BOSTON (AP) — Boston declared a public health emergency Wednesday as flu season struck in earnest and the state reported 18 flu-related deaths so far.

The city is working with health care centers to offer free flu vaccines and hopes to set up places where people can get vaccinated. The city said there have been four flu-related deaths, all elderly residents, since the unofficial start of the flu season Oct. 1.

“The best thing you can do to protect yourself and your family is to get the flu shot,” said Boston Mayor Thomas Menino.

The city was experiencing its worst flu season since at least 2009, Menino said, with about 700 confirmed cases of the flu, compared with 70 all of last season.

Massachusetts was one of 29 states reporting high levels of “influenza-like illness,” according to the most recent weekly flu advisory issued by the Centers for Disease Control and Prevention.

The CDC said the proportion of people visiting health care providers with flu-like symptoms climbed from 2.8 percent to 5.6 percent in four weeks. By contrast, the rate peaked at only 2.2 percent during the relatively mild 2011-12 flu season.

The estimated rate of flu-related hospitalizations in the U.S. was 8.1 per 100,000 people, which is high for this time of year, according to Dr. Joe Bresee, chief of the epidemiology and prevention branch of the CDC’s influenza division.

Barbara Ferrer, director of the Boston public health commission, said the emergency was declared in part to get residents’ attention. She said that the 700 confirmed cases represent only those reported to the city and that thousands of other people may be ill.

Boston hospitals had counted about 1,500 emergency room visits since December by people with flulike symptoms. Menino said people with symptoms shouldn’t go to work or school.

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