NORTH ATTLEBORO - Nearly 20 percent of North Attleboro High School's students were absent from school last week as school nurses saw a spike in reports of flu-like symptoms.

Superintendent James Rice said to his knowledge the district has not had any confirmed cases of H1N1 flu, but that more than 200 high school students were absent on one day last week.

H1N1, also known as the swine flu, has reached the area, however, with Foxboro High School and Norton's Solmonese Elementary School reporting confirmed cases of the disease. The Seekonk School District also reported suspected cases of the virus last week.

"I've been told we're not alone - what we're experiencing is happening across the state," Rice said. "We have been lucky because our staff has stayed healthy, so we haven't been faced with closing a school. What we've been telling parents is healthy kids should come to school and sick kids should stay home."

Judy Aubin, North's head nurse, said the district has been preparing for a pandemic flu for almost five years and is working with the town's board of health to closely monitor the situation. The school district is also accepting sign ups for students who want H1N1 vaccinations. The forms, which must be returned by Nov. 16, are available online at the district's Web site www.naschools.net. Aubin said not all of last week's absences were from the flu.

"Last week, we did have a spike in absenteeism at our high school," Aubin said. "The high spike wasn't all due to the flu. There were also cases of strep, students who were absent for doctor and dentist appointments and some who stayed home out of fear of being sick. This week, we're seeing a decrease at the high school and an increase at some of the other schools."

She said parents should prepare for students to be out of school for three to five days if they become sick with the flu. She also urged that parents continue sending healthy children to school, saying keeping them out for a week will not prevent the illness from spreading.

"Like the seasonal flu, H1N1 will be around for more than a week," she said. "Taking kids out isn't going to keep them from being sick. If they go to the mall, it's there. If they go to the movies, it's there. If they go to the grocery store, it's there. If you keep them out of school for a week when they're healthy, they are just going to miss another five days when they're sick."

Symptoms of the flu include a fever of greater than 100 degrees, cough, sore throat, body aches, runny nose and fatigue. Students with a fever should stay home from school until they are fever-free for at least 24 hours.

Aubin said parents should keep their eye on children even if they are feeling better after having a bout of the flu, because H1N1 makes the lungs susceptible to secondary infections.

She also asked students and parents to take precautions against getting sick, including frequent hand washing, drinking plenty of fluids, getting plenty of rest and eating a nutritious diet.

U.S. health officials say swine flu has caused at least 19 more children's deaths - the largest one-week increase since the pandemic started in April.

At least 114 children have died from swine flu complications since the spring. That's up from 95 reported a week ago. The Centers for Disease Control and Prevention released the statistics on Friday.

In nearby Rhode Island, health authorities have opened school-based swine flu vaccination clinics, the same day they announced the second death of a child with flu-like symptoms.