Public Health Grand Rounds Discussion Forum

Vaccine Shortages

• prioritizing high risk flu vaccine recipients - Cindy Burbach 01/28/05 ( 1)
  • Re: prioritizing high risk flu vaccine recipients - Nicole Smith 02/02/05 ( 0)
• Pediatric Flu - Vivian Flores 01/28/05 ( 0)
• Welcome to the Forum - Nicole Smith 01/27/05 ( 2)
  • Discussion of Vaccine Supply - Kent Kitagawa 01/28/05 ( 1)
    • Re: Discussion of Vaccine Supply - Nicole Smith 02/02/05 ( 0)

       

I would hope that further discussions of prioritizing high risk vaccine recipients will consider epidemiologic risk equally important to individual mortality risk. For example, in a true public health model, direct care health workers are at much greater risk of spreading the disease (and thus should be vaccinated)than are the frail elderly patients in a nursing home. They will not die of the disease if no one brings it to them and nursing homes enforce strict visitation policies during flu season and outbreak.

The Advisory Committee on Immunization Practices (ACIP) Influenza Working Group met on January 26-27 in Atlanta and discussed vaccine prioritization in the event of vaccine shortages. It considered four factors in developing prioritization recommendations:

- Morbidity and mortality impact
- Ability to reduce disease (vaccine effectiveness)
- Herd immunity
- Economic impact

Their recommendations will be presented to the entire ACIP on February 10 for approval.

As the Vaccines for Children Program in San Antonio we ordered adequate supplies of preservative free flu vaccine for 6-23 month olds. We sent VFC providers numerous letters, faxes, and newsletters to get the information to them about the availability of the vaccine and the recommendation to immunize this group. The uptake of the pediatric flu has been slow. How have other programs improved the uptake of the pediatric flu vaccine?

As a member of the CDC Influenza Vaccine Supply Team, I'd like to welcome you to this discussion forum.

We look forward to reading your comments, suggestions, questions, and best practices regarding the challenges of responding to vaccine shortages.

I have a question arising out of this Grand Rounds Presentation. Given the limitations of the ability to supply vaccines, what are the contingent plans in the case of the outbreak of an emerging disease threat such as the current Avian Flu cases we are seeing, which may become more virulent as it mutates?

The concept of trying to contain early pandemic influenza outbreaks at the point of origin is being discussed and is, theoretically, attractive. However, whether events can be identified early enough and whether the practical issues of sending and effectively using antiviral drugs quickly enough is very uncertain. Therefore, the U.S., along with many other countries, is working on pandemic preparedness plans.

CDC, with the Department of Health and Human Services (DHHS), is further developing plans for managing patients infected with avian influenza in healthcare institutions, implementing community containment measures, using the available antiviral medications, as well as any available vaccine. A/H5N1 influenza vaccine trials should begin in March or April, and if these go well, larger amounts of this vaccine will be manufactured in the near future.

In addition, DHHS, with CDC, is working with the World Health Organization and the member countries in Southeast Asia to understand the outbreak there and contain it.