Maryland may receive just half its expected supply of the swine flu vaccine for October, state health officials said Monday as they scrambled, along with hospitals and other providers, to confront a projected shortfall.

As H1N1-related hospitalizations and deaths continue to rise, people have flocked to health department clinics to get inoculated, waiting in lines that stretched several hours. Meanwhile, in Baltimore County, officials have canceled several clinics because of a lack of vaccine.

The Centers for Disease Control and Prevention initially said Maryland could expect about 1 million doses of the vaccine by the end of this month, said John M. Colmers, state health secretary. Because of a delay in production on the federal level, they now expect that figure to be 530,000.

"People are saying to us 'Where is it? Where is it?,' and we're saying the same thing up the chain," he said. "We would love to get this out as quickly as possible."

Colmers said health officials are discussing possibly changing their plans for distributing the vaccine to some 3,000 hospitals, doctors' offices, clinics and other health care providers as they struggle with limited supplies.

It has been two weeks since the vaccine arrived in Maryland and some hospitals have yet to receive any of it. The few doctors' offices that have received scant shipments say they have been inundated with calls from their patients - and people off the street - eager to get vaccinated. While opinion polls show some public distrust of the vaccine, so far in Maryland, plenty of people are clamoring for it.

Colmers said state officials are doing everything they can to increase supply quickly. Monday, the state ordered 20,000 doses in addition to some 195,300 requested so far.

Colmers said that he doesn't think the shortage will be permanent and that he has been told by federal officials that the state should expect to reach the 1 million dose mark by the middle of November. But, he cautioned: "I can't say with absolute certainly if the numbers that we have now aren't going to change again."

"We have ordered every drop of vaccine that we could," Colmers said. "Over the last two weeks we have seen the estimates coming to Maryland have been reduced twice. We are not alone in this regard; we are feeling the same frustration as many states are. Production is continuing - it doesn't mean that we won't be getting it. It's that the schedule has been pushed back for us and everyone."

For a huge health care system such as Johns Hopkins, the shortage is felt acutely. The Hopkins health system, which includes hospitals, clinics and the university, has 50,000 people to vaccinate, not including patients or affiliated physicians who disseminate some 50,000 doses in the community, said Dr. Gabe D. Kelen, director of Hopkins' Office of Critical Event Preparedness and Response.

So far the health system has received 7,000 to 8,000 doses of the vaccine. It expected between 10,000 and 15,000. "This is pretty bare-bones," said Kelen. "It's extremely challenging."

Officials have been forced to be creative with vaccine distribution. For instance, Hopkins Hospital has had to share vaccine supply with its affiliate, Howard County General Hospital, which has yet to receive its own shipment, Kelen said.

Because they don't have enough vaccine to begin inoculating all vulnerable groups, Hopkins officials are putting a contingency plan in place, using a tiered system to designate the neediest, starting with health care workers who work in high-risk settings, pregnant patients and hospital staff, children 4 years old and younger and children 18 and younger who have compromised immune systems and underlying health problems.

And yet, said Kelen: "We don't believe we have enough for that group."

The CDC initially said 120 million doses of the H1N1 vaccine would be available to the states by October. Last Friday, Dr. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases, told reporters that figure would be closer to between 28 million and 30 million. She said the figures change daily and asked that people remain patient as the government carefully rolls out the vaccine to the public, testing for potency, purity and safety.

St. Joseph Medical Center in Towson has not received the 3,100 doses of vaccine for hospital staff and another 2,000 intended for patients that administrators ordered. The one area that has received a shipment - the perinatal center - has burned through its supply.

Dr. Judy Rossiter, director of the perinatal center and head of the department of obstetrics and gynecology at the hospital, said the center received 300 doses of the vaccine last Tuesday and began making it available to its patients. Despite reports that pregnant women have been reluctant to be vaccinated against the flu, more than 80 percent have accepted, Rossiter said.

Once word got out that the center had a shipment of the vaccine, Rossiter began getting calls from parents who were not patients, hopeful to have their children vaccinated. She had to turn them away.

Pregnant women whose doctors are not affiliated with the center called, too. Rossiter accepted those patients, but she stresses that now that the center is nearly out of vaccine, it is taking no more appointments.

Still, she said, she's comforted that so many pregnant women want the vaccine.

"As a high-risk obstetrician, I've had the misfortune of seeing healthy pregnant women be extremely sick," she said. "It really makes you a convert. ... I'm pleased to see this response. People know that this flu is affecting young children and pregnant women disproportionately. The message has clearly gotten out."

Since Aug. 30, 43 children have died of the flu, as many as die in a typical flu season, according to the CDC. In Maryland, 10 people have died from the swine flu, including a 14-year-old Baltimore girl with no underlying health problems. Nationwide, in the first four months of the H1N1 outbreak, 100 pregnant women with the virus were hospitalized in intensive care units and 28 have died, according to federal statistics.

Faithe Williams of Pasadena made sure she got an appointment last week at a public health clinic in Annapolis, the first that Anne Arundel County offered. She took Alicia, 3, and Devon, 7, as soon as she could.

"My main concern was my children," she said after the kids had gotten the nasal spray version of the vaccine at the clinic. "One member of the family gets sick, and there is the trickle-down effect. I wanted the vaccine as soon as it was available."

Like many other school nurses in the region, Susan Bartolini, the school nurse at Friends School of Baltimore, is now seeing more cases of H1N1 flu.

"We have had good attendance, with little illness," she said. "But like everywhere else, now the numbers are starting to go up. There is more in the last week, though it's nothing alarming. Like everywhere, we're waiting for supplies to come in."

School officials also are reminding students to wash their hands or use the sanitizer that has been available in the classrooms for more than a year. And, stay away from those who are coughing, the nurse said.

"This is frustrating for parents," Bartolini said about the slow pace of vaccine distribution. "Some are able to hunt it down and some aren't. ... It's important to remember that most kids who become sick recover just fine at home with the supportive treatment of their parents. That doesn't mean it's not anxiety producing."

Swine flu vaccine comes slowly

* Maryland officials now expect to receive just 530,000 doses of H1N1 vaccine this month - nearly half the amount they initially hoped for.

* Nationwide, federal officials now expect to release 28 million to 30 million vaccine doses to the states in October, compared with the 120 million they planned.

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