While customs and agriculture agencies continue to monitor animal entries into Hawai'i to prevent the introduction of avian influenza, health officials are more closely watching human arrivals.

Hawai'i was the first state in the nation to establish an airport surveillance program designed to detect flu viruses and other serious communicable diseases in arriving passengers. The program was launched in November by the Queen's Airport Medical Service, the federal Centers for Disease Control and Prevention's Quarantine Station and the state Department of Health.

Of the more than 2 million passenger arrivals since the program began, only 15 to 20 people consented to the voluntary flu tests, according to state medical officer Catherine Chow. Three of the tests were positive for a normal, seasonal flu virus.

That's a pretty small sample, but Chow said the surveillance program is serving as a dry run for if and when a flu pandemic erupts. Health officials have been able to identify issues such as how to approach people, collection of samples and educating passengers about the program.

"It highlights the fact that we need to improve on our voluntary program. There are people who might decline because they feel there might be some sort of repercussions to their testing," Chow said.

Passengers suspected of being infected with the bird flu or other dangerous diseases such as small pox could face quarantine.

Health authorities are notified when airline crews or airport staff become aware of ill passengers. Travelers with a fever and at least one other flu symptom are asked to undergo testing for flu virus by sampling with a nasal swab.

Duane Gubler, director of the Asia-Pacific Institute of Tropical Medicine and Infectious Diseases, said Honolulu was identified as one of 25 central cities in the global airline network, and "that puts us at high risk" in a pandemic. But for now, he sees no need to boost the airport program in anticipation of a potential bird flu outbreak.

"The Department of Health is gaining experience with it right now. There's no reason to enhance the surveillance. As soon as anywhere in the world there's an indication the virus has adapted to humans, then we'll see the difference. The response will be more proactive," Gubler said.

"It makes no sense to be alarmed. It makes sense to be aware, and for people to protect themselves, their family and the community."

This can be done, he said, by reporting unusual illnesses in your neighborhood and using common sense on matters of hygiene, such as regular hand washing.

Reach Christie Wilson at cwilson@honoluluadvertiser.com.