Eye on Washington: CDC grapples with vaccines

October 1, 2007

The challenges of making and using flu shots. Plus: What does thimerosal do to young children?

Officials at a September 19 news conference in Washington, DC on influenza urged pediatricians and others to take every opportunity from now through at least February to vaccinate children against the flu, both to protect them and to interrupt transmission to adults.

The Centers for Disease Control and Prevention (CDC) says that an average of about 36,000 Americans still die each year from the virus.

Jay Berkelhamer, MD, president of the American Academy of Pediatrics, told the conference only 18% of children 6 months to 2 years get the shot.

Last year, 121 million doses were produced and 102 million were distributed. That does not equate to doses actually given, because it's unknown how many of the doses were left over in doctors' offices and elsewhere.

William Schaffner, MD, vice president of the National Foundation of Infectious Diseases, explained that the vaccine was being distributed at the time of the conference, but by various manufacturers on separate timetables. Jeanne Santoli, MD, MPH, deputy director of the Immunization Services Division within CDC, told the news conference that the United States is now making flu vaccine, "approximately at our capacity, although manufacturers are trying to expand their capabilities. And so what that means is that it is not possible, the way it was seven or eight years ago, to have all the vaccine produced and distributed prior to the season. And that is very frustrating, for health care providers, and people who want to plan."

The panel did urge that health care professionals begin vaccination of patients as soon as shipments of the vaccine arrive. CDC indicates influenza infection rates are highest among children, that children under 2 years of age have some of the highest rates of serious illness and death, and that nearly 100 children under the age of 5 die each year from influenza and its complications.

The agency also stressed that people in close contact with high-risk populations (such as children under 6 months, who cannot receive the vaccine) should also be immunized.

• Extending the season

"After Thanksgiving, the patient demand for vaccine dramatically decreases, leaving numerous doses unused and many Americans unprotected," said Ardis Hoven, MD, a member of the American Medical Association's board of trustees. But flu season often peaks in February, so continue to press for vaccination into the new year.

• Health care workers

Hoven noted that only 40% of health care workers have received flu vaccine over the last several flu seasons. This year, she said, the Joint Commission (the health care accreditation body) has a new standard that requires health care facilities to offer the flu vaccine to their staff.

She also pointed to research showing that health care facilities can greatly improve employees' vaccination rates by highlighting the value and safety of the vaccine, as well as making it convenient and free.

Schaffner cautioned health care workers not to believe they can protect their patients by staying home after symptoms begin: "The day before, you are covering your patients with the influenza virus."

Berkelhamer's take-away message for pediatricians was, "You have an ethical obligation to be sure that you and your staff are well immunized. You don't want to become a vector of spread."

• Nasal spray vaccine

The day of the press conference, the Food and Drug Administration extended the approval of the FluMist intranasal vaccine for children ages 2 to 5. It had previously been approved for people 5 to 49, who are healthy.