Hundreds of U.S. schools are heeding the government's call to set up flu-shot clinics this fall, preparing for what could be the most widespread school vaccinations since the days of polio.
On Sunday, the head of the World Health Organization said the world must remain on its guard against swine flu, which has been mild so far but could become more serious as the northern hemisphere heads into winter.
Margaret Chan, on a visit to Tanzania, noted that most people infected with the H1N1 virus had suffered only mild symptoms but it affected certain groups such as pregnant women and people with underlying medical conditions much more severely.
"Looking ahead in the weeks and months ahead, especially for countries in the northern hemisphere, when they will be going into the winter, we need to maintain our vigilance and see how the disease will evolve," Chan told reporters.
In the U.S., an Associated Press review of swine flu planning suggests there are nearly 3 million students in districts where officials want to offer the vaccine once federal health officials begin shipping it in mid-October.
Many more may get involved: The National Schools Boards Association told the AP three-quarters of the districts in a recent survey agreed to allow vaccinations in school buildings.
In South Carolina, "there will be a massive attempt to use schools as vaccination centers," said state Superintendent Jim Rex. He plans at least one vaccination clinic in each of the state's 85 school districts.
South Dakota started offering free children's vaccination against regular winter flu in 2007, and this year it plans to offer both kinds in many schools, said state Health Secretary Doneen Hollingsworth.
Now come the difficult details: figuring out all the logistics in giving squirmy youngsters a shot in the arm or a squirt in the nose.
That's in addition to measures being taken to keep the swine flu virus from spreading inside schools and to keep sick kids at home.
Already, Lee County, Mississippi, schools have reported a few cases of swine flu during the first week of school, and a Louisiana high school football team reported 20 players sick or recovering from it.
To make sure students wash their hands, Minneapolis schools have outfitted every restroom with tamperproof soap dispensers.
Bismarck, North Dakota, is insisting that parents keep feverish children home. "We're going to have to be a little firmer on that this year than in the past," superintendent Paul Johnson said.
Keep schools open
It can be hard to tell if a child has a bad cold or flu — and swine flu and regular flu share the same symptoms. For many schools, a 100-degree Fahrenheit (38-degree Celsius) temperature automatically means sending a child home.
The goal is to keep schools open; federal officials said last week schools should close only as a last resort. The emergence of the never-before-seen flu strain last spring prompted more than 700 schools to temporarily close, giving students an unexpected vacation as parents scrambled to find child care.
The government is urging parents to have a backup plan for caring for their kids in case they are hit by swine flu once the new school year begins.
Health and Human Services Secretary Kathleen Sebelius says parents need to consider alternative strategies for caring for kids who are sick with swine flu.
School officials are already taking preparations to minimize the spread of the flu at schools. One strategy is frequent hand washing. Sebelius endorses the idea that kids should wash their hands for as long as it takes them to sing "Happy Birthday to You" to themselves.
Sebelius spoke Sunday on ABC's "This Week."
Some big states, like California, Ohio and Massachusetts, are focusing on stopping spread and not on vaccinations, because they don't know how much vaccine the federal government will send or when it will arrive. Boston has decided against in-school vaccinations because an attempt at regular winter flu inoculations at a middle school last year flopped, and Dallas officials also have decided against school shots.
But hundreds of districts are preparing for vaccinations. At least 700 health and school officials joined an online seminar last week by the National Association of County & City Health Officials on how to run school flu vaccinations.
The government is awaiting results of vaccine studies that began last week before making a final decision on whether and how to offer swine-flu inoculations. If vaccinations go forward, children are to be among the first in line. They could get vaccine at a variety of places, but federal officials want schools to play a starring role.
"The vaccine over time will be available to every child," Education Secretary Arne Duncan said in an interview with the AP. "And I personally think the best place for them to have access would be at their local school or at a school in their neighborhood."
An AP-GfK poll last month found parents like that convenience: Nearly two-thirds said they were likely to give permission if their child's school offered vaccinations.
The school setting is attractive for many reasons, said Dr. Anne Schuchat of the Centers for Disease Control and Prevention.
Swine flu seems to strike the young most often, and it's particularly easy to spread from child to child. Moreover, school-age children "don't see doctors very often," Schuchat told the AP, after they have accumulated the list of vaccinations required for school entry.
She added that it should be relatively easy for schools to offer flu-shot clinics because the federal government would be buying swine flu vaccine and sending it free to states.
There is plenty of experience with vaccinating school kids for regular flu, and there is plenty of evidence it works.
For the fourth year running, Knox County, Tennessee, vaccinated 30,000 children for free in schools and daycare centers last year. The county often closed schools because of winter flu outbreaks in the past, but it has not since vaccinations began.
There is an important difference with this year's swine-flu inoculations: Health officials think two separate doses, about three weeks apart, will be needed. Studies are under way now to confirm that. If so, it means any school that offers the first shot must set up for each recipient to get the second dose.
Different school districts handle vaccinations differently. Some will offer only vaccine against the regular winter flu — also important, as both types are expected to hit this year. That could be confusing for parents trying to remember which vaccine their child is getting.
Chicago probably will have swine-flu shot clinics at select high schools, not elementary schools, saying it simply doesn't have the workers to send teams to more than 600 schools.
Taking advantage of lead time
In New York City, swine flu exploded in the spring at Saint Francis Preparatory School, which sent home 102 sick kids in one day. Today, City Health Commissioner Dr. Thomas Farley's first choice is for kids to get vaccinated by their own family doctors, but he's looking into clinics at schools or other locations.
"There's an awful lot of children who need to be vaccinated," Farley said.
Once the decision is made to offer flu shots at school, there are still issues to be worked out. Health professionals will need to administer shots and also check kids for reaction to the vaccine.
While educators and health officials decide how best to ward off a stronger strain of the virus in the fall, St. Francis Assistant Principal Patrick McLaughlin said his students may have already learned from experience to be vigilant.
He already noticed the changes: Sharing water bottles at school suddenly became a major transgression. And in 25 years of teaching health class, McLaughlin had never seen students get so excited about communicable diseases.
"I don't want them to come to school being afraid," McLaughlin says, standing by neat rows of empty classroom chairs. "But I do want that awareness ... that knowledge, that it's out there. It could come back. Be ready for it."
No one wants to call the city's outbreak a blessing, but the spring's out-of-season flu invasion did provide a peculiar kind of gift. Now New York City's Health Department and schools are trying to take advantage of the lead time — preparing for a fall season that is expected to be even worse.
The details of the city's swine flu plan are still being finalized by a Health Department panel.