State health officials have confirmed a report of four new cases of the H1N1 flu virus in New Hanover County, all in elementary-aged school children.

Three of the children attend the same school; the fourth is from a different school. According to a news release from the Department of Health and Human Services, school closure is not recommended at this time.

These latest cases come on the heels of two cases confirmed in the Triangle over Memorial Day weekend - in Orange and Durham counties. North Carolina now has 18 confirmed cases.

State Health Director Dr. Jeff Engel said the state lab in Raleigh is processing about 30 tests for the H1N1 virus each day, but that is likely only a sampling of the potential cases across the state.

"It's probably in every county in North Carolina at a low level," he said. "And we're just beginning to understand its spread in the state."

According to a news release, the New Hanover County Health Department is working to determine who might have been exposed before the patients showed symptoms. Officials will be notifying anyone with whom there was close contact. People who have been in close contact with the patients will be advised to go home at the earliest sign of illness and to minimize contact in the community to the extent possible.

Nationwide, the virus is affecting children over 5 and young adults at a much greater rate than the seasonal flu. Engel said with the majority of schools about to dismiss for the summer, the chance of more outbreaks like the one in New Hanover County is reduced.

"With the cluster that we're seeing in Wilmington, we do know that they have a much higher absentee rate right now," he said. "If those children are out with flu-like illness, we could also assume that they have the H1N1 and they're just not going to be tested because it's mild disease."

Because cases have been mild, Engel also noted that the state stockpile of anti-viral medication remains untouched. He said medication is only necessary in severe cases and in patients who are hospitalized. Most patients, he said, can recover at home, but should seek medical attention if their symptoms become serious. Signs to watch for include:

*high fever (over 104 degrees)
*nausea, vomiting, dehydration
*chest pain (in adults)
*difficulty breathing, shortness of breath
*bluish tinge to skin from lack of oxygen