With supply growing and demand waning, Maryland officials announced Tuesday that they are expanding distribution of swine flu vaccine beyond priority groups and making it available to any adult who wants one.
In Maryland and nationwide, infections from the H1N1 virus peaked in late October and have plunged since. In recent weeks, once-mobbed flu clinics across the state have seen just a trickle of people - so much less demand than expected that officials have had vaccine left over once the doors closed.
Public health officials view the lull as an opportunity to urge everyone to get vaccinated. As officials open access to the general population, they are reaching out to the elderly, planning more robust clinics and intending to supply vaccine to local pharmacies, which can offer vaccinations at their customers' convenience.
While infections are down, a third wave of the virus is possible once winter sets in, influenza experts warn.
"We are preparing ourselves in the event that it happens. Whether it happens or not, I don't know," said state Health Secretary John M. Colmers, adding that, to date, the state has received 1.5 million doses. "But we want to focus our attention on getting people vaccinated."
Shortly after doors opened Tuesday at the Baltimore County Health Department vaccine clinic at the Maryland State Fairgrounds in Timonium, several hundred people had already rolled up their sleeves for a shot. About half of those waiting were senior citizens, who had been given low priority for the vaccine because they have shown more immunity to the virus.
Diane Dona, 79, of Towson rushed to the fairgrounds as soon as she heard she was eligible for the vaccine. The last few months, she had called the Health Department so many times inquiring about the vaccine that she was on a first-name basis with staff.
Distance aside, the swine flu shot was the one thing that separated Dona from her daughter in Boston. Without one, Dona feared she could pass along deadly germs to her daughter, who is waiting for a double lung transplant.
"I am so excited I got the shot, I can't keep myself together," said Dona, who plans to visit her daughter for Christmas.
"This is going great, we have a lot of elderly people coming out," said Dr. Gregory Branch, the county's health officer, who was chatting up people at the fairgrounds clinic. "It's very important to do this now. We know during the holiday season people will visit family members and travel, increasing the chances of transmission."
County health officials were hoping to vaccinate 5,000 to 6,000 people Tuesday and the same amount at today's clinic at the fairgrounds.
Recently, however, clinics have been running a 20 percent no-show rate for appointments, Branch said. Last week, at a Reisterstown clinic intended for 4,000 people, about half that number showed up. Meanwhile, for months, the department has fielded calls from people not in the priority groups but eager to get vaccinated.
The lack of people at recent clinics is a huge contrast to one of the department's early efforts at Perry Hall Middle School in October, when thousands clamored for vaccine, some even camping out the night before. Many were turned away when inoculation doses ran out.
Since the vaccine became available this fall, the Centers for Disease Control and Prevention urged states to restrict it to the groups at most risk for complications from the virus - pregnant women, children and their caretakers, health care workers and people with chronic health problems.
After the outbreak in the spring, flu experts warned that the virus could come back with a vengeance in the fall. While CDC estimates showed the virus has sickened as many as 22 million people nationwide from April through mid-October, with about 98,000 hospitalizations and 3,900 deaths, infections have slowed substantially. The virus is widespread in 25 states, down from nearly every state a month earlier, the CDC said last week.
Flu experts aren't sure why infections are down but believe it's partly because the virus has circulated so widely that it has fewer people left to infect. Still, experts warn, the flu is unpredictable. Last week, Johns Hopkins Hospital reported two cases of antiviral-resistant swine flu. While those cases are isolated, experts worry that if the resistant strain spreads, the flu could become harder to treat.
Now that the vaccine will be available to more people, Baltimore officials expect to see an uptick in people seeking vaccinations. At a health department clinic Tuesday offering immunizations of all types, about 90 people received the swine flu vaccine, about three times the number in recent clinics, said Dr. Anne Bailowitz, the city's acting chief medical officer.
The city has vaccinated about 10,000 of the school system's children, with plans to reach every city school by the end of this week. The department will offer clinics in the city's private schools next week.
Dr. Robert Hsiao, a primary care doctor at Greater Baltimore Medical Center, said he is looking forward to vaccinating patients who have been patiently waiting. His practice of 10,000 patients had available just 200 doses of vaccine the first week of November.
Dr. Gabe D. Kelen, director of Hopkins' Office of Critical Event Preparedness and Response, said the health system and university's most vulnerable populations have already been vaccinated and he hopes to reach more people - particularly university students before they leave campus for winter break.
"The payoff of the vaccine is not just to the individual," he said. "You are protecting your friends and families and the population at large."
H1N1 vaccination clinics
* Baltimore County: 9 a.m. to 3 p.m. Wednesday at the 4-H building at the Maryland State Fairgrounds, 2200 York Road, Timonium.
* Baltimore City: 10 a.m. to 2 p.m. Friday at the Enoch Pratt Central Library, 400 Cathedral St. Seasonal flu shots will also be available.
* Anne Arundel County: 10 a.m. to noon and 1 p.m. to 3 p.m. Tuesday, Dec. 15, at the Health Services Building, 3 Harry S. Truman Parkway, Annapolis.
* For more clinics, visit baltimoresun.com/health/swine-flu