State health officials yesterday confirmed four deaths in Hawai'i related to swine flu between June and August, bringing the total since mid-April to 10.

Two of the recent deaths involved people who had other health issues and two did not, meaning the H1N1 virus, or swine flu, was responsible for the deaths.

The two who died of swine flu included a young adult, who had gone back to work after getting the flu, and a child under age 5. It was the first child in the state to die of swine flu.

Dr. Sarah Park, state Department of Health Disease Outbreak Control division chief and state epidemiologist, said in addition to the swine flu-related deaths there were three people who died of seasonal flu in Hawai'i since April.

The flu season usually runs from October through March.

That's not unusual that there have been so few seasonal flu deaths so far this year, Park said.

"There hasn't been a lot of seasonal flu," she said. "So there won't be a lot of deaths. It's not a surprise, but it is a reminder to people that flu is serious."

Over the past month, the number of cases of swine and seasonal flu has dropped, Park said.

"Most likely the flu you'll get is the one your body hasn't seen before," she said. "There is no indication that things are getting worse. In fact, we've seen a decrease in the number of cases."

But with 177,000 public school children back in the classroom, the universities and private schools back in session, health officials worry that they're in for a bad fall flu season.

Children age 5 through college-age appear to be most vulnerable to swine flu, Park said.

"We have our fingers crossed hoping to see less of a burden once the real flu season hits because so many have been sick already," Park said. "Hopefully the second wave won't be as severe. Our first wave was pretty severe.

"It taxed our health care system this summer."

36,000 DEATHS A YEAR

Every year on average, 36,000 people die of seasonal flu in the United States. The Centers for Disease Control and Prevention have identified 40 deaths of U.S. children due to swine flu this year.

Nationwide there have been 550 lab-confirmed deaths and 8,800 hospitalizations related to the swine flu.

The World Health Organization says at least 625 people have been reported dead from swine flu in the past week. The swine flu virus has caused at least 2,837 deaths worldwide since it emerged in Mexico and the United States earlier this year and developed into a full-blown global epidemic. Most of the deaths are in the Western Hemisphere.

On average, 9.6 percent of all deaths in Hawai'i in August were from flu of all kinds. The data on the four most recent deaths is coming out only now because it took time for lab confirmations, Park said.

The news of the new deaths renewed health officials' push for vaccination against influenza. Park called the deaths a wake-up call to the seriousness of the disease.

Last year, according to state health data, there were 258 pneumonia and influenza deaths recorded during the past flu season. That number is not accurate as not all doctors list flu as the cause of death, Park said.

VACCINES ON WAY

Seasonal flu vaccinations have been in the Islands since last month.

Come next month, swine flu vaccinations will become available. The CDC, however, recommends that the vaccination first be given to those who are most likely to get the swine flu: children ages 6 months to 24 years of age, caregivers of infants, pregnant women, those with underlying medical conditions and emergency and health care workers.

"We don't know how many doses will come in," Park said. "We are recommending that you get two separate vaccines this year. We want to keep the level of flu illness at a low level."

At the Waianae CoastComprehensive Health Center, which runs clinics around west O'ahu, they've been pushing seasonal flu shots since last month, said Milo Huempfner, chief compliance officer. Flu preparations began at the start of summer at the health center, Huempfner said.

"We bumped up our health precautions early in the summer when we saw so many flu cases hit," Huempfner said.

Health officials still are pushing the message that the best thing you can do is stay at home if you are sick.

The goal is to prevent infection as influenza is spread from person to person, Park said. Wash your hands, stay home when you're sick and get your flu shot, she said. The Stop Flu at School program is in full swing, with a goal of immunizing more than 60,000 school children, she said.

"We don't talk about flu for no reason," Park said. "Most healthy people will be fine. Prevention is always preferable to cure. And that's why our focus is on prevention."