Update: Influenza Activity
and Vaccine Availability -- United States, 1991-92
During the 1991-92 influenza season, widespread influenza-like
illness (ILI) activity* was first reported in Louisiana for the
week ending November 9, 1991, and in Mississippi the week ending
November 16. Through November 30, six additional states (Alaska,
Missouri, New York, North Carolina, Tennessee, and Texas) reported
widespread activity; 13 (Alabama, Arkansas, California, Florida,
Georgia, Indiana, Kansas, Kentucky, Minnesota, Nebraska, New
Jersey, Ohio, and Pennsylvania) reported regional activity.
Influenza A outbreaks in schools this season have been
previously reported (1). The first laboratory-confirmed influenza
A(H3N2) outbreak in a nursing home occurred in mid-November in
Cleveland, Ohio, and affected 46 (14%) of the 335 residents; nine
(20%) of the ill residents were hospitalized for pneumonia or other
complications of influenza A infection, and two (4%) died.
Based on CDC's 121-city mortality reporting system, 5.4% of
reported deaths were associated with pneumonia and influenza for
the week ending November 30--a level that remains below the
seasonal baseline for this period. However, reports of increases in
mortality associated with influenza tend to lag behind reports of
increased influenza activity.
Reported by: Participating state and territorial health department
epidemiologists. EA Mortimer Jr, MD, Dept of Epidemiology and
Biostatistics, J Fishman, MD, Dept of Medicine, Case Western
Reserve School of Medicine, Cleveland; TJ Halpin, MD, State
Epidemiologist, Ohio Dept of Health. WHO Collaborating Center for
Surveillance, Epidemiology, and Control of Influenza, Influenza Br
and Epidemiology Activity, Office of the Director, Div of Viral and
Rickettsial Diseases, National Center for Infectious Diseases; Div
of Immunization, National Center for Prevention Svcs, CDC.
Editorial Note
Editorial Note: Rates of morbidity and mortality in the Ohio
nursing home outbreak are equal to or lower than those reported
during influenza A(H3N2) outbreaks in previous years (2-4).
Although influenza activity for 1991-92 has been reported earlier
than in past seasons, the overall severity of influenza activity
for this season cannot be predicted. However, because influenza A
(H3N2) activity may be associated with excess mortality,
health-care providers should continue efforts to vaccinate
high-risk persons and their household members and caregivers (5,6).
The early influenza activity and resulting increase in demand
for vaccine have raised questions regarding supply and distribution
of influenza vaccine. Vaccine manufacturers produced and
distributed 32 million doses of the 1991-92 influenza vaccine for
civilian use, a 12.7% increase over doses produced during the
1990-91 season (CDC, unpublished data). Each year since 1985, 85%
or more of influenza vaccine doses have been distributed to private
physicians and health organizations, with the remainder being
distributed to the public sector (federal, state, and local health
departments and programs), resulting in wide variation in
distribution and use of the vaccine (CDC, unpublished data). In
response to reports of vaccine shortages in some areas,
representatives of CDC, the Pharmaceutical Manufacturers
Association, the Food and Drug Administration, and the companies
that manufacture influenza vaccine are assessing vaccine supply,
distribution, and the possibility of redistributing vaccine from
areas of surplus to areas reporting a shortage.
Persons at increased risk for complications of influenza
include those who are aged greater than or equal to 65 years;
residents of chronic-care facilities; persons with chronic
pulmonary (including asthma) or cardiovascular disorders; persons
who require regular medical care or have been hospitalized because
of chronic metabolic diseases (including diabetes), renal
dysfunction, hemoglobinopathies, or immunosuppression (including
that caused by medications and human immunodeficiency virus); and
children and teenagers receiving long-term aspirin therapy (who may
be at risk for developing Reye syndrome after influenza) (6).
Although most publicly funded vaccination campaigns have been
completed and most persons at high risk should have been vaccinated
by December 1, the 1991-92 vaccine can be administered throughout
the winter, and efforts to vaccinate high-risk persons and their
contacts should be continued by health-care providers, especially
private physicians, until influenza activity has begun to decline
in the community. Amantadine may be used as an adjunct to vaccine,
or alone if vaccine is contraindicated or unavailable, for
prophylaxis against or treatment of influenza A infection,
especially in high-risk persons (4,6).
Arden NH, Patriarca PA, Fasano MB, et al. The roles of
vaccination and amantadine prophylaxis in controlling an outbreak
of influenza A(H3N2) in a nursing home. Arch Intern Med
1988;148:865-8.
Goodman RA, Orenstein WA, Munro TF, et al. Impact of influenza
A in a nursing home. JAMA 1982;247:1451-3.
CDC. Control of influenza A outbreaks in nursing homes:
amantadine as an adjunct to vaccine--Washington, 1989-90. MMWR
1991;40:841-4.
ACIP. Prevention and control of influenza: recommendations of
the Immunization Practices Advisory Committee (ACIP). MMWR
1991;40(no. RR-6).
*Levels of ILI or culture-confirmed influenza activity are
reported by state and territorial health department
epidemiologists. Levels of activity are: 1) sporadic--sporadically
occurring ILI or culture-confirmed influenza, with no outbreaks
detected; 2) regional--outbreaks of ILI or culture-confirmed
influenza in counties having a combined population of less than
50% of the state's total population; 3) widespread--outbreaks of
ILI or culture-confirmed influenza in counties having a combined
population of greater than or equal to 50% of the state's total
population.
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