The first vaccine available will be MedImmune's FluMist inhalable vaccine, but injectable vaccines should be distributed soon after that, Dr. Jay Butler, chief of the Centers for Disease Control and Prevention's 2009 H1N1 vaccine task force, said at a morning news conference. The inhalable vaccine has not been approved for children younger than 2, adults older than 49 or pregnant women, so it may go primarily to health care providers. Distribution of the vaccine will be complicated logistically, at least in part because the government is paying for the vaccine supplies and most of the paraphernalia needed to give shots, such as needles, syringes and alcohol swabs. Patients may receive the vaccine free or may have to pay for administration, depending on where they receive it. Many insurance companies have agreed to pay for the shots. Physicians, clinics and other providers will place their orders for the vaccine with state health departments, who will compile the orders every day and forward them to the CDC, which will ensure that the vaccine is distributed equitably. Allocations will be based primarily on state populations. Physical distribution of the vaccine will be handled by McKesson Corp. of San Francisco, which also handles distribution of vaccines for the government's Vaccines for Children program. That program normally ships vaccines to about 40,000 sites around the country from its 30 warehouses. The flu vaccine will go out to 90,000 sites, so McKesson has added an additional six distribution facilities to handle the increased demand. All five swine flu vaccine manufacturers will ship their product directly to McKesson. Each morning, the company will receive a list of orders from the CDC. Within three days, those orders will be processed and shipped overnight to the local providers, Butler said. No shipments will be made on Fridays and Saturdays to avoid having the vaccine arrive and sit unattended. Those 90,000 sites include physician's offices and clinics, but they also include distribution points such as the warehouses of chain pharmacies, which will then send the vaccine out to their own stores. Local health departments also may distribute it to clinics, schools and other sites. At the same news conference, Dr. Daniel Jernigan, deputy director of the CDC's influenza division, said that the flu season has begun early and that all 50 states are now reporting activity, with 21 reporting widespread activity. 'It's very strange to see that kind of activity this time of year,' he added. Most of the cases are swine flu, not seasonal flu, and the good news is that there has been no increase in virulence of the virus and no increase in resistance to antiviral drugs used to treat it. 