health-care organizations are encouraged to assess their
providers' influenza vaccine use and provide feedback on coverage among
persons aged >65 years and other high-risk patients
(3).
The Public
Persons at high risk for complications from influenza, including those
aged >65 years and those aged <65 years who have underlying chronic
illnesses, should seek vaccination with their provider when vaccine is available.
The optimal vaccination period is October through November but may
include September if vaccine is available. Unvaccinated high-risk persons
should continue to seek vaccine later in the season.
Persons who are not at high risk for complications from influenza,
including household
contacts† of high-risk persons, are encouraged to seek
influenza vaccine in November and later. Persons who are unsure of their risk
status should consult their provider to determine whether they should
receive vaccine earlier and, if so, whether vaccine will be available. When
additional vaccine is available, providers are encouraged to send a reminder to
persons deferred from vaccination.
Manufacturers, Distributors, and Vendors
Distribution of vaccine to worksites, where campaigns primarily
vaccinate healthy workers, should be delayed until
November. Delaying distribution of vaccine to worksites makes more early-season vaccine available
to providers of high-risk patients. Manufacturers and distributors should
identify worksite orders, or those placing orders should indicate they are doing so
for worksites, so arrangements can be made for later vaccine
shipment. Delivery of vaccine to hospitals and chronic-care facilities serving
high-risk patients should not be delayed.
All providers who have placed orders should receive some early
season vaccine. This strategy will ensure that virtually all providers will be able
to vaccinate some of their high-risk patients early in the season. As
an exception, complete orders for chronic-care facilities serving
high-risk populations should be provided early so that vaccine can be administered
in October or November, the optimal time for vaccination of this highest
risk group.
Manufacturers, distributors, and vendors should inform providers of
the amount of vaccine they will be receiving and the date of
shipment. This will allow providers to notify high-risk patients when vaccine will be available.
Health Departments and Other Organizations
Organizers of mass vaccination campaigns not in workplaces (e.g., at
health departments, clinics, senior centers, and retail stores) should plan
campaigns for late October or November or when they are assured of vaccine
supply and make special efforts to vaccinate elderly persons and those at high
risk for influenza complications. Information that may be used in a
campaign setting is available at http://www.cdc.gov/nip/flu.
Influenza vaccine service providers should develop contingency plans
for possible delays in vaccine distribution. In a delay or
shortage, communications among partner organizations and potential redirection
of vaccine to high-risk persons in the community will be important. State
and local health departments can provide guidance that is appropriate for
their population and systems of care.
As preparation for the 2001--02 influenza season proceeds, updates on
vaccine supply, and other information about influenza vaccination that may be helpful
to providers and health departments, will be available at http://www.cdc.gov/nip/flu.
References
US Department of Health and Human Services. Healthy people 2010 (conference ed., in
2 vols). Washington, DC: US Department of Health and Human Services, 2000.
Task Force on Community Preventive Services. Recommendations
regarding interventions to improve vaccination coverage in children, adolescents, and adults.
Am J Prev Med 2000;18:92--6.
* Manufacturers predict vaccine production based on anticipated demand,
production capacity, historic and current experience with yield of vaccine, and duration
of production. Accuracy of predictions may be affected by production problems such
as strain yields, lot failure, or good manufacturing practices (GMP) issues.
One manufacturer that did not produce vaccine in 2000 because of GMP problems
has withdrawn from the market.
†Within a high-risk household, either when the person at risk or the household contact is
a young previously unvaccinated child aged <9 years who requires 2-doses for
protection, earlier vaccination of contacts may be reasonable; however, this should be a
lower priority than vaccination of high-risk persons.
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