In the midst of a nationwide vaccine shortage, the flu has arrived in the Buffalo area.
Erie County public health officials reported three confirmed cases Tuesday, all elderly residents in one nursing home.
But whether the cases reflect a localized event or the start of the more widespread annual influenza season remains unclear.
The flu season generally begins in earnest in January and February, but can start as early as November.
"It could just be a sporadic outbreak," said Dr. Anthony J. Billittier IV, county health commissioner.
In addition to the three people with confirmed cases of flu, other residents of the nursing home exhibit flu-like symptoms, he said.
The nursing home, which officials declined to identify, has taken precautions that include limiting visitors, Billittier said. It also has received vaccine to immunize the remaining residents and staff.
Nationwide, a handful of states has reported sporadic outbreaks, but at the recent American Public Health Association's annual conference, Dr. Julie Gerberding, director of the federal Center for Disease Control and Prevention, said no widespread activity had been detected.
Earlier this month, the state began to distribute its supply of flu vaccine.
The majority of doses -- 42,000 -- went to the federal Vaccines for Children Program, which serves children who are uninsured, enrolled in Medicaid or who are Native American. More than 32,000 doses of vaccine were shipped to local health departments.
New York and other states are awaiting a decision on how the CDC will distribute the 22.4 million doses of vaccine that Aventis Pasteur, its manufacturer, has not yet shipped.
The U.S. supply of influenza vaccine was cut in half when British regulators halted production of the vaccine by another manufacturer, Chiron Corp., because of contamination.
The inactivated vaccine containing three killed influenza viruses that health officials believe will be the dominant strains during the flu season. Billittier said officials do not yet know if the flu cases reported here correspond to the strains in the current vaccine.
In other flu-related events, the Fort Erie Urgent Care Clinic announced that it will open on weekends to accommodate the hundreds of U.S. residents crossing the border to obtain the vaccine in Canada.
The clinic, which is getting customers from as far away as Texas, is one of a handful of medical offices in Fort Erie that began providing shots to Americans when the shortage in the U.S. arose.
"We originally purchased a few hundred extra doses. Then things just went crazy," said Tim Windsor, clinical services director. "People are calling from California, Iowa, the Carolinas. They are driving in from New York City."
The clinic, which now has several thousand additional doses of vaccine, is immunizing about 150 Americans a day for $40 U.S. a shot.
The shortage has pushed demand higher, reflective of what Windsor called the "Beanie Baby effect." But he also said the Americans crossing the border tend to be among the groups at high risk for complications from the flu.
Influenza kills about 36,000 Americans each year, and the CDC recommends that vaccine be reserved for people in eight priority groups, including children 6 to 23 months old, adults 65 years and older, anyone with underlying chronic medical conditions, pregnant women and health care workers in direct patient care.