Florida's surgeon general says the state is preparing for massive swine flu immunizations, starting with schoolchildren, as the Obama administration urges states to prepare for the likelihood that the virus might worsen in the fall.

''We may end up averting a crisis. That's our hope,'' said President Barack Obama, who took time away from the G-8 summit in Italy to telephone another summit back home -- the 500 state and local health officials meeting to prepare for swine flu's fall threat.

''We want to make sure we aren't promoting panic, but we are promoting vigilance and preparation,'' Obama said.

Kathleen Sebelius, Health and Human Services chief, told the flu summit some H1N1 vaccine should be ready by mid-October.

''Scientists and public health experts forecast that the impact of H1N1 may well worsen in the fall, when the regular flu season hits or even earlier, when schools start to open, which is only five or six weeks away,'' she said.

Florida already is planning for such vaccinations, said Dr. Ana M. Viamonte Ros, Florida surgeon general, as she emerged from the summit.

''We're already meeting with local schools and day-care centers on how we would do this,'' she said. ``By mid-October we won't have doses for everyone. The vaccines will have to be directed toward individuals at high risk.''

Complicating the issue is the need to vaccinate against regular seasonal flu and the swine flu with different vaccines at the same time, Viamonte Ros said. Priorities would have to be different, because regular flu hits older people harder while swine flu is most widespread among the young.

No final decision has been made on whether to vaccinate Americans, Sibelius said. That depends on studies with experimental batches that are to start in August. But if all goes well, the federal government will buy vaccine from manufacturers and share it free among the states.

Confusion could arise as doctors, clinics and even pharmacies are in the midst of dispensing 100 million doses of regular winter flu vaccine at the same time schools are vaccinating against swine flu, Sibelius said.

She announced $350 million in federal grants to help states prepare.

Local officials also worry about the prospect of closing schools if the flu gets worse in the fall. School closures last spring created havoc for working parents without day care, until health officials reversed the policy and reopened schools even if they had swine flu cases.

Miami-Dade schools already are preparing for widespread vaccinations and also planning in case some schools have to close in the fall, said Wilma Steiner, Miami-Dade schools' director of health services.

If Florida schools have to close again, they must be ready to use distant learning techniques to cope, she said.

''We're already using a lot of these things -- teachers posting assignments, holding study sessions online so when schools reopen the kids won't have fallen behind,'' Viamonte Ros said.

Following Obama's lead, Broward and Miami-Dade health leaders said Thursday that they already have extensive plans in place in case of serious swine flu pandemic this fall and winter. But they have much work to do.

''We're working really hard to be prepared,'' said Lillian Rivera, director of the Miami-Dade Health Department. ``But we've never experienced a pandemic before.''

A major concern is having enough qualified personnel available for big vaccination programs, she said.

''We've had a mass vaccination plan in place for some time, working with law enforcement, emergency management services and healthcare providers,'' said Dr. Paula Thaqi, director of the Broward County Health Department. ``We're making sure we're ready with supplies, locations and staffing.''

U.S. health officials say the H1N1 virus has been relatively mild so far, and has shown no evidence of mutating into a more virulent strain.

Of 170 deaths so far in the United States, 75 percent involved people with underlying health conditions such as asthma or heart problems.

On Thursday, Baptist Hospital confirmed a swine flu death, putting total deaths in Miami-Dade County at four. It did not reveal details of the death.

The state health department Thursday also reported two other swine flu deaths -- a 55-year-old man in Duval County and a 25-year-old woman in Palm Beach County -- raising the number of lab-confirmed deaths in Florida to eight.

This report was supplemented with material from The Associated Press.

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