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Assistant Surgeon General Asks Health Care Providers to Reassess Orders for Flu Vaccine

Kate Traynor

Faced with the likelihood that only 60 percent of this season's flu-vaccine doses will be available by the end of October, Assistant Surgeon General Walter A. Orenstein has asked health care providers to reassess the amount of vaccine they expect to use in the coming months. Health care providers who overestimated their need for the flu vaccine or placed orders with multiple suppliers are asked to promptly give correct estimates to vaccine suppliers and manufacturers.


August 30, 2001

Dear Health Care Provider:

I am writing to ask for your help in maximizing influenza vaccine health benefits and minimizing possible disruptions due to influenza vaccine distribution delays.

CDC previously encouraged those of you with high risk patients to order vaccine early, to help manufacturers and distributors gauge demand and improve the opportunity to immunize high risk individuals as early in the season as possible. We are pleased to learn that many of you followed that advice. Manufacturers have reported that even though current projections of the total vaccine supply expected for this year exceed that of prior years, all anticipated influenza vaccine has been obligated much earlier than has previously been the case. (Some vaccine may still be available from distributors.)

Because orders were placed much earlier this year, we believe that some providers may have over-estimated their anticipated vaccine needs for the upcoming season and ordered more vaccine than needed. Given the limited amount of vaccine that will be available prior to November, along with the fact that vaccination of lower risk individuals should be deferred until November when supplies should increase, we are now asking that you reassess your needs. If you find that your influenza vaccine order over-estimates your needs, or if orders were placed with multiple suppliers, prompt notification of your actual needs to your vaccine providers ( i.e., manufacturers or distributors), will facilitate a broader distribution of vaccine to providers with high risk patients.

Immunization with influenza vaccine is the best means of preventing serious complications from influenza infection. During an average influenza season, approximately 20,000 deaths and approximately 114,000 hospitalizations result from influenza-related complications. Persons at greatest risk from influenza include those >65 years of age, those in nursing homes, and those with certain chronic diseases, particularly of the lungs and heart.

Influenza vaccination typically takes place in October through mid November before there is significant influenza activity. The optimal period for immunization is October through the end of November. Nevertheless, many persons at high risk of influenza-related complications remain unvaccinated after this time period and vaccination in December and later can still be beneficial. During the last 19 years, influenza peaked in December during 4 seasons and January or later in 15 seasons.

During the 2001-2002 influenza season, the three influenza vaccine manufacturers are predicting that the overall number of doses to be produced will be greater than in past years, resulting in about 79 million doses. However, there will be a substantial delay with 47.8 million doses of vaccine projected to be distributed by the end of October (60% of projected season totals). Often, over 99% of vaccine doses are distributed by the end of October. However, current projections indicate the difference this year will be made up with increased production and distribution of more than 31 million doses in November and December.

The following plan, based on four primary principles, is designed to minimize the potential adverse effects of an influenza vaccine delay:

  • Target use of vaccine available early in the season to persons at greatest risk of complications from influenza.

This will facilitate vaccination of persons most in need of protection from influenza in the unlikely event of an early influenza disease epidemic.

  • Distribute a portion of vaccine early to all providers.

All providers are likely to serve some high-risk patients and having some early vaccine will enable them to vaccinate at least some of those individuals.

  • Defer vaccination of low risk persons until November when vaccine supplies should increase.

Such a step encompasses deferral of vaccine distribution to work site clinics until November since those clinics largely vaccinate persons at low-risk for influenza complications. It also includes asking persons at low-risk of influenza-related complications to delay seeking vaccination until November.

  • Extend the recommended optimal time for vaccination from October through the end of November and encourage continued vaccination through December and later, as long as vaccine is available.

This will facilitate effective utilization of vaccine that becomes available later in the season and will help increase vaccination levels in high-risk and targeted populations.

Achieving influenza vaccination goals will require the combined actions of vaccine providers; the public; manufacturers, distributors, and vendors; and health departments and other organizations providing vaccine. The participation of all groups who are involved in the spectrum of influenza immunization activities is essential to the success of the plan.

For updated information about influenza availability as the season progresses, we urge you to check our website at We appreciate your efforts to ensure individuals at high risk of complications from influenza are appropriately targeted for immunization and thank you for your consideration in this important public health matter.


Walter A. Orenstein, M.D.
Assistant Surgeon General
National Immunization Program