Dr. Eladio Pereira realizes that local custom requires we shake hands, hug and sometimes kiss when greeting each other. But those are gestures that must be set aside when one has the flu or is in the presence of someone who is sick.

The handshake is “a sign of respect or friendship and part of our culture,” said Pereira, medical director at Mariposa Community Health Center.

“It is important that we preserve that. But when one is sick, we need to take ownership of the problem. People need to stay home so that they do not spread the virus. We cannot overemphasize prevention.

“I have patients that come in to see me. They tell me, ‘I’m sorry doctor, but I’m feeling sick so I won’t shake your hand.’ And that’s OK. I appreciate that concern” for wanting to avoid the spread of whatever bug may be afflicting the person, Pereira said.

With the recent outbreak of H1N1 (swine) flu and two confirmed cases cropping up in Santa Cruz County, Pereria said prevention is even more critical.

In the last two weeks, the Centers for Disease Control and Prevention (CDC) confirmed two cases. The latest is a 7-year-old boy who is a first-grade student at Bracker Elementary School, said Shawn McCollough, superintendent of the Nogales Unified School District No. 1.

Shelly Patton, preparedness coordinator for Santa Cruz County Health Services, said the boy is not related to the victim of the first case, who is also a student at Bracker. Both have recovered, she added.

Patton said that “there is one probable case pending case” from samples submitted by SCCHS to the CDC for testing.

About 6,000 NUSD students are scheduled to return to school on Monday after McCollough ordered all 10 NUSD schools closed on May 4.

In an interview, he said that this week janitorial crews were “scrubbing and disinfecting all hard surfaces” such as desktops, countertops and banisters in preparation for students’ return.

On Tuesday, Dr. Richard Besser, acting director of the CDC, said that he no longer feels that closing schools is warranted and Health and Human Services Secretary Kathleen Sebelius said the H1NI virus has not turned out to be more infectious or deadly than seasonal influenza.

Pereira said that it is important to note the difference between the flu, which is an illness and the common cold. Symptoms of a cold are mostly sneezing, some congestion and perhaps a slight fever. Influenza is primarily spread through the respiratory system, causing high fever, sore throat, coughing, aching muscles and headaches.

Whereas with a cold one may continue to function, work or attend school, the flu usually requires plenty of rest, he noted. “You should stay home and do not expose others,” he said.

Mariposa, SCCHS, City of Nogales, Carondelet Holy Cross Hospital and health-care counterparts in Nogales, Sonora were lauded last week by state health officials

For parents ...

For parents or guardians of children heading back to school, the CDC this week issued new recommendation specifically aimed at the school setting:

* Students, faculty or staff with influenza-like illness (fever with a cough or sore throat) should stay home and not attend school or go into the community except to seek medical care for at least seven days even if symptoms resolve sooner.

* Students, faculty and staff who are still sick seven days after they become ill should continue to stay home from school until at least 24 hours after symptoms have resolved.

* Students, faculty and staff who appear to have an influenza-like illness at arrival or become ill during the school day should be isolated promptly in a room separate from other students and then sent home.

* Parents and guardians should monitor their school-aged children, and faculty and staff should self-monitor every morning for symptoms of influenza-like illness.

* Ill students should not attend alternative child care or congregate in settings other than school.

* School administrators should communicate regularly with local public health officials to obtain guidance about reporting of influenza-like illnesses in the school.

* Schools can help serve as a focus for educational activities aimed at promoting ways to reduce the spread of influenza, including hand hygiene and cough etiquette.

* Students, faculty and staff should stringently follow sanitary measures to reduce the spread of influenza, including covering their nose and mouth with a tissue when coughing or sneezing (or coughing or sneezing into their sleeve if a tissue isn’t available), frequently washing hands with soap and water, or using hand sanitizer if hand washing with soap and water is not possible.

Visit the CDC Web site at http://www.cdc.gov/h1n1.