Boston reported two children have died related to the flu this season Tuesday, the first pediatric flu-associated deaths in the city since 2013, bringing total related deaths Massachusetts children up to four.

“We’ve noted a dramatic increase in flu cases in Boston, particularly among children, and we are very concerned about the severity of illness that we’ve noted amongst children this season,” said Bisola Ojikutu, Boston’s Commissioner of Public Health. “Tragically, two children under two years of age have died from flu-associated illness thus far in Boston.”

Boston saw a 126% jump in confirmed flu cases in the most recently reported week ending Dec. 27, the Boston Public Health Commission (BPHC) reported, and hospitalizations nearly tripled.

Among children under five, there was a 142% increase in confirmed flu cases in the last two weeks of December, Ojikutu said. Emergency department visits for the young children grew 225%, and hospitalization almost tripled in the same time frame.

“Compared to last year, we’ve noted twice as many kids who’ve been hospitalized for the flu this season,” said Ojikutu. “And the number of hospitalizations among children under five this season has actually already exceeded last season’s hospitalizations at the peak of the season. And we’re nowhere near our peak yet.”

The Boston commission’s announcement comes a day after Massachusetts reported three pediatric deaths from flu-related illness. Massachusetts reported one of the deaths in Boston, while the other was confirmed overnight, the BPHC said.

The state has reported 30 confirmed flu-related deaths on its flu dashboard.

The deaths come amid a surge of a new flu variant, H3N2 subclade K, which has spread across the U.S. and other countries. The variant is “behaving in a more aggressive way,” Ojikutu said, contributing to an early surge this season.

Though the flu vaccine is not a perfect match for the variant, health officials have emphasized getting vaccinated remains vital.

Data show “this year’s vaccination will decrease the risk of serious illness, hospitalization and death,” Ojikutu said.

“It’s not too late to vaccinate your children,” Ojikutu said. “Everyone six months of age and older is eligible to receive an annual flu vaccination in our state. Please vaccinate your children as soon as they are eligible. There has been a lot of misinformation related to delaying vaccination in children. It is safe to vaccinate children as soon as they are eligible. The flu vaccine is safe, effective, and it saves lives.”

Only 32.5% of Boston residents have received a flu shot this year, the commissioner said. Across the state of Massachusetts, about 34% of residents have been vaccinated.

In response to the deaths, a “major part” of the city’s plan is to offer at lease six additional vaccination clinics for all age groups in January, Ojikutu said. The free clinics will start on Wednesday at City Hall from 10 a.m. to 2 p.m. and continue across the city, with no appointments or identification cards needed.

Health officials also urge parents and caregivers to “be aware of the signs and symptoms of severe illness related to the flu in kids,” Ojikutu said.

In addition to typical flu symptom like cough, fever and runny nose, residents should watch out for sick children having trouble breathing, persistent fever lasting for several days, a fever not relieved by medications, lethargy or extreme weakness or tiredness, confusion, and decreased urination, said Ojikutu.

“These are all serious signs,” said Ojikutu. “And basically what a parent or caregiver should do is bring that child into the emergency department immediately for medical attention.”

The BPHC also warned people who are under two years old, over 65 years old, pregnant, immunocompromised, or with underlying illnesses like asthma, lung disease or heart disease are at higher risk of serious complications from the flu and should seek medical care when exposed.

The commission encouraged prevention strategies like good hand hygiene, increased ventilation, mask wearing indoors, and staying home when sick.

The rise in flu cases also comes as the Trump administration has rolled back childhood vaccine recommendations, which Ojikutu called “reckless and dangerous.”

More information on vaccination and the flu can be found at boston.gov/vaccine-clinics, vaccinefinder.org, or via the mayor’s Health Line at 617-534-5050.

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