Investor Alert

Dec. 10, 2003, 4:37 p.m. EST

On the hunt for more flu vaccine

CDC looks to Europe, U.S. government for help

By Kristen Gerencher, CBS.MarketWatch.com

SAN FRANCISCO (CBS.MW) -- People seeking a flu vaccine need to be persistent as government agencies look for ways to address shortages and balance supplies across the country, the Centers for Disease Control and Prevention said Tuesday.

With stockpiles running low, the CDC is looking into the possibility of buying additional vaccine from drug manufacturers in Europe and redistributing U.S. doses to areas hardest hit by the bug, CDC Director Julie Gerberding said.

The CDC also is investigating the possibility of warehousing vaccine for emergency use in future years, which may require guaranteeing manufacturers won't lose money if they overproduce vaccine that doesn't get used, as has happened in the last few years, she said.

Since many Americans receive their flu shots in October and November, it is not unusual for vaccine supplies to be limited this time of year. But because the flu outbreak began earlier this year than normal, strong demand for shots has continued through December, according to the CDC.

"We're asking people to use common sense and look at this as a supply-and-demand issue," Gerberding said. "We have a gap between what we wish we had and what we have, and we're trying our best to get it to the people who need it most."

Thirteen states are reporting widespread flu outbreaks: Colorado, Alaska, Arkansas, Idaho, Nebraska, Nevada, New Mexico, Pennsylvania, Tennessee, Texas, Utah, Washington and Wyoming.

On Wednesday, Sen. John Edwards (D-N.C.) asked the General Accounting Office, a nonpartisan research arm of Congress, to investigate flu vaccine shortages.

Demand driving shortages

About 70 to 75 million Americans receive a flu shot in a typical year, though this year manufacturers Chiron (PSE:CHIR) and Aventis Pasteur produced about 83 million doses of flu vaccine. The U.S. has never used more than 80 million doses in a season. Chiron said it is working with the CDC to see if it can supply an additional 400,000 doses of its vaccine.

The annual U.S. death toll from influenza is typically 36,000, although health experts expect that number to climb this year. The outbreak has reached epidemic proportions in Oklahoma, where six people have died, state health officials said Tuesday.

Increased attention on the disease's severity this season is persuading more people to get immunized, said Dr. Arnold S. Monto, an epidemiology professor at the University of Michigan School of Public Health.

"As soon as you start seeing this happen, people become concerned, and, whereas they often would not be going out of their way to get vaccinated, they are because of what's been occurring," Monto said.

The flu is also to blame for the deaths of nine children in Colorado and three in Texas. Children are especially vulnerable to complications from the flu because they haven't been exposed before and lack the stronger immunity that many adults have.

Even so, the "vast majority" of people who get the flu find it annoying rather than life-threatening, Gerberding said.

Preparing in advance

The A-Fujian H3N2 strain of the flu virus typically causes more severe illness and hospitalizations than the A-Panama H3N2 strain, which is the one that's targeted in this year's vaccine and is related to the Fujian strain, said Dr. Paul Glezen, an epidemiologist for the Influenza Research Center at Baylor College of Medicine in Texas.

"It's probably more severe than we expected, but we knew we hadn't had a [A-Fujian] H3N2 since '99-2000, so unfortunately we were due," Glezen said. "H3N2 always produces the most severe epidemics, and that's what we're having this year."

Healthy people age 5 to 49 can get vaccinated with a more expensive nasal spray called Flu Mist, produced by MedImmune , which is made with a live virus and is more widely available than the injection form that's made with a killed virus, Gerberding said.

The live inhaled vaccines, available at some doctors' offices, may have the added advantage of giving people broader immunity than they would receive with the shot's dead virus, Monto said.

"The suppliers have run out of inactivated vaccine but still have several million doses of live vaccine available," Monto said.

Who should get a vaccine

CDC suggests health care workers and people at high risk for complications receive a flu vaccination while supplies remain available. That includes:

  • People 50 and older

  • Residents of nursing homes and other long-term care facilities

  • Anyone 6 months or older who has chronic heart or lung conditions, including asthma, and those with other chronic conditions

  • Children and teenagers 6 months to 18 years who are on long-term aspirin therapy and therefore could develop Reye syndrome after the flu

  • Women who will be more than 3 months pregnant during the flu season

  • Children 6 to 23 months, who may be at higher risk for complications, and caregivers of children younger than 6 months 

Antivirals also can help

After studying seasonal variants of the flu, an advisory group at the Food and Drug Administration typically determines which three viruses to grow in eggs for use in next year's vaccine, a long process that often begins in February or March, Glezen said. Researchers are investigating alternative techniques like tissue cultures to speed up the process, but nothing has received FDA approval yet, he said.

The World Health Organization also is involved in planning what's included in flu vaccines, Monto said. "These decisions are usually harmonized because flu vaccine is a global commodity now. These are viruses that may be isolated in a different place but are similar in their makeup."

For those who get the flu, tea and chicken soup aren't the only remedies. Antiviral drugs such as Roche's (OTC:RHHVF) Tamiflu, Forest Laboratories' Flumadine and Relenza from GlaxoSmithKline (NYS:GSK) are available, Glezen said.

"They're underused and that's unfortunate because they're a very important adjunct to our management of flu," Glezen said.

"It's important treatment be started 48 hours after the onset of symptoms. If you can accomplish that, then you not only shorten the duration of the illness, but you reduce the chance of complications and reduce the chance of spreading it to contacts," he said.

Gerberding was more conservative, reserving the recommendation for high-risk people who need extra support in the days following vaccination. "For short term prevention or to cover someone in the high-risk group temporarily, we have a supply of antivirals that would meet those needs," she said.

Both Glezen and Monto agreed that antivirals play a role in not only treating but also preventing some types of influenza and may be useful in the future.

"If we started a new pandemic, the only protection we'd have is the antivirals," Glezen said. "There wouldn't be time to make a vaccine."

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