Seasonal flu vaccines started arriving in Honolulu last week and some people have already received their annual flu shot in hopes of warding off the illness during what could be a busy influenza season.

As soon as some customers heard that the pharmacies at seven Safeway grocery stores had received the seasonal flu vaccination, they asked for a flu shot, said Alanna Isobe, Safeway Kapahulu pharmacy manager. That was before the company started advertising in a circular on Wednesday that it had the seasonal flu immunization at its pharmacies.

"There's a lot of interest," Isobe said. "We weren't going to officially start until Sept. 1, but our customers have been asking about the shots. A lot of insurance companies are aware we're starting earlier. Everyone is getting a jump on the regular flu shots so they can get the swine flu shots later in the fall."

There's a heightened awareness of flu this season because of the so-called novel flu, H1N1 or swine flu, outbreak this summer. More than 1,400 confirmed cases of swine flu have swelled overall flu numbers in Hawai'i, and seasonal flu is up as well. Federal and state health officials are encouraging schools and workplaces to provide vaccinations for both seasonal and swine flu.

There's no way to predict the severity of the coming flu season, said Janice Okubo, spokeswoman for the state Department of Health.

"Given the ongoing H1N1 flu activity this summer, in combination with the circulating seasonal flu in the fall and winter, the Centers for Disease Control anticipates more flu cases, hospitalizations and deaths (nationwide)," she said.

The Hawai'i Medical Service Association, the state's largest health insurance provider, has about 45,000 doses of seasonal flu vaccine waiting to be given at clinics around the state, said Laura Lott, HMSA spokeswoman. Because the vaccines are just arriving, few inquiries have been reported at HMSA, though there is a heightened awareness of the flu, she said.

"No one knows if this will be the worst season," Lott said. "(But) we do anticipate that more people will be interested in getting vaccinated against the flu because of all the interest from swine flu."

A vaccine for the swine flu is not yet available. As soon as the vaccine has completed its clinical trials, it should be ready for limited release, Okubo has said.

It's still early in the seasonal flu season, which starts in October and peaks in February. Typically, flu shots are given at the end of September, Lott said.

The first mass seasonal flu vaccination session run by HMSA for its members will be on Sept. 21 at the Consolidated Theatres Mililani Stadium 14 and the Marukai Market Place Ward Center. HMSA and the state Department of Health hope that more people will take advantage of the flu shots as a way to control the spread of the disease, which travels person to person mainly through the coughs and sneezes of those who are sick with the virus.

Like the past two years, schools and health officials are teaming up to offer free seasonal flu immunizations at public and private schools, Okubo said. The Stop Flu at School program kicks off next week with letters being sent home to parents encouraging them to sign up for the free flu shot or nasal spray vaccinations. Schools superintendent Pat Hamamoto is featured in a radio spot encouraging parents to sign up their kids.

"It's definitely been a great partnership between DOH and public and private schools to provide free flu immunizations, especially given our concerns about the flu season," said Sandy Goya, DOE spokeswoman. "The program makes the flu immunization more accessible."

Over the past two years of the program, 120,000 students and 15,000 faculty and staff have received free flu shots, Okubo said.

Since April, there have been 477 deaths associated with the swine flu nationwide. In Hawai'i, six people have died since the first cases were confirmed on May 5. All six H1N1-related deaths in Hawai'i have involved people with other health problems. The first reported swine flu-related death in Hawai'i was on June 19. "It's hard to judge if it will be a big flu season," said Safeway's Isobe. She added: "We have our vaccines and we're ready."