By Anita Manning, USA TODAY

Delayed shipments and spotty distribution of available flu vaccine are frustrating doctors, frightening senior citizens and spawning an unprecedented demand for the vaccine.

On Tuesday "we had a (flu shot) clinic where normally they'd see 200 to 300 people and they saw 700," says Steven Dettwyler, director of the immunization program for the Delaware Department of Health and Social Services.

"A lot of doctors and long-term-care facilities have not gotten their shipments, and some have been told they're not getting any at all," he says.

Dettwyler says the shortage has made vaccine a "desired commodity." People who have skipped a flu shot in previous years are lining up, he says. "There's a lot of flu hysteria going on."

Shipments from vaccine producers are more than a month behind schedule because of manufacturing problems and an unexpectedly low yield. Many doctors and public health officials say they're receiving only partial orders, if any. Meanwhile, in some parts of the country, vaccine campaigns sponsored by large employers or retail chain stores are raising questions in some minds about whether vaccine is getting to those who need it most.

"If you're giving it to employers, that's not the high-risk group that should be getting it," says Ross Black, a family doctor in Cuyahoga Falls, Ohio.

A spokesman for Aventis Pasteur, which manufactures about half the U.S. flu vaccine supply, says there is a misperception that the company is delivering vaccine to big customers first, leaving smaller medical practices for last.

"Those customers who requested early distribution got (vaccine) in early September," spokesman Len Lavenda says. "The rest are based on when they ordered it."

He says that until last week, the company's policy was to fill orders completely in the order in which they were received. But a Centers for Disease Control and Prevention advisory committee suggested splitting shipments so that more health care providers would have at least some vaccine.

"We decided to change our policy," Lavenda says. "The goal is to have all customers receive partial shipments prior to Nov. 17 so everybody has some for high-risk patients. We're trying to act in the most responsible manner possible in the context of a very difficult situation."

Most years, shipments begin going out in late July and are completed by mid-October. This year, the company didn't start shipping until early September and will continue through January, he says.

That should give most people who need vaccine the time to get it, health officials hope.

The CDC recommends that people at greatest risk of serious illness or death from influenza — the elderly, the chronically ill, and those in the second or third trimester of pregnancy — be vaccinated first, and that others wait until December, when supplies are expected to be more plentiful.

Sporadic cases of the flu are occurring in 12 states, says Keiji Fukuda of the CDC's influenza branch, but in most years the epidemic doesn't take hold until late December or beyond.

"Ideally, we do like to get vaccinated in October through mid-November, so it's always a little bit of a gamble vaccinating people later on," Fukuda says. It takes about two weeks for the vaccine to develop full protection, he says. But in 14 of the past 18 flu seasons, the epidemic peaked between January and March, so the odds are favorable that vaccinating through December will get the protection into people before the height of the influenza season.

High demand for vaccine is creating a spike in the price for flu vaccine, says Steve Wright, national director of wellness services for Maxim Health Services in Columbia, Md., which administers flu shot campaigns at corporations and retail locations.

He says his company pays $25 to $35 for a 10-dose vial, but he has received calls from distributors asking for much more. "We've been getting offers up to $150 a vial, which we've turned down because we can't afford it."

Food and Drug Administration spokeswoman Lenore Gelb says the agency has heard of higher prices for flu vaccine, but she says the FDA regulates only the manufacturers, not the distributors.

Wright says his company initially delayed flu shot campaigns by three weeks, in accordance with CDC recommendations. But because demand was so high, once the campaigns began in mid-October, the company ran through half a million doses in two weeks . Normally, that supply would last seven weeks, Wright says. The company has run out of vaccine and has put a hold on vaccination campaigns until at least Friday.

The CDC, which warned of a possible vaccine shortage in June, ordered 9 million doses — a first for the agency — Fukuda says . He expects the available vaccine supply to reach 75 million doses.

"Right now, there clearly is a level of anxiety about the vaccine," he says. "We want to get the word out that there is more vaccine coming. It will be coming out in November and through December. We're expecting there will be approximately as much vaccine available this year as there was last year. It's just that the time sequence coming out is slower than usual."

Doris Huston, 77, of Boothwyn, Pa., is keeping in touch with her doctor, hoping his supply comes in soon. Huston knows she's in a high-risk group -- she has asthma and emphysema -- and has had a flu shot annually for at least 10 years. "I would be worried if I couldn't get it," she says of the flu shot. "You get a shot, and you pray. What else can you do?"

But some patients are growing anxious.

"People with diabetes, chronic lung diseases, coronary artery disease <ellipsis> are clamoring," Black says. "We have people who typically get it, then go to Florida for the winter, and we don't even have it to give yet."

In Florida, which has a large population of retirees, the vaccine shortage is the same as elsewhere, says Landis Crockett, head of disease control for the state Health Department.

"Some doctors' offices have not received theirs and have been told maybe they won't receive theirs," he says. "On the other hand, some grocery stores have received vaccine, and some (doctors) are unhappy about that."

Acting under an "emergency rule," he says, the Health Department is looking for areas where there is surplus vaccine so it can be moved to areas in need. In previous years, he says, about 5% of the vaccine was unused and returned to the manufacturer. That's not likely to happen this year.

In fact, he says, it's likely that far more people than usual will be vaccinated. "I do think there's been an increased public response so far. This can be a good thing," he says, but it could mean there won't be enough vaccine available later in the season to vaccinate all the younger, healthy people who want it.

Alma Littles, a physician with the Tallahassee (Fla.) Memorial Hospital family practice residency program, says patients aren't the only ones who are worried.

"We're remembering last year, when we had vaccine available, and the number of days the hospital was overflowing with people during flu season, when we hardly had enough beds," Littles says. "Going into the same season with people not immunized is scary."

1. California Medical Association Flu Vaccine Emergency: E-mail to Medical Staff.

2. Federal Center for Disease Control and Prevention: Flu Vaccine Supply Advisory.