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Two more Utahns have died after testing positive for the H1N1 swine flu, including the first death reported outside Salt Lake County.

A Davis County man and a Salt Lake County woman, both between the ages of 25 and 50, died Saturday, bringing the state's total to eight. Five deaths have also occurred among adults in the same age range, and a child under 18 has also died.

Utah has "one of, if not the most, active outbreaks in the country," state epidemiologist Robert Rolfs said Wednesday. And it's not clear why.

Last week, the CDC reported 44 deaths nationwide. A new total will be released Friday.

While H1N1 deaths are far fewer than the estimated 300 annual Utah deaths caused by seasonal flu -- which don't generate nearly as much attention -- Rolfs said there are three reasons to take H1N1 seriously:

» It is affecting young people, from children to people in their 50s, while seasonal flu mainly affects the very young and people older than 65.

» H1N1 is continuing to spread during the summer, when seasonal flu is dormant.

» Even if the spread dies down this summer, history shows pandemics return in a more severe form in the fall and winter. "A lot of what we're concerned about is its potential," Rolfs said.

Another challenge around the corner: When the vaccine now in development becomes available, there won't be enough for everyone. "It will have to be prioritized," he said.

Federal officials are still figuring out who should get the upcoming vaccine, which would be distributed through public clinics, not private doctors, to ensure the approved populations get it, Rolfs said.

He said people will need two doses, in addition to a seasonal flu shot. And officials will have to maintain public confidence in the vaccine when those inoculated report side effects, he said. In 1976, a mass vaccination against a different swine flu led to reports of people being paralyzed, even as the outbreak never materialized.

Rolfs said there is an "emerging belief" that inoculating school-aged children will limit the transmission in the general population. Health and Human Services Secretary Kathleen Sebelius told the Associated Press she has urged school superintendents to prepare to use their schools as shot clinics if the government decides to mass vaccinate.

Federal officials will decide who should get the vaccine based in part on how the novel virus behaves in the Southern Hemisphere this summer, where the flu season is just starting, she said.

The Swiss pharmaceuticals company Novartis AG recently announced it has produced a first batch of vaccine weeks ahead of expectations, according to the AP. It will be used for testing. More than 30 governments have requested vaccine supplies, including the U.S. Department of Health and Human Service, which placed a $289 million order in May.

The state health department reported Wednesday that 129 flu patients have been hospitalized. That's 39 more than the last time hospitalizations were reported on Thursday. Four have been among health care workers and 11 patients were pregnant. By comparison, 255 Utahns have been hospitalized for seasonal flu since the end of September.

For now, H1N1 is still considered a "mild" pandemic, with most of the ill recovering.

Based on its generic pandemic flu plan, Utah public health officials would consider 1,700 deaths a year to be a "moderate" pandemic and 16,000 deaths "severe." Those figures are based on population estimates and historic pandemics, and don't take into account advances in medicine.

One theory about why Utah seems to be suffering more from H1N1 is the state's younger population. Older people who have been exposed to several flus appear to have antibodies that help protect them, according to the Centers for Disease Control and Prevention.

Nathan Dean, chief of pulmonary critical care at Intermountain Medical Center in Murray and LDS Hospital in Salt Lake City, also hypothesizes that younger patients are having an "overreaction" to the virus, triggering a "vigorous inflammation response" that can cause septic shock and adult respiratory distress syndrome, which lands them in the hospital.

Local health departments are no longer reporting whether the patients who die have underlying health conditions that would have put them at higher risk for complications. Rolfs said that is because it risks breaching patient confidentiality and it can be seen as blaming the victim. Plus, many Utahns have the risk factors: being pregnant or obese, having asthma or diabetes, he noted." Target="_BLANK">

Advice from health officials

With some sick Utahns reporting difficulty getting treated for the flu, the state health department advised:

» Patients with flu-like symptoms can be treated with antivirals like Tamiflu without confirmation that they have the flu, since the rapid tests can be inaccurate.

» Treatment is especially important for those with serious symptoms and who are at risk for complications, including those who are pregnant, under age 5, or have chronic medical conditions.

» Antivirals should be "strongly considered" to prevent the flu among people who have been exposed to the virus and are at risk of complications.

» Once you have a prescription, call pharmacies to ensure they have antivirals on hand, since some report being out.

The toll in Utah

Deaths in Salt Lake County

» 21-year-old Marcos Antonio Sanchez died in May. He was overweight and had sleep apnea.

» A child between the ages of 5 and 8 who had a "pretty severe underlying chronic condition" and respiratory problems, according to a health official, died in early June.

» Doug Dunford, a 42-year-old from Cottonwood Heights, with a liver condition, died June 12.

» Francine Rushton, 47, died June 13.

» A woman between ages of 25 and 60, died mid-June.

» A man between the ages of 25 and 50, died June 13.

» A woman between ages of 25 and 50, died June 13.

Davis County

» A man between ages of 25 and 50 died June 13.

How H1N1 compares to seasonal flu

Deaths from seasonal flu are not tracked. But based on Utah's population, the Utah Department of Health estimates 200 to 350 Utahns die each year of the seasonal flu, with 36,000 deaths nationally.

Nationally, more than 90 percent of the deaths and 60 percent of hospitalizations occur in people ages 65 and older.

The novel H1N1 swine flu has a different pattern: 72 percent of the hospitalized cases have been between the ages of 5 and 64 as of June 12, according to the Centers for Disease Control and Prevention.