Those who receive annual flu vaccinations may be rolling up their sleeves several more times than they have in the past.

Historically, seasonal flu shot recipients receive a single dose of vaccine to prevent the illness that typically strikes in the fall and winter.

That flu shot soon could be coupled with a series of two additional shots to vaccinate against the H1N1 (swine flu) virus that gained national attention in the spring, causing some schools and businesses to close and events nationwide to be postponed or canceled.

Malae Lucas, director for emergency services at Metroplex Hospital in Killeen, recently returned from a state pandemic summit where flu vaccinations -- seasonal and H1N1 -- were the topics of discussion.

Though no decisions have been made yet, Ms. Lucas believes Center for Disease Control officials will support administering two shots to protect residents from the H1N1 virus.

"Seasonal flu shots will be available to the general public at the end of this month, and vaccinations for the H1N1 should be ready for a targeted group in mid-October," she said.

Those encouraged to get swine flu vaccines are pregnant women; people who live with or care for children younger than six monhs old; health care and emergency medical services personnel; those ages 6 months to 24 years old (the group most affected by the swine flu); and those ages 25 to 64 with chronic health conditions that could be aggravated by the flu, such as diabetes, lung diseases, immune system disorders or heart conditions.

No shortages are expected for H1N1 vaccine, Ms. Lucas said, and once the priority groups have received an initial dose, those not considered at high risk are advised to get an H1N1 shot.

"I encourage everyone to get a seasonal flu shot," said Ms. Lucas, "and then get the H1N1 shot if you are in one of the high-risk groups."

The ER director also plans to attend a national summit early next week, and she hopes to see firm recommendations made on the course of shots.

Within the next several weeks, a determination should be made as to when the H1N1 vaccine -- currently under development -- will be available and how many shots will be required, Ms. Lucas said.

The Texas Department of State Health Services lists ways to prevent the spread of flu:

• Wash hands often with soap and water or an alcohol-based cleaner.

• Cover coughs using a tissue or the crook of the arm.

• Steer clear of others who are sick.

• If you do get sick, stay home to prevent the spread of germs.

• Get a flu shot. More information is available at www.texasflu.org.