Dear Immunization Provider:

On October 5, 2004, the Centers for Disease Control and Prevention (CDC)
was notified by Chiron Corporation that none of its influenza vaccine
(Fluvirin(r)) would be available for distribution in the United States for
the 2004-05 influenza season. The Medicines & Healthcare products
Regulatory Agency (MHRA) in the United Kingdom, where Chiron's Fluvirin
vaccine is produced, has suspended the company's license to manufacture
Fluvirin vaccine, preventing any release of Fluvirin for this influenza
season. This will reduce by approximately one half the expected supply
of trivalent inactivated vaccine available in the U.S. for the 2004-05
influenza season.

Because of this urgent situation, CDC, in coordination with its Advisory
Committee on Immunization Practices (ACIP), is issuing interim
recommendations for influenza vaccination during the 2004-05 season.

*These recommendations take precedence over earlier recommendations.*

*Priority groups* (of equal priority) for vaccination with inactivated
influenza vaccine this season are:

* All children aged 6-23 months
* Adults aged 65 years and older
* Persons aged 2-64 years with underlying chronic medical conditions
* All women who will be pregnant during influenza season
* Residents of nursing homes and long-term care facilities
* Children aged 6 months-18 years on chronic aspirin therapy
* Health care workers with direct patient care
* Out-of-home caregivers and household contacts of children aged <6
months.

Other vaccination recommendations:

* Health-care workers (except those who care for severely
immunocompromised patients in special care units) and persons
caring for children aged <6 months, who are healthy, 5-49 years of
age, and not pregnant, should be encouraged to be vaccinated with
intranasally administered live, attenuated influenza vaccine(LAIV).
* Persons in priority groups identified above should be encouraged
to search locally for vaccine if their usual health-care provider
does not have vaccine available.
* Children aged <9 years require two doses of vaccine if they have
not previously been vaccinated. All children at high risk of
complications from influenza, including those aged 6-23 months,
who present for vaccination should be vaccinated with a first or
second dose, depending on vaccination status. However, doses
should not be held in reserve to ensure that two doses will be
available. Available vaccine should be used to vaccinate persons
in priority groups on a first come first serve basis.

*Persons who are not included in one of the priority groups above should
be informed about the urgent vaccine supply situation and asked to
forego or defer vaccination.*

-----------------------------------------------------------------------------

If you have any questions, please call the Hawaii Immunization Program
at 586-8300 (Neighbor Islands calls are toll-free at 1-800-933-4832). We
appreciate your assistance and cooperation in ensuring that the limited
supply of influenza vaccine goes to those who are most vulnerable.

Sincerely,

PAUL V. EFFLER, M.D., M.P.H.
State Epidemiologist