WPost Transcript: Effectiveness and Availability of the Flu Vaccine

[Guest guest]

Transcript: Preparing for Flu Season

The Effectiveness and Availability of the Flu Vaccine

Abigail Shefer, Epidemiologist

Monday, October 23, 2006; 12:00 PM

The shortage of this season's flu vaccine may prevent you from

receiving the shot until late November. Abigail Shefer, associate

director for Science in the National Center for Immunization and

Respiratory Diseases, was online Monday, October 23, at Noon ET to

answer your questions about what to expect this flu season.

Related Articles: More Flu Vaccine Expected for U.S. Market (Post,

Oct. 19)

Kids' Flu Vaccine Is Being Delayed (Post, Oct. 16)

Abigail Shefer is Associate Director for Science in the Immunization

Services Division of the National Immunization Program at the Centers

for Disease Control and Prevention. For the past 12 years, she has

been a medical epidemiologist in the National Immunization Program.

_______________________

Abigail Shefer: Hello, I am Dr. Abigail Shefer from the Centers for

Disease Control and Prevention. I just wanted to say hello and welcome

your questions.

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Reston, Va.: I'm very concerned about the delay in the kids' vaccine,

as my 10 month old will need two shots since it is her first dose of

the flu vaccine. Why is creating and delivering the vaccine such a

huge problem EVERY year? Should the government take over vaccine

production, as we could see another pandemic in the next few years?

Abigail Shefer: The problems associated with the US influenza vaccine

supply are multi-faceted. The influenza manufacturing process is

complex and influenza vaccine production begins as early as 6-9 months

before the beginning of vaccine distribution. Influenza viruses vary

from year to year, so influenza vaccine must be updated annually to

include the viruses that will circulate in the upcoming season. Once

viruses are selected for the new formulation, manufacturers must

operate under a very tight timeline. Influenza vaccine production and

distribution are primarily private sector endeavors. CDC and the

government does not have the authority to control influenza vaccine

distribution nor the resources to manage such an effort.

_______________________

Arlington, Va.: Why has Congress failed to do anything to remedy the

constant shortages in flu vaccine that occur every year? Will it take

a major flu pandemic before they act?

Abigail Shefer: The Department of Health and Human Services has made

significant efforts to enhance production capacity of seasonal and

pandemic influenza vaccine, including 1) contracts to secure a year

round egg supply (currently used in the manufacturing process of flu

vaccine); 2) contracts to increase capacity, including the use of the

more advanced and timely cell-culture techniques to produce vaccine;

and 3) enhanced guidance for influenza vaccine manufacturers from FDA.

It is important to note that even during 'shortage' years, millions of

doses of flu vaccine are left unused at the end of the season. There

needs to be more education of the public as well as providers

(doctors, nurses and other health care professionals) regarding the

reality of phased distribution of flu vaccine (distribution of flu

vaccine in September, October, November and December) and the

importance of continuating vaccination in December and beyond.

_______________________

Bethesda, Md.: Persuading an ever-larger proportion of the American

public to get a flu shot each year makes good public health sense,

both because more people will be protected against seasonal flu and

because the nation's vaccine-production capacity can be sustainably

increased to prepare for pandemic flu. But at the individual level,

getting a flu shot each year is often hard because of so-called

distribution delays or other reasons. People give up if they have to

work too hard to get the shot, and late-season vaccination is a hard

sell. If manufacturers have unsold vaccine at the end of flu season,

there is no incentive for them to increase their capacity. How does

CDC meld these conflicting issues into effective policy?

Abigail Shefer: This is a very important question. Because of the

manufacturing process, it is not possible for all of the influenza

doses to be produced and distributed before the vaccination season

begins. Doctors and the public must understand the phased nature of

influenza vaccine production and distribution, and we have tried to

get away from the term " delay. " Given the current technology and the

fact that manufacturers are working at near capacity, this is just the

reality of how influenza vaccine is manufactured and distributed.

Efforts have been made by the manufacturers and major influenza

vaccine distributors to ensure that all providers have at least some

vaccine to begin vaccination in October, but it is CDC's expectation

that doses will be distributed over the next two months to support

ongoing vaccination in October, November and beyond. Vaccinating

beyond November is important and beneficial because the peak of

influenza disease typically occurs in February or later, and many high

risk persons and their household contacts who are recommended for

vaccination are not vaccinated by the end of November. Patients need

to understand and providers need to make significant effort to offer

influenza immunization in December, January and beyond. I think this

will require allot of education on the part of CDC, state health

departments and providers (doctors, nurses and other health care

professionals) so the public is aware of the benefits of influenza

vaccination throughout the season.

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Washington, D.C.: Hi!

I was wondering if you could list some of the more uncommon side

effects of the flu vaccine? I ask because I was vaccinated a week ago,

and I've had swelling of the wrists and ankles, with a slight rash.

Could this be a reaction (it occurred two days after vaccination) or

just some concurrent problem?

Thanks!

Abigail Shefer: There are two types of influenza vaccine: the

inactivated injectable influenza vaccine and the live attenuated

influenza vaccine (nasal spray). The inactivated vaccine is licensed

for 6 month olds and older and the nasal vaccine is licensed for those

5-49 years old, who do not have chronic high-risk conditions, and are

not pregnant.

For the inactivated vaccine, the most common side effects are soreness

and swelling at the vaccination site. Fever, malaise, myalgia and

other systemic symptoms can occur and most often affect persons who

have had no previous exposure to the influenza virus. As with all

vaccines, allergic reactions (e.g., hives (rash), more severe

swelling, and systemic severe reactions can occur but are very rare.

If you experience any unusual symptoms after receiving the influenza

vaccine, this should be reported to your doctor. It is important to

note the inactivated vaccine cannot cause influenza.

The most common side effects after the live attenuated nasal spray

vaccine in adults are runny nose, nasal congestion, headache and sore

throat.

_______________________

Bethesda, Md.: When does flu season generally start? Our pediatrician

says they won't even have the flu vaccine for a couple more weeks.

Should I try to get my 3-year-old son (who is in daycare) vaccinated

elsewhere sooner, or would mid to late November give him enough

protection?

Abigail Shefer: The start of the flu season varies from year to year.

The flu season usually runs from October to May, and peaks in February

most years. Although the optimal time to vaccinate is

October/November, vaccinating beyond November is important and

beneficial because the peak of influenza disease typically occurs in

February or later, and many high risk persons and their household

contacts who are recommended for vaccination are not vaccinated by the

end of November. If you can obtain flu vaccine for your 3-year old at

another location, besides your pediatrician, that is fine. It is

appropriate to let your pediatrician know this so he/she can prepare

accordingly.

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New York, N.Y.: I read about the deaths in Israel last week from flu

vaccine. Is this the same batch we will be using in the U.S.? Is this

year's batch safe? We're especially concerned for our 2-year-old son.

Thank you

Abigail Shefer: This is a different batch. The vaccine used in Israel

was manufactured by sanofi pasteur at one of their European plants.

The sanofi pasteur influenza vaccine is manufactured at a US-based

plant. There has been no indication that any batches of influenza

vaccine distributed in the US are unsafe. In addition, the deaths in

Israel are still under investigation and it is unclear if there is any

connection between the deaths and the vaccine.

_______________________

Gaithersburg, Md.: Should pregnant women get a flu shot this season?

Abigail Shefer: Yes, women who are pregnant or will become pregnant

during the influenza season are recommended to get a flu shot. Only

the inactivated injectable flu vaccine is recommended for pregnant

women, not the live attenuated nasal spray vaccine. Pregnant women are

recommended to get vaccinated because studies indicate that pregnancy

can increase the risk for serious medical complications of influenza.

_______________________

Denver, Colo.: Although I understand that flu vaccine is produced from

dead virus strain, my now 7 year old has become quite ill (vomiting

and general discomfort) within 4 hours of receiving his flu shot in

each of the past two years. Observing this, I wonder if my efforts to

protect him from flu are only making him sicker than he might be

without the vaccine. Incidentally, my now 25-year-old daughter used to

claim the same thing when she was young, but since she lived with her

mother, I discounted her reports, since the common view even then was

that flu vaccine can't make one sick. Any idea of what's gong on here?

Thanks.

Abigail Shefer: There are 2 types of influenza vaccine - the

inactivated injectable vaccine and the live attenuated flu vaccine

(given via nasal spray). You are right that the inactivated influenza

vaccine contains noninfectious killed viruses and cannot cause

influenza. Most of the side effects after flu vaccination are mild and

may include soreness and swelling at the injection site. Fever,

malaise, body aches, and other systemic symptoms can occur after

vaccination with inactivated vaccine and most often affect persons who

had had no previous exposure to the influenza virus (e.g., young

children). These reactions usually appear within 6-12 hours after

vaccination. Remember that coincidental respiratory or other illness

unrelated to influenza vaccination can occur after vaccination.

It is important to remember that if you or your child experience any

unusual symptoms after vaccination, you should contact your doctor

immediately.

_______________________

Washington, D.C.: Hi,

I am wondering if I should get a flu shot this year. I'm 47 years old,

healthy female (although I'm just getting over a cold). I've never

gotten a shot before and was recently told that if you've never gotten

a flu shot, you shouldn't start. So I'm confused. Over the past 10 or

15 years, I've maybe gotten the flu once or twice. Should I get one

this year?

Thanks for your answer!

Abigail Shefer: The flu shot is recommended for the following adults:

adults 50 years of age or older, adults with chronic disorders of the

pulmonary or cardiovascular systems (including asthma) as well as

other high risk conditions, residents of nursing homes, household

contacts and caregivers of children aged 0-5 years and persons at high

risk for severe complications from influenza, and health care workers.

If you do not fall into one of these groups, doctors should also offer

and administer influenza vaccine to any person who wishes to reduce

the likelihood of becoming ill with influenza or transmitting

influenza to others should they become infected, depending on vaccine

availability. It is expected that there will be ample doses of

influenza vaccine available this season.

_______________________

Falls Church, Va.: What was the outcome of the flu season a year or

two ago when vaccine was largely unavailable, and vaccination was

primarily limited to high-risk groups? I don't remember ever hearing

about significant increases in flu rates. And if the flu rate was not

significantly worse, does that suggest that it's acceptable from a

public-health standpoint to vaccinate only high-risk groups every year?

Abigail Shefer: During the flu shortage/delay several years ago, there

were guidelines from the CDC to vaccinate persons in high risk

categories before other persons. Nationally reported influenza

vaccination rates showed that this strategy was relatively successful

in maintaining vaccination delivery to the high risk and priority

groups. It is difficult to correlate vaccination rates with actual flu

activity (disease activity) in the community, because influenza

illness rates can vary widely from year to year. Influenza disease

depends on the circulating strains of the virus, timing of peak of the

flu season that year and effectiveness of the vaccine.

_______________________

Washington, D.C.: What's the best way to encourage sick people to stay

home? Every year, my office ends up erupting in illness because of

" heroes " who come to work sick. We have ample sick leave, so why won't

they take it?

Abigail Shefer: The workplace must develop an environment that

encourages sick workers staying home when they are sick. Sometimes,

this takes the managers and leaders in the office being models

themselves and not coming to work sick. Gentle reminders from

supervisors when people do come in sick can also be beneficial.

Educational materials (posters/flyers) can also help to educate employees.

_______________________

New York, N.Y.: Can you tell me about this nasal spray vaccine as I

was thinking it would be a good alternative for my 10-year-old

daughter. Are there any supply issues with it?

Abigail Shefer: The Live Attentuated Influenza Vaccine (LAIV) is

licensed only for use among healthy persons aged 5-49 years, who are

not pregnant. The vaccine is administered annually. LAIV contains

live, attentuated viruses and, therefore, has a potential to produce

mild signs or symptoms related to influenza virus infection. LAIV is

administered intranasally by sprayer. LAIV is produced by MedImmune

Vaccines, Inc. and the total number of doses are expected to be

adequate based on number of doses utilized during past influenza seasons.

_______________________

Falls Church, Va.: If I (70 years old) got a face rash and swelling 5

years ago from a flu vaccine, will I get the reactions again if I got

the vaccine again?

Can the doctor try a little bit first and wait before giving me a full

shot to make sure it's safe?

Is the medicine of the vaccine the same each year?

Abigail Shefer: The issue of whether you experienced an allergic

reaction to the influenza vaccine should be discussed with your

doctor. Although rare, some persons do have anaphylactic

hypersensitivity to eggs or to other components of the influenza

vaccine. Persons who have a history of anaphylactic hypersensitivity

to vaccine components but who also are at high risk for complications

from influenza can benefit from vaccine after appropriate allergy

evaluation and desensitization.

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washingtonpost.com: Thank you for joining us.

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