The state Department of Health is advising the public to be patient while waiting for wider availability of the H1N1 influenza vaccine — and, meanwhile, to keep washing your hands and covering your coughs and sneezes.

Health Department spokeswoman Janice Okubo said the state has been assured by the U.S. Centers for Disease Control and Prevention that eventually there will be enough vaccine for all those who want to be inoculated against the H1N1 flu virus, which has been a contributing factor in 11 deaths in Hawaii.

Health officials have acknowledged the H1N1 vaccine campaign got off to a slow start. But unlike on the Mainland, where the H1N1 influenza, or swine flu, is rampant, there have been no reports in Hawaii of long lines of people waiting to be immunized.

As vaccine manufacturers boost their production, "the number of doses delivered to Hawaii increases from week to week and even day to day," Okubo said.

A spot check of pharmacies and health care providers by The Advertiser found varying degrees of vaccine availability in either the injectable or nasal spray form. At some sites, the vaccine was being administered to members of priority groups, but at others the supply was more limited.

The Maui Medical Group ordered 5,000 doses and so far has received two shipments totaling approximately 2,000 doses, said president and chief executive officer Dr. William Mitchell. Fewer than 100 doses remain while the medical group awaits additional shipments.

Mitchell said the obstetrics and pediatrics departments received the largest share, since they serve the two biggest high-risk populations: pregnant women and children.

The Maui Medical Group has about 450 pregnant women under its care, and 150 of them have received the H1N1 vaccination, Mitchell said.

Another 30 pregnant women declined because of concerns about its safety, he said.

"There is some real misinformation about flu shots," Mitchell said. "To me that's too bad, because you're really immunizing two-for-one — the baby to be born as well as the mother. We're sorry that some people have these beliefs that we don't think are substantiated at all."

Maui Medical Group doctors this week are reporting an uptick in flu cases, but Mitchell said he hasn't detected a sense of panic in the public about getting vaccinated.

"A lot of people are wondering about it but many understand they are not in a high-risk group and they are putting off calling," he said.

Maui Medical Group has also been referring callers to pharmacies at Safeway and Walgreens where H1N1 vaccinations are offered.

There has been no shortage of H1N1 vaccine so far at the five Bay Clinic community health centers in East Hawaii, and patients in the priority groups are being given vaccinations as they come in for appointments for other services, said director of administration Sarah Naeole.

WIDESPREAD IN ISLES

Because the H1N1 influenza is so widespread, the Department of Health no longer tracks the number of cases. But the agency reports that, based on laboratory results from specimens sent in for testing, the H1N1 strain is the most prevalent in Hawaii, responsible for more than 90 percent of influenza cases here.

The CDC anticipates distributing 10 million to 20 million doses of H1N1 flu vaccine each week nationwide as states place orders. Vaccine doses are allocated on a weekly basis according to availability and population.

Okubo said H1N1 vaccine is sent to Hawaii from a central distributor in California. The vaccine and needles, syringes, alcohol swabs and needle containers are federally funded.

Hawaii ordered 104,000 doses of the vaccine and received an initial shipment of 30,000 doses last month.

Okubo said most states, including Hawaii, did not order their maximum allotment because of storage or distribution limitations. In Hawaii, there are more than 550 registered vaccine providers. Half of them are community health centers, group practices and other multiple providers, Okubo said.

"Some providers have been allocated more (doses) than others based on the numbers of priority groups and populations they serve as well as what they ordered," she said. "The total number of doses are limited now, therefore we cannot give everyone all the doses they want now. The department's goal, at this time, is to distribute doses as widely as possible to try to make vaccine available to all priority groups without focusing on just one group or area, so that some proportion of each group is vaccinated."

The first vaccinations were offered to health care workers, emergency medical service and critical civil defense personnel. Okubo said information on how many people have been vaccinated is not yet available.

According to CDC guidelines, next in line for the vaccinations are anyone between the ages of 6 months through 24 years; pregnant women; caretakers of infants less than 6 months; and people through age 64 who have chronic medical conditions that make them susceptible to complications from the flu.

After that, everyone else.

The Health Department said it will notify the public through its H1N1 Web site, the 211 help phone line, and the media when it is time for certain groups to get vaccinated.

FREE SCHOOL CLINICS

Free H1N1 vaccination clinics begin next week for students in kindergarten through grade 8 at more than 300 public and private schools. The clinics are separate from the regular "Stop Flu at School" clinics already under way for seasonal flu vaccinations.

The number of students who signed up for H1N1 vaccinations is not yet available because the deadline for parents to submit consent forms was Friday and the forms haven't yet been counted, Okubo said.

Approximately 75,000 parental consent forms were turned in for seasonal flu school-based vaccination clinics.

Although high schoolers fall into the same priority risk group as younger children, the state is not providing on-campus vaccinations for them. Students in grades 9 to 12 will have to get the H1N1 vaccine from their medical provider, and will probably have to pay a fee for it.

Okubo said the program was limited to elementary and middle schools because there already is a mechanism in place — the seasonal flu campaign — to run H1N1 vaccination clinics at those sites.

"The most efficient way for us to expedite the school vaccination for 2009 H1N1 influenza is to use the same system we already have in place," she said.

Okubo said that turnout was poor during a pilot project three years ago for the seasonal flu vaccination clinics at high schools. As a result, the Health Department decided to focus its efforts on kindergarten through eighth grade, where participation was much higher.

"With very little time to implement the over 300 additional (H1N1) school-based vaccination clinics statewide, DOH made the decision to focus on what we felt could realistically be accomplished," Okubo said.

Even though the CDC recommends two doses, four weeks apart,for children ages 9 and younger, only the first dose will be provided at school-based clinics. Parents should get the second dose from their child's medical provider, according to the Department of Health.

"The priority given to states by the CDC was to get the first vaccination completed as quickly as possible. This affords at least some protection," Okubo said.

UH STILL WAITING

University of Hawaii Health Services Mänoa plans to schedule H1N1 vaccination clinics when it receives the vaccine. About 9,000 students at the Mänoa campus fall into the priority age group, according to Dr. Andrew Nichols, interim director of UH Health Services Mänoa.

"We still have not received any vaccine. We ordered a bunch but how much we're going to get I don't know," Nichols said. "We're hoping to receive some soon. I was hoping we were going to get some in October."

Nichols said he ordered "thousands" of doses, and, if UH Health Services Mänoa receives only several hundred doses, "we really are going to have to target" who receives the vaccine.

Priority will be given to health care workers on campus, students in the medical, nursing and dental hygiene programs who have direct contact with patients, and students with chronic health conditions such as asthma and diabetes.

"That's 700 doses right there," he said.

Nichols said "there was so much hype" that the vaccine would arrive in October that some people have become anxious about delays.

"There are parents who really want it badly for their children and others who don't seem too worried. I feel it is out of our control. It's coming from the federal government, followed by state government. We are checking with the Department of Health a couple times a week to get the status. They're doing the responsible thing by distributing it in a way that's most appropriate," he said.

"If they get as many doses from the manufacturer as they say they are, there should be enough of this vaccine."

Because H1N1 influenza outbreaks have increased awareness of the flu in general, the number of seasonal flu shots administered by UH Health Services Mänoa is up 50 percent from previous years, Nichols said.

He said H1N1 immunization scheduling details will be announced as soon as the vaccine arrives.

Okubo said that eventually all providers that registered for the vaccine and placed an order will receive their supply.

"Until then, it is important for everyone to practice good health habits to prevent the spread of illness, such as staying at home when they are sick, covering their cough or sneeze, avoiding touching eyes, nose and mouth, and washing hands," she said.