State advises rationing of flu shot to high-risk groups

By Robbie Dingeman
Advertiser Health Writer

Health officials in Hawai'i reacted quickly yesterday to the announcement of a nationwide flu vaccine shortage by recommending voluntary rationing so the elderly and others at highest risk for influenza can get first priority.

Dorothy Yuen, 73, of Liliha, gets a flu shot from Carol Keanini of The Medical Corner at Times grocery store on Beretania Street. People are asked to let infants, elderly and other high-risk groups get shots first. Deborah Booker • The Honolulu Advertiser

As a result of the shortage, the state's largest health insurance company canceled a series of popular flu shot clinics.

Dr. Linda Rosen, deputy state health director, said people should evaluate whether they or family members are at high risk for the flu before getting the shots this year.

"Those who are in those high-risk groups should get in as soon as possible," Rosen said. "We are asking for the public's help to make sure the vaccine goes to those who need it most."

But Rosen also noted that the state has faced other vaccine shortages in the past and "gotten through them."

Word of the shortage helped send Ruth Muller of Hawai'i Kai to a flu shot clinic set up by The Medical Corner at Times Supermarket on Beretania Street.

Muller, 72, heard the news on the radio. She found out the shots were being offered near her workplace from her friend and co-worker Abbie Muragin. "My doctor said he wasn't getting it in his office," Muller said.

Muragin, 51, got her flu shot at her doctor's office yesterday during a routine appointment. She said she had gotten in the habit of getting the annual shots because she has worked in healthcare.

The huge shortage emerged abruptly yesterday after British regulators suspended the license of Chiron Corp., citing manufacturing problems at a factory in Liverpool. That canceled the scheduled delivery of 46 million to 48 million doses of the vaccine, half of the U.S. supply.

The announcement left health officials across the country scrambling to find enough doses of the vaccine to cover those at highest risk, and led HMSA — the state's largest healthcare insurer — to suspend its community immunization clinics.

HMSA senior vice president Cliff Cisco said HMSA would cancel clinics on O'ahu, Maui, Kaua'i and Hawai'i until further notice. That affects 15 clinics on O'ahu and eight on the Neighbor Islands.

"HMSA is currently working with the state Department of Health to determine a reasonable and efficient method of identifying those healthcare consumers who are most vulnerable, so they may have access to a vaccine from the limited supplies already on hand," Cisco said.

He said HMSA was working to inform consumers that the clinics have been suspended, but some advertising could not be canceled in time. For example, Longs newspaper ads in today's Advertiser could not be changed to show the cancellations, he said.

Nurse Carol Keanini gives shots for The Medical Corner at community clinics scheduled through January at Times Supermarkets across O'ahu. She said yesterday's clinic on Beretania Street drew more than 250 people between 8 a.m. and 1 p.m.

Keanini said more than 180 of those who got shots yesterday were age 65 or older, one of the high-risk groups that should still get their shots this year.

Others targeted to receive the vaccine include infants and toddlers ages 6 to 23 months and healthcare workers who care for high-risk groups.

After hearing about the shortage, Dorothy Yuen of Liliha walked into Times Beretania yesterday with her sister, Grace Yuen, to see if they could get their shots the day before the clinic moves to their neighborhood. They worried that lines might grow and the vaccine might run out.

"We got our shots," Yuen said. "I do every year — I'm 73."

Manoa residents Darlene Murakami and her 15-year-old daughter, Marisa, both got their flu shots yesterday. They fall outside of the top risk groups but wanted to be cautious and had planned to get the shots before news of the shortage broke.

Darlene Murakami, 51, is married to a doctor and helps in his office, so she falls under the general recommendations for the vaccine. Marisa, a Punahou student, knows how serious the flu can be.

"You could be laid up for weeks," she said. "I know there's not going to be enough (vaccine) to go around."

Kaiser Permanente Hawai'i spokeswoman Alison Russell said the shortage would have little impact on Kaiser members, as the organization already has the 70,000 doses of vaccine that it ordered for members this season. "We're not anticipating any shortages," she said.

At the Health Department, Rosen said federal officials were considering diluting the vaccine for healthy individuals in the lower-risk groups, which would allow vaccines for twice as many people. She said there was no reliable estimate of how many doses had been given out through doctor's offices, clinics and other sources statewide.

The state distributes about 20,000 doses a year directly through its outreach to children, she said. The children's vaccine supplies are not made by Chiron and are not affected by the shortage.

Cisco said HMSA had received 12,000 doses of the vaccine — less than half of what it ordered — and used up 4,000 so far.

Last year's flu season came earlier than usual, and more people sought flu shots after the deaths of a number of Mainland children and adults led to a spike in flu shots across the country.

Reach Robbie Dingeman at rdingeman@honoluluadvertiser com or 535-2429.

Details of the vaccine shortage

Q: Will there be enough vaccine for all those in high-risk groups?

A: No. There are about 185 million people in the recommended group, and fewer than a third that many doses of flu vaccine. Health officials had expected that about 100 million doses would be available this year. Now it appears there will be about 1.5 million doses of FluMist nasal spray vaccine, which is licensed only for healthy people ages 5 to 49, and 52 million doses of vaccine made by Aventis Pasteur. Aventis has shipped 30 million doses to doctors.

Q: This year, babies 6 to 23 months old are supposed to get flu shots. Will the vaccine shortage change that recommendation?

A: No. Chiron's vaccine was licensed only for those older than 4, so the shortage will not affect the vaccine supply for babies.

Q: Why can't manufacturers just make some more vaccine to replace Chiron's supply?

A: The vaccine is grown through natural biological methods involving a virus designed specifically to address the strains of flu expected in the coming season, said Dr. Linda Rosen, deputy state health director. Millions of cultures are created to make the vaccine, she noted. "All of that takes quite a bit of time," she said.

Q: What was wrong with the Chiron vaccine?

A: That's not clear. In August, the company told the Food and Drug Administration that it had discovered a problem with the sterility of a few lots of vaccine, or 6 million to 8 million doses. The vaccine was contaminated with the bacteria serratia, which is sometimes found in water and is known to cause urinary tract infections. The company believed it had isolated the problem and taken steps to resolve it, but regulators in England, where Chiron's flu vaccine factory is located, were not satisfied and suspended the company's license.

Q: Has any tainted vaccine been sent to doctors or given to patients?

A: No. Though Chiron reported in July that it had shipped a million doses to distributors in the United States, none of that vaccine has been sent to doctors.

Q: How dangerous is this shortage?

A: Flu causes an average 36,000 deaths a year in the United States and sends about 200,000 people to the hospital. Each year, 10 percent to 30 percent of the U.S. population contracts flu.

Q: How can I protect myself and my family?

A: If you are in a high-risk category, get a flu shot. If you are not in a high-risk group, use precautions to avoid catching or spreading flu, including washing your hands frequently, covering your mouth when sneezing, staying home when you're ill and avoiding contact with ill people.

Q: What flu vaccines are available in the United States?

A: There are two types: a shot made by Aventis Pasteur and a nasal spray called FluMist, made by MedImmune.

Q: Haven't there been flu vaccine shortages before?

A: Yes. In 2000-01, vaccine supplies were delayed because of production problems. At that time, health officials instituted a priority plan for the vaccine similar to the one announced yesterday.

Last year, because flu season got off to an early and severe start, causing serious illnesses in children and adults, there was a rush to get vaccinated, and manufacturers sold out. But the Centers for Disease Control and Prevention says there has never been a year when everyone in recommended groups gets a vaccine.

Q: Will the shortage affect prices?

A: Possibly. In the 2000-01 season, when vaccine supplies were delayed, some doctors reported paying more than four times the expected price, the Government Accountability Office said in a report last week.

— Sources: USA Today, state Health Department