BURLINGTON - Vermont has officially joined 41 other states with confirmed "widespread" H1N1 influenza activity, Health Commissioner Wendy Davis said Wednesday. She said the so-called swine flu has been confirmed in three of Vermont's five regions, and in reality probably is occurring in all five.

Davis said there have been no swine flu deaths in Vermont and only sporadic reports of people requiring hospitalization. There are about 36,000 deaths annually across the country from seasonal flu, and although there will certainly be more flu cases this year because of H1N1, Davis said it's too early to know if the swine flu outbreak will drive the number of deaths up.

"The number could be higher, but so much depends on the disease's severity," Davis said at a news conference at the Health Department in Burlington.

The commissioner said that last week 112 "specimens" were sent to the Health Department's lab for flu testing, with 48 testing positive for influenza A; of those, 45 were from the H1N1 strain.

But because so little testing is actually being done now, Davis said, "Those numbers are truly the tip of the iceberg."

She considers the outbreak serious but controlled. Two changes in the situation would prompt her to become more concerned: A dramatic increase in the severity of the disease, with more Vermonters requiring hospitalization, or a loss or change in the vaccine supply.

Some schools across the state, including U-32 Middle and High School in East Montpelier, are experiencing high rates of student absenteeism, in part due to the flu. At this point, Davis said, 90 percent of all flu cases are assumed to be H1N1 strains. Fortunately, most people seem to be recovering well from the virus.

And, she said, those absences show that parents are responding appropriately in keeping sick children home from school to allow them to recover and reduce the spread of the flu to classmates.

Older Vermonters are generally being spared from the H1N1 virus, Davis said, but young people are particularly at risk. For that reason, children are among the first slated to receive the vaccine, which so far is only trickling into the state.

The commissioner said Wednesday that her office would determine in the next 24 to 48 hours whether vaccination clinics slated for next week at some schools – including U-32, which is tentatively scheduled for Oct. 30 and includes students from the district's five elementary schools – will take place. Lack of vaccine in Vermont could prompt the delay of those clinics.

Davis said she's hearing three questions from parents about the vaccination effort. First, they wonder if their child should be vaccinated if he or she has already experienced what appears to be the flu. The answer, Davis said, is yes. Not all flu cases are the H1N1 strain, and not all illnesses with flu-like symptoms are, in fact, influenza.

Second, they ask if the vaccine is safe. Again, she said, the answer is yes. None of the few thousand Vermonters who have been vaccinated has reported any adverse affects, other than the typical vaccination complaints of soreness of the arm, mild fever and muscle aches.

Finally, Davis said, some parents are concerned they aren't allowed to attend a school vaccination clinic with their children. The commissioner said the procedures for Vermont's school-based clinics were based on the experience of other states, and the fewer adults involved, the smoother the vaccination process proceeded.

While Montpelier saw no significant increase in student absences, U-32 reported 140 students out earlier this week due to illnesses including flu. Davis said colleges around the state are also reporting "clusters" of influenza, as well, and are also planning to hold vaccination clinics.

Asked how U-32 could experience so many absences due to illness while nearby Montpelier High School saw no significant illness this week, Davis and Patsy Kelso, state epidemiologist, said the flu moves in such an unpredictable pattern, spreading heavily in one school or area one week and then moving to another.

The commissioner, who is a pediatrician, said the school vaccination effort, with 330 public and private schools working with the Health Department to get as many children vaccinated as possible, is "unprecedented" in recent history. Delivered in shot form, the vaccine takes between eight and 10 days to become effective.

Davis said the shipments of vaccine to Vermont are increasing each week, starting with about a thousand doses a week. She expects that number to increase to tens of thousands of doses per week to fully implement the school clinics and provide vaccine to doctors' offices, local health clinics and hospitals.

"We're rolling it out as equitably as we can," Davis said, noting that "several thousand at least" health care providers have been the first to receive the vaccine.