For months, people were told to get flu shots, and it looks like they got the message. So where are they supposed to get them?

“The majority of our offices are completely out of seasonal flu vaccine, and there’s no guarantee they will receive any more,” said Pamela Zemaitis of Heritage Medical Group.

Public health experts knew from the beginning this flu season would pose challenges. The first obstacle was to produce a vaccine against H1N1, also known as swine flu. H1N1 is different than regular “seasonal flu” and requires a separate vaccine.

Then public health officials had to convince people that, in most cases, they needed both the H1N1 vaccine and the regular flu vaccine.

But now there are shortages, or at least delays, involving both vaccines. Many health care providers and state health officials hold out hope a sufficient supply will eventually arrive.

The federal government paid for the H1N1 vaccine. Pennsylvania, like most states, is controlling the supply. Hundreds of doctors, retailers and health-related organizations have signed on to obtain and dispense H1NI vaccine. but the vaccine is arriving slower than expected.

Of the vaccine delivered to Pennsylvania so far, most has gone to the parts of the state with the most H1N1 cases. The vaccine has further been reserved for children and young adults, who have the highest risk of becoming severely sick from H1N1.

Stacy Kriedeman of the state Department of Health said Pennsylvania had distributed 964,100 doses as of Friday and expected more to arrive, although later than originally expected.

Holy Spirit Hospital, for instance, has received a “very limited” supply of H1N1 vaccine, spokeswoman Lori Moran said Friday. It reserved most of those for employees who work with high-risk patients and for patients who are at high risk of flu complications.

Holy Spirit-owned pediatric and family medical practices also have limited supplies of H1N1 vaccine, and are holding them for high-risk patients.

Regular flu vaccine also is in short supply, with little expectation of receiving more, Moran said.

Penn State Milton S. Hershey Medical Center was dealing with similar circumstances, spokeswoman Megan Walde said. Moran and Walde, like other providers interviewed, stressed that doses of both H1N1 and regular flu vaccine would go only to existing patients ” not the public. they said that’s standard policy, not a response to a shortage.

The belief among health care providers is that the shortage of seasonal flu vaccine is the result of production being temporarily cut back to allow greater production of the H1N1 vaccine.

Giant Food Stores received fewer doses of regular flu vaccine than ordered and had to stop offering them as of Oct. 22 instead of November. Spokeswoman Tracy Pawelski said the situation is the result of limited supply as well as higher than usual demand for shots.

Numerous health care providers also cited increased demand for regular flu shots and attributed it to flu-related public health messages of recent months.

Pawelski said Giant has signed on with the state as a distributor of H1N1 vaccine, but hasn’t been told when or if it will get the vaccine.

Rite Aid is dealing with “spot shortages” of seasonal flu vaccine. The Cumberland County-based national chain has flu vaccine in its warehouse and is trying to keep its stores supplied, spokeswoman Cheryl Slavinsky said Friday. Rite Aid didn’t get its full order on time, but continues to receive shipments, she said.

Slavinsky said the only way to find out if a particular store has vaccine is to call the store. Calls to five Harrisburg-region Rite Aid stores Friday found none with vaccine. An employee of one said she was aware of no local retailers with regular flu vaccine. “You might want to call your doctor,” she said.

Kriedeman, the health department spokeswoman, said the department has received most of the 424,200 doses of regular flu vaccine it ordered. but she stressed those are intended for people with no health insurance and others who need flu shots because of health reasons, but are unlikely to obtain one on their own. most are distributed through state health centers and state and federal health clinics.

Kriedeman said that, with seasonal flu vaccine, the state leave it up to the private market to supply the vast majority of vaccine. She added that according to federal officials, 82 million doses of seasonal vaccine had been distributed as of Oct. 8, and officials expect 114 million will eventually be distributed. She noted that regular flu season often doesn’t peak until March, so it makes sense to continue to seek a shot. “Seasonal flu vaccine is out there, but you may have to look for it. We encourage people to be persistent,” she said.

As for H1N1 vaccine, Rite Aid has so far been able to supply only five stores in three states, and none in Pennsylvania. “I expect it will be a little while before it trickles down full force to the drug store chains,” Slavinsky said.

At the end of last week, there were some signs the Harrisburg-area H1N1 vaccine shortage is easing. Carlisle Area and Cumberland Valley school districts announced they had received H1N1 shots and would begin dispensing them on Monday. Harrisburg school officials, who began dispensing doses last week, planned to dispense more on Saturday, and at a succession of future dates. Several other districts said they are expecting doses.

All the while, H1N1 seems to be rapidly spreading in the region. at Holy Spirit, 30-40 people per day have been coming to the ER with the flu, although most didn’t need to remain in the hospital, Moran said.

Health officials have been urging people not to go to a doctor or hospital unless they believe there are dangerously ill. The purpose is to avoid spreading the flu.

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Since the beginning of October, Boston has seen an increase in cases of gastrointestinal illness, including nine clusters at local schools, day-care centers, and a hospital, the Boston Public Health Commission said yesterday.

For the week ended Dec. 18, complaints of vomiting or diarrhea accounted for 2.9 percent of all emergency room visits in the city, compared with 2 percent for the same week in 2009.

The illnesses have been linked to norovirus, a common and easily spread viral infection that causes severe nausea, vomiting, and diarrhea. it usually resolves on its own in about two days, said Dr. Anita Barry, director of the infectious disease bureau at the health commission.

She said samples from two clusters that were tested by the federal government confirmed the presence of the virus. It’s often referred to as the “cruise ship’’ virus because it has been known to sicken seaborne tourists.

This time it is staying on land, though it is tough to say how many folks in this region have come down with the stomach bug. the health commission counts 2,251 people who were seen in Boston emergency departments from October through Dec. 18. An increase of 0.9 percent translates into 20 extra people going to a hospital over that period.

While you can get infected with norovirus by eating contaminated food, the virus typically is not the source of a single foodborne illness outbreak like the salmonella outbreak earlier this year in eggs, Barry said.

Norovirus often spreads from person to person because of poor hygiene such as not washing hands properly after going to the bathroom or changing an infant’s diaper.

You also can also remain contagious for up to three days after your symptoms disappear. “That’s why food handlers have to stay out of work for 72 hours after they’ve been sick,’’ Barry said.

People who come down with an intestinal bug, Barry said, should drink plenty of fluids to stay hydrated; take ibuprofen or acetaminophen to reduce any fever; wash their hands frequently to avoid infecting family members; and avoid food preparation while sick and for three days afterward.

If the illness doesn’t resolve after a few days or you start to feel dizzy or faint, call a doctor.

© Copyright 2010 Globe Newspaper Company.

The U.S. gonorrhea rate fell to a record low in 2009, but the syphilis rate notched up again and the chlamydia rate reached a historic high, the federal government said in its annual report on sexually transmitted diseases.

The new Centers for Disease Control and Prevention (CDC) report also shows that the nation is nowhere near meeting the STD goals of Healthy People 2010, an ongoing national scorecard for good health that was last updated in 2000 by the Clinton administration.

For instance, Healthy People 2010 sought to have only a small fraction — 3 percent — of young men and women test positive for chlamydia at STD clinics. Instead, the 2009 data showed much higher chlamydia infection rates among clinic visitors — 16 percent for women and 24 percent for men.

Also, the 2009 gonorrhea rate of 99 cases per 100,000 persons was the lowest the government has seen since it started keeping records in 1941. But as welcome as this rate is, it still dwarfed the hoped-for 2010 rate of 19 cases of gonorrhea per 100,000 persons.

Gonorrhea is “still the second most commonly reported infection in the United States, so there’s still a high burden of it,” said Charlotte Kent, acting director of the CDC's Division of STD Prevention.

STDs are “hidden epidemics of enormous health and economic consequence in the United States,” the CDC said in its report, Sexually Transmitted Disease Surveillance, 2009.

Many Americans are reluctant to address sexual health issues, and yet all of their communities are affected by STDs, the agency said, noting that the estimated 19 million new STD cases a year cost $16.4 billion a year in health costs.

In 2009, a record 1,244,180 cases of chlamydia were reported. This was a 2.8 percent increase over the 2008 rate and the largest number of cases for any condition ever reported. This is also less than half the estimated 2.8 million chlamydia cases that are believed to be out there, said Ms. Kent, an epidemiologist.

Chlamydia is a troublesome infection because it typically has no symptoms, so people do not seek treatment. in women, chlamydia can lead to pelvic inflammatory disease, which, if left untreated, can rapidly impair or destroy their ability to become pregnant.

“We estimate conservatively that about 24,000 women a year become infertile because of undiagnosed and untreated chlamydia and gonorrhea,” Ms. Kent said.

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