Notice to Readers: Delayed Influenza Vaccine Availability for 2001--02 Season and Supplemental Recommendations of the Advisory Committee on Immunization Practices

Manufacturer projections of vaccine distribution for the 2001--02 influenza season suggest that 49.8 million doses will be available for delivery by the end of October 2001;* this is approximately 26 million fewer doses of influenza vaccine than were available by the end of October 1999 (75.8 million doses) (Figure 1). Manufacturers also project distribution of 27.3 million doses in November and December, bringing the cumulative projected total to 77.1 million doses, which is greater than in 2000 (70.4) and comparable with 1999 (76.8). Predictions of monthly vaccine distribution vary by manufacturer, and providers will probably receive vaccine on different schedules.

Because of the 2001--02 influenza season vaccine delay and the large number of doses projected for distribution in November and December, the Advisory Committee on Immunization Practices (ACIP) has developed supplemental recommendations. The goals of these recommendations are 1) to prioritize and phase in using vaccine for the 2001--02 influenza season to ensure that persons at greatest risk for severe influenza and its complications and their health-care providers receive vaccine early in the influenza season, and 2) to increase overall protection of those at greatest risk for severe influenza and its complications as targeted in the Healthy People 2010 objectives (1). Persons at high risk include those aged >65 years; nursing home and other chronic-care facility residents; adults and children with chronic disorders of the pulmonary and cardiovascular systems, including asthma; adults and children who required regular medical follow-up or hospitalization during the preceding year because of chronic metabolic diseases (including diabetes), renal dysfunction, hemoglobinopathies, or immunosuppression, including that caused by medications or human immunodeficiency virus; children and teenagers (aged 6 months--18 years) who receive long-term aspirin therapy; and women who will be in the second or third trimester of pregnancy during the influenza season (2). Achieving influenza vaccination goals will require the combined actions of vaccine providers; the public; manufacturers, distributors, and vendors; and health departments and other organizations providing vaccine.

ACIP Supplemental Recommendations for 2001--02 Influenza Season

Vaccine Providers

• Providers should target vaccine available in September and October to persons at increased risk for influenza complications and to health-care workers. The optimal time for vaccinating high-risk persons is October through November (2). To avoid missed opportunities, vaccine also should be offered to high-risk persons when they access medical care in September, if vaccine is available. Vaccinating high-risk persons early can be facilitated through reminder and recall systems, in which such patients are identified and encouraged to come into the office for a vaccination-only visit (3). Additional information that may help providers implement a reminder/recall system is available at http://www.cdc.gov/nip/flu.
• Beginning in November, providers should offer vaccine to contacts of high-risk persons, healthy persons aged 50--64 years, and any other persons wanting to reduce their risk for influenza.
• Providers should continue vaccinating patients, especially those at high risk and in other target groups (2), in December and should continue as long as there is influenza activity and vaccine is available. To increase vaccination rates, health-care organizations are encouraged to assess their providers' influenza vaccine use and provide feedback on coverage among persons aged >65 years and other high-risk patients (3).

The Public

• Persons at high risk for complications from influenza, including those aged >65 years and those aged <65 years who have underlying chronic illnesses, should seek vaccination with their provider when vaccine is available. The optimal vaccination period is October through November but may include September if vaccine is available. Unvaccinated high-risk persons should continue to seek vaccine later in the season.
• Persons who are not at high risk for complications from influenza, including household contacts^† of high-risk persons, are encouraged to seek influenza vaccine in November and later. Persons who are unsure of their risk status should consult their provider to determine whether they should receive vaccine earlier and, if so, whether vaccine will be available. When additional vaccine is available, providers are encouraged to send a reminder to persons deferred from vaccination.

Manufacturers, Distributors, and Vendors

• Distribution of vaccine to worksites, where campaigns primarily vaccinate healthy workers, should be delayed until November. Delaying distribution of vaccine to worksites makes more early-season vaccine available to providers of high-risk patients. Manufacturers and distributors should identify worksite orders, or those placing orders should indicate they are doing so for worksites, so arrangements can be made for later vaccine shipment. Delivery of vaccine to hospitals and chronic-care facilities serving high-risk patients should not be delayed.
• All providers who have placed orders should receive some early season vaccine. This strategy will ensure that virtually all providers will be able to vaccinate some of their high-risk patients early in the season. As an exception, complete orders for chronic-care facilities serving high-risk populations should be provided early so that vaccine can be administered in October or November, the optimal time for vaccination of this highest risk group.
• Manufacturers, distributors, and vendors should inform providers of the amount of vaccine they will be receiving and the date of shipment. This will allow providers to notify high-risk patients when vaccine will be available.

Health Departments and Other Organizations

• Organizers of mass vaccination campaigns not in workplaces (e.g., at health departments, clinics, senior centers, and retail stores) should plan campaigns for late October or November or when they are assured of vaccine supply and make special efforts to vaccinate elderly persons and those at high risk for influenza complications. Information that may be used in a campaign setting is available at http://www.cdc.gov/nip/flu.
• Influenza vaccine service providers should develop contingency plans for possible delays in vaccine distribution. In a delay or shortage, communications among partner organizations and potential redirection of vaccine to high-risk persons in the community will be important. State and local health departments can provide guidance that is appropriate for their population and systems of care.

As preparation for the 2001--02 influenza season proceeds, updates on vaccine supply, and other information about influenza vaccination that may be helpful to providers and health departments, will be available at http://www.cdc.gov/nip/flu.

References

1. US Department of Health and Human Services. Healthy people 2010 (conference ed., in 2 vols). Washington, DC: US Department of Health and Human Services, 2000.
2. CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2001;50(no. RR-4).
3. Task Force on Community Preventive Services. Recommendations regarding interventions to improve vaccination coverage in children, adolescents, and adults. Am J Prev Med 2000;18:92--6.

^† Within a high-risk household, either when the person at risk or the household contact is a young previously unvaccinated child aged <9 years who requires 2-doses for protection, earlier vaccination of contacts may be reasonable; however, this should be a lower priority than vaccination of high-risk persons.

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