More than 100 people in an aboriginal community north of Tofino, B.C., have reportedly fallen ill with swine flu, in what's being described as the first pandemic outbreak in Canada's fall flu season, while one death linked the virus has been reported on a reserve near Victoria.

The outbreak is centred on the remote community of Ahousat, the principal settlement on Flores Island off the west coast of Vancouver Island, which is accessible only by water or air. But other communities in the area, including Hot Springs Cove and Tofino, also appear to be affected.

According to a story on the Canadian Medical Association Journal's website, Dr. John Armstrong, a family physician, says he has treated dozens of cases of people infected with the virus.

But the deputy chief of the Ahousaht First Nation, John Frank, said that in the last few weeks more than 100 people have become sick — more than five per cent of the local population — and people are still falling ill.

A death in Beecher Bay

According to the CMAJ article, all the cases in the Ahousat outbreak have been "fairly mild" and treatable with the antiviral drug Tamiflu, with only two patients — an infant and an adult age 50 — requiring hospital care. Most of the cases are reportedly younger adults, between ages 20 and 40, and some teenagers, the article states.

However, health officials criticized the article for being inaccurate Thursday, saying no one from the community had been hospitalized.

But the Vancouver Island Health authority confirmed on Thursday that other First Nations communities on Vancouver Island have also been hit with the virus.

On Wednesday, an aboriginal woman from the Beecher Bay reserve, southwest of Victoria, died after becoming infected with the swine flu. The health authority said the unidentified woman had an underlying health problem, and did not link her death with the outbreak in the Tofino area, which is roughly 200 kilometres away.

Officials also revealed that two children on Vancouver Island have been hospitalized with swine flu.

One child, from Beecher Bay, is reportedly doing well. However, a second child, from a non-aboriginal community on Vancouver Island, is in critical condition.

Meanwhile, officials from the Musqueam Indian band in Vancouver confirmed Thursday the reserve has one lab-confirmed case of swine flu.

Officials said approximately 10 per cent of the reserve's population of 600 is also suffering from flu-like symptoms.

Coreen Paul, the health program manager for the Musqueam, said people started getting sick in August.

"Is there concern for our community? Yes there is, because we are an aboriginal community and we do have a higher incidence of chronic disease," Paul said.

"We also have overcrowding where we can have as many as three generations living together in one household, so if one person gets sick, it's very likely that the rest of their family will get sick."

The person with the confirmed case has since recovered.

Since the virus was first detected in B.C. last winter roughly 50 people have been hospitalized with swine flu and five other deaths — all involving people with other health conditions — have been linked to the virus.

Swabbed and treated

The cases are being treated under a new program that has pre-positioned antivirals and other medical equipment near remote B.C. communities, said Dr. Evan Adams, who has been tracking the outbreak as the province's aboriginal health physician adviser.

While it is not clear exactly how many people have become sick in the communities, there is no reason to panic, said Adams.

"I think it's important to note that most cases, if not all cases, were mild. Often when people had flu they didn't see a physician. They just knew to stay home or stayed home. And very few of those actually got swabbed for a lab confirmation," said Evans.

The province's public health lab in Vancouver recently instructed Armstrong to stop sending swabs because all of the samples he had already sent for testing were positive for the H1N1 virus, according to the CMAJ article.

There are likely similar outbreaks all over the country right now, but because nearly all cases are mild, little attention is being paid outside the affected communities, said Evans.

But because people did get swabbed in Ahousat, the community is in the news today as the so-called first outbreak of the fall season, he said.

Start of school linked to spread

Four cases of the virus were reportedly detected in Ahousat in early September, and aboriginal leaders and health officials held public meetings and took actions that were initially successful in containing the spread of the virus. But with the start of the school year the virus appears to be spreading once again, says the CMAJ article.

Ahousat is the main settlement of the Ahousaht First Nations (spelled differently), whose hereditary chief, Shawn Atleo, was recently elected national chief of the Assembly of First Nations. Hot Springs Cove is a smaller community of the Hesquiaht First Nation farther to the north, on Vancouver Island.

Atleo said it come as no surprise the outbreak was detected on a reserve, considering the problems of poverty, lack of infrastructure and lack of clean water First Nations communities face.

"It doesn't surprise any of us. First Nations are well known to be the most vulnerable," said Atleo

"H1N1 is only a window into broader chasm of division that's been created between First Nations and the broader health-care system," he said.