CDC Response to nine AHA-submitted questions
A Message to America’s Hospitals:
On October 5, 2004, the Centers for Disease Control and Prevention (CDC) announced that a Chiron-owned flu vaccine manufacturing plant in England was shut down due to contamination and would leave the U.S. with about half the doses ordered to vaccinate the population. Since then, the CDC has been working with Aventis Pasteur, another flu vaccine manufacturer; MedImmune, a manufacturer of the nasal administered vaccine FluMist; and federal, state and local health officials around the country to handle the vaccine shortage.
This Quality Advisory is a follow-up to our October 14 advisory regarding this flu vaccine shortage. Since then, the American Hospital Association (AHA) has been working with the CDC to get information and answers for hospitals coping with the flu vaccine shortage. The attached CDC response to nine AHA-submitted questions begins to address hospitals’ concerns about CDC’s two-phase vaccine redistribution plan, how hospitals can acquire additional doses, and where to go for help in the event that a hospital or health care facility receives no vaccine.
Here is an update on issues related to this year’s flu vaccine shortage:
Patient Screening – As reported in the earlier advisory on the vaccine shortage, the CDC developed guidelines suggesting that only those at risk of serious complications from the flu receive the vaccination. These high-risk populations include people 65 and older, those with chronic health conditions, pregnant women, and children six to 23 months old, among others. The CDC has developed a patient self-assessment, found at www.cdc.gov/flu/professionals/flugallery/pdf/vaccinescreeningform.pdf, designed to enlist patients’ help in determining if they fall into the high-risk categories.
CDC Two-Phase Distribution Plan – Phase I of CDC’s vaccine distribution plan includes orders that were immediately identifiable on October 5 – primarily orders placed directly with Aventis from health care providers serving CDC-identified priority groups. In Phase II, CDC and Aventis are working with state and local health departments to identify the supply and needs throughout the country and distribute vaccine accordingly. This will include attempting to identify providers with little or no vaccine serving patients in the high-risk group, and will focus on long-term care facilities, hospitals, pediatricians and other primary care providers, and local public health departments who ordered directly from a Chiron distributor. The CDC has stressed that work on both phases is taking place simultaneously. The CDC also said that shipping resumed in the second week of October and likely will continue through the week of December 19, with about 2-3 million doses of vaccine being shipped weekly.
Sub-prioritization – The CDC said that at this time they will not sub-prioritize among currently identified priority categories. They do recognize, however, that some state and local health departments are using their emergency powers to do so. Instead, the CDC has convened a panel of five ethicists to deliberate on ethical questions that arise as the limited flu vaccine is distributed. The panel will issue individual written opinions that the CDC and state and local health officials may consider when deciding how to distribute the remaining vaccine.
Price Gouging – After initial reports of price gouging for flu vaccine in some areas of the country, Department of Health and Human Services (HHS) Secretary Tommy Thompson wrote to all state attorneys general, promising HHS support to combat price gouging not only of flu vaccine, but also of the antiviral medications used to treat the symptoms. Documents from the Secretary can be found at www.hhs.gov/flu.
Antiviral Medications – The CDC issued interim recommendations for the use of antiviral medications during the 2004-2005 flu season. These guidelines can be found at www.cdc.gov/flu/professionals/treatment.
CDC Hotline – Providers and consumers can call (800) CDC-INFO, a CDC-dedicated hotline, with questions, to get more information on the flu vaccine shortage and distribution plans, or to report suspected price gouging for flu vaccine.
Influenza Update NetConference – On November 19, the CDC will host a teleconference and Web-based presentation for clinicians, and provide an update on the influenza season with a focus on antiviral medications. To register, go to www2.cdc.gov/nip/isd/fluconference. Registration will close on November 18 or when the course is full.
The AHA will continue to monitor the flu vaccine shortage and work with the CDC in ensuring that flu vaccines are distributed to areas of greatest need. But the CDC encourages all health care providers to work with their state and local health officials and help identify areas where flu vaccine is needed as well as areas with a surplus.
As we move into the flu season, put the following items on your “To Do” list:
- Work with your state and local health departments on vaccination plans for your community.
- If you are a provider that uses Chiron vaccine, contact your normal vaccine supplier/distributor to determine the status of your order. Be prepared to provide an estimate of the doses you ordered and, of these, the doses you need to vaccinate your high-risk populations.
- Meet with local officials, including public health officials, and keep them up to date about flu vaccination activities and outbreaks. Ask for their help in ensuring the public health and well being of residents.
Log onto www.cdc.gov/flu for more information and public materials on flu prevention guidance.
Share this advisory with your infection control team, pharmacy staff, risk managers, and emergency department and medical staff.