The first swine flu death in the state and the hospitalization of another person raised concern about the spreading infection that has stricken 545 people in Hawaii.

But the head of the state Disease Outbreak Control Division said the occurrence of severe cases is not unexpected and does not reflect an increased threat to Hawaii residents. In both cases, the patients had underlying health problems when they contracted the novel H1N1 influenza infection.

“;These two new severe cases of novel H1N1 are a sad reminder of the seriousness of influenza, particularly for those at risk for complications,”; said Dr. Sarah Park, Department of Health epidemiologist. “;Unfortunately, we knew this would happen eventually.”;

Meanwhile, a reported outbreak among Molokai firefighters spurred public health officials to conduct education and outreach efforts on the island. Dr. Lorrin Pang, Maui district health officer, and a team from Maui were to fly to Molokai today.

After an initial report of 20 firefighters afflicted, Health Department spokeswoman Janice Okubo said there was a “;cluster of cases”; but the number was unconfirmed.

Park said: “;The situation on Molokai shows how influenza can affect basic central services and cripple limited resources. It is so important that we all continue to consider and plan for the impact a flu pandemic can have on our workplaces, schools and communities.”;

Later yesterday evening, Maui County issued a statement saying only one of 39 Molokai firefighters had been infected.

“;We are reviewing how one employee being ill has turned into a declaration of an outbreak by the Department of Health,”; the statement said.

Park said the woman in her late 60s who died June 19 in Tripler Army Medical Center had “;multiple serious health issues. The influenza infection was not the primary cause of death in this case, it was a contributing factor to the patient's already declining condition.”; The state and Tripler would not identify the woman other than that she was affiliated with the military and not on active duty.

The other person, now recovering in a hospital, had “;underlying health issues (and) developed pneumonia as a complication of their H1N1 infection,”; according to the department announcement.

It was the first H1N1 case here to require hospitalization. In May, a Maui resident became ill after traveling to Washington state and was hospitalized there.

There have been at least 27,000 cases of the H1N1 virus nationwide and 127 deaths in this country, according to the Associated Press.

The first cases in Hawaii were confirmed on May 4.

The state Laboratories Division tests from 60 to 120 samples of Influenza A daily, of which about 40 percent are found to be H1N1.

In this same two-month period, Okubo said, two local deaths were related to seasonal flu. “;We see deaths in the flu season but often it is not listed as the primary cause of death,”; she said.