The 2009 H1N1 flu vaccine continues to trickle into the region, and health department officials in the Roanoke and New River valleys are concentrating vaccination efforts on high-risk groups that include pregnant women and children between 6 months and 18 years old.

The H1N1 flu is commonly referred to as swine flu.

Dr. Karen Remley, state health commissioner, said Thursday the majority of Virginians who are not in high risk groups have been patient and willing to wait until more vaccine is produced and available nationally and regionally. But others who demand the vaccine from health departments must receive it, she said, if available.

"It happens rarely," she said.

The Alleghany/Roanoke City Health Districts launched school-based clinics today, and more are scheduled next week. Last month, the districts elected to postpone school clinics until more vaccine became available. On Oct. 22 it held appointment-only vaccination clinics at four health department offices.

School-based clinics resume in a limited way Monday in the New River Valley.

All clinics in the region will hinge on vaccine availability.

Dr. Jody Hershey, director of the New River Health District, said the district also has scheduled clinics this month targeted to children -- from 6 months to 18 years old -- and pregnant women.

The relevant word is "targeted."

"I really hope that people not in the target groups will be patient and allow time for us to receive more vaccine," Hershey said.

Remley said Thursday that the Virginia Department of Health hopes vaccine will be available to the general public by the end of November. Many private physicians who are registered vaccinators have received the H1N1 vaccine, Hershey said.

The H1N1 is especially contagious because few people have immunity to the novel virus.

Children 9 and younger will need two doses of the vaccine, spaced about a month apart. 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.

Meanwhile, supply of the seasonal flu vaccine remains spotty, too.

Eric Earnhart is a spokesman for Carilion Clinic, which, like other health care providers, has received doses in fits and starts of both the H1N1 and seasonal flu vaccines. Health care workers involved in patient care have been among the priority groups for vaccination.

"The good news is we have a core group of employees who have been vaccinated and are able to provide some continuity of care should things turn bad in this region," Earnhart said.

He said the vaccine production delays, though frustrating for many, will help inform efforts to prepare us for future pandemics when the virus strain may be much more dangerous than what we have today."

As of Thursday, the VDH had recorded 21 deaths in the state related to H1N1.