Published Date: 2009-09-21 23:50:00
Subject: PRO> Influenza pandemic (H1N1) 2009 (54): vaccine availability
Archive Number: 20090921.3325
INFLUENZA PANDEMIC (H1N1) 2009 (54): VACCINE AVAILABILITY
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Date: Fri 18 Sep 2009
Source: CIDRAP News [edited]
<http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/sep1809update-jw.html>
The 1st wave of H1N1 [i.e. Influenza pandemic (H1N1) 2009 virus]
vaccine will probably consist of 3.4 million doses of MedImmune's
nasal-spray product and is likely to reach providers the 1st week in
October 2009, federal health officials said today [18 Sep 2009]. At
the same time, officials said the pandemic virus is now circulating
widely in 21 states, 10 more than a week ago, and the number of
patients going to clinics and hospitals with flu-like illness is
about twice what is normal for this time of year.
Health and Human Services Secretary Kathleen Sebelius said on 13 Sep
2009 that the 1st doses of vaccine could become available the 1st
week in October 2009, but today marked the 1st time officials gave a
specific number. Previously, the general expectation was that the 1st
doses wouldn't be available until mid October 2009. "We actually
anticipate being able to start receiving orders for the vaccine by
early October 2009, and actually vaccine going out and being
distributed by providers by the 1st week of October 2009," Dr. Jay
Butler, head of the Centers for Disease Control and Prevention (CDC)
H1N1 Vaccine Task Force, said at a news briefing today [18 Sep 2009].
"Initially, we anticipate that about 3.4 million doses of vaccine
will be available," he said. "Additional doses may be available as
well, but 3.4 million is the hard number we have now. All of that is
the nasal spray vaccine."
The live attenuated vaccine from MedImmune is indicated for children
and adults aged 2 through 49, under the approval granted by the Food
and Drug Administration (FDA) on 15 Sep 2009. The vaccine will be
allocated to states in proportion to population. Under a centralized
distribution system set up by the CDC, vaccination providers request
doses from their state health department. States will screen the
requests and then place orders with the CDC, which will transmit
orders to McKesson Corp., the company handling the distribution.
While the doses are recommended 1st for high-risk groups, such as
pregnant women, healthcare workers, children, and adults with certain
chronic health conditions, who actually gets the 1st doses will
depend on local decisions and circumstances, Butler said. "In any
given location, the availability of the vaccine may actually vary. So
oftentimes that decision of who is actually administered the vaccine
may ultimately be decided by the provider and the patient," he said.
He said some states have identified maternity hospitals where they
may want to send the 1st doses of vaccine, though that would require
an injectable rather than the nasal-spray vaccine. States may also
try to steer early doses to healthcare workers and to people who will
be living with babies under 6 months old, he said.
Vaccine will be shipped from 4 sites around the country to facilitate
rapid distribution, Butler said, but added that he didn't know the
locations. The distribution system is an expanded version of what the
CDC uses for its Vaccines for Children program, which involves about
40 000 providers. The agency expects about 90 000 sites to
participate in the campaign. Not all of those 90 000 will be
individual vaccination providers, Butler said today [18 Sep 2009].
Some may be retail chains that may redistribute vaccine to their
outlets.
Regarding vaccine dosage, the expectation is that children under age
10 will need 2 doses, while one dose will suffice for older children
and adults, Butler noted today [18 Sep 2009]. (The age
recommendations differ slightly among the 3 vaccines the FDA has
approved for use in children. For MedImmune, the indication is 2
doses for children 2 through 9 years old; for Novartis, it is 2 doses
for ages 4 through 8, and for Sanofi Pasteur, 2 doses for ages 6
months through 8 years.)
The CDC has been predicting that about 45 million to 50 million doses
of vaccine will become available in mid October 2009, followed by
about 20 million a week after that, reaching a total of 195 million
in December 2009. Butler reaffirmed that forecast today [18 Sep
2009]. At today's briefing, Dr. Dan Jernigan, deputy director of the
CDC Influenza Division, emphasized that the extent of flu activity is
very unusual for this time of year, with some flu in every state and
widespread cases in 21 states.
From monitoring at outpatient clinics and emergency rooms around the
country, "What we're finding is there is an increased amount of folks
coming into clinics with influenza; it's about twice at least what we
would expect at this time of year," he said. "We expect to see a
whole lot more illness in coming weeks and throughout the flu
season," Jernigan said. As for hospital cases, he said, "What we see
so far is there is some increase in the rate of hospitalization for
children and young adults, but it's not up at the same levels we see
during seasonal influenzas." Jernigan cited "considerable" flu
activity in the Southeast, where schools opened earlier than
elsewhere, but did not mention any other regional hot spots. The vast
majority of viruses in ciculation are the novel H1N1 [pandemic (H1N1)
2009 virus], and they remain well matched to the vaccine that's on
its way, he said.
In response to a question, Butler said people who have had a recent
flu-like illness should still get the H1N1 vaccine if they are in a
target group unless they had a confirmed case of H1N1. "People who
have actually been infected with the 2009 H1N1 virus likely do have
some immunity," he said. But most cases were not lab-confirmed, and
other flu strains, as well as other respiratory viruses, have
circulated during the epidemic, he noted.
In other developments, the World Health Organization (WHO) in its
weekly update reported varying levels of H1N1 activity across the
globe. The United States is seeing increased flu activity, most
notably in the South, Southeast, and Northeast, whereas activity
remains low in Canada, the WHO said. Europe and Central Asia also
have low activity overall, but France is seeing increases, and
localized activity is reported in several European countries and
Israel. Flu activity in Japan is holding above the seasonal epidemic
threshold, the WHO said. Meanwhile, much of South and Southeast Asia
has regional or widespread outbreaks, with cases increasing
particularly in India and Bangladesh. Regional to widespread activity
also continues to be the story in tropical parts of Central and South
America. In temperate parts of the Southern Hemisphere, flu continues
to wane or has sunk to the seasonal baseline in most countries, the
WHO said.
[Byline: Robert Roos]
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Communicated by:
ProMED-mail <promed@promedmail.org>
See Also
Influenza pandemic (H1N1) 2009 (53): vaccine donation 20090919.3290Influenza pandemic (H1N1) 2009 (52): WHO update 66 20090918.3272
Influenza pandemic (H1N1) 2009 (51): antibody deficiency 20090917.3261
Influenza pandemic (H1N1) 2009 (50): oseltamivir-resistance 20090917.3260
Influenza pandemic (H1N1) 2009 (40): global update 20090906.3138
Influenza pandemic (H1N1) 2009 (30): assumptions 20090813.2879
Influenza pandemic (H1N1) 2009 (20): Peru, 33 percent asymptomatic
20090730.2668
Influenza pandemic (H1N1) 2009 (10): vaccine 20090720.2577
Influenza pandemic (H1N1) 2009 - Viet Nam: patient data 20090708.2450
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