The average number of daily COVID-19 cases in Hawaii remains steady as health officials continue to urge people to get a bivalent booster shot ahead of the winter season.

The response to the new bivalent boosters, which were federally approved in late August, has so far been lackluster across the nation, according to the Kaiser Family Foundation’s latest vaccine monitor report. About half of adult respondents in the nationwide survey conducted last month said they had heard little to nothing about the updated COVID-19 booster.

About 1 in 3 respondents said they heard “a little” about it, while 1 in 5 said they had heard “nothing at all” about the boosters formulated to target both the original COVID-19 strain and more contagious omicron subvariants BA.4 and BA.5. Four in 10 fully vaccinated adults were not sure if they were eligible for the bivalent booster.

On top of that, federal financial support for vaccination campaigns has not been renewed, the Commonwealth Fund noted, partly because of the perception that the pandemic is over. Yet an aggressive fall COVID-19 booster campaign could prevent thousands of deaths and save billions of dollars, the nonprofit said in a recent analysis.

Hawaii has a higher rate of COVID-19 vaccinations than most states, with 77.7% of the state’s population having completed a primary series and 45.5% having gotten a first booster.

As of Wednesday, the Hawaii Department of Health reported 81,601 bivalent boosters had been administered in the state since Labor Day weekend, when they became available.

The new bivalent COVID-19 vaccines are available to individuals age 12 and older if at least two months have passed since receiving a primary shot or booster. The DOH said more than 236,000 doses have been delivered to the state, and appointments should be easier to schedule as the doses become more widely available.

Additionally, the DOH has pre-ordered 14,000 Pfizer bivalent boosters for kids ages 5 to 11, which will be shipped upon Food and Drug Administration approval, possibly next week.

After a downward trend that began in early June, the epidemic curve appears to now be at a plateau, with the state’s seven-day average of new cases Wednesday at 166, compared with 164 per day reported Sept. 28.

The DOH also reported eight more deaths, all among seniors ages 60 and older, bringing the Hawaii’s coronavirus-related death toll to 1,694.

The state’s average positivity rate, meanwhile, bumped up to 6.3% compared with 5.7% reported the previous week. Hospitalization numbers also increased this week, with a seven-day average of 73 patients hospitalized per day, up from 64 per day the previous week, according to the Healthcare Association of Hawaii. There were 71 patients with COVID-19 in Hawaii hospitals Wednesday, with seven in intensive care.

The DOH reported 1,273 new COVID-19 infections over the past week, bringing the total number of cases since the start of the pandemic to 357,232.

The week-over-week count now includes reinfections, which DOH on Sept. 28 announced it would begin counting because they now account for about 10% of new confirmed cases.

The DOH on Tuesday unveiled its inaugural wastewater surveillance report, which showed that levels of coronavirus in wastewater have been consistent with reported case trends. The report uses data provided by Biobot Analytics of Cambridge, Mass., as part of a national wastewater surveillance program.

The Centers for Disease Control and Prevention contracted Biobot in May to collect and analyze wastewater samples from hundreds of sites across the U.S., including Hawaii, for levels of SARS-CoV-2, the virus that causes COVID-19. Samples are collected from 15 wastewater sites in Hawaii and sent to Biobot for analysis, with test results provided about a week after collections.

The report shows COVID-19 cases have been on the decline since early June, with omicron subvariant BA.5 still the dominant strain in Hawaii. The data for the report was for June 1 to Sept. 19., so does not include trends from most recent weeks

DOH said wastewater surveillance reports will be published every two weeks using Biobot’s data and that its Laboratories Division, meanwhile, would continue to develop its own COVID wastewater surveillance capabilities.

CDC recently expanded its contract with Biobot to include wastewater analysis for the monkeypox virus, but did not announce participants yet.

The current Biobot contract for COVID and monkeypox wastewater analysis lasts through January.

Epidemiologists, meanwhile, are keeping a wary eye on new mutations of the virus as the year wraps up.

Some new immune-evading subvariants spreading in other countries, such as BA.2.75.2 and BQ.1, are of concern, as well as XBB, which has shown resistance to antibodies developed from previous infections and vaccinations.

With most mitigation dropped, many are expecting another wave of infections to hit this winter as people head indoors, compounded by flu season.

Some European countries and Northeastern U.S. states are already experiencing a rise in COVID-19 cases. Australia and New Zealand recently had their most severe flu season in five years, said infectious disease experts from Cedars-Sinai, and similar patterns tend to follow in the Northern Hemisphere.

BOOSTER REQUIREMENTS

Eligibility for the bivalent COVID-19 boosters

>> Pfizer bivalent booster: Ages 12 and older if it has been two months since completing the primary series or the previous booster (one or more boosters).

>> Moderna bivalent booster: Ages 18 and older if it has been two months since completing the primary series or the previous booster (one or more boosters).

>> To search for a specific vaccine near you, visit vaccines.gov.