The first shipments of swine flu vaccine should start arriving in Maryland by Tuesday, but the initial batch will be so limited that the doses will be offered mainly to health care workers in hospitals and clinics, state health officials say.

The state is getting just 31,600 doses of vaccine to start, according to the Department of Health and Mental Hygiene - only about 1 percent of what's needed to vaccinate all the children and vulnerable adults that federal health authorities have said should be given priority for protection against the H1N1 virus. Nine people in the state have died from the virus, including two children.

But John Colmers, secretary of the Department of Health and Mental Hygiene, said he hopes to have 55,000 doses on order by today and expects the flow of vaccine to swell rapidly in the days and weeks to come.

"We will order everything that's made available to us," Colmers said. "This is just the very beginning of a very substantial amount that will be coming in."

For now, at least, pregnant women as well as children and adults with chronic health conditions or compromised immune systems will have to wait for doses of injectable swine- flu vaccine, because the first week's batch will be nasal spray. The spray is made from live virus, which experts say presents a risk of complications for those more vulnerable people. Even so, Colmers noted, the nasal spray is considered safe to give to children 2 years old or older.

Maryland was among 25 states and large cities that placed orders for vaccine Wednesday - the first day they could - for the first 600,000 doses to be made available nationwide, according to the U.S. Centers for Disease Control and Prevention.

"More vaccine is being produced and ordered, and will be shipped regularly," said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases. Amid growing public anxiety over the spreading flu pandemic, she acknowledged that the small first shipment of vaccines represents "a slow start" to preventing the spread of the illness, but she said the distribution is happening earlier than expected.

The state health department is acting as a clearinghouse for vaccine requests from Maryland health-care providers, and as supply becomes available, shipments will be made directly to doctor's offices, hospitals and health clinics that requested it. The state and local health departments also plan to obtain vaccine, to administer directly to residents and to furnish to smaller doctor's offices or clinics.

The state health secretary said the gradual rollout of swine flu vaccine presents "a logistical puzzle" to ensure that the limited supply gets first to those who need it most. It comes as health providers are experiencing spot shortages of vaccine against the seasonal flu, which authorities had recommended everyone get. The Harford County Health Department, for instance, had to cancel a drive-through vaccination clinic at Ripken Stadium earlier this week because it could not get enough of the seasonal-flu vaccine.

Nasal spray complications
The logistics are also complicated by the fact that those getting nasal spray for both seasonal and swine flu must wait four weeks between doses. If one vaccine is injected and the other is given by nasal spray, or if two shots are given, they can be given together.

Health officials say they hope and expect to eventually have enough vaccine against H1N1 to give to everyone who wants it. But as the production is ramped up, federal authorities say priority should be given to vaccinating pregnant women, people who live with or care for children younger than 6 months, health care and emergency workers, young people from 6 months to 24 years old, and adults 25 through 64 years old who have chronic health conditions or compromised immune systems.

Colmers said he has been assured by federal officials that the state should be able to get 900,000 to 1 million doses of vaccine by the end of the month. That would immunize a third or less of the priority population of about 2.9 million, he said, since children under 10 would need two doses of the vaccine to be fully protected, with 21 days between doses.

Health officials say parents and other adults wanting to get themselves or their children vaccinated should contact their physicians and ask for an appointment or to be notified to come in when the vaccine is available.

"And ultimately, it'll be available broadly," Colmers said, not just in doctors' offices and public clinics but at pharmacies and elsewhere.

A number of local health departments have formulated plans to offer vaccine in community clinics and at public and private schools. But officials said yesterday those plans are on hold until they learn more about how much vaccine they can expect when.

"The quantity received will dictate what we do with it," said Brian Schleter, spokesman for the Baltimore city health department. But he added that however much vaccine the department gets, it will be offered promptly to "those who need the protection the most" at two standing immunization clinics open Monday through Thursday. Though the clinics are open to anyone, the spokesmen said top priorities would be vaccinating children and pregnant women.

There are plans to vaccinate children in city schools who don't get it from their doctors or at free health department clinics, Schleter added in an e-mail. He said school staff will be notifying parents about those vaccination clinics as soon as the vaccine is in hand.

Monique Lyle, a Baltimore County health department spokeswoman, said that the county is considering two regional clinics to administer the vaccine, but hasn't confirmed their locations yet.

Howard County's health officer, Dr. Peter Beilenson, said that the county does not plan to vaccinate schoolchildren there until the first week in November, when both injections and nasal spray should be readily available.