Carilion Clinic's flu expert shared two words of advice about the ongoing regional spread of illness attributed to the 2009 H1N1 flu virus, also known as swine flu.

"Don't panic," said Dr. Tom Kerkering, Carilion's infectious diseases medical director.

But don't be complacent either, he said.

Last week, Carilion Clinic asked visitors not to bring children along. On Wednesday, responding to increasing cases of flulike illnesses believed linked to the H1N1 virus, Carilion drew the line. "Visitors under the age of 18 will not be allowed to visit the hospital."

Carilion's mandate is but one of many signals that H1N1 flu is becoming increasingly widespread in the region. Doctors' offices, emergency rooms and urgent care centers are being deluged with patients who have flulike symptoms attributed to H1N1.

Most of the new flu cases involve children, according to both Kerkering and HCA Southwest Virginia, which includes Lewis-Gale Medical Center in Salem.

Public school students in the region, including in Roanoke and Roanoke County, will be able to receive H1N1 vaccinations in school. School officials have not provided dates for the clinics but this week notified parents that consent forms and vaccination information sheets soon will be sent home. Health services officials from both divisions said the forms need to be returned within two days, and parents will receive an automated telephone alert when the documents are en route.

Dr. Stephanie Harper, director of the Alleghany/Roanoke City Health Districts, said on-site vaccination clinics will be available to "all school districts that desire this." Harper's districts include Roanoke, Salem, Vinton, Covington and Clifton Forge, as well as the counties of Roanoke, Alleghany, Botetourt and Craig.

Nationally, many parents have cited concerns about whether the vaccine is safe. On Wednesday, Kerkering expressed full confidence in the H1N1 vaccine's safety, as did Harper.

"The vaccine is being manufactured exactly the same as the seasonal flu vaccine, which has a very well-established safety profile," Harper said. "The same processes, materials and safeguards are being used."

No vaccine is risk-free, she said, "but we expect the H1N1 vaccine to be very safe."

She added, "We believe that, in most cases, the risks of falling ill with the flu are much greater than any risk associated with receiving the vaccine."

Experience to date with the H1N1 flu suggests it is not more dangerous than seasonal flu. But because it is a novel flu virus, few people have immunity against it, which makes it especially contagious.

Kerkering said several forces are probably at play in the increase of pediatric cases. Children returned to schools in late August and early September, concentrating potentially infectious peers, he said.

In addition, an adult suffering flu symptoms might just cope and stay home from work. But parents are typically less likely to take such a relaxed approach when their children are ill, he said. As a result, children's cases can be overrepresented.

And other experts have said children are less likely than adults to follow standard precautionary practices, such as hand-washing.

On Wednesday, administrators at Roanoke Catholic School said they were canceling classes through Friday for eighth through 12th grades because of widespread flulike symptoms.

Both Carilion Clinic and HCA Southwest Virginia have received some shipments of H1N1 vaccine in its nasal mist form. These early doses will go to employees who are in priority groups according to their relative risk for exposure. Kerkering said the nasal mist is effective in children but seems less so in adults. H1N1 shots should soon be available also, he said.

As of Wednesday morning, the Virginia Department of Health was due to receive and distribute, through drop shipments from contractors, a total of 88,200 doses of vaccine, according to Melodie Martin, a VDH spokeswoman. She said the bulk of doses, for now, is in the nasal mist form.

These initial shipments will go to hospitals, health departments, primary care physicians and other priority health care providers, Martin said. She said VDH has decided to stop issuing news releases each time another person in Virginia dies from causes attributed at least in part to H1N1 flu. As of last week, few deaths had been reported.

The health department operates a hotline for people with questions or concerns about flu, whether seasonal or H1N1. Martin said about 70 percent of recent callers have had questions about H1N1 vaccines, with inquiries about dates of availability, locations offering vaccinations and vaccine safety.

The toll free hotline number is: 1-877-275-8343.

Staff writer Courtney Cutright contributed to this report.