The flu has arrived early in the Islands with the first confirmed outbreak of the season at a small, undisclosed private school on O'ahu.

The state Health Department's confirmation of the outbreak comes as Hawai'i parents face a deadline tomorrow to turn in consent forms for free vaccines being offered to students in kindergarten through middle school. The state has 115,000 flu shots or nasal spray vaccines that will be sufficient for 90 percent of Hawai'i's private and public schools.

Hawai'i has been enjoying relatively mild flu seasons the past few years, said state epidemiologist Dr. Paul Effler. But Effler worries that could change in the next few months.

"We know a series of mild seasons is often followed by a heavy season," he said. "You can't predict for sure, but it could indicate we're in for a heavy flu season."

Test results by the State Laboratories Division Tuesday found that a kindergartner and a first-grader came down with influenza A at the private school late last month, Effler said.

A 4-year-old sibling of a student at the school also contracted influenza A, the more serious form of the flu. Another student came down with pneumonia, and "a handful of other students" also had flu-like symptoms but did not have clinical specimens collected to be tested, Effler said.

"These children were pretty sick, with high fevers, sore throat and cough that kept some of them out of school for as long as a week," he said.

The Health Department agreed not to disclose the name of the school at the request of the principal.

"We want schools to report and we want people to tell us (about outbreaks), so we would like to be able to accommodate their privacy issues," said Janice Okubo, Health Department spokeswoman. "It's important that we get cooperation from doctors and schools."

During the 2005-06 flu season, Hawai'i public schools saw 11 outbreaks of multiple flu cases, seven that were confirmed through laboratory testing.

OFF-SEASON FLU

The August outbreak was unusual because it happened in what typically is considered the flu's off-season.

"Hawai'i always sees cases sporadically throughout the year," Effler said, "but this is a fairly early outbreak. The majority of cases typically happen in December through March."

He is particularly concerned about the flu this year because Australia has seen three times as many cases as normal, including the deaths of six children.

"It could be another indicator that we're in for a heavy flu season here," he said. "We're wondering if that might be our fate coming up."

Pediatricians, other doctors and private caregivers are also reporting sporadic cases in the Islands, he said.

Dr. Marian Melish, a professor of pediatrics at the University of Hawai'i's medical school and chief of infection disease service and the infection control department at Kapi'olani Medical Center for Women & Children, said the typical October-through-May flu season has been sprinkled with cases throughout this year.

"We also have been seeing some very severe cases of influenza, particularly in July, when the heaviest period for influenza is the fall and winter months," Melish said.

Two children were put on ventilators in Kapi'olani's intensive care unit this summer. Others have been treated in the emergency room for symptoms that included high fevers, respiratory symptoms, vomiting and diarrhea.

Melish yesterday did not have data on the number of influenza cases but said, "We didn't see the tapering off as much at Kapi'olani that we tend to see. Through May, June and July, we had considerable numbers of influenza but not as heavy as the winter months."

People are getting sick before pharmaceutical companies on the Mainland have sent their full supplies of vaccine to Hawai'i, which typically arrive in September and October, Effler said.

Hawai'i usually dispenses 10,000 to 15,000 doses in the winter months, to be administered by pediatricians to children with no health insurance.

This year, 115,000 additional doses will arrive for private and public students from kindergarten through middle school in a new program called "Stop Flu at School."

Joyce Won's 13- and 11-year-old children won't be eligible because their Voyager Charter School is among the 10 percent of public and private schools that chose not to participate.

But Won wouldn't allow her children to be vaccinated anyway.

"My kids have never been vaccinated and they've never missed a day of school for the last five years," Won said. "I'm not a real big fan of it."

But Sanae Chan wishes her 4-year-old daughter, Jasmine, could participate now, even though Jasmine is too young.

"Lots of different kids are in school," Chan said. "So she has a much greater chance of getting the flu from the other kids. We don't want that."

The $2.5 million to administer the program — including $1.8 million for the vaccine — primarily comes from the federal Centers for Disease Control and Prevention.

Some 60 percent of the injectable vaccine is already on-island, but all of the nasal mist and the rest of the vaccine has yet to arrive, Okubo said.

UP AND RUNNING

When state health officials dispense the vaccine from Oct. 15 through January, Hawai'i will be the first state to include both private and public schools on a statewide basis, Okubo said.

Health officials are focused on getting the program running and will evaluate the results before considering what to do next year, she said.

Effler hopes that parents push up the demand for even more vaccine.

"A lot of kids that clearly have risk factors weren't getting the flu vaccine," he said. "So we decided to make this as convenient as possible to make sure parents get their kids vaccinated. You keep them well, you keep them in school and their families have less illnesses."

Reach Dan Nakaso at dnakaso@honoluluadvertiser.com.