Hawaii has been lucky so far to get through the H1N1 pandemic with one wave of “;mild to moderate severity,”; but flu is unpredictable, cautions Dr. Sarah Park, the state epidemiologist.

“;We're certainly not saying we're over it yet,”; she said in an interview. “;Hawaii has not, and hopefully will not, see a second wave, but recent deaths highlight that vaccinations can do something for you, even with a low level of disease.”;

Park, chief of the state Health Department's Disease Outbreak Control Division, urges residents who have not been vaccinated for H1N1 or swine flu to take that step to protect themselves and those around them.

Although flu activity has waned on the mainland, the pandemic is worldwide, with a lot of activity in some areas with travel potential to and from Hawaii, she said. The first cases here were travelers, she pointed out.

Thirteen deaths associated with H1N1—most with underlying medical conditions—have been reported in Hawaii since the first three cases of the virus were confirmed here May 5. The latest two deaths were in December and the week of Jan. 10.

Bill Gallo, with U.S. Centers for Disease Control and Prevention, says he is concerned about a potential new wave hitting the state with “;a lot of vaccine unused.”;

“;I think maybe a lot of people struggled to get vaccinated early on when the supply was limited and gave up,”; he said in an interview. “;While we're having a lull in flu activity, we all know there could still be a wave in store.”;

Because of the delay by manufacturers in getting vaccine out, said Gallo, Hawaii and other states “;dealt with a lot of challenges just trying to manage the flow and everything. We're hoping next time it will go quicker. The best solution is improving vaccine technology.”;

Gallo, the CDC's senior management official for Hawaii and the U.S.-affiliated Pacific islands, said “;there is a lot to be learned”; from the pandemic, “;and hopefully all states and counterparts”; will share stories and learn from each other. For example, he said, Hawaii can teach other states about school-based flu vaccination clinics.

Meanwhile, the Department of Health staff is gathering data and working on “;after-action”; reports to better prepare for other potential vaccine-preventable or food-borne diseases or disasters, Park said.

“;Our response doesn't end when the pandemic is on the decline and vaccine distribution is over,”; she emphasized. “;Part of it is understanding who got vaccine; where did it go? Are there more areas or parts of the state that have more people vaccinated than others? Which age groups were vaccinated?

“;SARS (severe acute respiratory syndrome) is still out there, and we don't know what this (H1N1) virus may do,”; she added. “;If we're lucky, it will remain quiet into spring and summer, but we don't know what the next season will hold.”;

Hawaii's H1N1 wave started a little later than on the mainland and seemed to last longer, Park said.

“;When mainland states were revving up in mid-August and beginning September (with a second H1N1 wave), we were waiting for the other shoe to drop, and we got lucky.”;

There were “;a few close calls,”; she said, with a school cluster and a little rise in activity at the end of September and beginning of October. But even during the H1N1 wave, she said, “;We saw a lot of morbidity but not the mortality I heard about from colleagues on the mainland.”;

Health officials repeatedly emphasized the importance of prevention and good hygiene, and Park said she has noticed more people washing hands and covering coughs and sneezes.

“;The vaccine did arrive just in time, and we were able to vaccinate a big portion of our population, especially with our school program,”; she said.

Three years' experience with seasonal flu vaccination clinics at schools enabled the department and partners to add H1N1 school clinics to the anti-flu campaign despite the economic situation and state and school furloughs, she said.

Hawaii and other states would have had a tough time dealing with the pandemic if extra federal funds had not been available, Park said.

“;We were all prepared, but still it's a huge struggle for all of the labs because of the volume hitting us at a time of economic crisis. The staff here, not just mine and the lab, but a lot of folks here, go above and beyond because public health means something to them beyond the job, but it is a struggle. You only have so much resource support.”;

H1N1 medical alerts and advisories were posted for the first time on the department Web site, and the pandemic strengthened relationships between the health agency and various partners, Park said.

It also highlighted some issues, she said. For instance, a lot of people did not understand why priorities for limited vaccine included workers in the state's critical infrastructure, she said.

“;There needs to be more discussion and better identification ... who needs to be protected so our society doesn't collapse,”; she said. “;The biggest issue is the challenge of public messaging, trying to get the word out and insure that everyone understood what was going on.”;