As reported by the New Haven Register, October 18, 2005.

Flu Vaccine Should Be Plentiful, Experts Say

By Abram Katz

There should be plenty of influenza vaccine to go around this year, but no one knows for sure because federal and state health agencies cannot track private sales.

Since private physicians normally administer 80 percent to 90 percent of the immunizations, health agencies have no definite tally of how many vaccines have been shipped or to whom, doctors and public health officials said.

The United States expects to receive up to 97 million doses of flu vaccine this year.

Those at high risk from the virus should be vaccinated by Monday.

That includes people over age 65 and people with chronic diseases such as diabetes, heart disease and pulmonary conditions. Workers at nursing homes should also be vaccinated now, along with young children, pregnant women and people with compromised immune systems, according to the U.S. Centers for Disease Control and Prevention.

The CDC recommended that high-risk patients be vaccinated first this year to reach as many of them as possible.

Margaret La Croix, vice president of communications with the Connecticut Lung Association, said about 600,000 Connecticut residents fall into this high-risk group.

"I haven’t heard of anybody having difficulty getting a flu shot. We would only know about a shortage when mass immunizers and doctors start to talk," she said.

Flu vaccines seem trouble-free now.

However, CDC records show that distribution delays and vaccine shortages have occurred in three of the past five years, including last year when the country received about half of its order.

Sanofi Pasteur Inc. has filled 60 million vaccine orders; Chiron Corp. plans to produce 18 million to 26 million; and GlaxoSmithKline Inc. is making 8 million.

MedImmune Vaccines Inc. expects to provide 3 million doses of an attenuated live virus spray mist vaccine.

"So far 28.2 million doses have been shipped," said CDC spokeswoman Lola Russell.

Distributors consider sales figures to be proprietary and keeping tabs on millions of vaccines would require a vast bureaucracy, physicians said.

This system, coupled with the small number of flu vaccine manufacturers, can complicate the annual program.

Even when flu vaccinations are going smoothly, trouble with one producer can cause a serious shortfall, said Dr. Matthew Cartter, epidemiology program coordinator with the state Department of Public Health.

"We have a real underlying supply and demand problem here. We feel it nationally," Cartter said.

"There’s no way to know who got what," he said. "We’ve gotten a fair number of calls that doctors’ offices haven’t gotten them yet." Chiron’s first batch of vaccine was approved last week, meaning orders placed with the company remain unfilled.

Dr. Louise Dembry, hospital epidemiologist at Yale-New Haven Hospital, said central distribution may be necessary for a well-planned flu vaccine program.

"From last year, we’ve learned a lot. No shortages are predicted for this year," she said.

Public health agencies in Connecticut have ordered 175,000 vaccines from Sanofi Pasteur. The shots will be used in health centers, clinics, and by mass immunizers like the Visiting Nurses Association, according to the state Department of Administrative Services.

About 20 percent of the order has been delivered.

Last year the entire state allocation was about 674,600 vaccines, including private purchases. A state health department analysis indicates that the private sector supplied about 70 percent, 10 percent to 20 percent below normal.

Last winter, the vaccine shortage prompted the CDC to ask private purchasers to inform local health departments of their stocks.

"If there is a shortage, we need to know who has extra vaccine to redistribute. Last year, the CDC worked for the first time with manufacturers" to ascertain that information, Cartter said.

This year’s flu vaccine contains A/California H3N2, A/New Caledonia H1N1, and B/Shanghai.

The avian flu that originated in Vietnam in 1997 and has been spread by birds as far west as Turkey and possibly Greece is H5N1.

This deadly flu is transmitted from bird to bird and from bird to people who were apparently in close proximity to infected birds.

It cannot be passed from person to person. But doctors, epidemiologists and public health specialists around the globe fear that a shift in H5N1’s genetic material could enable the virus to spread among humans.

If or when that happens, the world could be consumed by a pandemic rivaled only by the 1918 pandemic that killed about 40 million people.

The existence of H5N1 avian flu will have no effect on the relative severity of "human" flu in the United States, said Dr. Richard Garibaldi, an infectious disease specialist at the University of Connecticut Health Center.

The essence of our defense against avian flu is to stockpile antiviral drugs like Tamiflu, said Michael Merson, professor of epidemiology and public health at the Yale School of Medicine.

While the prospect of an avian flu pandemic is a nightmare, the "regular" flu kills about 40,000 adults and children in the United States every year, Dembry said.

Which is why flu vaccines are important.