CDC Predicts Remaining Flu Vaccine Delivered by End of Year

The flu vaccine delay is rapidly diminishing. By Nov. 29, 71 percent of the normal supply of 75 million doses had been shipped. The U.S. Centers for Disease Control now say most or all of the remaining doses will be delivered to healthcare providers by the end of December.

The CDC this year took the unusual step of ordering 9 million doses on its own, to have them available as insurance against delivery system glitches that might cause local delays. Normally the federal government takes no part in the purchase and distribution of flu vaccine.

Now, the CDC says, it is time for everyone who has not been vaccinated to get a shot as soon as possible. If the vaccine is not available from one provider, the agency’s advice is to keep trying. “Be patient but persistent,” is the way it was put in the most recent update on the vaccine situation.

It’s Not Too Late
Health experts are in agreement: It’s not yet too late to get a flu shot. Ten days or so are needed for the vaccination to become fully effective. During 14 of the last 18 years, CDC records show that the flu did not peak until mid-January.

Influenza is highly contagious, and can be very dangerous for people 65 or older, or who have health problems such as diabetes or heart or lung disease.

Because pneumonia and other pneumococcus bacteria infections are common and very dangerous complications of influenza, people in those high-risk groups are advised to get vaccinated for pneumococcal infections.

Surgeon General David Satcher, M.D., has urged everyone 50 and older to “take action for their health and get a flu shot,” and echoed the CDC assurance that December is not too late to benefit from vaccination. “You can still get protection,” he said.

Satcher dismissed fears that one can get flu from the vaccine as “a myth.”

“The scientific evidence is overwhelming,” Satcher said. “The influenza vaccine is safe and effective and definitely will not cause the flu. Don’t let the flu stop you from enjoying life.”

During a typical flu season, 110,000 people are hospitalized with flu complications, and nearly 20,000 die. And good health is no protection, Satcher says. “Even if you are healthy and feel fine, you should get a shot.”

State Flu Incident Reports
Latest reports collected by the CDC show that during the week ending Nov. 25, the flu had been reported in 18 states, in two of which — Texas and Kentucky — it was classified as “regional.” In the other 16, it was classified as “sporadic.” Twenty-four states reported no flu activity, and eight states did not send reports.

The CDC’s classifications do not relate directly to the number of cases identified. “Sporadic” means influenza infections are present, but none are affecting schools, nursing homes or other institutions. “Regional” means there are outbreaks, but they are in areas of a state containing less than 50 percent of its population. There is a third classification — “widespread” — for outbreaks in areas where more than 50 percent of the population live. It has not been used so far this year.

The total number of cases identified by official laboratories so far is small. Between Oct. 1 and Nov. 25, 8,511 virus specimens sent in by hospitals, clinics and physicians were analyzed, and only 101 were found to be influenza viruses. The most common by far was influenza type A (H1N1), and the second most common was type A (H3N2). This year’s vaccine is designed to provide protection against both strains.

The other states in which cases of influenza have been identified are Alabama, Alaska, Arkansas, Colorado, Florida, Georgia, Hawaii, Indiana, Kansas, Louisiana, Maine, Michigan, New Mexico, Ohio, Oklahoma and Tennessee.

Price-Gouging Begins
The General Accounting Office, an agency which does studies and makes investigations for Congress, has been asked to investigate the flu vaccine production and distribution system, particularly the charges that profiteering flourished when it became apparent that manufacturing problems were going to make delivery of this year’s full supply much later than usual.

Difficulty reproducing one of the three flu virus strains needed for this year’s vaccine and U.S. Food and Drug Administration findings that two of the three major U.S. vaccine manufacturers’ plants were not in compliance with FDA standards caused the delay.

The National Flu Surveillance Network, a private organization, says the manufacturers “magnified” the delay by adhering to their normal first-come, first-served vaccine shipping policies. The NFSN says that meant some vaccine went to hospitals, doctors and public health clinics, but much went to for-profit wholesalers and companies that offer vaccines to employees.

Doctors used to ordering vaccine in October and receiving it several days later “were left to scrounge for vaccine for their high-risk patients,” the NFSN said. Some Detroit doctors crossed the border to buy vaccine in Canada, where it was readily available.

Reports of price-gouging began to flood in. Some resellers who had obtained a supply from wholesalers were asking for, and getting, prices four to 10 times normal. There was nothing illegal about what they did, but there was widespread anger at having to pay, for instance, as one Detroit hospital did, $12 a dose for vaccine that should have cost $1.60 a dose.

The Haves and Have-Nots
Physicians and public officials were also angry to learn that the vaccine they were having trouble obtaining for people in the high-risk categories was being freely dispensed to employees of large companies that had ordered early, and even to all comers in supermarkets.

One doctor, David Westbrock, M.D., who practices in Centerville, a Dayton, Ohio, suburb, says he was outraged when he discovered that a local Kroger supermarket was giving flu shots to customers — at $12 each — while he and other local healthcare providers were unable to get the vaccine.

“To me, it’s an absolute scandal,” Westbrock told the NFSN. “I can’t believe there has been no plan to ration these [shots] for the people who really are at high risk. That’s a decision a doctor ought to make.”

The American Medical Association has condemned what it called “medical price-gouging,” and CDC officials voiced concern. But nothing could be done, because neither the CDC nor any other federal agency has any power to regulate the distribution of the vaccine.

Nor is it clear that it would be a good thing if such authority existed. The head of a CDC committee on vaccines, John Modlin, M.D., said he was “not sure that the federal government had any constitutional right to step into private commerce.”

Medicare will pay for flu shots for all its beneficiaries who have Part B coverage. The Health Care Financing Administration approved that change in benefits earlier this year, and will also no longer require that the vaccine be administered by a physician or doctor of osteopathy. State regulations, though, may still impose that requirement, and Medicare will not cover people with Part A only.

Medicare will also pay for pneumococcus vaccination, but will require a signed consent and a check on the recipient’s age and health, and whether the individual has been vaccinated before. Normally, one pneumococcal immunization is good for a lifetime.

Vaccine Alternatives, Not Substitutes
The CDC has called attention to four prescription drugs on the market that may alleviate influenza symptoms, or shorten the duration of a patient’s suffering. But the CDC also stressed that while they can be useful for controlling outbreaks “in specific and circumscribed situations,” they are not a substitute for the influenza vaccine.

However, the agency warned that two of them, amantadine and rimantadine, were not recommended for widespread use in healthy people because they can cause harm to the central nervous system (the brain). The other two, Relenza (zanamivir) and Tamiflu (oseltamivir), had been shown to reduce the severity and duration of types A and B influenza. Recently, the FDA approved Tamiflu for flu prevention, finding that a pill a day during an outbreak can prevent the illness almost like a vaccine. In addition, Relenza might be risky for people with asthma or chronic obstructive pulmonary disease.


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