BOSTON — The city of Boston declared a public health emergency Wednesday as it tried to deal with an unusually harsh flu season and the state reported 18 flu-related deaths so far.

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

Boston Mayor Thomas Menino said there had been about 700 confirmed cases of the flu in Boston so far this season, 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 2011-2012 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. The agency’s next advisory will be issued Friday.

“This is the worst flu season we’ve seen since 2009, and people should take the threat of flu seriously,” Mr. Menino said in a statement. “This is not only a health concern, but also an economic concern for families, and I’m urging residents to get vaccinated if they haven’t already.”

The mayor also urged people to stay home from work or school if they are sick.

Frederica Williams, president of the Whittier Street Health Center in Boston’s inner-city Roxbury neighborhood, said her facility had opened a special flu clinic and was using social media and sending letters to residents urging them to come in and get flu shots.

She estimates that the number of patients who have come to the clinic seeking treatment for flu-like symptoms is triple that of the same time a year later.

Hospitals around the state were also taking precautions to protect patients and staff from exposure to the flu.

Baystate Health, which operates Baystate Medical Center in Springfield and two other hospitals in western Massachusetts, announced Wednesday that it was changing its visitor policy. The hospitals will no longer allow visitors younger than 14 and are recommending no more than two people visit a patient at one time.

“This is the worst in several years,” said Dr. Sarah Haessler, an infectious disease specialist at Baystate. She said the flu outbreak has strained the hospital’s resources and helped to fill its beds to capacity.

Nationally, health officials have been urging people to get flu shots while cautioning that vaccines will not guarantee prevention of all illnesses. But 91 percent of the flu viruses that have been analyzed by the CDC were included in the 2012-2013 influenza vaccine.

“I hate needles, and I got [a shot],” Gov. Deval Patrick said Wednesday, adding that he was not aware of any shortages of vaccine in the state.

As of Friday’s report, the CDC said 18 children had died from the flu so far this season. While the CDC does not keep a tab of deaths overall from the flu, it estimates that 24,000 Americans die each year from it.

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