First allotments of the vaccine have been small, providing enough vaccine to reach only a fraction of states' target populations. The number of high priority individuals that can be vaccinated is further reduced by the limitations of the nasal spray form of the vaccine that is currently available. The current version uses a live strain of the virus, so it is not safe for those with compromised immune systems such as young infants, the elderly, those who are pregnant, or those with asthma or respiratory illness.
As a result, facilities have been giving the vaccine predominately to eligible health care workers who come into contact with flu patients -- and in a few locations, to healthy children between the ages of 2 and 4.
In Chicago, where swine flu prevalence is widespread, Children's Memorial Hospital received 500 doses on Monday and chose to allocate them all to hospital staff. Similarly, in other swine flu hot spots such as Indiana, Minnesota, Wisconsin, Utah, Mississippi, and Virginia, shipments of vaccine have arrived and are being given to health care workers who treat flu patients.
Still, a few hospitals and clinics are expanding vaccine programs to include 2- to 4-year-old children. As of Tuesday morning, a few hundred children were given the nasal spray vaccine in Georgia, Illinois and Nebraska. Oklahoma will hold the state's first H1N1 flu clinic for schoolchildren in Newcastle on Wednesday.
As the number of available doses is too small to advertise the vaccine publicly, most centers are offering the vaccine to eligible children already coming in for their annual check-ups.
"There is a dramatic and pressing need at the present time" for the vaccine, said Dr. Mark Rupp, Medical Director of Epidemiology for the Nebraska Medical Center. "Our ER and some of our clinics are operating at record levels right now with a large number of patients with influenza-type illness."
Rupp added that the hospital will take and use "whatever form of the vaccine we can get our hands on. We're looking to protect people as quickly as possible."
Not all in the medical profession are so eager to give out the nasal spray vaccine, however.
Though the Lahey Clinic in Burlington, Mass., received 500 doses of the nasal vaccine on Monday, it has yet to vaccinate anyone.
"Lahey Clinic generally prefers to vaccinate its caregivers with the injectable flu shot [instead of] the nasal spray with the live virus," said Dr. Robert Duncan, an infectious disease specialist at the clinic. "This method eliminates the risk, albeit small, of transmitting a live virus to immune-suppressed patients."
As a result, infectious disease doctors at the clinic are currently reviewing when and to whom they will give the nasal spray. This more deliberate approach runs counter to advice from Frieden. "We ask that places don't hold vaccine back, vaccinate as many people as you can," he said.
But the doctors at Lahey Clinic are not alone in their desire to more carefully approach who gets what vaccine when.
Dr. Ira Rubin, a pediatrician in Naperville, Ill., has chosen to wait for the injectable vaccine before vaccinating his patients. Though the state offered his clinic doses of the nasal spray vaccine this week, he feels that there are risks associated with the giving the spray that he would rather not take.