The state Health Department has confirmed four more deaths in Hawaii from the H1N1 influenza A pandemic, including the first child to die here from swine flu.

The four fatalities, which occurred from June through August, bring the state's death toll from the virus to 10 since the first Hawaii cases of the virus were confirmed May 5.

Three adults in their 40s died, including two with underlying chronic medical conditions, the state Department of Health reported yesterday. The child, under 5 years old, and one adult had no other medical problems, according to the Health Department. No details were released about the cases.

The child had not been hospitalized because of flu and was not related to any of the ill adults, said Janice Okubo, Health Department spokeswoman.

Underlying medical conditions were involved in the previous six deaths, according to the Health Department.

The U.S. Centers for Disease Control and Prevention and states, including Hawaii, stopped counting cases as H1N1 flu spread through communities.

State epidemiologist Sarah Park, chief of the Health Department's Disease Outbreak Division, has said that seasonal flu also causes deaths, and the pandemic H1N1 virus is not expected to act any differently, although cases generally have not been severe.

“;People shouldn't be surprised,”; she said. “;They don't need to panic, but need to recognize the seriousness of this and understand they can't be passive and expect someone else to do the work of preventing the disease.”;

Three deaths have occurred this year from seasonal flu, and there could have been more because it is difficult to track, Okubo said.

Health officials have emphasized protective measures, urging people to wash hands frequently, cover coughs and sneezes, and remain home from work or school with flulike symptoms.

“;It's really important for anyone with respiratory problems, with bluish color to their skin and trouble breathing to seek emergency medical services very quickly,”; Okubo said.

Swine flu vaccine is not expected from manufacturers until next month, but residents are encouraged to protect themselves with shots for seasonal flu.

Pregnant women, especially those with underlying medical disease; children; teenagers; and young adults are at high risk for H1N1.

Seasonal flu largely affects the very young and very old and people with underlying chronic medical conditions.

The CDC issued guidance yesterday on its Web site to help child care and early childhood programs respond to influenza. Children under age 5 are at increased risk of flu complications, and the risk is greater among children under 2 years old, the CDC said.

Children less than 6 months of age are particularly vulnerable because they are too young to receive seasonal or H1N1 influenza vaccine, CDC said. “;As a result, individuals responsible for caring for these children constitute a high-priority group for early vaccination.”;

Recommendations are listed on the CDC Web site for child care programs, such as checking each child as they enter the door.