Pregnant women, health care workers and children and young adults ages six months through 24 years should be placed at the front of the line for swine flu vaccinations this fall, a government panel recommended Wednesday.
The panel also said those first vaccinated should include parents and other caregivers of infants and non-elderly adults who have high-risk medical conditions.
The Advisory Committee on Immunization Practices voted to set vaccination priorities for those groups Wednesday during a meeting in Atlanta. The panel’s recommendations are usually adopted by federal health officials.
The recommended priority groups are people at greater risk for the disease and for a greater burden of complications, said Dr. Anne Schuchat, director of the Centers for Disease Control's National Center for Immunization and Respiratory Diseases.
The recommendations are designed to address potential limits in vaccine availability this fall if there is heavy demand and limited supplies.
The government estimates that about 120 million swine flu vaccine doses will be available to the public by late October. Nearly 160 million people are in the priority groups considered most vulnerable to infection or most at risk for severe disease, Schuchat said.
If the population for whom vaccination is recommended is larger than the vaccine available, the CDC may need to prioritize, Schuchat said.
"In general, under most circumstances, we ought to promote vaccine in all five of these focus groups," she said.
But if the initial supplies are very limited, or if in local communities, supply and demand doesn’t match, they recommend five other groups be targeted first in what Schuchat called a “who’s first in line kind of scheme.”
They are:
This more focused target group includes about 41 million people.
“We do think it’s likely most people will need two doses of this vaccine,” Schuchat said.
Although the number recommended to get doses exceeds the projected supply, health officials don’t think everyone will run out and get vaccinated. Traditionally, less than half of the people recommended to get seasonal flu shots get them. Only about 15 percent of pregnant women get seasonal flu vaccinations.
The new guidelines may raise thorny questions as about who should have access to limited supplies of the vaccine.
Dr. Richard Gower, president of the American College of Allergy, Asthma and Immunology, had hoped that the early group would include the 20 million to 25 million people in the United States with asthma, including about 8 million children. About a third of U.S. patients hospitalized with H1N1 infections have had asthma, according to the ACAAI.
Health officials need to clearly define which people fall into the target groups, Gower said.
“The rub is going to be how you define high-risk issues,” he said. “There will be a jockeying for position there. If you don’t define it, when the rubber hits the road, people will get angry if their constituency is not included.”
If there is ample vaccine, vaccinations also would be recommended for all non-elderly adults, the panel also voted. And if there’s still plenty of vaccine, the swine flu shots and spray doses should be offered to people 65 and older. Fewer illnesses have been reported in the elderly, who appear to have higher levels of immunity to the virus, health experts say.
“So far, the H1N1 flu has been sparing those people,” Schuchat said.
However, the elderly should be pushed to get shots against seasonal flu, which is a significant health risk to older adults, she added.
Panel members say they hope swine flu vaccinations will be opened up quickly. “The only sin is vaccine left in the refrigerator,” said Dr. William Schaffner, a Vanderbilt University flu expert, in a comment to the panel.