U.S. government officials said Tuesday they are searching for alternative supplies of influenza vaccine and monitoring whether shortages are putting patients in danger. The country may be facing a more serious than usual flu season and wide publicity has caused a run on flu vaccines, said Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention.
"We know that some areas of the country are particularly hard hit with influenza and it has been a difficult and frightening thing for many people, particularly in the context of reports of vaccine shortages,” Gerberding told a news conference.
She said the two companies that make the flu vaccine thought they made enough, but did not anticipate that the flu season would start earlier and include a more severe strain than seen last year.
“We have a gap between what we wish we have and what we have,” Gerberding said. “We are trying to get vaccine to the people who who need it most.”
These include people over 65, children aged 6 months to 2 years, patients with certain chronic conditions like AIDS or cancer, pregnant women and those who care for them.
The vaccine was formulated last year and includes a mix of the three most common strains at the end of the season in February. The Fujian strain now causing severe disease was around, but manufacturers had trouble getting it into the vaccine mix, Gerberding said.
“Viruses are finicky. They don’t always grow well in eggs,” she said. The vaccine is made using chicken eggs.
So the manufacturers decided that they would leave the Fujian strain out of the mix so as not to jeopardize overall production, she said.
Increase demand for vaccine
Last year the vaccine manufacturers -- Aventis Pasteur and Chiron -- had to throw away 12 million doses because so few people bothered to get flu shots.
Gerberding said 185 million Americans fall under the guidelines for getting the flu vaccine, but only between 70 million and 75 million usually are vaccinated.
"For the last five years we have thrown a lot of flu vaccine away,” she said. Last year the two companies made 95 million doses, but because of the 12 million doses left unused, they reduced that number this year to 83 million doses.
“So the trick here is what we can do as federal agency to assure the manufacturers will make more doses than we need on average,” Gerberding said.
She said Health and Human Services Secretary Tommy Thompson had asked the CDC to make recommendations, which may involve the government paying the manufacturers to make more vaccine.
The CDC meanwhile is checking who has the vaccine and who does not. The entire production had been spoken for, but Gerberding said it would take time to determine where all the doses went.
“Aventis has a few doses ... we are looking into the possibility of securing those so we can redistribute them to high priority areas if necessary,” she said.
Chiron’s British operation also had half a million doses that are licensed but not cleared for use in the United States, she said.
The CDC said it would closely watch flu complications among children, who have swamped hospitals in some states and surprised doctors with the severity of their illnesses.
Children hard-hit by flu
A new concern is the rise of a common drug-resistant staph infection that is undermining efforts to treat children with the flu, an official with the CDC said Monday.
Dr. Tim Uyeki, epidemiologist with the influenza branch of CDC, said that some children have died from the staph infections -- a phenomenon the CDC has not seen before.
Flu complications for children have always been dire: pneumonia, kidney and heart failure, possible brain damage.
“We’ve just never seen them in the proportions we’ve seen them this year,” said Dr. Steve Schexnayder, chief of pediatric critical care at Arkansas Children’s Hospital in Little Rock.
Eight children have died in Colorado over the last three weeks and another death of a child is suspected to be flu-related, state health department officials said on Monday. Usually one or two children die every year in Colorado from the flu. So far 6,306 Colorado residents have been diagnosed with the flu.
“Because it seems to be a strain that has not circulated in the U.S. before and is not well-covered by the existing vaccine, we’re seeing far more cases,” said Dr. James Todd, director of epidemiology of Denver Children’s Hospital. “Just because you’re seeing more cases, you’re seeing more complications.”
Doctors say some children are coming into hospitals with so much damage they are put on heart-lung bypass machines just to stay alive.
Others face additional problems: Nine-year-old Nick Collins at Arkansas Children’s Hospital needed four chest tubes to drain fluid from holes in his lungs caused by bacterial pneumonia. Doctors are trying to prevent a blood clot from killing him.
He also had methicillin-resistant staphylococcus aureus (MRSA), a usually mild infection which led to his severe pneumonia. Staph bacteria are commonly found on the skin or in the nose and often go undetected.
Uyeki said the children with staph-related flu likely picked up the bacteria before they were hospitalized. In October CDC warned parents that many school athletes had been found to carry MRSA.
These infections don’t normally cause pneumonia without the flu virus, said Dr. Frederick Hayden, a flu expert and professor of internal medicine at the University of Virginia.
But the flu virus can impair the body’s ability to fight the bacteria and expel it. The bacteria, in turn, can produce enzymes that enhance the flu’s ability to infect cells, he said.
Nick, a healthy boy until he got the flu in early November, is doing better, having been removed from a ventilator on Friday. But he’ll likely have to stay in the hospital through the end of the year, his mother says.
“It’s scary to find that something as common as the flu can cause something this major every year,” said his mother, Kim Collins of Texarkana, Texas. “We sit around for days in awe of the fact the flu has caused all of this.”
Major cause of death in kids
Flu and its complications are the sixth leading cause of death nationally among children age 4 and younger, according to the CDC.
Children have smaller trachea and bronchi making it harder to fight the flu. They are also more vulnerable because they might wash their hands less often than adults and are in contact with other children either in the classroom or the playground.
Anecdotally, this flu season seems to be worse for children. But because the CDC doesn’t keep track of flu deaths, it’s unclear how much worse. This year the agency is planning to collect data on children who die from the flu, those with MRSA, and those who develop brain damage, said Dr. Keiji Fukuda, chief of epidemiology in the CDC’s influenza branch.
It's also uncertain whether any of the children who have died from the flu were vaccinated or how many may have had underlying health issues.
Some connected with the CDC say there may be a push to add school-age children to the list of those most strongly urged to get the flu shot -- the best protection against the virus. The current recommendation for children covers those from 6 months to 2 years and those who have certain chronic conditions.
“My own prediction is what you’ll continue to see is a broadening of the recommendation for influenza immunization,” said Dr. Greg Poland, a Mayo Clinic professor and a member of the CDC advisory committee on immunization.
Pregnant women a concern
Pregnant women -- urged to get the flu shot if they are in their second or third trimester -- have also become a concern this year
The CDC is looking closely at some cases in which pregnant women have displayed high pulse rates -- which could be a symptom of a dangerous, and potentially fatal, inflammation of the heart, said Dr. William Schaffner, a flu expert with Vanderbilt University Medical Center. Texas in particular has reported several such cases.
In North Carolina health officials made it a point last month to single out both pregnant women and children up to age 9 as risk groups that should get the vaccine.
Despite the complications seen among sick children, however, better medical care is keeping alive many of those who do develop the flu. The Little Rock, Ark., hospital has not had a flu death yet, despite the severity of their illnesses.
“Even 15 years ago, Nick would have probably succumbed to his illness,” Schexnayder said. “But we have better technology to support an incredibly ill patient.”
As a result of shortages in stricken areas, health officials, those in Colorado in particular, are urging healthy people under age 49 to use the new, and more expensive, FluMist nasal spray, which is still in abundance. Its maker, MedImmune Vaccines, has almost 5 million doses available.
The spray has limitations -- it cannot be used by older people, children under 5 years of age, or at-risk people with chronic ailments. Data indicates that the spray is as effective as a shot.
Not a killer pandemic
As serious as the early outbreak is, health experts said Monday it is not the killer pandemic they have been warning will eventually come.
"It's not the big nasty that everyone was worried about," said Richard Webby, an influenza virus expert at St. Jude Children's Research Hospital in Memphis.
This year, extra attention has been focused on flu because of the outbreak earlier in the year of SARS, or severe acute respiratory syndrome, experts said.
Flu symptoms include fever, headache, extreme tiredness, dry cough, sore throat, runny or stuffy nose, and muscle aches. Children may also suffer nausea, vomiting, and diarrhea.