October 7, 2004, Thursday Late Edition - Final

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For Flu Shots, Smaller Supply, More Concern

By KIRK JOHNSON; Reporting for this article was contributed byTerry Aguayo in Miami, Chris Dixon in Los Angeles, Laura Griffin inDallas and Mindy Sink in Lakewood, Colo.

DENVER, Oct. 6

Suzanne Walker arrived at a suburban grocery store near hereWednesday afternoon for the annual ritual of a flu shot.

So she filled out the forms and stood in line, but when she got tothe front was told that while there was plenty of vaccine for others,there would be none for her. As a healthy 58-year-old, she was notamong the groups on the priority list: infants, elderly, chronicallyill and front-line medical workers. Ms. Walker understood, but stillfound herself annoyed.

''I just wish they would have called and told me,'' she said.

The flu season is not here yet, but with the nation suddenlyfacing a profound vaccine shortage, an uncertain triage of prevention-- who will get a shot and who will not -- began in earnest onWednesday.

The British government halted vaccine shipments to the UnitedStates on Tuesday because of concerns about contamination at afactory owned by the Chiron Corporation, a major vaccine supplier,and health officials estimated that as much as half of the expectedAmerican supply could be affected. The flu season typically begins inlate fall.

An equally profound wrinkle, health officials said, is that thevaccine supply is uneven, and in most cases largely unknown as well,since most vaccine purchases are private transactions that are notreported to the government.

The federal Centers for Disease Control and Prevention, which haslong tracked the spread of flu, said on Wednesday that it wouldimmediately start tracking vaccine supplies, to try to match hotspots of infection with available reserves.

Some health officials around the country were celebrating theirluck in landing supplies early or ruing their fate in having none tooffer.

The Texas Department of State Health Services, for example, byWednesday had received most of the 543,000 doses of vaccine that ithad ordered, a spokesman said.

But in Florida, Dr. Gordon Dickinson, a specialist in infectiousdiseases at the University of Miami and at the VeteransAdministration Medical Center in Miami, went to get his own shot atthe center and was told there was not enough vaccine, even for thestaff.

Last year, the V.A. hospital received between 10,000 and 11,000doses, Dr. Dickenson said. So far this year it has received only acouple thousand, now all but gone. ''We're down to one or twodoses,'' he said.

Private companies around the country, from Boeing in Chicago, toQwest Communications here in Denver, said they were putting theiremployee-vaccination programs on hold. Hospitals began prioritizingwho among their staff and patients would get vaccinated, and when.

At the University of Southern California Medical Center in LosAngeles, Jeff Goad, an assistant professor of clinical pharmacology,said that the first to receive vaccinations would be primary healthcare workers like doctors, nurses and pharmacists. Patients, he said,would be screened according to the interim federal guidelines.

Those guidelines give priority in vaccination in particular toinfants 6 to 23 months old; adults 65 and older; people with chronicmedical conditions; women who will be pregnant during the flu season;nursing home residents; children who take long-term aspirin therapyfor illnesses like juvenile rheumatoid arthritis; health care workersresponsible for direct patient care; and people who live with or carefor children younger than 6 months old.

But the director of the Centers for Disease Control andPrevention, Dr. Julie L. Gerberding, said Wednesday in a conferencecall that the guidelines could be tightened or loosened based on theseverity of the flu season and the problems of supply.

For example, Aventis, the other major supplier of the vaccine, hastold the government that it could produce an additional million dosesthis year, but no more than that, according to Tommy G. Thompson, thehealth and human services secretary, who spoke on the same conferencecall.

Federal officials had hoped to have 100 million doses of vaccinethis flu season, but the halt in shipments means that perhaps onlyabout 55.4 million will be available, Mr. Thompson said, plus anotherone million or two million doses of a nasal spray vaccine, which isnot suitable for the full population, particularly young children.

Doctors say that no two flu seasons are ever alike, but someresidents here in Colorado, where the last season started early andhit hard, said they were taking no chances. At least 619 people,including 12 children, were killed last year by influenza andpneumonia in Colorado.

''I like being active, I don't like being laid up,'' said BernardReder, who showed up at Flu Central, a clinic in Lakewood justoutside Denver. Mr. Reder, 68, was old enough to qualify for the $18vaccination, which he sought in preparation for a trip abroad.

Doctors like Larry Wolk were bracing for some tough choices. Iftwo children show up at his nonprofit clinic here, Rocky MountainYouth, and he has only enough flu vaccine for one, who gets the shot?

''We may have to make a clinical judgment as to who is most atrisk, and then discriminate,'' said Dr. Wolk, the clinic's founder,who was vaccinating children on Wednesday. A child with asthma, forexample, would get priority over a healthy child, he said, sinceasthma could compound the flu's effects. A 1-year-old would be ahigher priority than his 2-year-old sister, and so on.

Dr. Wolk said he had hoped, until Wednesday afternoon, that anyshortage of regular vaccine might be made up by the clinic'sparticipation in a medical study for a nasal mist vaccine. But hesaid a representative of the manufacturer, MedImmune, called and saidsupplies might be directed to the military, so the mist might be inshort supply as well.

In some hospitals, officials said they had adequate supply fortheir patients, but not their doctors.

Tanya Bell, a spokeswoman for Penrose-St. Francis Health Services,a 522-bed hospital in Colorado Springs, said the hospital had 320doses of vaccine, enough for the patients who needed it. The staffvaccination program usually begins in November, Ms. Bell said,adding, ''We're just hoping we'll have it by then.''

At the offices of Pediatricians of Dallas, nurses were callingpatients on Wednesday to cancel their flu-shot appointments. Doctorsthere, expecting a rough flu season, sent cards to the patients lastmonth recommending that everyone get a shot. Now they havebacktracked.

''Parents are angry and wondering what they're supposed to do.It's frustrating to everyone,'' said one physician at the practice,Dr. Claire S. Curtis. ''We do have the flu in Dallas now. It's beenreported. We know it's out there. And we've given the shot to a lotof people, but there are a lot more waiting.''

Dr. Curtis said that most of those who got the shot did not havepriority status, just families who came in early or came in forcheck-ups when supplies were bountiful.

''We had ordered so much, we were initially giving it to everyone,kids and their parents,'' she said. ''But we never received the restof our order.''

Images: Photo: Customers lined up yesterday for a flu vaccinationat the King Soopers grocery store in Lakewood, Colo. (Photo by KevinMoloney for The New York Times)(pg. A33)

Graph: ''Flu Vaccinations''

The number of Americans vaccinated for the flu nearly tripledduring the 1990's.

Graph tracks the doses of flu vaccine distributed in millions from1998-2004*.

*54 million doses of the flu shot are expected to be availablethis year.

(Source by Centers for Disease Control and Prevention)(pg. A33)