By Stephanie S. Daly, Globe Correspondent

State public health officials today announced the deaths of two people from swine flu, including a child under the age of four, underscoring the vulnerability that young people appear to have to the unusual virus.

The child is just the second in Massachusetts to die from H1N1, and the first child to die from the virus during this fall's flu season. The first child died in the spring.

"Death due to H1N1 is rare, but it does happen,'' said Dr. Lauren Smith, medical director of the state Department of Public Health. "I understand that the death of the child is a tragic thing.''

By Stephen Smith

Somewhere in Massachusetts this week, the state's millionth dose of swine flu vaccine should arrive.

Public health authorities announced today that with an allotment of shots and spray Tuesday, the state had received or ordered 1,020,000 doses of vaccine to slow the march of the H1N1 virus. And Dr. Lauren Smith, medical director of the Department of Public Health, cautiously forecast that by the end of this month, 1.5 millions doses will be in the state or headed here.

Still, that's about 300,000 doses fewer than state authorities originally expected to have on hand by the start of December. Production of swine flu vaccine has not met the projections of pharmaceutical companies or the expectations of federal health authorities, who have been criticized in some quarters -- including on Capitol Hill -- for overly rosy predictions about how much vaccine would be available and when.

Vaccination efforts in Massachusetts are being targeted at 1.6 million patients at greatest risk of complications from the virus and the people who take care of them. That includes pregnant women, children under 18, adults who take care of children younger than 6 months, and health care workers with direct patient contact.

As more vaccine becomes available -- the state expects 3.5 million doses by late January -- the priority list will be expanded, state officials said.

By Stephen Smith, Globe Staff

She began guarding the public's health when Jimmy Carter was president and Michael S. Dukakis was in his first term as governor. Nancy Ridley has ridden herd over laboratory safety, food and drug safety, radiation control, patient safety, and, in the wake of the Sept. 11, 2001, attacks, emergency preparations.

Ridley, who's retiring, was hailed this morning for her 32 years of service at the Massachusetts Department of Public Health. She was showered with flowers, a plaque commemorating a new safety award that bears her name -- and a Paul Revere bowl. The last was a gift with a message: Paul Revere, after he'd done his midnight ride thing, became America's first public health czar when, in 1799, he became Boston's first health officer.

Albert Sherman, a veteran member of the state Public Health Council, offered an effusive tribute to Ridley, noting that former House Speaker Thomas Finneran back in the day referred to Ridley as one of the two most powerful women in state government.

Sherman recalled, too, how when it was revealed that the steely Ridley was en route to a nursing home for an inspection, the powerful, wealthy owners of facilities would turn weak-kneed "and drop a dime to their lawyers."

Ridley smiled, wistfully. The audience applauded, heartily.

By Stephen Smith, Globe Staff

Swine flu has killed at least 540 children nationally since emerging in the United States last April, according to federal estimates released today that provide compelling evidence that the novel virus is causing serious illness among more young people than typical seasonal strains.

The report from the US Centers for Disease Control and Prevention, based on a sophisticated but not-fully-vetted statistical model, estimated that 8 million children fell ill with the H1N1 virus from April through Oct. 17, resulting in 36,000 hospital stays. Children under the age of 18 accounted for more than one-third of all swine flu cases, the report said.

It is not so much that the swine flu is more lethal than the seasonal strain, specialists said. Instead, the virus found a whole swath of millions of children and young adults who had never been exposed to ancestors of this H1N1 strain and who therefore had no natural immunity. And vaccine only started to become available during the past month.

The CDC report did not break out state estimates, but in the past month, coughing, feverish children have flooded Massachusetts emergency rooms. Since early October, two-thirds of those hospitalized with confirmed cases of swine flu have been 18 or younger, according to data provided today by the state Department of Public Health.

Among all age groups in Massachusetts, visits to doctors offices for flu-like symptoms have reached levels almost twice the peaks of recent flu seasons.

By Stephen Smith, Globe Staff

A 65-year-old Boston man with existing health problems died Oct. 31 from swine flu, the 14th person to succumb to the virus in Massachusetts, city health officials said this afternoon.

The man, whose identity was not disclosed because of patient confidentiality laws, was hospitalized Oct. 14 and was described by the Boston Public Health Commission as having "multiple health conditions." People with chronic conditions such as asthma are more likely to suffer serious complications from the H1N1 flu virus.

He is the fifth Boston resident to die from the H1N1 virus. Laboratory test results confirmed that his death was caused by the germ.

While the young have disproportionately been struck by the disease, there is increasing evidence that the virus may prove most lethal in the elderly, whose ability to fight illness is compromised by both age and infirmity. Two of the 14 Massachusetts swine flu victims have now been 65 or older.

Flu activity continues to be widespread in Massachusetts, public health officials said today in a weekly report drawn from the number of people visiting their doctors with fever, cough, and sore throats.

Patients are not routinely tested to see if they have swine flu, or H1N1, but because there are so many more cases than usual this early in the winter flu season, most illnesses are assumed to be caused by the H1N1 virus. About 5 percent of visits to doctors represent flu-like illnesses, the state said, well above peak levels in previous years.

A growing number of flu cases among patients has prompted Massachusetts General Hospital to change its policy for visitors. Last week the hospital barred children and teenagers from its obstetrics unit because children are both more likely to catch and transmit the flu.

As of Monday, children 18 and under are asked not to come to any part of the hospital unless they are patients, associate chief nurse Debra Burke said today. She also urged people with flu symptoms and anyone who has been around someone sick with the flu to stay away, again unless they are patients.

"Before you have symptoms of flu, you could have the flu and be shedding the virus for up to two days," she said. "We're just asking people to be really careful."

Alcohol advertising inside MBTA subway cars reaches thousands of Boston Public School students every school day, a new study from Boston University reports, exposing young people to the kind of messages that research links to increased underage drinking.

A team from the Boston University School of Public Health sampled about 30 percent of Boston's subway cars and found an average of almost two ads for alcohol per subway car on the Orange, Red, Green and Blue lines. The Orange Line had the most and the Red Line had the fewest alcohol ads.

They concluded that the ads -- mostly beer and bourbon -- were seen more than 18,000 times per day by students from 11 to 18 years old as they rode to and from school, reaching about half of the more than 9,000 students who travel to school by subway each day, according to ratings used by advertisers to measure the success of their ads. That level of reach is the same as those students seeing about five Super Bowl ads every day, study senior author Dr. Michael Siegel said in an interview.

State public health specialists are warning consumers that ground beef contaminated with E. coli bacteria may have been sold by four Massachusetts supermarkets, in a second, unrelated outbreak affecting the state in a week.

Shaws, Price Chopper, Trader Joe’s, and Wild Harvest may have sold fresh ground beef products distributed by Fairbank Farms, an Ashville, NY, meat distributor, Massachusetts health officials said today. The US Department of Agriculture has linked illnesses in Massachusetts, Connecticut, and Maine to ground beef contaminated with the same strain of E.coli:O157:H7. Each package had "EST. 492" inside the USDA inspection mark or on the nutrition label. For information on specific products at the four stores, go to the USDA site.

Today's news follows an unrelated E. coli outbreak last week in which more than 20 children and adults from Rhode Island became ill after eating ground beef at Camp Bournedale in Plymouth. South Shore Meats in Brockton recalled ground beef that had been distributed in institutional size packages.

Because raw meat can contain disease-causing bacteria, health specialists urge consumers to cook meat fully to a temperature of 160 degrees F, the level necessary to destroy disease-causing organisms such as E.coli, Campylobacter, and Salmonella.

E. coli can be deadly in the very young, the very old, and people with weakened immune systems. More information is available through the state Department of Public Health.

Budget cuts to public health programs in Massachusetts were not nearly as deep as some advocates had feared, but prevention programs will still suffer, a statewide group says.

Last month the Massachusetts Public Health Association warned that the state Department of Public Health would lose $32 million, or 9 percent of its non-hospital budget, to 9C budget cuts, named for the section of state law granting budget-cutting authority to the governor. But cuts made last week by Governor Patrick totaled $8 million. The spending changes are being made to help bring the state's budget into line with drastically lower revenues.

Some of the public health programs affected are smoking prevention and cessation services, teen pregnancy prevention programs, school health programs, and the sexual assault nurse examiner program.

"We are troubled that community-based prevention programs continue to be sacrificed," Valerie Bassett, executive director of the association, said in a statement. "These programs which prevent disease and injury in schools, community health centers, and out in the streets continue to be dismantled."

By Stephen Smith, Globe Staff

Massachusetts patients stricken with the chills, coughs, and fever that are the calling card of influenza are streaming into physician offices at a higher rate than any time during the past two flu seasons, state disease trackers reported today.

It is, said disease specialists and doctors on the front line, strong evidence that swine flu has the state in its cross hairs once again after subsiding in late summer.

The proof can be found in Davis Square, inside the waiting room of the Harvard Vanguard Medical Associates outpost.

"We're having people waiting much longer than we usually do, and we're having schedules that are overflowing, and having doctors and nurses staying longer than normal," said Dr. Benjamin Kruskal, who treats children in the Somerville clinic. "We're already starting to push the capacity of the system."