July 20, 2000

Glitch delays flu vaccine release Mass immunization will likely be pushed back

More health news, information at DuluthSuperior.com's Health Guide By Melanie Evans News Tribune staff writer

A production glitch is expected to delay this year's release of the flu vaccine by a month, causing local health agencies to rethink the time and promotion of their annual immunization campaigns.

For most Northland residents, that means they'll be receiving their influenza shots just weeks before the flu season starts.

The Centers for Disease Control and Prevention published news of the delay in its weekly publication Friday.

The CDC blames the delay on two factors.

One of three strains cultivated for this year's vaccine -- the A/Panama -- refuses to grow fast enough to meet production deadlines. And two of four drug companies came under Food and Drug Administration scrutiny for undisclosed problems at their manufacturing plants.

In 1999, four drug manufacturers turned out 80 million doses of the vaccine alone. Influenza causes an estimated 20,000 deaths in the United States and 110,000 hospital visits annually.

Although shots can be given at any time during the winter, the CDC recommends getting immunized in October and November, before peak flu months of December to March.

In Minnesota, cases of influenza normally crop up during late November or early December, although last winter's season got an early start. The state Health Department reported Minnesota's first case Nov. 4.

The Minnesota Department of Health plans to send out about 1,000 letters to clinics across the state by Friday, warning providers to push back annual mass immunization clinics.

Many are used to holding a clinic near Columbus Day, Oct. 9, said Diane Peterson, supervisor of statewide immunization services for the state Health Department. ``This year, plan on Veteran's Day,'' she said. The holiday falls on Nov. 11.

``It's still going to be done on time, hopefully, for the flu season. There will still be vaccine. There will still be clinics. Just not at the same time as last year.''

And last year wasn't ideal. For reasons still unknown, flu vaccine shipments arrived late, derailing public awareness campaigns and canceling clinics.

``Everybody was pointing their fingers at everybody else,'' she said. ``This year, I guess the good news is that we know early enough.''

The last thing St. Louis County epidemiologist Larry Sundberg wants is a repeat of last winter. A nightmare of cancellations and rescheduling ensued after the county's shipment of 2,000 doses failed to arrive on time.

Sundberg said the county will follow federal recommendations to delay immunization for at least a month. But that won't derail a campaign to promote the vaccine. ``We still need to be getting people in,'' he said.

Employees at a higher risk for falling gravely ill from the virus -- those older than 50, people with chronic medical conditions and pregnant women -- will receive the immunization first.

The late start likely will cut immunization campaigns in half, from two months to one, said Sundberg. ``It's going to be a shorter, more intensive vaccine season.''

The county expects to tackle logistics of the delay at a meeting in the next two weeks.

``Let's hope the flu season doesn't start early,'' he added. ``That would really kill us.''

St. Luke's Hospital and Regional Trauma Center will begin strategizing for the delay during the next two weeks, said Director of Pharmacy Mike Koranda.

St. Mary's/Duluth Clinic Health System, which ordered 38,000 doses in 1999, will start planning during the next week, said Dr. Mark Eckman, an infectious disease specialist.

As for the possibility of a shortage of the vaccine, ``I don't want to spend a lot of time crossing that bridge until we get to it,'' said Eckman.

Preparation for each winter's flu vaccination begins about nine months before clinics kick off annual immunization campaigns in October.

That's because influenza constantly undergoes change, said Dr. Tim Uyeki, medical epidemiologist for the Centers for Disease Control and Prevention's influenza branch.

``Influenza is unpredictable,'' Uyeki explained. ``We don't know the strain that's going to appear. We don't know where it's going to appear and we don't know when.''

So scientists pick the most prevalent strains for its three-virus vaccine each year. Seventy-five laboratories worldwide monitor influenza year-round looking for the most common, and unusual, mutations.

By January -- just as America enters its peak flu season -- the World Health Organization and several U.S. health agencies begin selecting strains for the upcoming winter's vaccine, said Uyeki.

By March the formula is complete and manufacturers begin to race against a September deadline.

The vaccine has proven effective in protecting against the flu bug, Uyeki said.

During 10 of the last 12 years, the vaccine closely matched strains circulating in the ``wild'', he said. Most recently, the unanticipated A Sydney strain caught health agencies off guard during the winter of 1997.

http://www2.duluthsuperior.com/healthscout/flu.htm

-- Martin Thompson (mthom1927@aol.com), July 20, 2000

Answers

RELATED STORY:

WA - Flu shots may be delayed this year Shortage of vaccine could stop delivery until mid-November By SHARON SALYER Herald Writer National delivery of flu vaccine could be delayed until mid-November, and even then there may not be enough to meet demand, health officials warn.

Production problems could lead to more people getting sick at a time when the recommended age to get the shots is dropping from 65 to 50. If there is a shortage, those most at-risk will likely be given priority for vaccinations.

The predicted delay in the vaccine's availability, up to six weeks later than usual, has been caused by problems in manufacturing safe virus for one of three flu strains covered in this year's vaccine.

"Yes, I'm worried about outbreaks in vulnerable populations" such as older adults, said Dr. Jo Hofmann, who oversees communicable disease issues for the Snohomish Health District.

"I would say there's a good chance there will be a shortage" of the vaccine, she added.

That's because all U.S. vaccine manufacturers are having production problems, she said.

"This is not just us," Hofmann said. "It (affects) every health department, primary care provider, visiting nurse association and other organization that provides influenza vaccinations across the country."

Influenza causes about 20,000 deaths and 110,000 hospitalizations each year in this country.

Officials at the federal Centers for Disease Control and Prevention in Atlanta suggest that flu shot campaigns be delayed until early to mid-November.

"To be honest, I can't tell you if it was ever this late," center spokeswoman K.D. Hoskins said Wednesday of the predicted delay in flu vaccine shipments. "If it has, it has been some time ago."

This year's shots will cover three strains of flu expected this flu season: A/Panama, which is the type causing the production slowdowns, Hoskins said, as well as A/New Caledonia and B/Beijing. The shots contain purified or noninfectious virus.

If initial demand does exceed supply, patients most at risk for developing serious illness or even dying from the flu, such as those with heart or lung problems, are expected to be given priority to prevent complications such as pneumonia and death, Hoskins said.

Younger and healthier adults, she said, may need to wait for shots.

Last year, about 90 million doses of shots were produced in the United States.

"This year, because of the delay and possible shortage, we really don't know how much (vaccine) we will have," she said.

Ironically, the delays and shortages come in a year when flu shots are being recommended for more adults than ever.

In the past, federal health officials said anyone age 65 and older should get the shots. This year the vaccine is recommended for anyone age 50 and older.

Hofmann acknowledged that the delay in flu vaccine delivery may cause public concern.

The combination of late vaccine delivery and possibly fewer doses "are two not very good things," she said, with the potential for the flu to spread more easily.

The flu season lasts for a limited period of time, she said. It takes two to four weeks for the shots to build up immunity to the disease.

"Really the ideal time to (give the shots) is in October because the immunity will last four to five months," she said.

However, people who get flu shots in mid-November still receive significant protection against the virus, a CDC statement says.

Federal health officials expect an update from manufacturers on delivery schedules and the amount of vaccine available by late August.

Meanwhile, Puget Sound-area organizations that provide the shots say they can only wait for more information before planning this year's flu shot clinics.

Among them: Group Health, which provided shots to 84,000 residents last year.

"It is a concern," Doris Visaya, clinic program manager for Visiting Nurse Services of the Northwest, said of predicted vaccine delays. Her organization administered 55,000 flu shots last year, mostly in Puget Sound.

"We're just hoping for the best," she added.

http://www.heraldnet.com/Stories/00/7/20/12791444.htm

-- Doris (reaper1@mindspring.com), July 20, 2000.