Many doctors' offices across the Los Angeles area are fielding frantic calls this week from patients demanding the swine flu vaccine, only to be told that none is available despite urgent warnings from the federal government that people need to be inoculated.
Patients report calling numerous doctors in hopes of getting flu vaccines for children -- who, in general, are hardest hit by the swine flu.
Some even plan to attend Los Angeles County flu shot clinics, which begin today in Encino and Culver City, that are intended for the uninsured, because they say it is their only hope of getting the vaccine soon.
The shortage has come as the flu is surging in California. On Thursday, state health officer Dr. Mark Horton said that the level of flu in the state is consistent with the peak of a regular flu season, and that the predominant strain is the H1N1 strain. Hospitalizations for the flu are also increasing.
Horton said that he understood the frustration of doctors, but that he remained confident that enough vaccine would eventually become available. Health officials have also noted that the flu remains relatively mild and that the vast majority of people who get it recover within two weeks.
California has received 1.7 million doses of H1N1 vaccine so far out of 20 million doses expected this season.
Some pediatricians said they were being inundated with sick children, and some doctors were unhappy about the lack of vaccine.
"It has been an abomination," said Dr. Marcy Zwelling, who practices in Los Alamitos. Zwelling ran out of seasonal flu shots in late September -- and was told that it was unclear when she would get more because manufacturers were switching to making swine flu vaccine. But she said she had not received any swine flu vaccine, either. Nearby Los Alamitos Medical Center has neither vaccine.
"This is certainly horrific," Zwelling said. "So we have nothing. Nothing."
Patients expressed particular worry about young children and pregnant women, who are among the most susceptible to severe and sometimes fatal complications from swine flu.
Daniel Hinerfeld, 46, who lives on the Westside, has been searching for a swine flu vaccine for his 19-month-old daughter, Willa.
"We are finding that pediatricians basically have no information whatsoever about when they're getting the vaccine," Hinerfeld said.
Chad Todhunter, a 33-year-old actor who lives in the San Fernando Valley, has tried for days to find vaccine for himself and his wife Emilee, 26, who is six months pregnant. "It's nerve-wracking," he said.
The main problem with the vaccine shortage is that the swine flu virus does not grow in eggs as rapidly as the seasonal flu virus does, which limits the amount of protein that is available for inclusion in a vaccine. Despite repeated inquires by the federal government, the manufacturers did not tell officials about the delay until about Columbus Day.
In part because of the shortage of vaccine, Gov. Arnold Schwarzenegger on Thursday ordered the release of half of the state's stockpile of 51 million N95 respirators--tight-fitting masks that prevent doctors and nurses from inhaling flu virus coughed by patients.
The masks are being distributed to local health departments to prevent shortages among healthcare workers, especially those who work at hospitals.
While L.A. County will begin distributing both the nasal spray and injectable versions of the swine flu vaccine today, Orange, Ventura, Riverside and San Bernardino counties have only the nasal spray.
That is a problem for babies between 6 and 24 months of age, pregnant women, those with chronic health conditions, and anyone who is older than 50, who can only receive the injection.
As a result, Orange County will not set up any swine flu clinics until injectables arrive. The county supply of nasal spray is being directed to other clinics.
Ventura County's Health Care Agency is providing only the nasal spray for those between the ages of 2 and 24, and those caring for infants less than 6 months old.
San Bernardino County officials are focusing on healthy children between ages 2 and 18 and caregivers of infants, while the Riverside County Department of Public Health is targeting healthy children between 2 to 12.
"Younger children can have more complications, so we're trying to target the youngest ones first," said Barbara Cole, director for disease control in Riverside County.
Dr. Robert Levin, Ventura County health officer, said it was particularly important that pregnant women and their doctors get the swine flu vaccine, because in the past, just 15% of pregnant women have gotten the seasonal flu shot.
"They should be at 100%," Levin said.
Meanwhile, doctors' offices are struggling with the influx of patient calls.
Jane Cruz, a medical assistant at a Long Beach pediatric clinic, said parents call her virtually every minute, and all she can say is call next week.
But at his Sherman Oaks clinic earlier this week, Dr. Ralph Salimpour, a clinical professor of pediatrics at UCLA, sighed with relief.
Salimpour's clinic Monday was so jammed with sick children that the entire staff was exhausted.
But on Tuesday his first shipment of swine flu vaccine finally arrived.
"I couldn't have been happier," Salimpour said.
Information on H1N1 vaccination clinics held by Los Angeles County can be found at lapublichealth.org or by dialing 211.
Thomas H. Maugh II contributed to this report.