HEALTHBEAT: High-risk patients need first flu shots

WASHINGTON - Dr. Raymond Scalettar is angry: He has to send elderly lung-disease patients to nearby supermarkets for a flu shot. Why? Some huge grocery chains received thousands of vaccine doses before manufacturers shipped them to many private doctors whose patients are so frail influenza could kill them.

The sick standing in store lines isn't doctors' only frustration. Manufacturers acknowledge shipping shots to large corporations for employee-vaccination programs ahead of many doctors - even though this year's vaccine delay means high-risk Americans, not healthy young workers, are supposed to be first in line.

''We have patients on cancer chemotherapy, who have chronic bronchitis and obstructive lung disorder, and immunodeficiency - people who really need the protection as soon as possible,'' says Scalettar, a prominent Washington physician who eventually will get the vaccines but doesn't want his sickest patients to wait.

''It doesn't make sense for corporations to give it to healthy people and we can't give it to sick people.''

Indeed, the ''worried well'' seem a tad frenzied to get flu shots this year. Doctor after doctor reports being cornered by healthy 30-somethings demanding vaccination. Tempers flared at a recent South Carolina vaccine fair that temporarily ran out of shots and turned away 100 people.

Yet influenza isn't threatening yet and plenty of vaccine is coming - it's just taking longer to arrive this year.

So federal health officials are urging healthy people to wait until late November for vaccination - letting the elderly, pregnant women and people with chronic illnesses such as asthma, heart disease or weak immune systems get the first shots now being shipped.

''We want to make sure that high-risk people get vaccinated first,'' stresses Dr. Keiji Fukuda of the Centers for Disease Control and Prevention. Other people ''are anxious, and we recognize that. But know that more vaccine is on the way and it's pretty quiet right now on the influenza front.''

Vaccine shipment was delayed because of some now-solved manufacturing problems. Contrary to earlier fears, and some continuing erroneous media reports, the CDC insists there's no impending shortage. Some 75 million flu shots ultimately will be distributed.

But typically, doctors finish vaccinating most high-risk patients, and lots of healthy people, by late October. This year, vaccine shipments only recently began and just two-thirds of doses will be sent out before December.

November or December is not too late to vaccinate healthy people, the CDC insists. While some flu strains typically start circulating by then, in 14 of the last 18 winters large outbreaks didn't begin until January or later. It only takes two weeks after vaccination to reap full protection.

But the flu typically kills 20,000 Americans annually, mostly the elderly and chronically ill. Thus, they need the earliest protection.

Capitalism means high-volume corporations that placed early orders may get their vaccines before many private doctors. Manufacturers like Aventis Pasteur are helping the CDC publicize the high-risk recommendations, but no one can enforce them.

So the CDC, receiving physician complaints like Scalettar's, is asking corporations to offer the first shots only to employees - and, this year, to their family members - who are high-risk, and vaccinate healthy workers later. Aventis, where the vaccine factory is running 24 hours a day, is doing just that.

Companies with early vaccine shipments could lend them to needier nursing homes or high-risk clinics, which would repay the loan when their own shots arrive, CDC suggests. The Atlanta-based agency plans to lend doses to needier neighbors after vaccinating its own high-risk employees in November.

And if the flu strikes earlier than expected, Aventis is setting aside some shots for priority shipment. Plus, the CDC has ordered 9 million vaccine doses set aside in December just for high-risk patients, as a ''safety cushion'' in case healthier persons squeeze out the neediest.

Also, once the flu hits, doctors in outbreak areas can check a new CDC vaccine-sharing Web site to hunt other regions with leftover doses. ---

EDITOR'S NOTE - Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

On the Net:

CDC: http://www.cdc.gov