MILILANI — Instead of stretching out their arms yesterday, students at Mililani Uka Elementary School tilted their heads back so nurses could squirt a protective "flu mist" in their noses as part of a pilot project that will help researchers better understand the most effective technique for warding off flu — but also could offer guidelines for safeguarding the state in a flu pandemic.

"Considering pandemic flu preparedness, kids are looked on by experts as a huge priority group because they're susceptible to infections and they spread them very quickly," said Dr. Sarah Park, deputy chief of the Disease Outbreak Control Division of the Health Department and chairwoman of the Hawai'i Pandemic Flu Preparedness and Response Working Group.

"So our little pilot project has a lot of far-reaching consequences and potential if we theoretically had to vaccinate all the school kids in the state. How could we do it effectively?"

In a new partnership between the state departments of Health and Education, several hundred Mililani children at three elementary schools will be vaccinated against flu over the next week as officials gather data on how quickly and efficiently the job can be done and whether it would be feasible to attempt statewide school-based flu vaccinations.

Park, who helped organize the project, said a dream of the Health Department would be to see statewide flu immunizations through the schools, but department spokeswoman Janice Okubo said findings from this project must be evaluated long before any next step can be determined.

"We don't want people to think we're moving ahead without their consensus and agreement," Okubo said.

Even if the project indicates the most efficient and protective vaccination method for students, Okubo said there also would be the question of funding.

HELPFUL RIPPLE EFFECT

Such school-based vaccination programs could have a ripple effect of also protecting parents, families, teachers, other students at their school and others in their community.

"When you target schoolchildren there can be indirect benefits in decreasing absenteeism, and also protecting those around them," Park said.

Mililani Uka principal Heather Wilhelm said students already miss school in winter months because of the flu and school counselor Scott Miyagi said one bout of flu could take a student out of school for days.

"Sometimes some of the kids catch it together and they're out about a week," Miyagi said. "That's a big chunk."

Yesterday, 204 Mililani Uka students received the mist and next week students with parental permission at Mililani Waena Elementary and Mililani Mauka Elementary also will be offered the shots or mist. Mililani Uka students yesterday all received the mist — made from a weakened form of the virus — but some students at the other schools will receive the flu shot, which is formulated from dead virus.

"The research will show if one works better than the other," said Maghna Zettle, whose staff of nurses from Kahu Malama Nurses were handling the applications.

MIST VS. SHOTS

Stephanie DeJuan, 11, said the mist was a great alternative to the flu shot.

"Shots can hurt a little more and the flu mist doesn't really hurt," the fifth-grader said before squeezing her eyes tight shut as nurse Elizabeth Bucasas sprayed the mist up her nostrils.

Kiralyn Kawachi, 7, said she didn't mind as the mist trickled down her throat.

"It tastes like vanilla ice cream and I love vanilla ice cream," said Kiralyn, who is in second grade.

First-grader Kiha Mossman, however, said that "it's salty — like beach water."

While the flu season is expected to be mild again this year, like last year and the year before, Park said there's never any certainty and everyone should consider getting a vaccination. The mist has been approved by the FDA for people ages 5 to 49 because those are the groups that have been involved in trials.

But there are also other ways to protect against the flu, including covering your face if you sneeze or cough, and washing hands regularly, especially if you have sneezed or coughed into them.

"Hand-washing is the No. 1 preventative for spreading illness," Zettle said. "We always teach people to cover their face with their hands if they sneeze, but then you have to wash your hands."

Park said that families also have to be extra vigilant about hand-washing at home, if their child comes home with an illness.

"Everyone around kids knows that they're the biggest spreaders of germs. Their immune systems are still developing and, while the elderly are at higher risk of complications from flu, children are probably the most susceptible group to infection," Park said.

Reach Beverly Creamer at bcreamer@honoluluadvertiser.com.