Tom Randall and Shannon Pettypiece
Published: September 2, 2009

(Bloomberg) -- New York, Los Angeles and Boston are spearheading a drive in U.S. cities to distribute 195 million doses of swine flu vaccine at schools, fair grounds and union halls, aiming to slow the world�s fastest-moving pandemic.

New York already has had as many as 1 million people infected, health officials said yesterday. The city will offer free immunizations at elementary schools and distribute the vaccine through about 100 health clinics, according to plans released by Mayor Michael Bloomberg. Los Angeles will give out shots at 70 sites, and Boston will let city employees leave work for two hours with pay to get vaccinated, spokesmen said.

The U.S. will provide the H1N1 vaccine for free, according to the Centers for Disease Control and Prevention. Shots are being tested and will be available in mid-October, the Atlanta- based agency has said. Patients will still have to pay to have the vaccine administered unless states and cities agree to cover those costs, as New York has.

�We are going to make sure we take care of our people first, then figure out how to pay for it later,� Bloomberg said at a news conference yesterday. �Like a hurricane, a big snow storm, or a building collapse, this is something that could happen in this city, and something we want to be prepared for.�

New York�s vaccination program will cost about $30 million and provide shots for about 1.4 million students at public and private schools, Bloomberg, who is founder and majority owner of Bloomberg News parent Bloomberg LP, said yesterday.

Officials from Dallas, Chicago and Seattle said that while they have no current plans to provide free flu shots, they are addressing the pandemic in other ways.

Hand Sanitizer

Chicago Public Schools, the nation�s third-largest system with more than 400,000 students, will provide every classroom with two bottles of hand sanitizer to start the school year, and begin real-time attendance tracking for the first time to find possible hotspots, said Monique Bond, a district spokeswoman. Students return to classes Sept. 8, she said.

If providing free flu shots �becomes the recommendation, we would be able to mobilize,� Bond said.

Swine flu outbreaks shouldn�t close U.S. schools unless so many students or teachers get sick that it interferes with teaching or puts students at risk, according to guidelines released by the CDC on Aug. 7. The agency is encouraging states to set up vaccination clinics in schools, as well as distributing the shot through health clinics and private doctors.

Isolating Cases

Through Aug. 28, Illinois had 405 confirmed H1N1 cases and 17 deaths. Bond said she expects the Chicago district will be able to avoid closing schools by isolating cases. If schools do close, the state is urging that students be dismissed for 5 to 7 days, and that a reassessment be done before classes resume.

Dallas County, Texas, plans to depend on normal health-care resources, such as personal physicians who normally immunize children, said spokeswoman Blanca Cantu.

�We are urging medical providers who care for these individuals to order vaccines for their patients� through the Texas Department of State Health services Web site, said Dr. John Carlo, the county medical director.

Public health authorities in King County, Washington -- which includes Seattle -- created a 12-page comic book about pandemic flu. Called �No Ordinary Flu.� Available in 21 languages, it follows a young boy whose great uncle died in the 1918 pandemic, the deadliest outbreak. The story shows how people can help prevent a recurrence by staying home when sick and washing hands frequently.

Fastest-Moving Pandemic

Swine flu has become the world�s fastest-moving influenza pandemic, sweeping across 177 countries in the four months since it was first identified, the CDC said. Lab tests have confirmed H1N1 in 2,185 deaths and more than 209,000 infections, though most infected patients aren�t tested, according to the Geneva- based World Health Organization.

H1N1 may eventually infect 30 to 50 percent of the U.S. population, according to a planning scenario released by outside advisers to the White House on Aug. 24.

The U.S. is already undergoing the highest flu rates for this time of year since the 1968 Hong Kong flu, said Joe Quimby, a CDC spokesman, in an Aug. 30 telephone interview. While the U.S. flu season normally runs from November to March, swine flu continued to circulate during the summer with outbreaks seen in at least 80 summer camps, the CDC said.

12% of New Yorkers

The virus has infected as many as 1 million New Yorkers, or about 12 percent of the population, Thomas Farley, the city�s health commissioner, said in a news conference yesterday. Most patients have had symptoms similar to those in seasonal flu, though younger people had elevated rates of infection and were more likely to develop severe infections, Farley said.

New York schools will offer an inhaled form of the vaccine for most children, and make shots available for kids with conditions that prevent use of the flu mist, such as asthma or developmental disabilities. All vaccinations will be voluntary and require a parent�s consent, the city said.

Cities and school districts are bracing for flu cases to rise as pupils return to school. Swine flu has infected hundreds of students in at least 17 U.S. colleges in the first weeks of school, health and education authorities said.

Los Angeles County, with a population of 9.8 million, has set up a program to distribute free swine flu vaccinations at more than 70 sites �as an important backstop for people who don�t have other sources of medical care,� said Jonathan Fielding, director of the Los Angeles County Department of Public Health, in a telephone interview.

Fairground Shots

Those sites include schools, fairgrounds, neighborhood centers and community clinics, and are intended to ease distribution to people who lack access to doctors, Fielding said. Some sites may include drive-thru access, he said.

Getting a large number of school children vaccinated will be challenging, Fielding said.

�It�s extremely difficult to get young kids to get a signed release form and then bring it back to school,� he said. �I think we are better prepared for this than we�ve ever been for an epidemic or pandemic. But without much clarity on when we will get the vaccine and how much, we have to be flexible.�

The U.S. government is paying for shots, nasal sprays and related supplies. It�s up to states to decide how to distribute the vaccine and who should pay for the doctor visits, according to the CDC.

The U.S. government took the unusual step of purchasing all of the swine flu vaccine for the country and plans to distribute it to state and local health departments when the shots are available. The vaccine is likely to require two doses, given three weeks apart, and patients won�t develop immunity to the virus for an additional two weeks, according to the CDC.

23,000 Bostonians

This month, Boston will set up flu clinics at union halls, churches, community health centers, elderly housing developments and other public gathering places. City of Boston employees will get two hours of paid leave to get vaccinated for seasonal influenza, and Boston Mayor Thomas Menino said other businesses should do the same.

From April to June, Boston saw 23,000 residents with influenza-like illnesses, said Ann Scales, a spokeswoman for the Boston Public Health Commission. The city�s health commission has said it expects about 20 percent of Boston�s residents to experience an influenza-like illness this flu season.

The city is aiming to hold free vaccination clinics once or twice a week, more frequently than in previous years, Scales said. Boston is also encouraging hospitals to provide free flu shots, �to be a good neighbor,� she said.

San Francisco Reaction

San Francisco plans to establish up to 20 vaccination centers at or near schools to provide free swine flu vaccinations for children and other groups at higher risk for the illness, said Susan Fernyak, director of communicable disease control and prevention for the city�s Department of Public Health.

The clinics would open after the city receives an expected first shipment of 80,000 doses of the H1N1 vaccine in October, she said. The centers would work with schools to provide vaccinations to children in the morning and later in the day to others at high risk from the flu, including pregnant women, health care workers and emergency personnel, Fernyak said.

�Our vision is these will be 12-hour clinics in or near schools, so that children can easily get to them� Fernyak said. �We�re creating a whole packet of release forms to distribute to families.�

To contact the reporter on this story: Tom Randall in New York at [email protected] or Shannon Pettypiece in New York at [email protected]

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