Hawaii Medical Service Association, one of the state's largest distributors of flu shots, does not expect to get more flu vaccine after running out early in the season, and the state Department of Health has passed out all its reserves.

"We distributed the last of those 6,000 doses this week," said Janice Okubo, a department spokeswoman. "But we understand there are still physicians out there who are still receiving supplies, so call your doctor or get a referral to a doctor who is still giving vaccinations."

More than 250,000 doses of flu vaccine were shipped to healthcare providers in Hawai'i at the start of the season, and Kaiser Permanente is among distributors expecting supplies to arrive during the holiday season.

"And we've ordered more, to make sure we have enough for our members," she said.

Other providers, including HMSA and Times Supermarkets, canceled shot clinics when supplies ran out because of unexpectedly high demand.

"When we purchased our allotment of flu vaccine from the vendor we deal with, we literally bought all the supply they had, which was 40,000 doses," said Chuck Marshall, an HMSA spokesman. "That was the most they could give us and that is what we bought."

NO MORE SHIPMENTS

HMSA does not plan to seek additional shipments, he said.

"We've been checking with the state Department of Health pretty much on a weekly basis regarding the supply statewide, and they've pretty much said that there is an adequate supply for Hawai'i," Marshall said. "So we're thankful for that, and we've been referring the few people who call us to other providers in the community."

Marshall said referrals are generally to Aloha United Way's information line, reached by dialing 211.

Operators at the 211 number have reported a steady decline in the number of shot clinics offered, but Okubo, the Health Department spokeswoman, said the number of calls to the 211 line has also decreased.

"The calls have been dropping off and that may be an indication that many people have already been vaccinated," she said. "That is a good thing, if many people got their shots early in the season.

"But there is vaccine out there and there are orders coming in."

Flu season in Hawai'i peaks in January and February, and a flu shot over the holidays, Okubo said, might ward off the illness.

CANCELED CLINICS

Shot clinics throughout the country have been canceled for lack of supplies as more people got vaccinated this year than before.

As flu season approached this year, doctors and clinics ordered flu shots based on demand in previous years. But in previous years, the shots were recommended only for people at high risk because of age or medical condition.

Late last month, the federal Centers for Disease Control and Prevention and the state Department of Health advised everyone, regardless of age or health, to get shots this season.

Although the flu shots are not geared toward bird flu, health officials said, avoiding the spread of regular flu could help protect people from mutations of avian flu or other potential pandemics.

Flu shot providers were not prepared for the increased demand. Like Times and HMSA, many canceled clinics. Others restricted the shots to those patients considered at high risk.

When the state Health Department began distributing the 6,000 doses it had ordered as a hedge against insufficient supplies, physicians were asked to limit distribution to high-risk patients.