The first doses of approved vaccines for the H1N1 "swine" flu will start trickling in across the U.S. on Tuesday. The first to arrive, 600,000 doses of MedImmune's FluMist nasal spray, will be for healthy people ages two to 49, the Associated Press reported.

"This is really just the beginning," Anne Schuchat, director of the U.S. Centers for Disease Control and Prevention (CDC) National Center for Immunization and Respiratory Disease, said in a recent media briefing, Reuters reported. "We need a little bit of patience the first couple weeks." The arrival of these first doses is earlier than expected, and millions more are slated to be distributed by mid-October.

The early doses will go to states for distribution as they see fit but will likely be administered first to individuals that the CDC has pegged as high-priority for vaccination, including health care workers, children and pregnant women.

New York State has issued a mandate (and other states are considering them) that all health care workers get both seasonal and H1N1 vaccinations. The New York State Nurses Association, however, is protesting the idea, asserting that although getting the vaccine should be encouraged, flu immunizations should not be "a condition of employment."

Pregnant women seem to be at a higher risk for complications from the flu. New data from the CDC (noted by the Center for Infectious Disease Research and Policy—CIDRAP) show that about 100 pregnant women had been hospitalized for H1N1 as of August, and about 28 of them had died, making them 5 percent of U.S. swine flu deaths even though they are only about 1 percent of the total population.

Despite approval from the U.S. Food and Drug Administration (FDA) and other agencies, the vaccine still may not be sought out by most Americans. A September poll of more than 1,500 U.S. adults by the Consumer Reports Health Ratings Center found that more than 20 percent of adults don't plan to get the swine flu vaccine—and 43 percent were undecided. About half of the parents surveyed said they had not decided whether to have their children vaccinated.

Others may have little choice. Incoming U.S. Army recruits are already being vaccinated against the seasonal flu in basic training camp, South Carolina's The State reports. And H1N1 vaccines may follow suit now that the Army's first swine flu-related death has been reported (yesterday). In an Army conference earlier this month, officials noted that members of the military community can expect to get both seasonal and H1N1 shots. "We have to take care during flu season to try to prevent getting ill…to prevent operational impact," Deborah Knickerbocker, chief of Emergency Preparedness and Response, said at the conference, the Army news service reported.

An outbreak of H1N1 influenza this summer aboard the USS Boxer, a ship stationed in the Pacific Ocean, which holds more than 2,200 sailors and Marines, was reported recently in the Medical Surveillance Monthly Report [pdf]. Between June 30 and July 30, about 160 people aboard the ship tested positive for the virus.

Image courtesy of iStockphoto/KarenMower