Flu season is hitting Hawai'i earlier than usual and the state is working to protect people, but it's unclear how many residents are getting immunized because of lax reporting by the people giving the shots.

Normally, Hawai'i wouldn't begin to see this many flu cases until December, Dr. Sarah Park, head of the state Department of Health's Disease Outbreak and Control Division, said yesterday at the department's weekly flu update.

"We (typically) start to see activity early December but it doesn't take off until the end of December," Park said. "We usually peak January, February. It's definitely early at least a month and you might argue two months early."

The federal government has been pressing manufacturers for more vaccine. William Gallo, a senior management executive with the Centers for Disease Control and Prevention, said the United States has 41 million doses of the H1N1 vaccine, up from about 35 million doses last week.

"It continues to come out being manufactured in large quantities but unfortunately not the quantities we had hoped for," Gallo said at the news conference here.

Park said the CDC has an alloted Hawai'i 181,400 doses of the H1N1 vaccine and the state has requested that they be delivered directly to various providers here. But so far only 18,000 doses have been accounted for as being administered, causing concern about the state's ability to request future allotments of vaccine.

"This will slow the process," Park said. "We can not release more doses to providers until we've accounted for the doses that have been administered."

Of the 181,400 doses for Hawai'i, 80,000 have been set aside for the free flu shot program in the schools that begins today at Moanalua Middle School, Park said.

Some three-quarters of the vaccine providers have received at least a portion of their request but have not reported back to the state. Park said it is imperative that they submit their paperwork.

The remaining 25 percent of the providers should be getting their supply within the next two weeks, with geographic pockets without any vaccine getting them first and the remainder to get at least 50 doses each.

With the flu season getting an early start, Park said the state will continue its strategy of delivering the vaccine first to providers that serve the priority groups and government personnel necessary to keep the city and state operating, such as people in sanitation, taxation and transportation.

"About 5 percent of every week's allocation is set aside for the critical infrastructure folks," she said.

Nationally, swine flu has sickened about 22 million Americans since April and killed nearly 4,000, including 540 children, according to federal estimates released yesterday.

The figures — roughly a quadrupling of previous death estimates — don't mean swine flu suddenly has worsened, and most cases still don't require a doctor's care. Instead, the numbers are a long-awaited attempt to more accurately quantify the new flu's true toll, the Associated Press reported.

"I am expecting all of these numbers, unfortunately, to continue to rise," said Dr. Anne Schuchat of the Centers for Disease Control and Prevention. "We have a long flu season ahead of us."