As H1N1 swine flu spreads, many Treasure Valley residents have questions about whether or when to get vaccinated, what kind of vaccine to get, and more. We're answering them online and in print. The newest questions appear first.

If you have a question, e-mail Statesman health reporter Colleen LaMay at clamay@idahostatesman.com

Q: My doctor is out of seasonal flu vaccines, and I can’t find the vaccine anywhere. Is there any left in the Treasure Valley?

A: At last count, Saint Al’s had doses left at each of its Express Care sites, a hospital spokeswoman said Tuesday. The vaccines cost $35 and are available only in nasal mist form. The mist is recommended for healthy people ages 2 to 49. Call 367-3627 for updates before you go. The addresses and number of doses still available Tuesday afternoon:

Æ Albertsons, at Eagle and McMillan roads. 24 doses.

Æ Rite Aid at 15th and State streets in the North End. 17 doses.

Æ Rite Aid, at Apple Street and Boise Avenue. 6 doses.

Æ Rite Aid at 2809 E. Cleveland Blvd., Caldwell. 11 doses.

More vaccines may arrive this month, according to federal officials.

Q: Why is the seasonal vaccine in short supply?

A: The federal Centers for Disease Control and Prevention says shipments from Sanofi Pasteur, the largest supplier of seasonal flu vaccine, are being delayed. More Idahoans than usual want the vaccination. “H1N1 has raised the awareness of flu overall,” said David Fotsch, spokesman for the Central District Health Department.

Q: I’m 68 years old and my wife is 66, and we both are diabetic with a note from our doctor. Are we eligible for the H1N1 vaccine?

A: You will be, but you aren’t yet. Federal guidelines put the elderly last in line, even behind healthy people up to age 64. Blame the statistics. Most people who suffer from H1N1 are young, under age 35. That’s the opposite of seasonal flu. Seniors go to the front of the seasonal flu line because they are hit hardest.

Q: I have heard that a type of H1N1 flu has already been around in past decades. If this is so, have people ages 64 to 84 already been exposed to this virus? And does that make them immune? Or do they also require the inoculation?

A: It can’t hurt to get the vaccination. There are theories — but no solid answers — about why seniors are the least likely to get sick with 2009 H1N1 flu. You might be immune if you were exposed to a form of swine flu when you were younger. That’s one theory. But you aren't immune if you had the swine flu or immunization during the 1976 swine flu pandemic. That was a different form of the virus, and it offers no protection against the 2009 H1N1 virus.

Q: My 6-month-old son and 2-year-old daughter were lucky enough to get their H1N1 vaccine at a Oct. 24 clinic. It is my understanding that they will need a booster shot in four weeks. Where do we go to get this booster vaccine? Do we go back and get in line again at the Saturday clinic, or will my doctor be able to give them their booster?

A: You can get in line again at a Saturday clinic, but you will need to wait at least two weeks to a month, depending on which version of the vaccine your children received. You are correct that they need a second dose. It's required for children up to 9 years old. There's no rush, though, officials say. The second dose can be given anytime before the end of the H1N1 season, Central District Health Department spokesman Dave Fotsch said. Meanwhile, your child will have partial immunity.

Q: I waited in line for almost four hours last weekend to have my 1-year-old vaccinated. When I reached the table where they actually give you the shot, they told me that my son was not able to receive the shot without a written doctor's note and to come back the following week. My son had an allergic reaction to a medication not related to the flu shot. Since he had an allergic reaction to something (doesn't matter what) in the past, they would not give him the shot without a note. I had spoken to two of his doctors the previous week and they gave me the OK for the shot. I ended up getting ahold of my pediatrician and having her fax a consent to the store next door. It was a complete pain and kind of stressful, but there was no way I was going to drag my 1-year-old to stand in line for four hours the following week. I do not know what other reasons people might need a note for, so the question I am hoping you could add is: What documentation do I need to bring with me to the clinic? I would hate for anyone to be turned away after waiting for so long, especially if they have little kids.

A: To be safe, you may want to bring a note from your physician saying an immunization is OK. Parents need to know exactly what their children are allergic to, state health officials say. For example, some vaccinations have trace amounts of certain antibiotics, and antibiotic allergies are among the most common childhood allergies, Health and Welfare Department spokesman Tom Shanahan said. Without that information, some clinic staffers may require you to contact your doctor.

Q: H1N1 vaccines contain thimerosal, a form of mercury. Is that dangerous?

A: Health authorities say no, but mercury-free vaccines are available for young children. None of the flu mist has mercury in it. Injectable vaccines for the rest of us do contain trace amounts of thimerosal as a preservative. There's 10 times more mercury in a six-ounce can of tuna than there is in a flu shot, state health officials say.

Question: Within priority groups, aren't there groups that are considered a higher priority than others? I am 8 months pregnant and can only receive the injectable vaccine. Wouldn't I be considered higher priority for vaccination than some other groups that may qualify for the injectable vaccine? If so, why aren't health officials sorting lines according to priority?

All "priority groups" are created equal, said Dave Fotsch, spokesman for the Central District Health Department.

To date, the priority groups in the Central District Health Department, which serves Ada, Elmore, Boise and Valley counties, are:

• Pregnant women.

• People who live with or care for children younger than 6 months of age.

• Health care and emergency medical services personnel with direct patient contact (i.e. diagnosing and treating patients with flu-like illness).

• Children 6 months to 4 years of age, healthy or with underlying medical conditions.

• Children ages 5 to 18 with chronic medical conditions, such as asthma, diabetes, lung, heart, liver or kidney disease, or who are immune-compromised because of cancer treatment or HIV.

Is it true that once you have the H1N1 virus that you won't get it again? Sort of like chicken pox. If it is true, then one who has had the flu wouldn't need the vaccine, right?

If you've already been sick with this season's H1N1 swine flu, you are not likely to get it again. That means you probably don't need the vaccination. It's up to you. Public health officials are counting most people with "flu-like" symptoms — including fever, headache and cough — as H1N1 victims, because that's mostly the bug floating around right now. If you want to get technical, the only way to know for sure if you had H1N1 is a laboratory test when you are ill. Most people don't get that test unless their illness puts them in the hospital.

People who had the swine flu or received a vaccination for it in 1976 have been advised to get the new flu vaccine, since this year's H1N1 virus is different from the one that swept the country then. But people who are 65 or older appear to have some immunity. They may have been exposed to an earlier virus similar to this year's.

Why are the health districts hogging the H1N1 vaccine? Why don't they give the vaccines to doctors so they can administer the vaccinations directly to patients in priority groups?

The federal Centers for Disease Control and Prevention initially recommended that health departments nationwide vaccinate the largest numbers of "high priority" people in the fastest way possible, Southwest District Health spokeswoman Laurie Boston said.

More private providers will get the vaccines when there are more to give. The state's seven health districts have leeway in how they parcel out the doses they receive. The Central District Health Department, which serves, Ada, Elmore, Boise and Valley counties, distributed about 1,000 doses among obstetricians to vaccinate willing pregnant women, who are among the people at highest risk of severe complications from H1N1. Some health districts are not giving vaccine to private doctors' practices until more vaccines are available.

Southwest District Health, which serves Canyon, Adams, Gem Owyhee, Payette and Washington counties, is working with state officials to get many private clinics the approval needed to get vaccines directly when the vaccines start flowing faster into the area, Boston said.

Are health departments going to broaden the priority groups back to what the federal priority groups are? I have underlying health conditions that would recommend me getting the shot but they cut my group off. I was supposed to be in the group for anyone under a certain age, but they cut the age down to 18.

Health officials at the local level have leeway in deciding who gets vaccinated first. In the mass public clinics, the health department serving Boise has had stricter criteria for getting a vaccination than neighboring Nampa, which is served by a different health department.

In the Southwest District, which serves Adams, Canyon, Gem Owyhee, Payette and Washington counties, people ages 25 to 64 can get a shot if they have underlying medical conditions such as asthma, diabetes, heart disease or lung disease.

The Central District Health Department, which serves Ada, Elmore, Boise and Valley counties, vaccinates people older than 18 only if they are pregnant, care for infants or provide emergency medical services. The department said it would vaccinate new priority groups, including 25- to 64-year-olds with chronic health conditions, as more vaccine becomes available.

Southwest Health chose to let more people into the "priority groups" to avoid confusing the public, Southwest Health spokeswoman Laurie Boston said.

“It’s not that one way is right and the other way is wrong," Boston said. "It’s just that we chose to do it this way.”

Question: Have any of the health authorities explained why Canyon County, despite its smaller population, received more doses (3,170) than much more populous Ada County, which received only 2,500 doses? People waiting in line in Boise who were in priority groups were turned away, while in Nampa one didn't need to be in a priority group and they never ran out. Will the allocation be adjusted for future Saturday vaccinations?

Canyon County didn’t get more doses overall, but more were offered at the high-profile public clinic Saturday at a former Sportsman's Warehouse in Nampa than in the two Boise clinics combined the same day.

Boise and the rest of Ada County are served by the Central District Health Department, which administered more than 7,100 doses of H1N1 vaccines to Boise and Meridian schoolchildren. Nampa and the rest of Canyon County are served by the Southwest District Health Department, which vaccinated some schoolchildren, but far fewer than in Ada County. That left more vaccine in Canyon County for the Saturday clinic.

I do not plan to take my 4-month-old with me to wait in line for the H1N1 shot. What proof do my husband and I need to submit to show that we care for a child under 6 months of age? Also, my parents and my in-laws care for my child. Can they too receive the shot? And if so, do they need proof that they care for a child under 6 months of age?

Ultimately, the mass H1N1 vaccination clinics on Saturday operate on the honor system. You will be asked to fill out a consent form, which you can download at the Web site for the Central District Health Department or get at the clinic site. The form asks you for your name and address, underlying health conditions and a few other facts. There are no questions about the children you care for, and you will not be asked to provide proof. You will be asked to tell the truth. Why would anyone in their right mind take any of that stuff?

The Centers for Disease Control and Prevention says 2009 H1N1 influenza vaccines are expected to have similar safety profiles as seasonal flu vaccines, which have very good safety track records. Over the years, hundreds of millions of Americans have received seasonal flu vaccines, CDC says. The most common side effects following flu vaccinations are mild, such as soreness, redness, tenderness or swelling where the shot was given. The CDC and the Food and Drug Administration say they will be closely monitoring for any signs that the vaccine is causing unexpected adverse events, and they pledge to work with state and local health officials to investigate any unusual events. See this Web page for more information from the CDC on vaccine safety: http://www.cdc.gov/h1n1flu/vaccination/vaccine_safety.htm

Why doesn't my doctor have the H1N1 vaccine? Why not distribute the vaccine to the doctors that care for high risk people — OB's and pediatricians — instead of making the patients stand in line at public clinics?

Idaho so far has been allotted 75,000 vaccine doses — shots and nasal mist. That's enough for just 5 percent of Idahoans.

Because so little is available, federal and state health authorities are parceling out the vaccines to hospitals and certain community health clinics for their employees, as well as to health departments for people who are at very high risk of serious complications if they get the flu.

The only private doctors' offices that may have vaccines for patients right now are OB-GYNs. They care for pregnant women, who are at very high risk of severe complications, compared to the rest of the population. Some of those doctors don't have the vaccine, either. The Central District Health Department six weeks ago sent out a survey to obstetricians asking if they were willing to vaccinate their patients. Just 13 responded.

The number of doctors' offices and other businesses asking for vaccine has skyrocketed since last week, Central District Health spokesman Dave Fotsch said. Vaccines will be distributed to pediatricians and other doctors who care for high risk patients as more vaccines arrive.

Has anyone at the health department considered developing a Web site that would allow people to fill out the consent form online?

The health department could, using a computer program, sort through the consent forms and identify the persons most at risk and send them an e-mail telling them the location and time to show up for vaccinations. Most people either have Internet access or know someone who has Internet access who could fill out a consent form for them online. This could avoid the frustration, panic and anxiety associated with telling thousands of people to show up at a location, stand in line for hours, with only a remote chance of receiving a vaccination.

The Central District Health Department says: "These are great ideas, and they certainly have our planners thinking about the possibilities. But implementing this kind of system is far more complicated than it would appear on the surface, especially with the small staff we have at CDHD. Our staff is already working long hours just to keep up with everything we’re doing now.

"We agree that being able to sort people by risk category in advance and then providing them some sort of online voucher and a time frame to go to one of the Points of Dispensing would be an ideal situation. We just don’t have the resources to implement these very good ideas at this time."

I have seen news reports suggesting that tickets may be distributed in advance. Will that actually occur and, if so, where and when will they be available? I wish to get my 9-month-old son vaccinated, but I don't want to wait in line with him for several hours.

CDHD says: "The health department is printing Vaccine Cards that will be handed out to people in line at the PODs starting about 9:30 in the morning, just before the doors officially open. The number of cards will match the number and type of vaccine available that day. Trained form screeners will review consent forms (available for download from the CDHD Web site: www.cdhd.idaho.gov) and determine which type of vaccine is appropriate, then hand the person a card identifying the type of vaccine that individual should get. When the supply of cards is exhausted those left without will be told to come back to the next POD.

"The card does not guarantee vaccination because everyone’s Consent Form will be reviewed one more time before actually getting vaccinated, and the availability of one type of vaccine or another can change over the course of the day."

Has anyone who has received H1N1 vaccinations so far had adverse reactions?

Central District Health Department spokesman Dave Fotsch was not aware of any locally.

How many doses of vaccine will be available at the two public clinics set to start at 10 a.m. Saturday in Boise?

Roughly 2,500 doses, split between the two sites: the former K-Mart store at 1001 ParkCenter Blvd. and the former Comp USA store at 1195 N. Milwaukee St.

Can I get a vaccination there?

The “priority groups” have not changed since Wednesday. The vaccines will be available only to people who fall into one of these categories:

• Pregnant women.

• People who live with or care for children younger than 6 months of age.

• Health care and emergency medical services personnel with direct patient contact (such as those who diagnose and treat patients with flu-like illness).

• All children 6 months to 4 years old.

• Children ages 5 to 18 with chronic medical conditions, such as asthma, diabetes, lung, heart, liver or kidney disease, or who are immune-compromised because of cancer treatment or HIV.

Will Nampa still have a flu clinic Saturday?

Yes. It’s from 11 a.m. to 5 p.m., or until about 2,500 doses of vaccine run out. Last week, officials ran out of shots at 3:30 p.m. or so. The H1N1 flu mist, which only can be administered to healthy people ages 2 to 49, lasted until 5 p.m. The clinic will be in the former Sportsman’s Warehouse, 16865 N. Market Place Blvd., the same as last week. A planned Friday clinic was canceled because of the vaccine shortage.

The priority groups are less restrictive in Nampa. Southwest District Health will vaccinate everyone up to age 24, healthy or with underlying medical conditions. Nampa also will vaccinate people ages 25 through 64 years of age who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems.

What’s to stop me if I don’t meet the criteria?

The Central District Health Department says you will be turned away if the department figures out you don’t belong there. It will use a consent form to help weed out people who should get their shots later, when they are available to other priority groups or to the general public. Southwest District Health in Nampa is asking people to honor the priority groups, but aren’t saying they will send people away or ask for identification.

How will officials handle crowds expected Saturday?

In Boise, clinic officials will work their way down the waiting lines of people, check the consent forms and hand each eligible person a card with the type of vaccine the person will receive -- mist or shot. When the cards run out, the remaining people will be told to return the following Saturday. The health department plans to hold the Boise clinics each Saturday as long as vaccines are available, except for Nov. 28.

What about the other counties in the Central District Health Department’s service area?

The health department is reserving another 2,500 doses of flu vaccine for administration next week to high-priority groups in the three other counties it serves -- Elmore, Boise and Valley counties. Ada County school vaccination efforts may resume when there is a better supply of vaccine.

Where can I learn more?

Visit the Central District Health Department Web site, www.cdhd.idaho.gov, or call the CDHD Flu Hotline at 321-2222. In Canyon County, visit the Southwest District Health Department Web site at www.publichealthidaho.com or call 455-5300.

What are "underlying conditions" and why do people who have them need the flu shot more than healthy people?

People with underlying conditions, especially asthma, are at higher risk of suffering severe complications from the flu. The federal Centers for Disease Control and Prevention reported that of 1,400 adults hospitalized for H1N1 flu by Oct. 13:

* 26 percent had asthma. Asthma prevalence: 8.7 percent of adults in Idaho, compared with 8.1 percent of adults nationwide.

* 10 percent had diabetes.

* 8 percent had lung diseases other than asthma.

* 7.6 percent had compromised immune systems.

* 6.1 percent were pregnant women.

Much smaller numbers of patients had other underlying conditions.

Children have similar underlying conditions and similar risks, according to a spokesman for the Idaho Department of Health and Welfare.

Colleen LaMay: 377-6448