Dr. Stephanie Harper promised Friday that everyone in her health districts, as well as others in Virginia, will eventually be able to receive a vaccination against the H1N1 virus after the vaccine starts to become available in the region -- probably in mid-October.

H1N1 has been referred to as swine flu, and the regional incidence of illness related to this novel influenza virus appears to be increasing steadily -- although at least one school district has not yet witnessed a significant effect on attendance.

"We have been seeing about twice the volume in flu cases of what we see this time of year," said Harper, who is director of the Alleghany/Roanoke City Health Districts. The districts serve Roanoke, Salem, Vinton, Covington and Clifton Forge, as well as the counties of Roanoke, Alleghany, Botetourt and Craig.

And these early season flu cases almost certainly involve swine flu, a conclusion based on trends during flu seasons past, symptoms, random testing and related analysis, she said. The Alleghany/Roanoke City Health Districts and New River Health District include "surveillance sites," such as emergency rooms, that collect random nasal swabs that are sent to labs for testing.

Swine flu is spreading worldwide because it differs significantly from current seasonal flu viruses.

"Many people will not have protective immunity against [swine flu], and the seasonal flu vaccine will not protect against it either," reports the Centers for Disease Control and Prevention.

From mild to fatal

Both swine and seasonal flus can cause severe illness, require hospitalization and even cause death.

As of Sunday evening, five deaths attributed at least in part to swine flu have been reported in Virginia -- with none, so far, in either the Alleghany/Roanoke or New River health districts.

But people should not get the wrong idea, said Harper, that there is some kind of regional immunity. Swine flu is widespread in Virginia and potentially deadly, she said.

Carilion Clinic hospital emergency departments and physician offices are seeing an increasing number of people with flu-like symptoms, according to clinic spokesman Eric Earnhart. Dr. Thomas Kerkering, section chief of Carilion Clinic Infectious Disease department, said all current flu activity is likely swine flu.

Vaccinations against seasonal flu viruses are available regionally. Health authorities advise people to get this vaccine and then the swine flu vaccine when available.

"We all believe there will be enough H1N1 vaccine for anyone who wants to be vaccinated," Harper said.

Swine flu vaccine will be distributed first to priority groups -- to people at highest risk, to pregnant women, obstetricians, pediatricians, emergency room doctors and other physicians and health care workers, emergency responders, caretakers of children younger than 6 months old, people age 6 months to 24 years and those 25 to 64 years old with underlying health conditions.

Harper said the swine flu vaccination will be offered at more than 110 sites in her districts. They will include health departments, retail stores, at least some public schools, physicians' offices, hospitals, pharmacies and elsewhere.

The 2009 swine flu vaccine, like seasonal influenza vaccine, can be administered as a nasal spray or an injection.

Schools

Harper said school sites allow the vaccination of a concentrated group of students and staff.

Meanwhile, school officials in Roanoke and Roanoke County are tracking absences and looking for flu-related trends.

A comparison in Roanoke County of absences on Thursday and one year earlier, on Sept. 24, 2008, showed an increase of less than 1 percent. Last year on Sept. 28, 316 students were absent, versus 440 on the same date this year. Some absences are likely due to influenza-like illnesses, but school system spokesman Chuck Lionberger said the overall increase is not unusual.

Tiffany Woods, a spokeswoman for Roanoke's public schools, said the division continues to work closely on its influenza plan with health department officials. Woods said she was unable to provide specific data on absences.

Woods did say that if a large proportion of students at any one school is affected by the illness, school officials would turn to the health department for consultation before closing the school. The division does not have a standing formula or specific threshold in place to initiate a closing, she said.

The CDC releases the vaccine to the Virginia Department of Health, which then releases it to health districts, Harper said. She said the CDC will issue one big burst of vaccine and then more doses will be distributed weekly.

"All vaccine the health department provides is free," said Harper, though there may be administrative fees at some locations.

New River

Robert Parker, southwest regional public information officer for VDH, said the swine flu picture is similar in the New River Health District, which includes Montgomery County, Blacksburg, Radford, Pulaski County, Floyd County and Giles County.

The virus has sickened people there, including students at Virginia Tech and elsewhere. Vaccination sites will include schools and other locations. If Tech students are part-time caregivers for children 6 months or younger, they could be included among priority groups receiving a first shot at the vaccine.

Precautions

During a visit Friday to The Roanoke Times, Harper and Parker entered an elevator while vigorously rubbing their hands with sanitizing gel -- one of several measures advised to help avoid infection from the swine flu virus.

Harper said she carries gel with her. To be effective, the formula should be at least 60 percent alcohol.

She said she also washes her hands more frequently, covers a cough or sneeze with a tissue, tries to avoid touching her eyes, nose or mouth and takes other precautions recommended by the CDC.

Earnhart said Carilion has a detailed plan to treat patients with serious flu symptoms while protecting hospital staff, other patients and the community.

For example, he said people visiting patients are asked not to bring children, a particularly susceptible group.

On the Net: www.flu.gov www.vdh.state.va.us www.cdc.gov/h1n1flu