Yamhill County Public Health is offering free H1N1 flu vaccinations at local daycares, pre-schools and schools, but it requires permission that many parents seem reluctant to grant.

Parents appear to be more willing to have younger children vaccinated than older ones, as vaccination rates have been highest at daycare centers and lowest at secondary schools, records show.

Public Health Manager Mike McNickle said roughly 80 percent of parents were consenting to vaccinations at local daycare centers.

However, only about one-third granted permission last week at the two Sheridan schools and earlier this week at the McMinnville School District's Patton and Duniway middle schools. And rates weren't a whole lot higher at the McMinnville district's Wascher and Sue Buel elementary schools.

At Duniway, about 240 of the school's 678 students, or 35 percent, brought signed permission slips Monday. At Patton, it was 235 of 818 students, or 29 percent. At Wascher, it was 230 of 420 students, or 55 percent.

"Parents who choose not to vaccinate their children at this time will have the opportunity later if they change their mind," said spokeswoman Sarah Bates.

"By vaccinating a large number of children at a school, this will reduce the chance of H1N1 spreading in a classroom to non-vaccinated children and among school staff," she said. "In turn, this will reduce the chance of other household contacts from getting exposed to the virus."

She said, "If parents have questions about whether their child should receive the vaccine, they can contact their healthcare provider or public health's information line at 503-434-7443."

Public Health has been offering a choice between the live-virus nasal spray version or the killed-virus inoculation version. However, it has not always had both available.

The live-virus version is considered significantly more effective, but has stirred concern among some parents. "In those cases, we just ask that they keep in contact with us so that when we have the type prefer, they can get it," County Public Health Officer Robert Moore M.D. said.

No problems with adverse vaccine reactions have been reported locally, and few nationally. However, fears have been raised by bloggers and talk TV and radio personalities.

"People have real concerns, and we understand that, because we can never say that it's 100 percent safe," Moore said. "No vaccine is 100 percent safe."

However, he said, "We do feel strongly that this is one of the safer vaccines.

"We feel comfortable in saying that because so many doses are given each year of influenza vaccine, and the millions of doses that have been given in recent years have shown that the vaccine can be very safe. There are very few adverse effects, and the same techniques are being used to prepare the H1N1 vaccine as have been used for many years in preparing the seasonal vaccine."

Moore said that it would be more effective to have broader participation - more on the order of two-thirds than the one-third his agency has been seeing in some of the local schools it has been visiting.

"Our concern for the community is that you only effectively control the spread of the disease if you have a significant percentage of the population protected, either by being vaccinated or by having and having gotten over the infection," he said. "As you move it over the 60 to 70 percent range, you get the community protected enough that it really slows down the transmission."

He noted, "As we hear reports of people dying from this virus, it makes us aware that even though for most people it is no more severe than regular influenza, people do die." And unlike the seasonal flu, which typically hits the elderly hardest, H1N1 has been hitting children and young adults hardest.

That is one reason the county has been targeting children with the limited supply of vaccine becoming available so far. They are considered the most vulnerable.

There are two other reasons as well, Moore said.

First, the disease spreads most widely among children in group settings where they have contact with a substantial number of peers. Second, group settings allow the agency to efficiently immunize a large number of people at one time.

Moore said the slow pace of vaccine distribution remains the department's biggest concern.

"I think we, in general, are worried at this point that we are not getting enough people vaccinated, because we're seeing so much disease," he said. "But the concern is not so much that people are refusing, but that we just don't have enough vaccine for people who would be quite willing to be vaccinated."

Public Health is receiving numerous calls from people frustrated that they are unable to obtain the vaccine yet, he said.

At the Willamette Valley Medical Center, flu-related emergency room traffic has dropped down to normal, following a surge from people frightened by news reports, according to Carla Galbraith, manager of patient safety and infection control. However, the hospital is still getting a steady flow of flu victims, some of them quite ill.

"We are not seeing large volumes of patients admitted with the flu, but those we do admit generally have some underlying illness that causes them more issues," Galbraith said. During recent weeks, she said, "we have transferred four patients out to Portland hospitals because they needed a higher level of care."

State records show 17 Yamhill County flu victims have required hospitalization since Sept. 1. The county has reported one death, that of a 44-year-old McMinnville man who had underlying health conditions.

Galbraith said the hospital received 30 doses of H1N1 vaccine last week and used them to vaccinate its frontline ER staff. It just received another 200 doses, which it plans to allocate to "other bedside care providers," she said.