All Michigan residents are now eligible to get the H1N1 influenza vaccine as more than 2.1 million doses of the vaccine has been ordered in Michigan. The state Department of Community Health announced Tuesday that due to the availability of the vaccine, it is lifting the high-risk group restrictions.

The Midland County Department of Public Health is working to set up a public clinic as well as coordinate vaccine sites with the Midland Public Schools, said Fred Yanoski, public health preparedness coordinator, on Tuesday, No other information was available as of this morning.

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Meanwhile, the Saginaw County Department of Public Health has scheduled an H1N1 vaccine clinic for 11 a.m. to 2 p.m. Saturday at The Dow Event Center, 303 Johnson St. There is no charge for the vaccine. Saginaw County residents wishing to get the vaccine for themselves or their children should bring proof of identification, and are encouraged to bring insurance cards with them to clinics, if available.

Any child 9 years old or younger, who received the first dose of the H1N1 flu vaccine on or before Nov. 14, can obtain the necessary second dose of the vaccine during the Saginaw clinic. Parents and guardians must bring their child’s influenza vaccination record in order to receive the second dose. It is expected that nasal Flu Mist vaccine will be administered at the Saginaw clinic unless specific illnesses or conditions prevent its use. The injections only will be given to those who cannot take the nasal vaccine.

The Centers for Disease Control and Prevention said that the 2009 H1N1 influenza vaccines have not been associated with any unexpected adverse events or possible side effects.

While all residents will be eligible for vaccine, health officials strongly encourage vaccination for pregnant women, people who live with or care for children less than 6 months of age, all people 6 months to 24 years, and people 25 to 64 years with chronic medical conditions.

“We encourage everyone to get vaccinated because it is the best way to prevent the flu,” said Dr. Greg Holzman, chief medical executive for MDCH. “The more people who are immune, the less likely the virus will spread in our communities.”

In addition to being vaccinated, Michigan residents can help stop the spread of the virus by washing hands thoroughly and often; covering mouths when sneezing or coughing, and staying home from work or school if sick.

Virginia health officials are opening up H1N1 vaccinations to more people, targeting patients being discharged from hospitals and releasing nasal mist vaccine to retail pharmacies in hopes of reaching more 19-24-year-olds.

Flulike-illness visits to emergency rooms and urgent-care centers remain low statewide, at about 3 percent of all visits, compared with 15 percent about a month ago.

“I am convinced [vaccine] is part of the reason we are seeing a significant downward trend in the incidence of disease,” Dr. Donald Stern, the Richmond City Health District director, said yesterday as he helped launch a vaccination campaign in city public-housing developments.

Virginia has been allocated more than 2 million doses of flu vaccine, Virginia’s health commissioner, Dr. Karen Remley, said yesterday.

Remley called the state vaccination campaign an “overwhelming success,” with vaccine reaching priority groups, including pregnant women and young children.

“We know that at least a quarter of the children in the state have been vaccinated,” Remley said.

“When you think about over a short period of time, that’s incredible,” she said, adding that vaccine is being delivered to providers every day.

In an effort to get more vaccine to more people, she is encouraging hospitals to offer the vaccine to patients being discharged as part of standing orders.

And while many college students have been vaccinated, there are many young people who are not in school but out working.

“We know that young adults . . . tend to be less engaged in seeing doctors on a regular basis. That is one of the reasons we are going to push that nasal mist out into pharmacies,” Remley said.

The nasal mist version of the H1N1 vaccine is made with a live, weakened virus and is recommended for healthy, nonpregnant people ages 2-49. Remley said it will be shipped to retail pharmacies starting next week. While the vaccine is free, pharmacies can charge a fee of up to a $20 fee to administer it. Many insurance companies have announced they will cover the cost.

“You can always come to the health department,” Remley said. “In the health department, the vaccine will always be free.”

Also, parents with young children need to be thinking about getting the second dose of vaccine recommended for children age 9 and younger. Many schools will be having a second round of vaccine clinics, but children also can get the shot at health departments and doctors’ offices, she said.

While the emphasis is still on getting priority groups vaccinated, anyone who wants a flu shot can request one at health departments.

Laboratory tests show all of the influenza circulating in the community is H1N1, or swine flu, Remley said. In Virginia, H1N1 flu has been blamed for 35 deaths, including of three children.

The Farmers Branch flu clinic that has been selling its 10,000 doses of H1N1 vaccine to anybody with $20 should never have received a single one, state health officials said Friday.The company, known as Flu Shots of America and Star Medical Group, misrepresented itself when it registered for the swine flu vaccine, Texas health department spokeswoman Carrie Williams said. The company identified itself as a private medical practice rather than a company in the vaccine business.

Because the vaccine is still scarce, the state is sending it only to private practices, public health departments and hospitals. But the huge amount shipped to the company should have tipped state officials that something was wrong, Williams said. No other private provider in the county has gotten as much as half that amount”It should have raised a red flag,” she said. “This is a lesson learned.”

Meanwhile, public health departments began mass vaccinations.Dallas County, people with appointments steadily visited the health department to vaccinate their children with chronic illness. And Tarrant County held its first walk-in clinic, using up almost all of the more than 1,600 doses it had on hand for pregnant women and children with chronic illnesses.

Officials from both counties said their first clinics had gone smoothly.

“We started our clinics as a test run because children are a high-risk population,” said Zachary Thompson, director of the Dallas County health department.

The Tarrant County clinic may offer a warning about crowd control for the Dallas County clinic, scheduled for Wednesday and open to county residents in the H1N1 risk category without health insurance.

On Friday, about 1,000 people came out to W.G. Thomas Coliseum in Haltom City for a clinic aimed at a much smaller target population. The available parking was filled long before the doors opened Friday morning.

High-visibility clinic

Like the two public clinics, traffic at Flu Shots of America was steady again Friday. Owner Jeff Vitt said he expected to give out 800 doses, a bit less than on Thursday.

Flu vaccine is finding its way to more private providers each day, but this clinic – labeled on building signage as Flu Shots of Texas – is the only high-visibility source in North Texas placing no restrictions on who got vaccinated.

State officials had two problems with that:

Because the national supply of the vaccine is limited, Texas is distributing it only to practitioners who serve the most patients at the highest risk of getting very ill with the H1N1 virus. The state defines that category as pregnant women, children ages 6-24 months, youths with chronic illness, health care providers and household contacts of infants younger than six months old.

Any provider who wants to give out H1N1 vaccine is required to register with the federal Centers for Disease Control and Prevention and identify what kind of practice it is and the types of high-risk patients it serves.

Williams said the state is investigating why Flu Shots of America misrepresented itself on the registration. The state will not ship any more vaccine to the company while it investigates.

The other concern, Williams said, is that the company offered the vaccine to people not in the high-risk groups.

‘Missing the point’

Vitt could not be reached to respond to Williams’ remarks, made late Friday afternoon, but he said Thursday that he has done nothing wrong.

Public records show that Vitt has registered several business names in recent years, often listing the Farmers Branch clinic address, 2300 Valley View Lane. Some are health-related, including Texas Family & Occupational Health Services, which does business as Star Medical Group, and Excel Occupational Clinics.

He also has formed a debt-collection business called Recovery Services of America, which describes itself as “a results-oriented recovery resource for companies and physician practices.”

On Thursday, Vitt said that he believes that everyone is at risk and that many of those who visited his clinic are in the official risk groups.

Vitt broke no law in selling the shots, Williams said. But that doesn’t mean state officials are happy about it.

“It is missing the point of what we are trying to do,” she said.

Officials at one local medical company, Home Health Services of Dallas, said they had alerted the state to what Flu Shots of America was doing days before the clinic came to public attention.

When told by a client that their competitor was offering unrestricted H1N1 vaccine, the company complained to the state, said Dr. Robert Kramer, the company’s flu program medical director. They were told the state was relying on the honesty of the providers.

“There is no due diligence or accountability there,” said Kramer, a pediatric pulmonologist who practiced at UT Southwestern for 30 years. “I am just furious there are people around who are doing something they know is unconscionable.”

In line with the rules

On the other hand, some people who are in the high-risk groups got their vaccines Friday from the two county free clinics.

People started arriving for the Tarrant County clinic in the chill drizzle long before dawn. By the time screeners emerged to check for eligibility, the line snaked around the building and along an adjacent road.

The third group in line was turned away by the screeners. Lauro Euribe said he came at 5 a.m. with friends and family. He seemed bewildered at being told none of them were eligible for that day’s clinic. But none of the women were pregnant and the kids were all healthy.

“We came here for nothing?” asked Ramon Jimenez, 11. “And we missed a test!”

But Kathleen Jenkins of Arlington got her vaccines for her children. She and daughter Charlotte, 15, and son Kelly, 16, were the first in line and had camped out overnight with a tent. Jenkins said that her two children were asthmatic and that she has suffered from serious bouts of pneumonia.

“We have been hypervigilant since they first announced two weeks ago that the swine flu vaccine would be coming,” Jenkins said.

In Dallas, the scene was more orderly. There were few walk-ups and those who did were turned away and told to make an appointment or wait for next week’s clinic.

By the time Fatima Rangel and her 7-year-old son reached the lobby at 9:30 a.m., there was no line. She was relieved to get the vaccine for her son, Zion, who has spina bifida and uses a wheelchair. Last year, he was hospitalized with breathing problems.

“Unfortunately, his pediatrician didn’t get the shots,” she said. “So we had to come here.”

Dallas only

Dallas County administered about 150 flu shots Friday and plans to do 200 more each on Monday and Tuesday for children, ages 6 months to 18 years old, who meet the department’s criteria.

On Wednesday, the health department will begin offering 10,000 free flu shots to anyone in the highest-risk groups, including children, pregnant women, caregivers of children under 6 months old, people aged 25 to 62 years old who have medical conditions and health care and emergency workers who might have contact with flu carriers.

The doses will go only to those who can prove they are Dallas County residents. The intent is to serve only people who have no medical insurance.

On Friday afternoon, staffers were unloading traffic cones that will be used to corral the onslaught of vehicles. Thompson said he hoped the public will understand that the county’s vaccine is not for everybody.

“We are the safety net,” he stressed. “When everyone has their vaccine, it’s a non-issue.”

Health officials statewide soon will offer free H1N1 vaccine to all residents — possibly in the next two weeks — reversing a national trend of giving it only to those deemed at high risk of contracting the virus.

“We really want to vaccinate as many people as possible,” Eden Wells, a medical epidemiologist with the Michigan Department of Community Health, said Monday. “We do know there are five more months of influenza season. Whatever vaccine we get in, we want to get out.”

Opening it up to everyone will be good for Michigan residents since so many people are out of work, said unemployed Detroit resident Michael Stephens. “Without health insurance, it’s a big deal if you get sick,” said Stephens, 29.

The vaccine is free because the federal government is paying for it, but private health providers may charge an administration fee.

The decision to make the vaccine available to everyone in the near future comes as five more deaths have been linked to swine flu in Michigan since last week, increasing the state death toll to 59 since April. The ages of the most recent Michigan deaths ranged from 23-59, and all had underlying health issues.

Meanwhile, hospitalizations associated with flu have climbed to 1,660 since September, and cases of flu-like illness reported to the state from Nov. 15-21 totaled 25,074.

Michigan health departments, physicians and hospitals began offering the H1N1 vaccine in October but the national delay in its production led the U.S. Centers for Disease Control and Prevention to recommend that shots be offered only to five priority groups: pregnant women, those ages 6 months to 24 years, caregivers of infants younger than 6 months, emergency and health care workers, and people ages 25-64 with underlying health conditions.

As H1N1-linked cases and deaths spiked, schools closed and hospitals limited visitors to adults in recent weeks, residents began clamoring to get the vaccine. They reported that their doctors didn’t have the vaccine or had run out.

Some local health departments faced thousands of people waiting in line for hours at mass vaccine clinics targeted at people in the high-risk groups.

Other Michigan health departments, and those nationwide, have faced such severe shortages they have offered the vaccine only to subsets of the priority group. It’s unclear how many health departments in Michigan narrowed the priority groups at their clinics in recent weeks. But beginning today, the state’s 45 health departments will no longer do so.

Since it received the vaccine, Macomb County has held nearly a dozen clinics. Of those, one offered the vaccine only to pregnant women and eligible household members; two clinics were held for only health care workers and volunteers.

“We saw them (the priority populations) as a key audience that needed to get the vaccine,” said Dan Artman, spokesman for the Macomb County Health Department.

Before the arrival of the vaccine, the CDC said Michigan would have 1.5 million doses by mid-October. Those supplies trickled in, but the CDC now has cleared the state to get 2.2 million doses. Of those, about 1.8 million have arrived.

For now, the vaccine is available only to priority groups, which is about half of the state’s 10 million residents.

Theoretically, a lot more people should be vaccinated, said Bob Swanson, state director of immunization. But local health departments have been reporting a slowdown at clinics.

“We’d like to encourage more people to be vaccinated,” said Swanson, stressing that people most at risk should try to get the vaccine.

The H1N1 vaccine will be available to all residents once state officials review vaccination data and local health officials can “assure (the state) that these high-risk groups have had an adequate chance to be vaccinated,” Wells said.

That could be as soon as the next two weeks, Wells said, or possibly by the end of the year.

The H1N1 vaccine will be available to everyone just as seasonal flu season is expected to peak, traditionally in February for Michigan.

Overall, the addition of the H1N1 flu strain has spiked the number of cases this year, unlike years past. Nearly 625,000 Michigan residents have reported flu-like illnesses since mid-November — a 35 percent increase over the 416,972 reported cases in 2008 and 404,476 cases in 2007.