Facing flu vaccine delays, health care workers hatch a plan to reach at-risk patients

Better late than never
Facing flu vaccine delays, health care workers hatch a plan to reach at-risk patients

By Carol Lindsay, RN
November 6, 2000
Photo: Carol Lindsay

The CDC does not anticipate a shortage of flu vaccine, rather a delay in distribution, according to the latest reports. Health officials advise those in at-risk populations to be proactive in arranging immunizations.


	You've read the article. Now tell us what you think. Related sites Centers for Disease Control Morbidity and Mortality Weekly Report Who’s at risk? People aged 65 years and older. Residents of nursing and other chronic care facilities that house persons of any age with medical conditions. Adults and children aged 6 months and older who have chronic pulmonary or cardiovascular disease, including asthma. Adults and children aged 6 months and older who have required regular medical follow-up or hospitalization during the past year because of chronic metabolic disease (including diabetes mellitus), kidney dysfunction, blood disorders (hemoglobinopathies), or immune system problems (immunosupressed, e.g. HIV infection, immunosupressed by medication, chemotherapy or radiation therapy). Children and teen-agers aged 6 months to 18 years who are receiving long-term aspirin therapy and therefore might be at risk for developing Reye’s syndrome after influenza infection. Women who will be in the second and third trimester of pregnancy during the flu season. Health care workers, employees of hospitals, clinics, offices and chronic care institutions who directly care for and have close contact with persons at high risk for complications of influenza. ~ Carol Lindsay, RN

Putting all your eggs in one basket can lead to trouble, as the CDC discovered this year. One of the first steps in the manufacturing of the flu vaccine involves injecting the virus into fertilized chicken eggs. The virus then is incubated and allowed to multiply and grow. Three different strains of flu are included in the vaccine and each strain is produced separately.

This year, one of the three components of the vaccine grew much slower than anticipated. Only four manufacturers are licensed to distribute the flu vaccine in the United States, which compounds the problem. Earlier in the production season, two of the manufacturers experienced manufacturing problems and their vaccine production was stopped. The combination of a 50 percent decrease in production and the slowed egg incubation process has led to a lot of scrambling.

The CDC does not anticipate a shortage of vaccine, rather a delay in distribution, according to the latest reports. The Food and Drug Administration estimates that 66 million doses will be available from manufacturers, and 9 million will be guaranteed by the CDC, for a total of 75 million doses. Last year, an estimated 64 million doses were distributed to providers, so about the same amount of vaccine will be distributed this year.

CDC media relations’ Sept. 28 update on the flu vaccine supply reports the situation as "fluid and that questions about supply and demand will remain unanswered until much later into the flu season. As vaccine becomes available, vaccinations efforts should be focused on persons at high risk of complications associated with influenza disease and on health care workers. Health care workers should be vaccinated to stop the potential spread to vulnerable persons."

A delay in the delivery of the vaccine is evident. "Most providers of flu vaccine have usually received their supply of vaccine by this time," said Dwayne Haught, MSN, RN, Texas Department of Health influenza coordinator. This delay could lead to complications for many.

The CDC Morbidity and Mortality Weekly Report on the prevention and control of the influenza virus reports that influenza epidemics occur nearly every year and are responsible for about 20,000 deaths annually in the United States. The infection rate for the flu is most common among children, but the number of serious illnesses and deaths is highest among those 65 and older and individuals who have medical conditions that place them at risk.

The flu virus is spread from person to person via airborne droplets. The virus can enter the body through mucous membranes of the eyes, nose or mouth. The onset is rapid and large numbers of people are commonly infected. Most who contract the flu will recover within a week.

"Influenza can lead to more serious illness such as primary influenza pneumonia or a secondary bacterial pneumonia. The risk of developing these complications is especially high for the elderly and for persons with underlying health problems," Haught said.

The optimal time to vaccinate high-risk groups of people is from the beginning of October through mid-November. Influenza activity in the United States generally peaks between late December and early March, so vaccination still is useful even when given later. However, the development of antibodies in adults after vaccination can take two weeks or longer.

"Nationwide, 64 percent of those 65 and older who receive their flu vaccine get it from their primary care provider. We are trying to increase the number of seniors immunized. We are educating seniors who’ve never had the flu as to why they need the vaccine, telling them that they are more at risk. This is a group of people who’ve seen pertussis, polio, measles, mumps and rubella. They understand the significance of being immunized against those diseases but not the flu and pneumonia," said Lisa Davis, adult immunization coordinator for the Texas Department of Health.

Additional resources are available outside of physicians’ offices for those who need the vaccine. "There are local health departments in every state and in Texas we have pharmacists in grocery stores and drugstores who are licensed and able to administer vaccinations," Davis said.

At significant risk for complications from the flu are those who have diabetes.

"It is important for everyone with diabetes, including those with Type 2, to be immunized for the flu every year," CDC spokeswoman Barbara Reynolds said. "The CDC’s data shows that people with diabetes have a three times higher risk of developing complications or dying from influenza. Yet, half of the adults with diabetes are not immunized.

"Death rates among people with diabetes increase by 5 percent to 15 percent during flu epidemics. This is true for diabetics under the age of 65 as well."

Ginny Peterson, community relations coordinator for Community Nursing Services in Salt Lake City, said, "Due to the manufacturing delays, the distributions channels may operate differently this year. If long-term care facilities and senior centers call us requesting a vaccine, they will get first preference.

"I am not receiving calls from nursing facilities or nurses associated with high-risk patients requesting the vaccine. Individuals involved with seniors and at-risk populations need to be proactive in arranging these immunizations or they’re not going to get done," she said.

"Health care professionals should encourage diabetics and all others at high risk for developing complications from the flu to be vaccinated. Early vaccination is recommended, but later is better than never," said Mike Greenwell of the CDC’s National Center for Chronic Disease Prevention and Health Promotion.