Six new cases of swine flu were confirmed yesterday, bringing the total in Hawai'i to 21, with more than half of them linked to schools, health officials said.

Four of the new cases of H1N1 influenza A are linked to 'Anuenue School in Palolo, making a total of eight connected to that school.

Principal Charles Naumu said the school has been following state education and health guidelines, and that he does not plan to ban handshakes or hugging at the school's June 6 graduation.

"Hugging is cultural," Naumu said. "Depending on how the flu progresses, and I don't think we've seen the end of it, we'll watch to see how and what we'll do. We're recommending that our families err on the side of safety and health. If there's a symptom, we're urging them to take the students to the doctor."

State Department of Health spokeswoman Janice Okubo said the state's numbers should not be cause for alarm. While they are rising, with 15 new cases in the past three days, Hawai'i's number of cases is significantly lower than in other states, she said.

"It's not surprising that we would find other cases, especially since it's all over the U.S. Mainland at this point," Okubo said.

And, she said, "We're expecting to find more cases."

Nationwide, the Centers for Disease Control and Prevention reported yesterday that there have been four deaths, 173 hospitalizations and 4,714 cases since the outbreak was detected in April.

All of the six Hawai'i patients confirmed yesterday are children. Four are school-age, one a preschooler and another an infant, Okubo said.

Two of the students attend 'Anuenue and two attend 'Ewa Elementary, she said. The 'Ewa students are siblings of one of the 'Anuenue students previously confirmed, she said. The infant is considered a "household contact" with two previously identified cases at 'Anuenue, she said.

"They're all recovering at home," Okubo said. "The cases are all of similar intensity and with no hospitalization," she said.

OTHER SCHOOLS

Individual student cases previously have been confirmed at 'Aina Haina Elementary and Mililani Middle schools. Another school-age child with a confirmed case of swine flu is not in the public school system, the Department of Education has said.

At 'Anuenue School, parents of about 100 students kept their children home on Thursday as a precaution.

Health officials are urging parents not to fear sending their children to school. But any child who has flu-like symptoms or a fever should be kept at home, Okubo said.

It's uncertain at this time how severe the H1N1 outbreak will be in terms of illness and death compared with other influenza viruses, according to the CDC.

In the meantime, some schools are making changes to their illness policies and refilling soap dispensers and posting bottles of hand sanitizer around their campuses.

The University of Hawai'i reconsidered yesterday after initially saying that handshakes would be banned at today's commencement ceremonies.

Instead, handshakes will be the graduate's choice. Each grad will find a foil packet of hand sanitizer on their seat and will have the option to shake hands or not, said Gregg Takayama, UH-Manoa spokesman.

In addition, hand-washing stations will be placed around the commencement grounds.

HUGS ALLOWED

At St. Francis School, principal Sister Joan of Arc Souza refuses to let the threat of the flu ruin the end-of-school traditions there of hugs and handshakes.

"We'll give hugs," Souza said. "We're taking precautions. It's like terrorists. You can't let them rule. Life goes on."

The school, however, has amended its illness policy to require students to bring a doctor's note if they are sent home for flu-like symptoms.

"We're seeing that the students are being much more cautious," Souza said. "It's raised everyone's awareness of cleanliness and hygiene."

At 'Ewa Elementary School, principal Stan Tamashiro hoped to put the swine flu in perspective. With nearly 1,000 students, having two cases at the school is serious, but not cause for undue alarm. Letters were sent home to parents yesterday with information from health officials in hopes of quelling parents' fears.

"Our school is taking it in stride," Tamashiro said. "We have been stepping up our cleaning efforts, replenishing paper towels and soap in the dispensers. Hopefully, it will be confined."