Doctors Report Feast and Famine for Flu Vaccines

A flu vaccination

The Centers for Disease Control and Prevention says there shouldn't be a flu-vaccine shortage this year. Corbis hide caption

itoggle caption Corbis

Scroll down to read about recent changes in the CDC's recommendations on who should get the flu vaccine.

It's the time of year when the Centers for Disease Control and Prevention tells Americans to get their flu shots or the nasal spray vaccine, for healthy people between the ages of 5 and 49. Apparently it's also the time for annual confusion about just when flu vaccine will be available — and where.

Some doctors are already reporting they don't have the flu vaccine they need, while large retailers are advertising early-October vaccine clinics.

Family physician Leonard Finn ordered flu vaccine for his patients in February. But so far, he and his colleagues in Natick, Mass., have received only 10 percent of what they need for the 700 patients in their practice who are at high-risk of flu complications.

Last week at a medical meeting, Finn asked 22 family doctors from around the Northeast if they were in the same boat. All but three said yes.

"We're talking about 19 out of 22 doctors with zero or less than 10 percent of their vaccine order," Finn says, "while big chains everywhere have all the vaccine they need."

It irks Finn to hear federal health officials urge Americans to get immunized against the flu before doctors have the vaccine.

"It's very frustrating for them to say there's vaccine," Finn says, "and then for patients to come in, and you say you don't have it. It's infuriating."

CDC officials say they don't control the nation's complicated flu-vaccine-distribution system.

But Jeanne Santoli, deputy director of the CDC's immunization services division, says the agency urges manufacturers and distributors not to favor big retail chains over doctors' offices. She says the CDC wants to be sure people at highest risk for flu complications get vaccinated.

"Everybody serves some patients who are at the highest risk," Santoli says. "A provider's office certainly does. Walgreen's certainly does."

So it doesn't make sense, she says, to disadvantage doctors, who provide 70 percent of flu vaccinations.

According to Santoli, vaccine suppliers have said they're cooperating with the CDC's plea to be fair.

"What we've heard from the manufacturers and distributors is that they are not favoring larger customers or orders over others," Santoli says.

But Mark Mlotek of Henry Schein, Inc. — perhaps the largest distributor of flu vaccine to doctors' offices — says the CDC has not put out a clear message about how vaccine should be distributed.

"I would have to say no, we don't have that recommendation from the CDC this year," Mlotek says.

In the end, the CDC says there should be no shortage of flu vaccine this year. In fact, there will be more than ever before – at least 100 million doses. But Mlotek says it's only beginning to arrive from his suppliers.

"We don't have a lot of flu vaccine yet. It's going to be coming every week from now until December," he says.

Until shipments ramp up, he predicts there will be feast and famine on the vaccine landscape.

"Will there be Wal-Marts that have it and doctors' offices that don't? Yes, I believe that will happen again this year," Mlotek says.

The CDC is mindful of the problem. So this year it's putting out a more nuanced message: not "Get your flu shot," but "Get your flu shot, just don't get it too soon." The CDC says it's OK to wait until November or December, or even later.

The bigger problem is indicated by a new national survey conducted for the National Foundation for Infectious Diseases. Less than half the respondents say they plan to be immunized against the flu. But the CDC's recommendations for who should get vaccinated totals 218 million Americans, nearly three-quarters of the population.

New Tack on Preventing Flu

Who Should Get the Flu Vaccine?

  

People at high risk for influenza-related complications and severe disease, including:

  

— children ages 6 months to 59 months

— pregnant women

— persons 50 or older

— persons of any age with certain chronic medical conditions

  

People who live with or care for those at high risk, including:

  

—- household contacts who have frequent contact with people at high risk and who can transmit influenza to those at high risk

—- health-care workers

  

Source: Centers for Disease Control and Prevention, 2006

Recent studies show that children are the main spreaders of influenza in a community, and that vaccinating children dramatically reduces the impact flu has on a community during flu season.

Each year, about 36,000 people — mostly elderly — die from flu and its complications.

The studies in children are one reason the Centers for Disease Control and Prevention is expanding its flu-vaccine recommendations this year. Before, the CDC advised vaccinating infants between 6 months and 23 months. Now, it says healthy children between 6 months and 5 years should be vaccinated.

Also new this year: The CDC is recommending vaccination for adults of any age who have household contact with children younger than 5, including any out-of-home caregivers. The CDC also advises that children younger than 9 get two doses of vaccine if they've never been vaccinated before.

Vaccination is not recommended in situations where a person with AIDS or another immune deficiency might come into contact with someone who's been recently vaccinated.

Two Types of Flu Vaccine

The most familiar vaccine is the flu shot, which contains the three strains of flu that experts think will be the most likely to circulate widely during the coming season.

The other is a newer product, FluMist. It's a nasal spray that contains a live, but weakened, form of the flu. The FDA has approved FluMist for healthy people ages 5 to 49 years, based on studies in these age groups. (Studies of other groups are still being evaluated).

Neither vaccine promises to prevent flu in 100 percent of people who get vaccinated. And in some groups, such as the elderly, shots may be less than 60 percent effective overall. Even so, many people who get the flu after being vaccinated have a milder case.

In some studies, the nasal spray has been shown to protect up to 85 percent of children and adults ages 49 and younger.

These numbers also depend on how well each year's flu vaccine — shot or spray — matches the strains that actually end up in wide circulation. Also, it takes approximately two weeks for the vaccine to produce full immunity in adults, according to the CDC.

Bad Reactions Are Rare

The risk of a serious reaction to the flu shot is extremely low. Some people experience fever and other flu symptoms for a day or so after a shot. Studies of the spray show no significant increase in flu-like symptoms after the vaccine is taken.

The shot may also slightly raise the risk of getting Guillain-Barre syndrome, a rare but serious neurological disease that affects about 20 Americans annually. The CDC says the shot might produce one extra case of GBS per million people vaccinated, but it is very difficult to study a disease that occurs in so few people. And the risk of dying from the flu — one in 10,000 — is far higher than the risk of GBS, the CDC says.

Studies of FluMist found no increased risk of serious side effects compared with placebo.

Public health officials have been concerned for many years that FluMist might theoretically spread the flu in some cases, rather than prevent it. That's because FluMist contains live virus that has been made less contagious.

The flu shot contains killed virus and cannot spread the flu.

One study showed that children vaccinated with FluMist can "shed" live flu viruses for up to three weeks after vaccination, meaning that they spread the viruses found in the vaccine to others. That study, in part, prompted researchers to look at a real-life situation in a day-care center.

They studied 197 children in the center and found that one of 99 unvaccinated children got the flu virus from children who had received FluMist. Four other unvaccinated children might have gotten it from vaccinated children, but the evidence was inconclusive.

In the documented case, the child developed very mild symptoms of the flu. Given this low rate of transmission, and the mildness of the symptoms, researchers say that exposure to vaccinated children may even be beneficial to unvaccinated children -– serving as a type of "passive immunization" against exposure to people with active cases of the flu.

When it was first developed, many experts thought a nasal-spray vaccine would gain wide acceptance, because adults and children generally dislike shots. Yet FluMist still lags in sales far behind traditional shots, partly because it is more expensive than shots.

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