Saturday, September 16, 2000

Flu shots might be delayed

Problems with supply could lead to rationing

By Peggy O'Farrell
The Cincinnati Enquirer

        Flu immunization clinics will be delayed until at least November while health care providers wait for vaccine.

        Experts say there's no reason to panic, but there may be shortages of the vaccine because of manufacturing problems. There should be enough vaccine for high-risk populations — the elderly and chronically ill — but some healthy adults may not get immunized.

  • Nationally, more than 20,000 people die of flu every year and more than 100,000 are hospitalized.
  • In Ohio, 9,073 cases of influenza were reported statewide during the 1999-2000 flu season, dropping from 13,989 cases in 1998-99. More than a third of last season's cases came in January.
  • 3,856 deaths were attributed to influenza and pneumonia in Ohio in 1998.
 Sources: U.S. Centers for Disease Control and Prevention, Ohio Department of Health
  Influenza is a highly infectious viral respiratory disease marked by fever, cough, sore throat, headache, muscle aches and extreme fatigue.
  The disease is transmitted by respiratory secretions from sneezing or coughing. Most people recover within one to two weeks, but pneumonia is a significant risk for people 65 and over or people with compromised immune systems. People with heart or respiratory disease or diabetes are also at risk for serious complications.
  Influenza viruses are referred to as “A” or “B” strains, and minor variations occur in each of those strains (such as the Hong Kong flu or A/Sydney).
  Major variations within the strain can cause massive outbreaks — called pandemics — that may spread worldwide. Pandemics, such as the ""Spanish flu” outbreak of 1918-1920, rarely occur but can be devastating. The Spanish flu outbreak killed at least 20 million people worldwide.
  Most of the recorded pandemic strains are thought to have originated in animals. The strain responsible for the 1918-1920 pandemic is believed to have originated in swine.
 Sources: The Centers for Disease Control and Prevention and the World Health Organization.
        Randy Hertzer, a spokesman for the Ohio Department of Health, sums it up this way: “Shortage, maybe. Delay, definitely.”

        “We feel pretty confident, given what we know, that at the very least those most at risk for the disease are going to get the vaccine,” he said.

        Providers are waiting for word on when the vaccine is coming and how many doses they'll get, which makes planning immunization clinics tricky, said Malcolm Adcock, Cincinnati's health commissioner. Clinics are usually held in October.

        “No one's going to be able to start until we get the vaccine,” Dr. Adcock said. Providers will give those most at risk priority.

        Pat Levy, the office man ager at Wyoming Family Practice, said people are calling to find out when the shots will be available. She doesn't like telling patients they can't get them yet. And she can sympathize with their frustration at the delay. Last year, she got the flu, even after getting vaccinated.

        “It was pretty bad,” she said. “I was sick as a dog.”

        Mrs. Levy, 44, is concerned about a possible shortage, but not for herself. “There's too many other people that need it worse than I do,” she said. Her husband and son both have asthma, one of the risk factors for complications.

        “We're kind of going day by day on when it's going to come in,” said Seanda Coppa, director of nursing for the Middletown Health Department. “The latest I've heard from the CDC (Centers for Disease Control and Prevention) is that it may not be until mid-November.”

        Experts hope delaying the bulk of immunizations by a month or so won't cause a spike in the number of influenza cases. The vaccine usually takes about six weeks to become effective, and in this area, flu season is usually the worst in January and February.

        “It won't be horrible if it's late,” Ms. Coppa said.

        Public health agencies could have a firmer time frame for vaccine shipments by the end of this month, she said.

        In the meantime, providers are waiting to find out what restrictions might be placed on giving the vaccine.

        “We don't know if we'll have to prioritize to specifically the high-risk patients,” said Hazel Bentley, director of clinical services for the Northern Kentucky Health Department, which serves Boone, Campbell, Grant and Kenton counties. The department usually distributes about 5,000 doses of the vaccine.

        According to CDC officials in Atlanta, manufacturers haven't been able to produce enough of one flu strain to make this year's vaccine. Quality control problems have also caused two manufacturers to curtail production.

        The CDC has issued recommendations on how the vaccine should be distributed, with the elderly, chronically ill and immune-suppressed coming first. Those groups are most at risk for developing pneumonia and possibly dying if they get the flu. Health-care workers and emergency personnel are also considered high priority.

        Hamilton County has ordered 1,500 doses from the state, said Tim Ingram, Hamilton County health commissioner. “They said they don't know when they're going to get it.”

        The state has ordered 320,000 doses of flu vaccine, and manufacturers so far are promising to ship 180,000 doses by the end of October, Mr. Hertzer said. “We're all keeping our fingers crossed and hoping we don't have an early season.” There are no indications that flu season will peak earlier than normal. The season doesn't officially start until Oct. 1.

        Dr. Robert Prichard, a family medicine specialist in Crestview Hills, wonders how his healthy patients will react if they have to wait for flu shots until at-risk patients have gotten their doses.

        “It's going to be an interesting process in the office,” he said.

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