Fears that swine flu will come raging back when school starts this fall have public health officials and school administrators scrambling to find ways to inoculate thousands of South Sound children.

A vaccine for the H1N1 virus is expected to be ready by mid-October, and the Tacoma-Pierce County Health Department wants plans firmly established by then to ensure that as many school-age children as possible are inoculated – most likely through school-based clinics.

“It’s a voluntary vaccination so we can’t require it of everybody,” said Joby Winans, a department spokeswoman. “But we know that school-age children have been particularly vulnerable.”

The average age of those infected with H1N1 so far is 15, Winans said. Unlike typical strains of seasonal flu, which tend to hit elderly people hardest, Winans said people in their 20s and younger are most likely to be hospitalized with swine flu.

Not only are children more likely to get swine flu, they also are more likely to spread it, said Nigel Turner, the department’s public health manager.

“Studies have shown that young children generally have a key role in transmitting the flu virus in a community,” Turner said.

Plans for massive school immunizations have raised an array of logistical issues, from transportation to obtaining parental consent to ensuring proper refrigeration for the vaccine.

Complicating matters is the fact that the swine-flu vaccination most likely will require two doses, separated by about three weeks. Also, health officials are recommending that children be inoculated against seasonal flu as well, which means at least one additional vaccination session.

Last Wednesday, Turner met with representatives of most of Pierce County’s public and private schools, including colleges, to discuss options for when the vaccine arrives.

“This will involve close partnerships with the schools,” Turner said. “We’re basically coming up with models that will work for them.”

At the meeting, Turner laid out these options for administrators:

 • Schools provide space to a commercial vaccinator who would administer shots for a fee.

 • School nurses provide FluMist (nasal spray flu vaccine manufactured by Medimmune) to eligible students. Others would be referred to private or public providers.

 • Large “hub schools” with plenty of parking provide space for mass immunization clinics, hosting other schools during school hours.

 • Hub schools host immunization clinics after school or on weekends.

The four options each have different benefits and drawbacks, Turner said, and more than one option could be employed within a single school district.

“It’s still early,” Turner said. “I think different schools are in different places on this, depending on the resources they have.”

None of the biggest school districts in the Tacoma area has settled on an inoculation plan yet. Representatives of all the districts contacted last week said they intend to let public health officials take the lead and will cooperate to whatever extent is possible.

“There are no shot clinics scheduled in Tacoma schools now,” said Patti Holmgren, the Tacoma School District’s interim director of public information. “If the Health Department decides that’s the way to go, I’m certain we would be open to discussing it.”

The Bethel School District’s director of special services, Bob Maxwell, attended Wednesday’s meeting, district spokeswoman Krista Carlson said, and administrators are considering the options.

“Our status right now is, basically, we have not submitted any recommendation to the Health Department,” Carlson said. “We’re reviewing all of the different options that are available. We’re just trying to figure out the best way we can partner with the Health Department at this point.”

Turner asked schools to report back by Sept. 8, identifying likely options and indicating how many schools could be served by each.

Once clinical trials are over, the H1N1 vaccine will be provided free by the federal government. If shots are administered by local health departments or other public agencies, there will be no charge.

Those who get their inoculations from private vaccinators or at a private health provider’s office probably will have to pay a service fee, according to Turner. The fee is likely to be covered by insurance, he said.

While preschoolers also are high risk for the H1N1 virus, the Health Department is not planning to set up inoculation sessions at day-care centers, Turner said.

“They are so small, it would be tough getting the scale necessary,” Turner said. Instead, he said, the Health Department will put its emphasis on providing information and advice to day-care operators.

Until the vaccine arrives, Winans said, the Health Department’s advice to parents and school administrators remains the same as it was at the end of the school year last spring: wash hands, smother coughs in arms and keep kids home if they have flu symptoms.

Rob Carson: 253-597-8693

rob.carson@thenewstribune.com