She said doctors will work with the Health Department to begin setting up appointments for those chronically ill patients, beginning in about two weeks and running for about a month, until mid-December. Those with no personal physician may go through community health centers for referrals, she said.

Park said there is no evidence of any large outbreak of flu, but officials have learned of both Type A and Type B illnesses. She said the season normally peaks in December.

"We are getting reports from all islands of a case here or there," she said. "It's definitely here."

She said the Health Department has notified doctors about how the appointments will be arranged statewide. As a key part of that process, physicians will be required to fill out a special "Flu Vaccine Order Form 2004-05" to give to patients to carry to their appointments.

There is no cost to the patient for the flu shot, she said.

Park said doctors who know the patients best will determine who needs the vaccine most. Health officials recommend that most healthy people skip the flu shot this year because of a shortage caused when manufacturer Chiron Corp. was prohibited by British authorities from distributing about 46 million doses this year, roughly half the U.S. supply.

Since the shortage was announced on Oct. 5, state and federal officials have recommended that flu shots be reserved for those at highest risk. They include babies 6 months to 23 months old; people 65 and older; anyone with a chronic condition such as diabetes, asthma, heart or lung disease; pregnant women; residents of nursing homes and long-term-care facilities; healthcare workers who tend to be in high-risk groups; people who care for infants; and children on aspirin therapy.

Because there is not enough vaccine available to give shots to all who fit in those groups, Health Department officials have targeted the state's vaccine supply only for chronically ill children, adults and elderly as well as the frail and elderly in long-term-care facilities.

"We don't know the patients. We're relying on our physicians to identify those who are most vulnerable," Park said.

Aloha United Way's 211 help telephone operation has had to add staff to cover the large number of calls they have received about flu shots, according to program director Havinne Anderson. 

"It's been crazy. We've been flooded with calls," Anderson said. Since the flu shot shortage began, Anderson said the majority of the calls received by the agency are about flu shots.

Since the regular clinics have run out of vaccine, 211 has continued to get calls, with a peak of 1,881 calls the week the shortage was announced.

Anderson said there was a smaller spike this week after news broke that more vaccine was arriving and would be available within weeks. She said the 211 staff encourages people to try back. "We just ask them to continue to be patient."

The Health Department was flooded with calls. Judy Strait-Jones, of the Immunization Branch, said the state received as many as 100 to 200 calls daily after the shortage began, but that number had declined in recent weeks. As doctors were notified of the new vaccine and how to refer patients, the calls are coming in again.

Strait-Jones said her office got 60 calls yesterday morning and helped set up 381 appointments on Wednesday for the chronically ill.

Deputy health director Dr. Linda Rosen said officials are hopeful that Hawai'i may have enough flu vaccine to protect those at highest risk for serious complications through this flu season. That's because Hawai'i healthcare providers received about 230,000 doses of flu vaccine this year although it's unclear how much is left or how that compares with the number of doses distributed last year.

Park said patients must bring the order form and make an appointment. "They should not just show up; they will not be given a shot," she said. "That order form is imperative."