Tissues are disappearing so rapidly from teacher Irma Natoli's desk that she's resorted to handing out paper towels to sniffling seventh- and eighth-graders struggling with flu symptoms.

"We've gone through boxes of them," said Natoli, who teaches at Morningside International Academy, a Fort Worth school for sixth- through eighth-graders. "They are constantly going to the bathroom for toilet paper and to wash their hands."

As a nasty flu outbreak spreads across the country, schools are reporting more empty seats as parents keep children at home to recuperate or to protect them.

The flu is being blamed for the deaths of at least six children in Colorado, three in Texas and one each in Oklahoma and New Mexico.

Children are particularly susceptible because their bodies have not previously been exposed to the virus that infects the nose, throat and lungs, according to the federal Centers for Disease Control and Prevention.

Children's Medical Center Dallas has seen more than 500 children with the flu since October. On Thursday more than two dozen were in the intensive care unit, Dr. Jane Siegel said.

"Most of those children require IV fluids ... and most have significant enough lung disease so they're on a ventilator," she said.

In a typical year 36,000 Americans die from the influenza virus, but flu researchers expect a higher death toll this year.

The flu season usually stretches from October to May, peaking in December and January, but this year cases were reported in some Western states as early as September.

Texas was the first state this season where the flu was considered widespread, the CDC's most severe ranking. Nine other states -- Washington, Idaho, Nevada, Utah, Colorado, New Mexico, Arkansas, Tennessee and Pennsylvania -- have since been classified as having widespread flu outbreaks.

More than 6,300 flu cases have been reported in Colorado, more than in the previous two years combined. North Dakota has tallied 292 flu cases so far, compared to just two this time last year.

Many states, including Texas, do not calculate the number of flu cases because they are not required to report such cases to the CDC.

Most of the outbreak this fall has been a strain called A-Fujian-H3N2 (search), which was not selected for this year's flu vaccine, according to the CDC. Health experts say the strain is closely related to the strain the vaccine targets, A-Panama-H3N2.

The high number of cases has prompted more people to seek flu shots this year. More than a dozen stood in line Thursday outside Fort Worth's Bagsby-Williams Public Health Center.

"I just got over the flu, and I don't want to go through anything like that again," day care worker Cynthia Bolen said. "It gets to your bones. You don't want to eat and you just ache. It's a thing that will paralyze you."

The outbreak in Texas started last month in Houston and spread quickly, according to the state Health Department. The weekly number of cases at Texas Children's Hospital in Houston peaked at 129 in mid-October. In previous years, the hospital averaged 10 or fewer weekly cases during the season's peak.

Hospitals are taking precautions. Wyoming's Campbell County Memorial Hospital has restricted anybody under 18 from visiting patients. And the Great Plains Regional Medical Center in North Platte, Neb., is asking anyone with even mild flu symptoms -- runny nose, sore throat or a cough -- to put on a mask before visiting someone.

(Xinhua News Agency December 5, 2003)