Topeka ? Kansas now has nine confirmed cases of swine flu.

The Kansas Department of Health and Environment on Wednesday confirmed two new cases in Johnson County and two in neighboring Wyandotte County.

The cases add to a cluster in the Kansas City metropolitan area that includes six of the nine confirmed Kansas cases, three in Johnson County and three in Wyandotte. Five cases on the Missouri side have been confirmed by health officials in that state, making the total 11 for the entire metro area.

Dickinson County has two confirmed cases and Sedgwick County has one.

Johnson County also has a probable case of the disease, for which the state is awaiting confirmation from the federal Centers for Disease Control and Prevention. And there are four probable cases on the Missouri side of the Kansas City metro area.

“People go back and forth,” Nancy Tausz, director of disease containment for the Johnson County Health Department, said in an interview. “With any disease, it doesn’t stop at a state line or county border. It’s going to go back and forth.”

Health officials in Kansas said the new cases might mean more people are getting sick or that heightened surveillance is identifying cases that otherwise wouldn’t be reported.

“There could be more people getting sick, but we’re also increasing the surveillance,” said KDHE spokeswoman Maggie Thompson. “The harder you look and the more you look, the more you’re going to see cases.”

The two new cases in Johnson County involve children, and the new cases in Wyandotte County involve a child and an adult. Health officials provided no further information. The older case in Johnson County involved an adult from Texas who traveled there. In the older Wyandotte County case, the victim was a child who was hospitalized but has since been released.

Kansas’ first two cases, a married couple in Dickinson County, were confirmed April 25. The Sedgwick County case is a student at a local parochial school.

At Wichita State University, concerns about the flu have led officials to alter graduation ceremonies. The Wichita Eagle reported Wednesday that new graduates won’t be receiving handshakes from the school’s president or deans at commencement ceremonies May 15 and 16.

Students will receive diplomas and have their pictures taken as they cross the stage, Provost Gary Miller said, but the most they can expect from administrators will be a smile and possibly a pat on the back.

Meanwhile, Gov. Mark Parkinson and legislators tried to reassure Kansans that pork is safe to eat by participating in an event outside the Statehouse at which the Kansas Pork Association provided free sandwiches for lunch.

Health officials have stated repeatedly that swine flu cannot be transmitted by eating or handling pork products and poses no threat to the nation’s food supply.