The Big Question: What to Expect This Flu Shot Season

By Roslyn Stone, MPH C.O.O., Corporate Wellness, Inc. Chair, CDC/ AMA National Influenza Summit Workplace Working Group

Needless to say, while many flu experts were not surprised by the emergence of a probable flu pandemic, a majority of the rest of us were.  Yes, we’d been hearing we were overdue for a flu pandemic.  We’d been warned to draft pandemic plans.  But there was not a real sense of urgency.  Now there is and there are several aspects of this evolving situation that are surprising even the experts:

Surprise #1: It’s swine flu and not bird flu.  We were very focused on avian flu and convinced that the next pandemic would likely come in that flavor.  We were wrong….

Surprise #2: It is a Novel H1N1 virus – meaning few of the working population (at least not those born after 1957) have any immunity at all. This had broad implications for employers. 

Surprise #3: It isn’t going away. It arrived late in the flu season and doesn’t appear to be going away as expected with traditional flu season winding down.  When we first heard about H1N1 flu a few weeks ago, most flu experts predicted it would continue to spread and then the spread would slow to a near halt as traditional flu season comes to an end in the northern hemisphere. Our greatest concern would be its return, in a more virulent and mutated form, next fall when flu season returns.  So far, that doesn’t seem to be how it is playing out.  There are media reports today that it may have peaked for this spring but many school districts disagree. 

So when asked what to expect this flu shot season, there’s no easy answer and there’s no single answer.   

A lot rides on the yet-to-be-made decision on whether to manufacture H1H1 Vaccine on a large scale basis.  To date, the US has only ordered 20 million doses – enough for healthcare workers, first responders and critical personnel.  

The H1N1 strain isolates haven’t been grown yet in the laboratories for vaccine manufacturing.  Early signs indicate it is slow growing strain– which means that a vaccine will  not be ready for quite some time.  If the strain grows slowly, it takes longer to get enough of it to manufacture a vaccine. When will a vaccine be ready?  No one really knows. 

The vaccine manufacturers report that seasonal flu vaccine production is well underway, and in some cases, nearly complete. However, there is variability between manufacturers and types of vaccine (adult vs. pediatric, single dose vs. vials).  We need at least 150 million doses of seasonal flu vaccine.  But if H1N1 vaccine is ordered, seasonal flu vaccine manufacture will stop and H1N1 vaccine manufacture will begin.  36,000 Americans die of the seasonal flu each year and more than 200,000 hospitalizations take place.  Anything that threatens the manufacture of seasonal flu vaccine is a source of great concern to US flu experts.

We’re hearing some talk that if the US goes ahead with H1N1 vaccine manufacture, we would be directed to begin seasonal flu vaccinations as early as August.  This would allow us to complete seasonal flu vaccinations before beginning H1N1 vaccinations.

If H1N1 vaccinations were to be recommended, we will need two shots - since most of us have no immunity to this particular strain. That means everyone who wishes to be protected against the flu will need three shots this year – posing unique and monumental challenges to the healthcare system.

So, back to the basic question, what should we expect this flu shot season?  The answer:  only time will tell.  It may be an early flu shot season.  It may be a triple flu shot season. It may be a pandemic.  It may not  It may mutate.  It may not. Our advice: continue to closely monitor the situation and be prepared to respond quickly.