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Weathering Flu Season

Aired December 9, 2003 - 13:04   ET


MILES O'BRIEN, CNN ANCHOR: We're going to go live now to the Centers for Disease Control and Prevention, Atlanta, Georgia. The head of that, updating us on the flu situation. This is Dr. Julie Gerberding.

DR. JULIE GERBERDING, CDC DIR.: Folks have already died this year and that is, of course, something that we are very sad about at the CDC, and our hears go out to the families of those individuals.

Influenza typically kills more than 36,000 Americans each year, and some of those are children, some of those are seniors, but it can affect people of all ages.

But it's also important to recognize that although there are people who suffer the severe consequences from influenza, most people who get influenza will have that typical mild illness that will be annoying, they might miss a day of school or a day of work, but they will recover without incident, and so we're hoping that most of the people affected this year will fall into that category.

Now, let me say that what we know about the epidemic right now is that the flu is widespread in at least 13 areas of the country, 13 states. As of the end of last week, there were only two jurisdictions that had not reported any influenza. That was the Washington D.C. area and the state of Massachusetts, although we wouldn't be surprised to see influenza there soon, if it hasn't arrived already.

We also recognize that the heaviest hit states were mostly in the West, and that we are weighing to see whether or not some of the Eastern states with large populations will see more widespread infection.

So the bottom line is that we have not piqued the flu season this year. We are expecting more cases of the flu. And we are watching very carefully to see where it's progressing and where the most cases are evolving so that steps can be taken to ensure access to care, and hospitalization and so on and so forth.

The main concern that we're facing at CDC right now is, of course, the gap between the demand for flu vaccine, and the context of this outbreak and the supply of the influenza vaccine. I'm going to say more about supply and demand and how those pan out in flu season, but I also wanted to address where we are right now with what's happened this year. This year, manufacturers created about 83 million doses of influenza vaccine. About four million doses, four to five million doses were in formulation of flu mist, which is for healthy people between ages 5 and 49, and other four or five million doses were a pediatric formulation for children between the ages of six months and 23 months; 73 million doses were the inactivated, Trivalant (ph) vaccine for adult immunization. That vaccine is something that has largely been distributed at this point in time. The manufacturers have very few doses of the killed virus.

There are, however, almost $4 million of the flu mist, which is the intra-nasal vaccine, which can be available for healthy people, again, between the ages of 5 and 49 who choose to receive that vaccine.

Unfortunately, it's not licensed for children under 5 or for people older than 49 years of age this year, although possibly that would happen sometime in the future.

So one of the steps that we're taking at CDC and the context of manufacturers who don't have a flu supply when there's an ongoing demand as to look at how we can, first of all, purchase whatever doses are remaining. Secretary Thompson sass has asked us to look into not only what we can purchase here in the United States, but also what might be available from a licensed vaccine in Europe, and we are doing that actively today, investigating what's out there, and possible and available for purchase.

In addition, state and local health agencies are working on assessing the availability of vaccine in their jurisdictions and developing plans for redistribution, which we, of course, are helping to assist with. We have a number of data inputs, and we'll be updating you with this information as we go forward about the localized availability of vaccine. We are working with the state health association, with local and county health departments, with the American Medical Association, the American College of Physicians, the American Association of Health plans, managed care organizations and several other groups who are surveying practicers, surveying hospitals, surveying member facilities, trying to ascertain where there is vaccine, where there's not vaccine and what can be done to facilitate local redistribution. All of that is ongoing in the majority of states right now.

We are receiving some reports of shortages, but we are also receiving reports from many jurisdictions where there's no apparent shortage and people can still access vaccine.

Now, for people who are at highest risk of influenza complications -- and let me stress that those are people over age 65 years old who have the highest risk, as well as people with chronic medical conditions, and children between the ages of 6 months and 23 months -- we are still encouraging people to be immunized and to be persistent about locating vaccine.

Our current recommendations for immunization this year included all people over age 50 and the recommended category. The main reason for that was because there's an enrichment of chronic diseases in people who are over age 50 years old. It was a simpler recommendation to simply say everyone over age 50 to get vaccinated than to try and hone in on the specific chronic illnesses that would be in that group.

But we are recommending the priority be given to the people with highest risk of complications. And so we're certainly not restricting vaccine access to anyone at this point in time, but like all situations, when there is the possible shortages, we want the people who need the vaccine the most to be the first in line to receive it, and I think we're getting good cooperation with that across the country at this point in time.

I would like to spend a little bit of time explaining why this situation evolved. Obviously, at CDC and elsewhere in the Department of Health and Human Services, we wish we had more vaccine. We wish the manufacturer had made more vaccine this year. And unfortunately, that isn't the case. So we're faced with a demand for the vaccine that exceeds the current supply, at least in some areas.

Manufacturer of flu vaccine in this country is entirely in the private sector. When you have measles vaccine development, you know exactly how many children are born every year, and you can accurately predict exactly how many doses of measles vaccine you might need, and a manufacturer can make a good assessment of, OK, we'll make this many doses, because we know we'll sell them. Influenza doesn't work that way. The best estimate is there are probably about 185 million people who would be included in our recommended groups for receiving influenza vaccine. That would include the high-risk people as well as the context, the household context and the health care workers who take care of those people. But we don't have a completely accurate assessment of the number of people, because those populations change and they're difficult to pin down, and it's very tricky up front to know exactly how many people need it.

Having said that, in no year have we ever vaccinated anywhere near that number of people.

Generally, the top number of people who come forward for flu vaccine is somewhere around 70 to 75 million people. So each year the manufacturer has to really look back on how many people got vaccinated the year before and make a guess about how many people will be vaccinated this year. For the last five years, we've thrown a lot of flu vaccine away.

For example, last year the manufacturer made 95 million doses of vaccine. We threw away 12 million doses, and that's how they arrived at the decision basically to make 83 million doses this year, because that was a pretty high-watermark, and it made sense that manufacturer would be likely to sell that many doses.

Unfortunately this year, we're dealing with a situation where the flu season started early, and because the predominant flu strain circulating right now is the H3-N2 strain, the Fujin (ph) strain we are concerned, although we haven't proven this yet, but this could be an specially severe flu season. More people have stepped up to the plate to get their vaccine than they did last year, and probably more people have stepped up to the plate than they have in the recent years. So the manufacturer's estimate of the appropriate amount of vaccine to make may have undershot the mark, and that's one of the consequences of having the vaccine manufacturing occur this way in the private sector.

O'BRIEN: We have been listening to Dr. Julie Gerberding, who is head of the Centers for Disease Control and Prevention, giving us some specifics on the issue of supply and demand as it relates to the flu vaccine this year. Some issues relating to supply and also distribution of the flu vaccine throughout the United States as this particularly virulent strain of flu spreads.

In some cases, she said there are shortages. In some cases, not. Of course, as we've been telling you, the vaccine was not finely tuned to go after the particular strain of flu which is causing most of the difficulties anyway.

In any case, we're going to continue monitoring her briefing there. Reporters will have an opportunity to ask some questions. We have people there, of course. We'll bring you more on that a little bit later in the program.


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