The number of flu cases in Hawai'i has surged this spring and summer, making conditions ripe for what could be one of the worst flu seasons in years when peak season for the illness sets in.

Flu usually takes a vacation this time of year, but that was before the arrival of novel H1N1, or swine flu.

More than 1,400 confirmed cases of swine flu have swelled overall flu numbers in Hawai'i, and seasonal flu is up as well. Swine flu was a factor in six deaths here since early May (all had underlying health issues), and one person died of complications related to seasonal flu in the same period.

Typically in Hawai'i, about 1 percent to 2 percent of all doctor visits are flu-related, but this spring and summer that increased to 19 percent, according to the state Department of Health.

"In the last five years we've not seen this amount of activity," said Dr. Sarah Park, state Department of Health Disease Outbreak Control division chief and state epidemiologist.

"With all this flu activity, we have a recipe for a heavy flu season."

Health officials say it's more important than ever for residents to get their flu shots, to wash their hands and to heed public health advisories to stay home when they're sick.

2 VACCINATIONS

Over the past five years, Hawai'i has had mild flu seasons, Park said. That's due to a combination of factors: public health education, a school-wide flu vaccination program and no real changes to the flu virus.

"Fall is usually the traditional season for flu," she said. "In the past few years, we have not seen a high level of activity here in Hawai'i. However, given the current level of influenza-like activity and the activity observed in the southern hemisphere, it's unclear what may come this fall. All the more reason to put into practice our recommendations on preventing infection."

This year that includes getting two flu shots — not just one.

Park encouraged everyone to get a flu shot for both seasonal and swine flu. The seasonal flu vaccine, a vaccination cocktail adjusted yearly, will be ready for release in October. School-age children and teachers all qualify for free vaccines that will be given in schools again this year. Last year about 40 percent of students were vaccinated in the in-school program.

Consent forms will be going home soon, and health officials encourage parents to sign them and have their children vaccinated.

As soon as the H1N1 swine flu vaccine has completed its clinical trials, it should be ready for limited release, said Janice Okubo, state DOH spokeswoman.

As supplies arrive in the Islands, state and federal health officials recommend the first to receive the vaccine be caregivers and parents, children 6 months to age 24, pregnant women, health care professionals and nonelderly people who have underlying health issues, Okubo said.

Once the vaccine becomes more available, the rest of the population could become inoculated.

The best defense against the flu is a good offense through education. State health officials are using public health education money from the federal government to get the message out to the public that if you're sick, stay home.

They are also working with educators to devise a public message that schools can adopt and pass out to students and parents.

The hope is to get health messages ingrained before the start of the official flu season Oct. 1.

The bottom line, though, is plain.

"It's amazingly simple, but if you're sick, stay home," Park said. "We've been lucky in the past with mild flu season. More could get vaccinated."

Meanwhile, the start of school signals new concerns for health officials. An estimated 178,000 public school students have begun returning to school, and tens of thousands of private school and University of Hawai'i students will return to classes in the next few weeks.

"Everyone across the United States is concerned about the start of school," Park said.

TAKING PRECAUTIONS

When school began on Tuesday for 415 Saint Francis School students, principal Sister Joan of Arc Souza had each classroom stocked with hand sanitizers. Students are being reminded to wash their hands often and stay home if they're sick.

"It's a simple thing," Souza said. "If you feel sick, stay home. And anyone who has the slightest fever is sent home until they have a doctor's clearance."

Swine flu spreads in the same way that regular seasonal flu does, mainly through the coughs and sneezes of people who are sick with the virus, but it may also be spread by touching infected objects and then touching your nose or mouth.

Audrey Torres has bottles of alcohol-based hand sanitizers in the car and in her home. She reminds her two children that now that they're in school they need to remember to wash their hands.

"I'm not too worried about the threat of more flu this fall," Torres said. "I am just trying to control what I can control. I will maintain my vigilance on prevention."

The precautions for seasonal flu are the same as for swine flu. What's different is the lack of immunity to swine flu for most people.

"This is a novel flu strain, so most of us don't have immunity to this flu," Park said.

Even mild protection is enough to keep people from getting sick because the body builds up an immunity, she said. That's why seasonal flu has been so mild over the past five years.

The best way to keep flu at bay is to stay home if you're sick, she said.

"It sounds like common sense, but when people are confronted with it, most folks feel obligated to go to work," Park said. "That doesn't do them or anyone else any good. Going to work basically continues this level of flu-like illness in our community."