UPDATED 12:20 p.m. Oct. 21: Roanoke health districts' phones overwhelmed; parents advised to keep trying

Editor's note: The story has been clarified to note that all school-age students in the Alleghany/Roanoke City Health Districts are eligible for the vaccination clinics, not just elementary-age children as the district had indicated on Tuesday.

Production delays by manufacturers of 2009 H1N1 flu vaccine pushed the Alleghany/Roanoke City Health Districts back to the blackboard this week.

For the time being, instead of vaccinating school-age children during on-site school clinics -- slated first for elementary schools -- the Alleghany/Roanoke City Health Districts plan first-come, first-served vaccination clinics for students Thursday at district offices in Roanoke, Salem, Botetourt County and Covington.

Vaccinations at the four clinics against H1N1, commonly known as swine flu, will be by appointment only. All school-age students in the districts are eligible. Vaccinations will continue until available doses are exhausted.

Temporary shortages of the vaccine also plague the New River Health District, but the district planned Tuesday to move forward today with vaccinations at five schools in the New River Valley -- two elementary schools in Floyd County, two elementary/middle schools in Giles County and one elementary school in Montgomery County.

Dr. Jody Hershey, director of the New River Health District, said enough vaccine is available for students at the five schools but currently low supplies of H1N1 vaccine in Virginia and elsewhere could alter the schedule of upcoming school clinics in the New River Valley.

"Our previous plans for vaccination, including our plans for school-based clinics, are being revised due to slower than expected release of vaccine," he said. "As a result, it may take us longer to complete our school-based vaccination efforts."

Dr. Stephanie Harper, director of the Alleghany/Roanoke City Health Districts, described a similar situation in her districts, where total student numbers are higher than in the New River district.

She said health officials decided to start with the clinics this week and that on-site school clinics will begin once vaccine stocks are replenished. She said that probably will happen within two weeks.

"The actual dates are a moving target right now," Harper said.

She said she had hoped the on-site school clinics in her districts would begin this week. The districts include the cities of Roanoke, Salem and Covington and the counties of Roanoke, Botetourt and Craig.

Craig County students whose parents consented received the H1N1 vaccine Oct. 15 as part of a pilot program.

Harper emphasized that the H1N1 vaccinations are voluntary and not required either by the Virginia Department of Health or schools.

Free vaccinations against H1N1 for students in both the New River and Alleghany/Roanoke City health districts will go first to younger children.

At least two realities support the initial focus on younger students, Hershey said.

First, children 9 and younger will need two doses of the vaccine, spaced about a month apart. Younger students also fall within one of several risk groups -- from age 6 months through 24 years old.

Only the injectable flu shot vaccine, containing the preservative thimerosal, will be offered in the New River Valley school-based clinics, Hershey said.

Harper said there are some supplies of both injectables and nasal spray vaccines in the Alleghany/Roanoke City Health Districts. Most are flu shots, she said.

In some quarters, the inclusion of thimerosal in vaccines has been controversial. But the Centers for Disease Control and Prevention, other federal agencies and several independent organizations have concluded that thimerosal is safe, Hershey said. The CDC has reported that "the most recent and rigorous scientific research does not support the hypothesis that thimerosal-containing vaccines are harmful."

The nasal spray vaccine does not include thimerosal or other preservatives.

"It is a live virus vaccine containing a weakened form of the virus," said Dr. Lee Anne Steffe, a pediatrician with Lewis-Gale Physicians in Salem. "It does not give you influenza but stimulates your body to produce antibodies in the same way as infection does."

For the injectable vaccine, the child needs to be at least 6 months old, and for the nasal spray, the child needs to be at least 2 years old and healthy, Hershey said.

"If parents prefer that their child receive another form of the 2009 H1N1 vaccine -- such as the nasal spray -- they should contact their primary health care provider or their local health department," Hershey said. Some children with underlying medical conditions should not receive the nasal vaccine, he said.

The majority of healthy children and adults are adequately protected against H1N1 about two weeks after vaccination.

For children unable to participate in school-based clinics, H1N1 vaccine also will be available eventually through other venues, including local health departments, private medical offices, pharmacies and retail stores.

Some parents missed deadlines for returning consent forms to schools. Deadlines help ensure enough vaccine would be on hand on the day of a school-based clinic, Hershey said.

According to the Virginia Department of Health, H1N1 vaccine should be available to the public in mid-November, and Harper said everyone who wants a vaccination will be able to receive one.

Meanwhile, the CDC, the U.S. Department of Health and Human Services and local infectious disease specialists all emphasize that children -- with few exceptions -- should be vaccinated against both H1N1 flu and seasonal flu.

"I am concerned that persons are more fearful of the vaccine than the illness," Steffe said Tuesday.

She added that the potential for serious complications related to H1N1 "is real and much higher than the risk of complications from the vaccine."

The CDC has reported that at least 20 percent of pediatric deaths that have been attributed at least in part to H1N1 have occurred in otherwise healthy children.

Steffe said the plan for school-based vaccinations is sound.

"I am so excited about the administration of the vaccine in schools," she said.

By vaccinating this age group, she said, "we have the opportunity to perhaps prevent spread to other vulnerable persons, younger siblings, pregnant mothers, teachers and older adults."

Hershey added, "It is my hope that New River Valley residents will be patient and voluntarily set their needs aside while we get our children vaccinated."

In Floyd County, school clinics today are at Willis Elementary and Indian Valley Elementary. In Giles County, they are at Macy McClaugherty Elementary/Middle School and Eastern Elementary/Middle School.

In Montgomery County the clinic is at Margaret Beeks Elementary.