Officials Hope to Stagger Flu Immunizations

RALEIGH, N.C. -- Flu shots became available this week, but they're being rationed again -- at least for now.

Because of supply uncertainties, shots are reserved until Oct.

24 for people who are at greatest risk of severe complications from influenza. They include health workers, older adults, infants and children with chronic diseases.

The reason: The Centers for Disease Control and Prevention wants to avoid the chaos of last year, when half the nation's supply was yanked from distribution early in the vaccination season. Across the nation, sick, frail people stood in line for hours, hoping to get a shot before supplies ran out.

It wasn't until late December and early January that vaccine supplies began picking up, and by then, many people had decided to go without shots. Many of the late batches went unused and had to be destroyed, since each flu season requires a new vaccine recipe to target the strains of virus that are in circulation.

The current vaccine guards against two strains that were targets of last year's vaccine, plus a new one. But no vaccine has been mass produced to attack a new strain of avian flu that worries world health officials, since that virus is not yet highly infectious to humans.

Public health officials say it's too early to predict whether this year's flu season will be severe. To be on the safe side, high-risk people are being encouraged to get shots early. Other people are recommended for vaccination through March.

"People think if they didn't get a shot by Thanksgiving, they don't need one," said Barbara Laymon, vaccine manager with the state's immunization branch. "One of the messages we're trying to promote is that you can get vaccine through the flu season."

Laymon said the state has ordered a record 370,000 doses for its child vaccination program; about 100,000 already have been delivered and distributed to public health clinics and doctor's offices. Children in North Carolina get the flu shot free, although private doctors often charge an administration fee.

Other doses have been shipped to companies that run private clinics at grocery and drug stores, which are complying with the CDC recommendation to limit shots to high-risk groups. Shots there generally cost $25.

Gibbie Harris, director of community health for Wake County, said the private retailers evidently were shipped vaccine ahead of many public clinics; the county has only about 17 percent of the 10,000 doses it ordered. As a result, Harris said, Wake's flu clinics won't begin until Oct. 24, after CDC restrictions are lifted.

This will be the third flu season since 2000 with supply problems, although they are less dire than last fall.

One manufacturer, Chiron, has cleared regulatory hurdles to resume production of vaccine for the U.S. market after its supply was pulled from distribution last year. But its planned shipment of 18 million to 26 million doses has not yet arrived.

Another supplier, Sanofi Pasteur, has committed to supply at least 61 million doses, and GlaxoSmithKline indicated it would produce about 8 million.

Dr. Kristina Simeonsson, a medical epidemiologist with the state Division of Public Health, said the problems are part of an annual routine that seems to grow more unpredictable.

"There's a saying we have in public health: When you've seen one flu season you've seen one flu season," Simeonsson said. "You just can't predict one year to another."

She said one of the biggest unknowns is the threat of a new strain that is infecting birds in Asia and has shown some inclination to jump to humans. If the strain were to combine with a common human flu virus and become highly infectious, humans would have no built-up immunity. Health officials warn that millions worldwide could die.

Simeonsson said state health officials have drafted a plan to deal with such an avian flu pandemic. Meanwhile, she said, the public health message to encourage people to get flu shots is a constant drumbeat.

"It's just starting to get on people's radar screens that influenza is a big deal," she said.