From the September 2000 Idaho Observer:

CDC still preparing for the coming influenza pandemic

By Ingri Harkins

July 13, the Centers for Disease Control and Prevention (CDC) broadcast via satellite to the nation's health departments a program designed to assist communities in effectively preparing for the impending influenza pandemic which has been predicted and scheduled for winter 2000-2001.

In attendance at the Kootenai County Extension Office were Randi Russo, the Panhandle Health District epidemiologist; Linda Kaarlgard, our area's immunization specialist; and several area nurses, hospital and emergency care clinic personnel.

The first hour of the program was on “Surveillance.” We were told that the best preparation for the upcoming flu outbreak is to make sure there is adequate immunization coverage. According to Dr. Keiji Fukuda, “Vaccinations are the heart and soul of preventive medicine.” This is stated despite the admission that the recommended inactive-virus vaccine being used is, according to their own statements, 70-90 percent effective in most people and only 30-40 percent effective in the elderly.

We were shown pictures of the 1918-1919 influenza pandemic in which we are told that 20 million died throughout the world; 500,000 in the United States. In San Francisco there were city ordinances passed in which it was a crime to walk in public without a mask covering the mouth and nose. People were quarantined to minimize the spread of the disease. Ignorance and fear reigned and it is predicted that this scenario will repeat if we do not have an organized surveillance system in place.

Currently there is no formal link between commercial surveillance systems (vaccine manufacturers) and the CDC. This is being worked on so that our communities will have the resources needed to avert an impending disaster. Marketing support is the number one goal for there to be a formal link between commercial and CDC organized surveillance systems.

They are now recommending that all persons aged 50 to 64 now receive the flu shot. Before now, the recommendation was for all persons over 65. This change is because:

1) up to one third are at risk due to medical conditions

2) 41 percent of this age group do not get the flu shot annually

3) age-based vaccines are the most effective and

4) many of this age group have contact with high risk persons

The Advisory Committee on Immunization Practices (ACIP) wants to expand its flu shot program to include children since infants 6 months and under were the age group affected most by last winter's flu season.

Eighty million doses of influenza vaccine were purchased from four companies to cover the 1999-2000 flu season. 90 million doses are expected to be needed and purchased for the 2000-2001 flu season. 500,000 chicken embryos are used daily in the production of influenza vaccine. It takes 90 million eggs to produce 90 million doses of influenza vaccine.

Due to the increased demand for this product coupled with an intensive marketing campaign, it is essential that the CDC, FDA and vaccine manufacturers work closely to ensure that enough is produced. It takes four to 10 weeks for reference strains (from sheep) to find out if it is a suitable strain for the one predicted to hit us this next flu season.

The problem we will be facing is a shortage of influenza vaccine due to manufacturing problems with two of the four manufacturers. The FDA cited problems with Wyeth Lederle and Park Davis pharmaceutical companies. Even so, of the 90 million doses needed for this flu season, 40 to 80 million doses are expected to be available. The CDC purchases 2 million doses annually from Aventis Pasteur and Wyeth Lederle. We were told that of all the influenza vaccine purchased, 10 percent is distributed through public health departments with the remainding 90 percent distributed through the private market.

So how is the upcoming influenza vaccine supply going to be conserved?

The recommendation is to routinely cover all “high risk” individuals first. This is defined as those with heart disease, diabetes, cancer and other autoimmune disorders. Also, children are considered high risk due to their immune systems being immature. The vaccine will be used to “prime” their immune systems for the upcoming influenza pandemic.

And how is influenza defined? For surveillance purposes, any individual who has a temperature over 100 degrees accompanied by a cough and sore throat will be listed as having contracted influenza.

So what is their worse case scenario prediction?

200 million affected; 40 million in out-patient care; 700,000 hospitalizations with a minimum of 200,000 dying.

Even with the predicted shortages in the vaccine supply, booster shots are recommended: one shot in September or October with a booster shot during the heat of the flu season. The reason booster shots are needed is due to the antigenis shift and drift of the various airborne viral strains.

Although there are commercial surveillance systems in place, they are not available to the public. For anyone wanting more information on “their” surveillance plans in the event of an influenza pandemic, contact Dr. Keiji Fukuda at kxf4@cdc.gov.

Dr. Martin Myers, director of the National Vaccine Program Office, is in charge of the CDC pandemic preparedness plan. According to him, the biggest concerns are the shortage of law enforcement and public health personnel in the event of a pandemic. The five areas for communities to focus on in developing a plan are:

1) surveillance

2) vaccine delivery -the cornerstone for prevention and control

3) anti-viral drug delivery -four different kinds; two types

4) communication

5) emergency response

Due to the impending shortage of service industry workers, the primary targets for the influenza vaccine are health care workers, all public health personnel, community safety resources such as police and EMTs, and essential community services (transportation and utility personnel). In addition, the pneumoccocal vaccine was highly recommended as a means to prevent the possibility of pneumonia which is often the end result after the initial onset of influenza.