Health officials yesterday urged the estimated 24,000 pregnant women in Hawai'i to get immunized against the H1N1 influenza virus.

Pregnant women are among the population groups that have experienced severe complications from the so-called swine flu, and several in the Islands have required hospitalization in intensive care units, according to obstetrician Dr. Tod Aeby of the University of Hawai'i's John A. Burns School of Medicine.

All of those women recovered, he said, but others are at risk because the physiological changes that occur during pregnancy make them vulnerable to complications.

"Once they become ill, a certain number develop viral pneumonia that doesn't respond to antibiotics," said Aeby, appearing at a state Department of Health media briefing.

As their condition worsens, the women may have to be placed on respirators, he said.

None of the 11 H1N1-related deaths in Hawai'i involved pregnant women, but nationally about 100 pregnant women with the swine flu have been hospitalized in intensive care and 28 have died, he said.

Aeby, who also works at Kapi'olani Medical Center for Women & Children, said an expectant mother can receive the vaccine from the earliest stages of pregnancy until just before delivery. Since newborns cannot be vaccinated, new moms leaving the hospital are being immunized to keep them from passing the virus to their babies, he said.

The UH medical school is making 300 injectable doses of the H1N1 vaccine available by appointment only to pregnant women. There is no charge for HMSA members, but for others there is a $7 fee.

Registration forms are available online.

Women also can get immunized at their physician's office, pharmacies and community health centers.

Aeby offered reassurance that the vaccine is safe for pregnant women and their unborn babies.

"Obviously, it's a relatively new vaccine and testing has been done nationally, and the experience on the Mainland has shown it's at least as safe or more safe than all the other seasonal flu vaccines because it's not a live virus," he said.

Maui Medical Group has immunized about 300 of its 400 pregnant patients, said president and chief executive officer Dr. William Mitchell. He said patient concerns about vaccine safety appear to be waning.

"There is less reluctance. A lot of the discussion has gone away and people seem to be getting it for the most part," he said.

A report yesterday by the U.S. Centers for Disease Control and Prevention that swine flu has been on the decline in recent weeks has Mitchell and other health officials worried the public may become complacent about getting immunized.

"In Hawai'i, I think we're not seeing a lot of (H1N1 influenza) but we're seeing some of it. It may well be that the other shoe is about to drop. I would still urge those people who should get (the vaccine) not to be lulled into thinking the potential for a flu epidemic is behind us," Mitchell said.

The CDC said the H1N1 virus sickened an estimated 50 million Americans and killed about 10,000 from April to mid-November. That means about 1 in 6 Americans have had the illness.

Most people who come down with the swine flu experience symptoms similar to or milder than seasonal influenza, which kills about 36,000 Americans each year.

The CDC also estimates that nearly 200,000 people were hospitalized through mid-November — about the same number that occurs normally in an entire winter flu season.

MORE DOSES ON WAY

The swine flu vaccine first came out in early October in very limited supplies, but deliveries have picked up dramatically, the CDC said. Hawai'i was allocated 344,900 doses, and 221,340 — or 64 percent — have been received or are in transit to the state, said Health Director Dr. Chiyome Fukino.

The Health Department said of the roughly 357,000 people in Hawai'i who should get H1N1 vaccinations, nearly 70,000 have done so. Getting detailed information on who is getting the vaccine is difficult because only 25 percent of providers have been reporting back, Fukino said.

For now, immunizations are being offered only to pregnant women and other priority groups: caregivers of children under 6 months of age; health-care and emergency services workers; people with asthma, diabetes and other chronic ailments; and everyone between the ages of 6 months and 24 years.

After complaints that major health care providers such as Kaiser Permanente weren't getting adequate supplies, the state dropped a first-come, first-served distribution system to one based on how many patients a provider has, whether the provider serves multiple islands, and whether the provider submits tracking reports on a timely basis.

Priority also is given to pediatricians and obstetricians because they care for two target groups: children and pregnant women.

Kaiser Permanente, which has 224,000 members throughout the state, received a vaccine shipment at the first of the month, but it's not enough, said spokeswoman Lynn Kenton.

"We have a large number of members in high-risk groups, and what we have received does not yet cover all of our high-risk members," she said.

Mitchell said Maui Medical Group went for a two-week period without vaccine, but received 400 doses last week and 200 this week.

"The Department of Health has been sending intermittent supplies and we never know when we're going to get it, but it's been pretty good," he said.

YOUTH GROUP LAGS

The state set aside 76,460 doses for its vaccination program in elementary and middle schools. Fukino said more than 33,100 students and school employees at 200 campuses have been immunized under the program, which will continue into the new year.

The student participation level is about 43 percent, similar to that of seasonal flu immunization clinics at schools, she said.

Now that health officials have a clearer picture of how many students signed up, excess H1N1 vaccine from the school clinics has been released to other providers, according to Fukino. Each of the state's 567 registered vaccine providers has been supplied with at least 50 doses, she said.

The latest Health Department statistics show the 19-to-24 age group is lagging in swine flu immunization, even though young adults are a high-risk group that has suffered a large proportion of H1N1-related deaths in the U.S.

Only 4 percent, or 2,950 college-age adults, have received the vaccine, the agency said.

UH-MÄNOA SHORTAGE

Distribution to University of Hawai'i Health Services Mänoa was delayed and the vaccine still is not widely available to the 9,000 or so students in the target age group. As of yesterday, the campus health center said it had received only 550 doses, which went to students in medical programs, health services staff and students with serious medical conditions.

Health Services reported on its Web site that the number of cases of influenza-like illness "is still low," and that six students with H1N1 symptoms visited the campus clinic last week.

Fukino said college and high school students will have to get their immunizations from their own physicians, a community health center or elsewhere. However, parents should be aware that under state Board of Pharmacy recommendations, most pharmacies will not administer vaccinations to children under 18.