CDC sets priorities for flu vaccine

Pharmacist, get your flu shot! That's the admonition from the Centers for Disease Control & Prevention and ASHP.

"It is irresponsible not to be vaccinated against influenza," said Kasey Thompson, director of ASHP's Center on Patient Safety. "When you are not vaccinated yourself, you are putting your patients at risk as well as yourself and your own family."

CDC's tiered vaccination guidelines are a response to the shortage of flu vaccine for the 2004-05 season. Vaccination programs were thrown into chaos last year when health authorities pulled Chiron's flu vaccine from the market because of contamination. "We learned that we cannot always predict the vaccine supply," said CDC director Julie Gerberding, M.D., MPH, at a Washington, D.C., press conference in September. "We are asking those who provide vaccine to give the first available doses to people in our priority groups and to healthcare providers who have direct contact with patients or people in the priority groups." CDC is asking providers to restrict flu vaccine to high-priority groups until Oct. 23. Next in line for vaccination are healthy adults ages 55-64. CDC is asking second-tier persons to wait until Oct. 24 for vaccination in case a vaccine shortage develops.

Top priority groups include: everyone over 65 years of age; anyone with a chronic health condition; pregnant women; children six to 23 months of age; healthcare workers; residents of long-term care facilities; household contacts; and out-of-home caregivers for children under the age of six months. Details are on-line at http://www.cdc.gov/flu

In a typical year, influenza kills 36,000 Americans and produces 200,000 hospitalizations. Vaccination rates seldom reach 50% for any of the high-risk groups. Among healthcare workers, vaccination hovers around 36%. "It is both embarrassing and tragic," Gerberding said. "Flu is prevalent in healthcare settings and largely preventable by vaccination."

Two studies, published recently by Lancet, might explain why vaccination rates have been low. One paper found the vaccine could ward off flu only to a modest extent among seniors. The other paper reported that flu viruses have become resistant to many older antiviral drugs in many countries.

CDC is not expecting a vaccine shortage for the 2005-06 flu season, Gerberding said. U.S. providers expect to have 79 million to 97 million vaccine doses for the season.

According to CDC, Chiron's UK-based manufacturing facility passed an initial Food & Drug Administration inspection in July and is on track for supplemental product testing. Chiron plans to ship 18 million to 26 million doses of flu vaccine to the United States. Sanofi Pasteur plans to produce 50 million to 60 million doses for the U.S. market. MedImmune has announced plans to ship about three million doses of nasal FluMist.

GlaxoSmithKline received FDA approval for Fluarix flu vaccine in August and has shipped about eight million doses from its plant in Germany. GSK shipped four million doses to the United States in 2004 under an emergency New Drug Application. The vaccine has been on the world market since 1992.

Disaster victims are a special concern. Many evacuees from Hurricane Katrina may be living for some time in crowded conditions-ideal for swift person-to-person transmission. "We have put Katrina evacuees in the early priority group," Gerberding said. "State and local health officials are already aware of this."

The cost of vaccination should not be an issue for evacuees, Gerberding added. Hurricane victims have been deemed uninsured in order to qualify for free vaccination under the federal "Vaccines for Children" and other programs.