MONTPELIER — A second Vermonter has died as a result of complications from the H1N1 virus, or swine flu, Health Commissioner Wendy Davis reported Wednesday.

Following department policy, Davis described the victim as an adult with other serious medical conditions, placing him or her in the high-risk group for the H1N1 influenza, but she declined to give any further information about the victim to protect the privacy of the family.

The first death was reported by Davis in late October and was also an adult suffering from a serious medical condition.

In addition, Davis said there have been three cases of students – she believes at elementary schools – attending vaccination clinics and receiving the vaccine without the required parental permission. She has been in contact with the families of those children and said there have been no health impacts from the vaccination.

Still, Davis said, she takes the mistake seriously. She said procedures for securing and confirming parental permission for children to receive the vaccine have been tightened to try and avoid a repeat of the mistake, which she said was the result of improper checking of paperwork at school clinics.

"I would never take any error lightly," the commissioner said during a weekly update on the outbreak. "We've expressed our concern and regret about how and why this happened."

Davis said swine flu remains widespread across Vermont, with 69 clinical samples out of 127 testing positive for the H1N1 influenza strain last week. At this point, she said, all influenza is of the H1N1 strain; there are no cases of seasonal flu.

The commissioner said that while the illness has been declining for about two weeks in other regions of the country, the H1N1 virus is on the rise in New England. That is due in part to the colder weather here, with the flu virus living longer in colder temperatures.

The state inventoried Vermont hospital admissions of influenza patients from Sept. 1 through last week and found that 79 Vermonters have been hospitalized with the illness, more than three-quarters of them suffering from another serious medical condition.

Of the 79 admissions, 25 were children (64 percent with medical conditions) and 54 were adults (88 percent with medical conditions), Davis said. She said their ages ranged from one month to 77 years.

Last week alone, six children and 14 adults were hospitalized with swine flu, the department reported.

The commissioner said roughly 368,000 Vermonters fall into one of the high-risk groups for the illness. To date, 53,932 doses of the vaccine have been administered to those in the high-risk groups, through 110 school clinics, physicians' offices, hospitals and public clinics around the state. She said there should be enough vaccine to cover everyone in a high risk group by January.

"This has been an unprecedented effort …," she said.

The state will have received a total of 106,300 doses of vaccine by the end of today, she said. But, Davis added, "This is about one-half to three-quarters of the amount that we had expected by this time."

Davis said some healthy Vermonters in high-risk groups who are eligible for the nasal spray vaccine – which contains weakened virus but cannot cause flu, she said — have been declining that form in favor of the flu shot, which does not contain live virus. Given the shortage of vaccine in the state, the department is trying to earmark the flu shots for certain high-risk people – those who are pregnant or suffering from other specific medical conditions (see www.healthvermont.gov for more information).

"The nasal spray is recommended for healthy people, ages 2 to 49 years who are not pregnant," Davis said. "FluMist cannot cause the flu in healthy people."

To encourage people to accept the nasal spray vaccine, the commissioner – who is a pediatrician — delivered a dose to 20-year-old Kala Correia of South Burlington, pulling on purple latex gloves and inserting the sprayer into each nostril and delivering the vaccine.

Correia, who said she was afraid of shots and preferred the spray vaccine, described the dose as "a little cold," but not unpleasant.

"I thought I would feel it a lot more," she said.

While the two deaths are serious, the swine flu outbreak in Vermont has been fairly mild, with most people recovering well at home following typical flu protocol of getting plenty of rest and fluids.

But, Davis said, "I never breathe a sigh of relief." She said flu outbreaks rise and fall with little predictability, and the H1N1 strain could shift into a vaccine-resistant format, which would be of concern.