Sept. 30, 2009 -- After all the waiting and worrying, the first of the swine flu vaccines will begin arriving in the United States next week.
Dr. Richard Besser, ABC News' senior health and medical editor and the former head of the Centers for Disease Control and Prevention in Atlanta, said the nasal spray will be distributed first, at the beginning of next week, with shots arriving by week's end.
"It's going to be rocky early on, as more people want the vaccine than is available," Besser said.
He also expressed concern about the rise in deaths, especially among normally healthy children and teens. Besser said his sons will be in line for their vaccine when it's available to them.
"We need to have a healthy respect for this infection," Besser said.
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Health officials across the country were concerned not with the availability of the vaccine, but the organization of vaccine distribution and public awareness of the need for high-risk patients to be vaccinated.
Ed Barham, at the Arkansas Department of Health, said "people are frightened of swine flu, but they're also frightened of the vaccine. We're worried parents won't allow their kids to get the vaccine, since it's optional."
Texas has seen the worst of the swine flu outbreaks, with the Northwestern states seeing rising numbers.
Dr. Ari Brown, an Austin-based pediatrician, told ABCNews.com that her office alone, which consists of seven doctors, is seeing "about 300 to 350 patients a day, many of which have swine flu."
Brown said her office has been inundated with swine flu cases for the past two weeks but, fortunately, "no one is very sick [and] we have had just one hospitalization."
Given the rise in swine flu cases, the Texas Department of State Health Services has created a 211 number that people can dial for medical guidance if they or a family member should come down with swine flu.
Dr. Daniel McCarter, who directs clinical affairs at the University of Virginia, said there are 20 staff members with flu, and the student health center at the university has 242 affected patients.
Virginia State Health Commissioner Dr. Karen Remley said, "We are seeing a lot of disease in schools and colleges, more in southern rather than northern parts of the state."
In Alabama, Dr. David Freedman, director of the UAB's Traveler's Health Clinic, said he expects cases in the state to peak this week or the next. And, in North Carolina, Dr. David Weber of the University of North Carolina-Chapel Hill said H1N1 cases have been increasing in the past two weeks.
Tennessee state epidemiologist Dr. Tim Jones told ABCNews.com that "almost 100 percent of flu cases we're testing are swine flu -- if they have flu, they have swine flu."
California, Northeast Faring Better With Swine Flu
He said there have been 13 confirmed deaths and the "western side of the state is hardest hit, particularly Memphis, where we're seeing 450 kids a day and had to set up triage tents."
Further south, at Florida State University in Tallahassee, Dr. Curtis Stine said there has been "quite a bit [of swine flu] in the community and quite a bit among students at the colleges," although he has seen few hospitalizations.
Northwestern states are also seeing steady increases in swine flu cases. Dr. Scott Fields of Oregon Health and Sciences University said he's just seeing a high rate of viral illness.
Dr. Frank James of the University of Washington said he has seen 14 swine flu deaths so far and that daily school absenteeism last week reached 10 percent in one school in each district, "so the number of cases … is definitely rising.
In contrast, California and the northeast seem to be faring better.
Dr. Amy Kaji of UCLA said H1N1 cases have dropped off since April-May, and Dr. Andrew Racine of the Montefiore Medical Center in New York said "we've seen very, very little flu activity so far -- which is in keeping with the information we're receiving both from the New York City Department of Health and from the CDC, which is showing only sporadic flu activity in New York."
Racine said all indications are that the first shipments of H1N1 vaccine will only be about 18,000 doses for New York City.
But given the low incidence rates thus far, he said, "ultimately the city will have more flu vaccine than it probably needs."