The first news of swine flu this spring brought out the germaphobes in cultures worldwide -- the fearful in Hong Kong donned face masks, Egypt ordered the slaughter of pigs and entire schools in the United States closed their doors.
Now that the annual flu season is looming over the Northern Hemisphere, fears of the H1N1 virus are nixing some time honored cultural traditions, especially in Europe.
In France, la bise, the cheek-to-cheek peck that the French use to say hello or goodbye, is a national tradition. For the French, it's just like buying a baguette at the local boulangerie or taking their summer holiday in August.
But these days, this tradition is being put in parenthesis due to the global threat of swine flu.
Some French schools and companies are telling students and employees to avoid the social ritual out of fear the swine flu pandemic could spread as winter approaches.
The French government is not calling for an outright ban of the bise. But the Health Ministry, on its Web site dedicated to the swine flu pandemic, recommends avoiding "all direct contacts between people and particularly with sick people: do not kiss, do not shake hands (…)".
The French government has launched a broad public awareness campaign on the swine flu pandemic. TV and radio spots are informing people of the basic rules to stop the virus from spreading, such as encouraging people to wash their hands frequently or to cough into their sleeves or tissues and not into their hands.
However, the mayor of the town of Guilvinec in the western region of Brittany has banned the bise in schools.
"In the process of prevention of a flu epidemic, it was meaningless to ask children to wash their hands several times a day, to sneeze in certain conditions, to blow their nose using disposable tissues, et cetera … while, at the same time, we would let the kids keep kissing each other," Hélène Tanguy, the mayor of Guilvinec, told ABCNews.com.
Instead, the teaching staff found other alternatives to the bise, such as teaching kids that not all peoples kiss each other to say hello or goodbye. For example, kids are greeting each other by raising their hand, just like "Native Americans who don't kiss each other," Tanguy explained.
New "bise boxes" containing heart-shaped pieces of paper are meant to make up for the lack of affection provided by a kiss. "Children write their names on the piece of paper and bring it to the person they wish to kiss," the mayor said.
Swine Flu Threats in the United States
Infectious disease experts in the United States believe the French may have a point in toning down the traditional affections this year.
"I will tell you that in our medical center there are people who are touching elbows, there are people who not from the Indian subcontinent that are doing the hand clasped and bow greeting of Namaste," said Dr. William Schaffner, chairman of the department of preventive medicine at the Vanderbilt University School of Medicine.
"I don't want the hugging police to be out there, but just to encourage people to recognize they have a role in maintaining their own health and the health of others," said Schaffner.
Several French companies have also asked employees to refrain from kissing the cheeks of their fellow colleagues when arriving at work. "We've been asked to be vigilant and to refrain from kissing each other on the cheeks" Gerard Burion, who works for a telecom company in Levallois-Perret, outside Paris, told ABCNews.com. "I'm careful. I try to control myself, but often I can't and I kiss my colleagues as this is an old habit of our society" he continued. "But then we say, 'I still gave you a kiss on the cheeks but don't forget next time, we won't do it.'"
"We've also been asked to stop shaking hands. And I must admit that this is a good measure as a lot of germs are spread this way," he said.
Pierre de Surville who works for an IT consulting group in Levallois told ABCNews.com, "We've received the recommendation from the management team to no longer give the bise and it looks like it will become an obligation if the situation gets worse."
"But for now, nothing has changed for me," said de Surville.
Some are even going further. At the end of last month, the mayor of Coulaines, in western France, issued a decree that bans spitting on public streets as a way to prevent the spread of germs linked to swine flu (the H1N1 virus). The mayor even wrote to the president of the French soccer federation asking him to encourage players to no longer give the "bad example" by spitting on soccer fields.
France has so far confirmed three swine flu deaths. According to the Health Ministry, 5,000 people contracted the disease the last week of August. But health officials fear a fast progression of swine flu cases in the coming weeks. In recent days, several classrooms and schools around France have been shut after cases of swine flu emerged.
As for the United States, students returning to school this week from the Labor Day holiday were inundated with material about preventing the spread of the H1N1 flu.
Are Schools in the U.S. Prepared, or Overprepared?
About 55 million students and 7 million staff attend more than 130,000 public and private schools in the United States each day, according to the U.S. Centers for Disease Control and Prevention.
Schools looking to stem the spread of flu have always turned to the government for guidance and with the swine flu, the CDC is distributing more advice than ever on things like the importance of washing hands and keep ill students home sick during flu season.
In more extreme outbreaks, the CDC encourages educators to "try innovative ways of separating students. These can be as simple as moving desks farther apart or canceling classes that bring together children from different classrooms."
But educators walk a fine line between imposing public health advice and encouraging children to work together.
The Glen Cove School District on New York's Long Island found itself under the media microscope this week after children told New York City area reporters that students were warned against giving or receiving high-fives or hugs this fall.
"There is no policy, there was no policy, there never was a policy -- there was simply a discussion about contact about passing along the swine flu," said Laurence W. Aronstein, superintendent of the Glen Cove School District.
Swine Flu Precautions in Church: No Kissing?
As with schools and businesses, Europeans may be taking more swine flu precautions in church than Americans are.
Each year devout Roman Catholics in Naples, Italy, honor the time-honored ritual of kissing a vial of blood from the city's patron Saint Gennaro.
St. Gennaro's dried blood is said to liquefy twice a year, a full 17 centuries after his martyr death.
However, in light of the swine flu, Roman Catholic and city authorities forbid the kissing. On Sept. 19, the faithful will only be allowed to touch the vial with their foreheads, according to reporting from Reuters.
While Italians have stopped kissing one of Naples' most sacred relics, the United States Conference of Bishops said churches on this side of the Atlantic haven't made any drastic changes in light if the H1N1 virus.
Swine Flu and the Catholic Mass
"In terms of Mass, we're not making any national change at the moment. But some local bishops may choose to make some specific policies," said the Rev. Rick Hilgartner, associate director of the Secretariat of Divine Worship for the United States Conference of Bishops.
Hilgartner said parishioners and priests should always follow proper hygiene -- refraining from the communion chalice if you feel ill, or washing your hands before ministering communion -- regardless of the swine flu threat.
But last spring Hilgartner said some Bishops took extra measures when news of Swine Flu hit, and they may do so again this fall.
"Many local bishops said that that the sign of peace would be suspended in least in terms of shaking hands," said Hilgartner. "Some bishops recommended receiving communion only in the hand," he said, adding that asking a parishioner to not open their mouth for communion is a serious request in the Roman Catholic Church.
"But I think that would be only put in place if there was a perceived need for extreme caution," said Hilgartner.
For all the sacrificed social rituals, or religious rites, some infectious experts say a little common sense may go much further in preventing swine flu this fall.
Which Restrictions Matter When Stopping Swine Flu
"I think social restrictions very hard to enforce. We can't really live in a bubble and we're social beings," said Dr. Dalilah Restrepo, an infectious disease expert at St. Luke's - Roosevelt Hospital in New York City.
"The common sense advice of washing your hands and using your sanitizer is definitely going to be the gold standard," said Restrepo. "And I can tell you from other viral infections the best thing is the vaccine."
But, Restrepo pointed out, the world will have to wait to see how well the H1N1 vaccines will prevent the spread of the swine flu this year.