Letters sent home by school systems are advising parents to return consent forms quickly if they want their child to receive a vaccination against the 2009 H1N1 virus, also known as swine flu, during a school clinic.

Robert Parker, a regional spokesman for the Virginia Department of Health, said clinic dates will vary from location to location and district to district, but he anticipates they will begin next week. All students who return a consent form and do not have underlying medical problems can get the vaccine.

So, for many parents, decisions loom. And, for at least some, anxieties about the vaccine loom, too.

Arranging for vaccinations for the H1N1 virus at school clinics will not be the sole opportunity for parents to have children vaccinated in the weeks ahead. But H1N1 vaccinations administered by the health department will be free and might be available sooner at schools than at other venues.

"Though schools are a major partner in distributing H1N1 vaccine -- particularly early in the season and for the key population of school-age kids -- they are by no means the only distribution channel," Parker said.

Both regionally and nationally, some parents remain torn about whether or how to proceed with H1N1 vaccinations for their children. News reports about national polls detailing this ambivalence seem to have contagious effects of their own.

Still, many parents in the region have made up their minds.

Some say 'yes'

Roanoke resident Pam Young's son, Josh, is 15.

"After researching on the Internet and talking to other parents, I've decided that my son is getting the H1N1 vaccine," she said. "As with everything I do for my son, I cross my fingers and say a prayer it's the right thing for him."

Dr. Cathy Swanson and her husband, Marc, both anesthesiologists in Roanoke, plan to have their son Jamie, 13, and daughter Tessa, 15, vaccinated against the seasonal flu and the H1N1 flu.

"The H1N1 vaccination has been deemed to be safe by the U.S. Food and Drug Administration and the Centers for Disease Control [and Prevention]," Cathy Swanson said in an e-mail. "A pandemic flu is much more dangerous to our society as a whole than the vaccination."

And one real danger, she said, is exposing other people to flu who "may be at extreme risk for complications, especially pregnant women or those immuno-compromised from other diseases."

And because 2009 H1N1 is a novel flu virus, it can be highly contagious -- especially in the close quarters of school settings.

The CDC recently reported an increase in H1N1-attributed deaths in children. Most of the children, and perhaps all, had an underlying medical condition. The current total of flu-related pediatric deaths in the United States is 81, according to Thomas Skinner, a spokesman for the CDC. That figure is comparable to pediatric mortality during many periods of seasonal flu, he said.

For most children, the H1N1 flu will be comparatively mild and symptoms will ease within a few days, according to the CDC.

Some say 'no'

"We are definitely not going to vaccinate our kids," reported Julia Collins and Dave Hrusovsky of Roanoke. "We plan on continuing to strengthen our immune systems and to keep adequate levels of vitamin D going. There are too many drawbacks to getting the vaccination -- the biggest is mercury."

The injection form of H1N1 vaccine can include a mercury-containing preservative called thimerosal, which the CDC reports has been used in vaccines and other products since the 1930s.

According to the CDC, "there is no convincing scientific evidence of harm caused by the low doses of thimerosal in vaccines, except for minor reactions like redness and swelling at the injection site." The CDC also reports studies have found no link between thimerosal and autism, a conclusion disputed by the National Autism Association and others.

Parents concerned about thimerosal can elect to have their child receive the nasal mist form of the vaccine, if available at their school and if appropriate for the child.

Joe Foley and his wife, Diane DeReu-Foley, are chiropractors in Salem. They have two daughters. Joe Foley said the girls have never been vaccinated and that he and his wife will make no exception this time.

"There are many reasons not to do it," Foley said. "For us, personally, we don't have a big fear of the illness."

He said many Americans, routinely armed with antibacterial gel, have become germophobic and have come to view even common illnesses as unacceptable.

"The reality is, the immune system is developmental," Foley said.

Some aren't sure

On Oct. 2, the Harvard School of Public Health released survey results that showed about 51 percent of parents surveyed were "absolutely certain" they would get the vaccine for their children. About 21 percent indicated they would not get the vaccine, and others either had not made a decision or were ambivalent.

Jenny Hungate, a resident of Roanoke County, has one foot in the ambivalence camp.

Hungate is pregnant and due to deliver Oct. 23. She and her husband have a 17-month-old daughter who has been vaccinated against the seasonal flu. Hungate said her husband typically gets a seasonal flu vaccination, too.

Now, they're grappling with decisions about the H1N1 vaccine. Should Jennifer receive the vaccination after she has delivered? What about the couple's 17-month-old?

"We've been very conflicted," Hungate said. "Many of the news stories quote people saying it's safe."

But then she hears about surveys like the one at Harvard that found many parents had decided against the vaccine.

"You wonder, 'What are they hearing?' " Hungate said.

Ultimately, Hungate said, she and her husband will likely follow the advice of their obstetrician and pediatrician.

A specialist's take

Dr. Thomas Kerkering is chief of infectious diseases for Carilion Clinic. Like other agencies and experts, Kerkering said evidence suggests the H1N1 vaccine is just as safe as the seasonal flu vaccine.

"The same manufacturing processes that have been used for the last 30 years were used in making the 2009 H1N1 flu vaccine," Kerkering said. "It took the same amount of time to make this vaccine as it does the seasonal flu vaccine."

He said the H1N1 vaccine has been tested in more than 1,000 people and "has now been given to many thousands more in the last week."

"There are no reports of immediate problems with the vaccine," Kerkering added.