A pre-teen girl has died of the H1N1 virus at the Children's Hospital of Eastern Ontario, the first part of an expected "widespread community outbreak" that will happen in outlying areas of Ottawa within the next week or two, says one health official.

"Eastern Ontario . . . is a hotspot with widespread activity, and how we come to that conclusion is we are seeing elevated visits to emergency rooms with flu-like symptoms," says Dr. Paul Roumeliotis, the chief medical officer of health for the Eastern Ontario Health Region Unit.

Within a week or two of outbreak in a school, he adds, "You see widespread community outbreak. We cover Prescott, Russell, Stormont-Dundas, Glengarry, Cornwall."

The H1N1 or "swine flu" vaccine is more potent and works quicker than regular flu vaccine, Roumeliotis adds. Given that vaccinations are on their way on Monday for high-risk groups, which include children under six years old, he says some of the population will have immunity in eight to 10 days.

"We do have a chance to vaccinate a good percentage of population and by doing that, I think we'll be able to blunt the infection spread."

Four other children at CHEO have the virus, adds hospital communications director Ann Fuller, and 20 others have been confirmed swine flu patients since September.

There are 26 schools outside of Ottawa with an "outbreak" of flu, meaning that there are at least 10 per cent of their students absent due to illness. Nine of the schools have confirmed swine flu cases.

From there, it is expected the children will spread the illness to their families and trigger a sudden outbreak of swine flu in the areas outside of Ottawa, Roumeliotis says.

However, he adds, few of those people will require hospitalization.

Girl admitted to hospital Saturday

The girl - the first child in the Ottawa area to die - was under 11 years of age and has siblings, and lived somewhere in the eastern Ontario region. Officials say they are not sure if she had underlying conditions that contributed to her death.

She was admitted to CHEO early on Saturday morning and died later that night. Few details are being released about the girl for confidentiality, Roumeliotis says.

It is the second confirmed swine flu death in Ottawa, with the first one coming in the initial wave of flu cases this spring.

"Staff at CHEO are very saddened by the death of the child," says Fuller. "Our thoughts go out to her family. It's a difficult time for them."

CHEO's emergency room this month has averaged about 177 patients daily, with about 35 per cent of those - or around 60 a day - showing "symptoms of an influenza-like illness," Fuller says.

Swine flu patients tend to deteriorate quickly once they arrive in emergency, Roumeliotis adds.

"It's not as typical as seasonal flu. I do know there are other children hospitalized with swine flu, but I don't know the numbers."

The Ottawa area is seeing a "second wave" of swine flu and is one of the most active regions in the country, although Romeliotis says nobody yet knows the reasons.

Once an outbreak is reported at a school, the health unit randomly tests children at home through lab swabs.

First swine flu clinic opens in Ottawa

As news of the girl's death emerged Sunday, Ottawa readied for the opening of the first H1N1 clinics in the city.

There will be five stationary and 11 mobile clinics set up around the city, most of which will open on Monday. For the first seven to 14 days, vaccinations will be available for the most high-risk groups only: children between six months and five years of age, pregnant women and people with chronic medical conditions who are under 65 years of age.

Ottawa institutions are already taking many measures to slow the spread of swine flu. At a convocation ceremony Sunday morning at the University of Ottawa, President Allan Rock announced the graduating students would no longer shake hands with university officials.

The health unit also advises residents to continue following other precautions for slowing the spread of all flus, including swine flu:

- Wash your hands often, and when you can't, use an alcohol-based sanitizer;

- Cough into your sleeve rather than your hands;

- Keep you and your children home when anyone in your family is sick;

- Avoid visiting hospitals and long-term care facilities if you're feeling ill;

- Contact your doctor if your flu worsens. Children who are having trouble breathing should be checked out in the hospital.

With a report from CTV Ottawa's Joanne Schnurr