Two Mountain elementary schools have been identified as suspected H1N1 flu sites.

James MacDonald and Our Lady of Lourdes are among four city schools where respiratory outbreaks have been confirmed. An outbreak at a school is called when five per cent of the school population is absent with the same illness.

It may never be known for sure if they are indeed swine flu cases, said Tara Hall, spokesperson for Hamilton Public Health Services, but it's rare for common forms of influenza to be so active at this time of year.

"It's really the only thing we're seeing as far as respiratory illness," she said.

She said the province is only testing for H1N1 in very ill patients or cases involving the very young and very old, as they have high risk of complications.

"None of these are severe cases, they're all mild cases," Ms. Hall said of the school outbreaks.

Public school board spokesperson Jackie Penman said they reported the increased number of absences at James MacDonald, a JK-8 school with about 305 students, to the health department last week and were notified Monday it was a respiratory outbreak.

The local outbreaks come after word that a six-year-old Brampton girl died as a result of  H1N1 flu. it was the first death of a child in connection with the pandemic flu; three adults with H1N1 in Ontario have also died.

While the school year is essentially over, the health department recommends children with a flu-like illness stay home and out of the regular population, whether it is at school or visiting someone in a hospital or nursing home, to ensure they do not spread the virus.

Anyone feeling ill is also advised to use common precautions such as coughing or sneezing into their sleeve and washing their hands frequently.

"We know it's in the community and we know we're seeing community spread, that's why really the best thing you can do is those basic infection control procedures," said Ms. Hall.

Associate medical officer of health Dr. Chris Mackie said late last week a number of students in three city high schools had developed respiratory illnesses, with one student testing positive for influenza A and the others "quite possibly" having swine flu.

He said all of the cases are mild and did not require hospitalization. Health officials did not reveal where the schools are located.

Hamilton health officials have been working with school boards providing information about the H1N1 virus.

Health officials said the H1N1 virus continues to spread throughout the community, with 23 confirmed cases as of June 19.

“The virus is spreading quickly, but (the health effects) are not as severe,” said Dr. Mackie. “The level of concern is not justified.”

The symptoms of the virus are similar to the seasonal influenza, such as chills, loss of appetite, sneezing and vomiting.

Canadian health officials are reporting about 5,000 confirmed cases, with 12 deaths, while the United States has noted about 18,000 cases and 44 deaths. The World Health Organization is reporting 44,287 cases and 180 deaths.

The WHO to weeks ago raised the alert level to a pandemic level six. But officials said it was done because of the spread of the virus and not the severity of it.