Topeka ? Health officials across Kansas expect the flu season that begins this fall to be unusually intense after watching swine flu cases pop up and spread for several months.

They’re anticipating thousands — perhaps even a few million — shots by hospitals, clinics, doctors and pharmacists to help ward off the H1N1 virus, on top of normal annual flu vaccinations.

Health officials don’t have many specifics yet on when new vaccines will arrive or how they’ll be distributed around the state — and can’t be entirely sure they’ll come at all. And they worry about schoolchildren being more vulnerable as a group to swine flu than to other strains.

“It’s a beehive of activity in every county health department across this state,” said Jason Eberhart-Phillips, the state health director. “Together with them, we have to anticipate immunization of the entire population.”

The Kansas Department of Health and Environment has reported 247 confirmed cases of swine flu in 41 counties. The agency also reported 23 hospitalizations and a death last week in which the H1N1 virus may have been a contributing factor in a victim who already suffered from a chronic medical condition.

But state officials say the case count is low, because the health department has moved away from counting individual cases in favor of focusing on trends. The state is not even accepting medical specimens for testing from some counties.

For the coming flu season, a big question involves the vaccine against swine flu. As of last week, three manufacturers had begun clinical trials. Health officials in Kansas hope doses will begin arriving by mid-October.

A committee advising the federal Centers for Disease Control recommends swine flu vaccinations for everyone from 6 months through 24 years old and anyone from 25 through 64 with chronic conditions, such as diabetes or respiratory problems, where flu could cause complications.

Also on the list are pregnant women, health care and emergency services workers, and people who have regular contact with children under 6 months. Eberhart-Phillips said about half the U.S. population is covered.

Health officials expect swine flu vaccinations to require two doses, several weeks apart.

If clinical trials for the new vaccines prove unsuccessful, then health officials expect to fall back on education tactics they used after the first swine flu cases were reported in late April. Those include stressing the importance of regular hand washing and staying home when sick.

They’re also likely to encourage people with mild cases to stay home from work or school — and avoid hospitals if they don’t face complications.

In 2007, the last year for which data was available, the state reported about 2,100 deaths in which pneumonia or influenza were at least a contributing factor and 51 in which flu was the direct cause.

Eberhart-Phillips expects that the H1N1 virus will cause deaths even though it seems stable and results in mostly mild cases, because of how widespread it could become.

“The virus is pretty easily transmissible, and none of us have an innate immunity without the vaccine,” he said. “We would anticipate that the mortality of this of this is going to be probably on the order of double.”