The Tacoma-Pierce County Health Department has issued tough new guidelines for who should be eligible to be vaccinated for swine flu, citing a critical shortage of the H1N1 vaccine in the county.

Starting Monday, only pregnant women and health care workers who have close patient contact will be the highest priorities for vaccination, said Eileen Finnigan, a Health Department spokeswoman.

That means, except in rare circumstances, children won’t be eligible for vaccinations until supplies increase, Finnigan said. Health officials aren’t sure when that will be.

Adults with underlying health problems and people who live with or care for infants under 6 months old also will have to wait, Finnigan said.

“We need to protect resources to respond to the pandemic,” she said. “Hopefully we can get these two groups immunized and then we can move down the list.”

Pierce County so far has received 75,600 doses of the H1N1 vaccine, only about 14 percent of the amount health officials have ordered. About 800,000 people live in the county.

Finnigan said all hospitals, private medical providers and retail pharmacists authorized to dispense the H1N1 vaccine in Pierce County were notified of the change late Friday afternoon.

The restriction is temporary, Finnigan stressed.

The department will monitor immunization levels, she said, and when sufficient percentages of the first priority groups have been treated, the vaccine once again will be available to children and others at special risk.

When the restrictions lift depends on how quickly vaccine manufacturers produce and distribute the vaccine, she said.

The new rules will not affect a free clinic the Health Department is sponsoring today at Clover Park High School.

The department publicized the clinic widely, and Finnigan said health officials decided it would be too confusing to change the rules so close to the event.

“We don’t want to have a riot of people,” Finnigan said.

The department has allocated 2,200 doses for today’s clinic, most of it in the form of nasal mist.

With an increasingly frustrated public clamoring for information on vaccinations, the department also is ramping up its public outreach efforts.

It has expanded its Web site (www. tpchd.org), has begun to issue daily bulletins regarding the availability of the vaccine, and, at the urging of Pierce County Executive Pat McCarthy, launched an H1N1 call center.

About 100 people called the hot line (253-798-7000) in just four hours of operation on Thursday, according to Hunter George, the county’s communications director. Another 250 people called the hot line Friday, George said.

Up until last week, the Health Department’s public swine flu outreach had amounted to little more than a Web page with “Frequently Asked Questions” cribbed from the Centers for Disease Control along with the often-repeated advice to wash hands and cover coughs.

“People were saying, ‘OK, we heard that,’” said Dr. Anthony L-T Chen, Health Department director. “What we want to know is, ‘Can I go to Fred Meyer and get a shot?’”

Better information flow was long overdue, said Elizabeth Mullen of Puyallup.

Mullen is pregnant and has asthma – credentials that clearly qualify her as a high-risk candidate, even with the tighter restrictions that start Monday. Even so, she said, she has been unable to find any vaccine.

Mullen said her doctor at Good Samaritan Hospital in Puyallup advised her to call in each day during the last week of October as hospital officials waited for an overdue shipment of the vaccine.

Mullen made the calls, then skipped a day. That turned out to be the day the shipment arrived. By the time she called the next day, she said, all the vaccine was gone.

“Now they have none, and they don’t know when they’re getting more,” Mullen said. “That’s absolutely frightening.”

Chen said his department’s plan to deal with epidemics and pandemics – developed during the bird-flu scare three years ago – details everything from appropriate staffing levels for dealing with a pandemic to setting up emergency vaccination clinics.

What the plan does not address is a shortage of vaccine.

“This is not acting like what we thought the bird flu was going to act like,” Chen said.

Making the job more difficult is that it is impossible to tell precisely how much of the vaccine is available in the county and where it is being distributed.

In Pierce County, most of the vaccine is being sent directly from the state distribution center to hospitals, private health care providers and retail pharmacies.

Of the doses shipped to Pierce County so far, only 17,200 have gone directly to the Health Department. All of those have been allocated.

To figure out who has vaccine available, Chen has assigned staffers to make daily calls to providers, a time-consuming and labor-intensive chore.

“Part of the problem is it’s so fluid,” said Chen, noting that a provider’s supply can change dramatically in a matter of hours.

The department’s revised Web site attempts to guide people to available vaccine, but advises: “Call first for availability!”

Predictably, the vaccine shortage has led to some sharp disagreements about who deserves to be at the head of the line.

Vaccine providers signed contracts agreeing to do their best to follow Health Department guidelines, but at most pharmacies the honor system prevails.

The department’s decision to distribute H1N1 vaccine at an Oct. 14 health fair for homeless and low-income people at the Tacoma Dome received little notice at first. But as the scarcity of vaccine intensified, that decision has become the target of criticism.

“Maybe I should have pretended to be a homeless individual and stood in line with the homeless that were being vaccinated at the Tacoma Dome,” Mullen said.

Finnigan said that only 109 doses of the H1N1 vaccine were administered at the health fair, and all went to members of the top-priority groups outlined at the time by the national Centers for Disease Control.

“The decision was made because it was an opportunity to reach a population that is difficult to reach.” Finnigan said.

Rob Carson 253-597-8693

rob.carson@thenewstribune.com