A panel of scientists recommended yesterday that the federal government immediately lift its moratorium on flu vaccinations and encourage state and local health officials to start limited and voluntary inoculation programs.
The panel, convened after an outbreak of 59 A/Victoria flu cases in a Miami nursing home, presented its recommendations to Health, Education and Welfare Secretary Joseph A. Califano Jr., who will announce his decision on the moratorium today.
Califano's advisers pointedly declined to recommend a restart of a coast-to-coast mass immunization effort with all federal, state and local resources. Instead, they urged Califano to issue "a positive recommendation" that would encourage health departments and doctors to give the shots and the high-risk part of the public - older persons and the chronically ill - to get the combined vaccine.
But there should be no other federal push or "hand sell" campaign unless A/Victoria outbreaks spread, said Dr. Ivan Bennett, provost of New York University Medical Center and vice chairman of the Advisory Committee.
The advisers also recommended officially lifting the moratorium on the single-purpose swine flu vaccine, but with the expectation that no health department will offer it unless swine flu epidemics begin. There had been only a handful of cases contracted from pigs since swine flu hit Ft. Dix, N.J., killing one soldier last year.
The advisers also recommended that the moratorium be lifted on B/Hong Kong flu vaccine so it can be given to children and adolescents. This kind of flu has hit schools in several states.
All flu vaccinations were halted in December following the discovery that swine flu vaccine and the combined A/Victoria-swine flu vaccine were causing a temporary paralysis in some persons.
One of the major architects of the swine flu vaccination program, Dr. David Sencer, has been asked to resign by Califano. Sencer is head of the Center for Disease Control in Atlanta.
Califano complimented Sencer on his leadership, including the direction of the swine flu program, but said he wanted a CDC director of his "own choosing."
But Califano's action - the first replacement of a CDC director by a new administration - aroused immediate speculation that Sencer was being dismissed for his role in the swine flu program, and charges that the CDC was for the first time being "politicized."
Califano said his planned replacement of Sencer has nothing to do with his role in the swine flu program but "he's been at CDC for 16 years and director for 10 years. I think it's important that institutions be rejuvenized and revitalized."
One Advisory Committee member - Dr. Alexander Langmuir of Harvard University, long CDC chief epidemiologist - told a reporter that "I can't believe it - this is politicization of CDC, and every important man is going to leave as fast as he can find a new job. Sencer has headed the swine flu program with immense competence."
The vaccine that will be used it Califano lifts the moratorium will be the combination A/Victoria-swine flu vaccine because no separate A/Victoria vaccine was made last spring and summer in view of the swine flu fear.
Califano's advisers, headed by Dr. John Knowles, president of the Rockefeller Foundation, made their recommendation after listening all day to CDC and other experts testify that.
The Florida cases, though still small in number, represent the kind of cluster that can start an epidemic.There have so far been 59 A/Victoria illnesses and three "flu-related" deaths among the nursing home's 176 patients, and another 15 cases among staff members.
There have been only a few scattered A/Victoria cases so far elsewhere, though more were reported yesterday by Canadian health officers.
The combined vaccine gave a high rate of protection to those nursing home patients who were vaccinated last fall. The flu attack rate among non-vaccinated patients was 42 per cent; among the vaccinated, only 7.3 per cent. But only 23 per cent of all the patients had been vaccinated.
If spreading A/Victoria should affect only 5 per cent of the U.S. population, it could cause 12.600 deaths. Guillain-Barre disease, the kind of paralysis associated with the vaccine, has caused only seven Guillain-Barre cases per million vaccinations and only one death per 20 cases. This means that if 20 million more people were vaccinated, there would be another 140 Guillain-Barre cases, with seven deaths. Among Americans who got swine flu shots of any kind last year, there have been 342 Guillain-Barre cases and 14 deaths so far.
Altogether, there are still some 20 million unvaccinated Americans in the over-65 and chronically ill categories, including those with heart, kidney and lung diseases; diabetes; and childhood cystic fibrosis and malignancies.
Another 20 million persons in these categories are among the nearly 50 million who were vaccinated in the campaign that started last October.
There remain some 27 million unused shots of the combined vaccine, mainly in state health officer's hands.