After a battery of calls to hunt down a dose of FluMist, Kimberly Gregoire-Cope finally identified a storefront clinic in Baltimore that carried the nasal spray version of the influenza vaccine.
"I said, 'You have FluMist? Are you sure?'" she quizzed the receptionist at the Passport Health in South Baltimore. She didn't want to drive from her Carroll County home and find only shots.
Like many parents, Gregoire-Cope and her husband, Ryan, had to put in some effort this year to avoid a needle — and tears — for their 4-year-old son Everett.
Schools across the region canceled or postponed annual vaccination clinics because FluMist shipments were delayed and officials didn't want to use needles on sometimes-anxious children without their parents present. Doctors' offices and drug stores have also run low.
The situation has raised concern among public health officials and doctors, who are sounding a common theme ahead of the usual flu season peak in January and February: Children should be vaccinated with whatever vaccine is available.
"It's not too late to get the flu shot," said Greg Reed, program manager for the Maryland Department of Health and Mental Hygiene's Center for Immunization. "Flu is unpredictable, and it's not possible to say when the season will begin in earnest, and getting a influenza vaccination is the best defense."
The U.S. Centers for Disease Control and Prevention recommends everyone over 6 months be vaccinated. Officials cite no preference for mist, approved by the U.S. Food and Drug Administration in 2007 for ages 2 to 49.
The flu, a contagious respiratory disease, generally sickens 5 percent to 20 percent of the U.S. population annually, with more than 200,000 hospitalized and thousands dying from complications, according to the CDC. Children, seniors, pregnant women and those with underlying health conditions are most at risk.
Last season was considered more severe than normal because one of the strains included in the flu vaccine "drifted," or mutated. In Maryland, that contributed to 3,700 hospitalizations and the death of one child.
The strain identified in Maryland's first case of the season in early November was included in this year's vaccine, though it's too early to judge the vaccine's overall protectiveness. (Even mismatches provide some benefits, doctors say.)
Reed said some school districts have begun rescheduled clinics, including Baltimore City, which plans to vaccinate kids in mid-December. Baltimore, Anne Arundel and Howard counties also have since offered limited amounts of mist to the public. A handful of Harford County schools will offer FluMist at clinics Dec. 11 and 12.
But even places that have offered the mist keep running out. That includes Passport Health, a nationwide chain of clinics, said Fran Lessans, a registered nurse and Passport's founder and CEO.
She said she understands parents' preference for mist but also said modern shots are "not a big deal."
"The needles today are very skinny, and half the kids don't realize they've even gotten it," she said. And more important, she added, "Shots are widely available."
The trouble with FluMist started in October, when Gaithersburg-based MedImmune, the nasal spray's maker, said it had production problems with two of four flu strains contained in the vaccine. The company has since shipped more than 7 million doses and plans to ship several million more in December, MedImmune reported. It ships up to 15 million doses each season.
It's not known how many parents have put off vaccinations this year because of the delay or if more kids will become sick. Documenting flu cases can be tough because many people never seek medical attention and most who do aren't tested for the virus.
Some community physicians and hospitals voluntarily report cases of influenza-like illness to public health officials. So far this year, pediatricians at Johns Hopkins Childrens' Center say they've logged few such cases.
But that makes it a good time to get vaccinated because it takes a couple of weeks for the body to build up protection, said Dr. Aaron Milstone, a pediatric infectious disease specialist in the hospital and an associate professor in Hopkins' School of Medicine.
"Parents forget that kids die from influenza every year and it is vaccine-preventable," he said. "It's something we can and should protect our kids from. … Even if they need a shot, the few minutes of minor discomfort is better than the tougher headaches of the flu."
Anyone who has suffered through the flu knows how awful it is, said Dr. Lisa Carey, a family doctor at the Greater Baltimore Medical Center Hunt Manor office. Carey said she's been vaccinated every year since she had the flu during medical school, with fever and aches so bad she missed a week of classes.
She said she tells patients how bad it can be, even in healthy people. She also dispels the myth that the vaccine causes flu. Most people who sickened either were already infected by the time they got the vaccine, or they had a cold or stomach ailment rather than influenza. Occasionally, some mild flu symptoms can arise after vaccination as the body builds immunity.
Carey hasn't seen any flu yet this season, though she's tested three adults who were negative.
"People think the flu is no big deal, or they don't need the vaccine because they never get the flu," she said. "But when I worked in a hospital, I saw lots of adults and children sick for the first time. Seeing flu in a little baby is one of the worst things. And everyone can have serious complications."
Many parents agree, which is why they have so doggedly been pursuing FluMist.
Wendy Muher got a flu shot through work, and her husband got one at the grocery store. But their 9-year-old son and 7-year-old daughter made it clear they preferred getting sick to getting flu shots. Her son looked so panicked at the prospect that the doctor suggested they look for mist.
She got some leads off her neighborhood listserv in Federal Hill, then drove to a couple of stores before scoring doses at a local Target.
"Knowing how much my kids hate the shot option, I knew I wanted to move swiftly and be sure to get them the mist," she said. "As the cold weather sticks around, I am sure it will become more of a scramble for busy families to squeeze in this necessary but not always pleasant task for kids."
As a Baltimore County teacher, Amy Schneider also hoped parents would get their kids vaccinated so "herd immunity" would protect those who couldn't be vaccinated, such as newborns. As a mother to a preschooler, she, too, wanted to avoid a needle.
"I know a lot of people are having a tough time" finding the mist, she said, "but I'm determined."
Kimberly Gregoire-Cope was relieved to see Ted Frankenhauser, a registered nurse at the Passport Health, mist in hand. Her husband was up first, a spray in each nostril. Then it was Everett's turn.
"One, two, three and a little tickle," began Frankenhauser.
When Everett scoffed at a sniff up the second nostril, a little coaxing and the promise of a green lollipop turned things around.
"I did it," Everett said with a smile. "I feel better now."