INDIANAPOLIS -- Indiana health officials said nine residents died last week from complications related to H1N1 flu, a surge that nearly doubled the state's H1N1 fatalities to 19 since June.

Health officials said hospitalization rates for influenza and pneumonia have risen 41 percent over the past three weeks as the current flu outbreak continues.

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"My heart goes out to the families," said Dr. Joan Duwve, medical director for Public Health and Preparedness. "It is a sad reality that H1N1 flu, just like any influenza, has the potential to cause severe illness and even death."

Even though last week was by far the deadliest week for H1N1 flu in Indiana, health officials see some signs that the illness is easing in the state.

"I understand that news of deaths from H1N1 flu-related complications is going to make the public even more anxious to get the H1N1 flu vaccine, and we do wish we had enough of the vaccine for every Hoosier," Duwve said. "We have placed orders for all of the H1N1 flu vaccine that has been allocated for Indiana, and the local health departments are working hard to get vaccine out to the public as soon as possible."

The state's weekly H1N1 report said emergency rooms saw a slight dip in influenza activity last week.

Only nine Indiana schools reported absentee rates higher than 20 percent, while university health centers saw a decrease in swine flu cases.

Still, health officials warned Hoosiers to be vigilant.

"The threat is not over," said Indiana Health Commissioner Dr. Judy Monroe. "We don't know when we will peak with this particular wave of the pandemic, and even if we are seeing encouraging signs that this is going to dip, we'll come out of this wave, we may have a third wave."