JEFFERSON CITY - As swine flu spreads across the nation, Missouri's state employees are laying down plans to keep vital services like jails and mental hospitals running effectively.

In Missouri's 21 prisons, the population is susceptible to disease because of their close proximity to one another as well as their interaction with the outside world through guards and visitors.

The Missouri Department of Corrections plans offer the H1N1 vaccine to high-risk employees and offenders once it becomes available, department spokeswoman Angie Morfeld said. However, guards without other health conditions, such as those with compromised immune systems, asthma and diabetes, will have to get the vaccine from their own health care provider.

Morfeld said the department has plans to keep all guard posts staffed during the pandemic but said she "can't talk about specific plans because of safety and security."

Offenders have access to on-site medical facilities and can be transported to a local hospital if necessary, a move that takes more staff as offenders must be with an officer at all times. Morsfeld said prisons are capable of housing all sick offenders separately from those that are healthy.

Psychiatric and developmental disability facilities face similar considerations due to their confined populations and may be forced to limit outings and reduce or restrict visitors if necessary to reduce residents exposure to infection, said Lynn Carter, deputy director for the Department of Mental Health.

She also said they will be relying on back-up, part-time employees to keep their psychiatric and developmental disability facilities staffed. Over 7,000 employees staff the 17 state-run facilities, the inhabitants of which require certain levels of supervision.

The department is working to get vaccines for all their health care employees and high-risk residents, she said. However, as employees become sick, the department may have to ask for more overtime from employees, and ask those working to cover additional duties.

Once employees who have fallen ill recover, they become ideal candidates to monitor those who are already sick, she said.

"They can work with the sick folks without the risk of contagion. They won't have to take all those protective measures," Carter said.  

Hospitals are also preparing for a surge of patients, but hospital officials are strongly encouraging H1N1 patients to go to their primary care provider before heading to the hospital, said Dave Dylan, spokesman for the Missouri Hospital Association.

"Most hospitals have some degree of vacancy in beds any given day," Dylan said. "But the vast majority won't be sick enough to need hospitalization."

Dylan said the key to keeping a hospital appropriately staffed, relies on doctors taking common sense procedures before they can be vaccinated.

"Most health care professionals are pretty savvy about hand washing because of the environment they work in," she said. "That's not to say they won't be exposed by sick family members, etc."  

For Missouri's public schools, keeping students in class plays a hand in ensuring schools get funding.

"Schools are reimbursed or paid for every hour a child is present in school, so better attendance is better for the school district," said Jim Morris, the spokesman for the Department of Elementary and Secondary Education.

In Jefferson City, three middle school students at Lewis and Clark Middle School -- which has a student enrollment of about 900 students -- have already been infected with the virus, and absences are climbing.

The University of Missouri has 48 known cases, while a spokesman at Missouri State University said "a couple of dozen" students there were confirmed to have swine flu.

Even with a lack of students, bus drivers and teachers, it's up to individual schools to shut down if they can't operate properly.

Schools have been known to shut down for some time during inclement weather, but shutting down for a disease is unusual. If a school has to close for a long period, the state legislature will occasionally step in and set new provisions for how much time has to be made up for that school for that year, Morris said.

"Unless the school shuts down, and then elected to make up those days later, the time that kids missed because of illness is simply time lost," Morris said.

 The same is true at Missouri State University, where administrators are asking faculty to work with students who have missed class due to illness.

"If five students are sick, we're not going to cancel class for the other 45," said Burnie Snodgrass, director of health and wellness at MSU.

Most universities are asking sick students to isolate themselves and inform professors of their illness.

At the University of Missouri, students have been asked to call ahead before going to the student health center and risk possibly exposing others to the disease.

Although there are currently no known cases of swine flu at the University of Missouri-St. Louis, masks are already being handed out to those with symptoms, hand sanitizer has been placed next to entryways and elevators in the dormitories, and thermometers will soon be handed out to dorm-dwelling students, said Marie Mueller, clinic coordinator for UMSL and a nurse practitioner.

Mueller said the school plans to isolate the infected by separating them from their healthy roommate and bring food up to the infected person.     

All universities will have to wait until the vaccine is available to distribute it to students, likely in October or November.