John Downing, 19, has multiple congenital anomalies, his father said. The cause is unknown and there is no single diagnosis because John manifests of multiple conditions. "He's chronically ill and medically fragile."

The Downings, who live in the Knoxville area of Washington County, said it is critical that John receive the H1N1 vaccine because his immune and respiratory systems are compromised by his condition. John has had pneumonia three times in the past year and in his 19 years has needed 60 surgeries, his father said.

John attends Boonsboro High School and can walk a bit, but uses a wheelchair. He communicates through rudimentary sign language and with a handheld symbol-based computer. He has the cognitive ability of a 2- or 3-year-old, his father said.

When John is sick, he can communicate to his parents he is not feeling well, but cannot answer complex questions about what ails him.

Until John can get the H1N1 flu vaccine, his parents will keep him home from school. Because of his suppressed immune system, he will need the injectable vaccine. Their fear with the H1N1 virus is its ability to penetrate deep into the lungs and cause viral pneumonia.

John falls into what the CDC calls a high-risk category for the vaccine -- if only the Downings could find it.

"Nobody can get the vaccine for some reason," Jim said. "The doctor cannot get it."

As of Oct. 14, the CDC said more than 130,000 doses of H1N1 flu vaccine have been shipped to Maryland. The Frederick County Health Department has received a very limited amount in the intranasal mist form and the shot vaccine.

The CDC said manufacturers' production delays means it will take longer for the vaccine to be available than was initially anticipated, but the CDC is confident supplies will be sufficient over the coming weeks.

On Tuesday at Mount St. Mary's University in Emmitsburg , the H1N1 vaccine was made available to only students and employees during the first of three clinics in the campus Wellness Center. Other student/staff clinics are set for Wednesday and Thursday. The college received 800 doses and 229 shots were given the first day, according to Mount spokesman Christian Kendzierski. If vaccine is still available additional clinics will be held next week.

The health department has earmarked its 600 doses of H1N1 intranasal vaccine for in-school vaccination clinics for children in pre-K through fifth grades in both public and private schools. Officials used a lottery system to decide the random order of schools to receive the vaccine.

The department is preparing to offer shots at future clinics to those within the priority groups.

The health department is following the CDC recommendations for those at higher risk, including children and young adults ages 6 months through 24, pregnant women, people age 25 to 64 with chronic health conditions, individuals in close contact with infants less than 6 months of age, and health-care and emergency medical services personnel.

Once demand for these groups has been met, the goal is to then vaccinate people ages 25 through 64. Both forms of the vaccine will be offered to the public free of cost from the health department.

Each state's allocation of H1N1 vaccine is based on population. The Maryland Department of Health and Mental Hygiene gives priority to providers that serve the CDC target groups.

Until the vaccine becomes readily available, the health department recommends these preventive actions to protect yourself and others from flu: Cover your nose and mouth with a tissue or your sleeve when you sneeze or cough; wash your hands often with soap and water or hand sanitizer; avoid touching your eyes, nose and mouth to reduce spreading germs; avoid close contact with sick people; and if you are experiencing flu-like symptoms, stay home for at least 24 hours after your fever is gone.

For people with high-risk conditions, a pneumonia shot is recommended. Talk to your health-care provider in advance about what you should do if you develop flu-like symptoms.

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