States with the most flu and pneumonia deaths

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October 28, 2020
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States with the most flu and pneumonia deaths

Health officials are worried that the 2020–2021 flu season could couple with rising COVID-19 cases to create a “twindemic.” If cases of the two respiratory diseases spike at the same time, hospitals may become overloaded with patients, and deaths may increase as a result.

The flu season in the United States lasts from October to May, although cases tend to peak in December, January, and February. Cases, hospitalizations, and deaths may stay relatively low during some flu seasons, but other years influenza is much more of a public health threat. Since 2010, cases have ranged from between 9 million and 45 million per year and between 12,000 and 61,000 deaths. Not all states are impacted equally. Alaska has the lowest number of flu and pneumonia deaths per capita from 2013 to 2020 at 233 per 100,000 people, and West Virginia has the highest at 687 per 100,000 people.

Australia, Chile, and South Africa all reported mild flu seasons lasting from June to August 2020, which suggests the same will be true in the 2020–2021 U.S. flu season. This is due in part to precautions such as masks and social distancing that protect against both COVID-19 and the flu, which can both lead to pneumonia.

Two influenza viruses—influenza A and B—are responsible for the seasonal flu season. New mutations of these viruses and flu vaccination rates can affect the severity of a season. Adults over 65 and children younger than 5, and especially those under age 2, are at high risk of complications from the flu.

To determine states that have seen the most deaths from flu and pneumonia, Stacker consulted the Centers for Disease Control and Prevention (CDC)’s Pneumonia and Influenza Mortality Surveillance, from the National Center for Health Statistics Mortality Surveillance System. This source includes deaths from influenza and pneumonia in all flu seasons from 2013–2014 to 2020–2021.

In this story, states are ranked based on their total flu and pneumonia deaths per capita from 2013 to 2020. Stacker also determined each state’s worst flu season from 2013 to 2020, excluding the current, 2020–2021 season, based on the share of all deaths during the season that were caused by flu and pneumonia. Data included in this story are as of Oct. 3, 2020.

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#51. Alaska

- Total flu and pneumonia deaths, 2013-2020: 1,723 (233 per 100,000 population)
--- Flu deaths: 100 (14 per 100K)
--- Pneumonia deaths: 1,623 (220 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 5.6% of all deaths
- Worst flu season: 2016-2017 (276 deaths, 37 per 100K, 6.3% of all deaths in the season)
- Deaths recorded so far in 2020-2021: Data not available

Flu and pneumonia were the 10th leading cause of death in Alaska in 2016. On average, each premature death led to a loss of 6.6 years of life.

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#50. Utah

- Total flu and pneumonia deaths, 2013-2020: 8,201 (269 per 100,000 population)
--- Flu deaths: 417 (14 per 100K)
--- Pneumonia deaths: 7,784 (256 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 6.5% of all deaths
- Worst flu season: 2013-2014 (1,177 deaths, 39 per 100K, 7.3% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 13 (0.4 per 100K, 7.4% of all deaths in the season)

In 2017, flu and pneumonia claimed 334 lives in Utah. Combined, these illnesses killed fewer people than both firearms and drug overdoses that year, which were responsible for the deaths of 410 and 650 people, respectively.

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#49. Colorado

- Total flu and pneumonia deaths, 2013-2020: 17,019 (308 per 100,000 population)
--- Flu deaths: 1,042 (19 per 100K)
--- Pneumonia deaths: 15,977 (289 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 6.4% of all deaths
- Worst flu season: 2019-2020 (3,138 deaths, 57 per 100K, 7.3% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 12 (0.2 per 100K, 3.9% of all deaths in the season)

Three children in Colorado died of influenza during the 2019–2020 flu season. However, children weren’t the only ones hit hard by the virus. Colorado experienced 64 outbreaks in long-term care facilities such as nursing homes that season.

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#48. Idaho

- Total flu and pneumonia deaths, 2013-2020: 5,530 (328 per 100,000 population)
--- Flu deaths: 380 (23 per 100K)
--- Pneumonia deaths: 5,150 (305 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 5.7% of all deaths
- Worst flu season: 2013-2014 (807 deaths, 48 per 100K, 6.4% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 3 (0.2 per 100K, 3.3% of all deaths in the season)

Based on data from the past three years, Idaho has the fifth lowest flu shot rate in the country with only 41.8% of residents vaccinated, according to a report from the insurance and research firm AdvisorSmith. The average state vaccination rate for the 2019–2020 flu season was 51.8%.

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#47. Georgia

- Total flu and pneumonia deaths, 2013-2020: 34,277 (333 per 100,000 population)
--- Flu deaths: 1,070 (10 per 100K)
--- Pneumonia deaths: 33,207 (322 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 5.9% of all deaths
- Worst flu season: 2019-2020 (7,310 deaths, 71 per 100K, 7.8% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 14 (0.1 per 100K, 3.9% of all deaths in the season)

The 2017–2018 flu season in Georgia brought about record-breaking numbers of hospitalizations. During the peak, more than 500 flu patients visited Grady Memorial Hospital on some days.

 

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#46. Oregon

- Total flu and pneumonia deaths, 2013-2020: 13,662 (335 per 100,000 population)
--- Flu deaths: 1,034 (25 per 100K)
--- Pneumonia deaths: 12,628 (309 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 5.4% of all deaths
- Worst flu season: 2013-2014 (1,985 deaths, 49 per 100K, 5.9% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 5 (0.1 per 100K, 2.8% of all deaths in the season)

From 2014 to 2016, flu and pneumonia were not in Oregon’s top 10 leading causes of death. However, in 2017 flu/pneumonia beat out hypertension to become the 10th leading cause of mortality in the state.

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#45. Virginia

- Total flu and pneumonia deaths, 2013-2020: 28,432 (338 per 100,000 population)
--- Flu deaths: 1,149 (14 per 100K)
--- Pneumonia deaths: 27,283 (324 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 6% of all deaths
- Worst flu season: 2014-2015 (4,547 deaths, 54 per 100K, 6.8% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 21 (0.2 per 100K, 4.1% of all deaths in the season)

The 2018–2019 flu season in Virginia lasted longer and further into the spring than previous years because two different viruses caused two waves of influenza. Various regions of the state reported different virus subtypes as more prominent than others for the first time since the state began recording this information.

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#44. Washington

- Total flu and pneumonia deaths, 2013-2020: 26,892 (369 per 100,000 population)
--- Flu deaths: 1,652 (23 per 100K)
--- Pneumonia deaths: 25,240 (346 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 6.9% of all deaths
- Worst flu season: 2014-2015 (4,123 deaths, 57 per 100K, 7.5% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 20 (0.3 per 100K, 4.3% of all deaths in the season)

During Washington’s deadliest flu season, listed from 2014–2015, most deaths occurred in people who had underlying conditions. However, one child who did not have pre-existing conditions died from the flu, as did two previously healthy adults in their 30s.

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#43. Texas

- Total flu and pneumonia deaths, 2013-2020: 106,286 (381 per 100,000 population)
--- Flu deaths: 3,740 (13 per 100K)
--- Pneumonia deaths: 102,546 (368 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 7.7% of all deaths
- Worst flu season: 2019-2020 (22,057 deaths, 79 per 100K, 9.7% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 54 (0.2 per 100K, 6.2% of all deaths in the season)

The Texas Department of State Health Services will provide 2.8 million vaccines to both adults and children in preparation for the 2020–2021 flu season. Texas residents can dial 211 for help locating a vaccine provider in their area.

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#42. Minnesota

- Total flu and pneumonia deaths, 2013-2020: 21,068 (381 per 100,000 population)
--- Flu deaths: 1,175 (21 per 100K)
--- Pneumonia deaths: 19,893 (360 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 6.8% of all deaths
- Worst flu season: 2014-2015 (3,131 deaths, 57 per 100K, 7.2% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 34 (0.6 per 100K, 6.8% of all deaths in the season)

During Minnesota’s deadliest flu season since 2013, from 2014–2015, 4,153 flu patients were hospitalized. There were 706 flu outbreaks in schools, and 10 children died.

 

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#41. Wisconsin

- Total flu and pneumonia deaths, 2013-2020: 22,040 (381 per 100,000 population)
--- Flu deaths: 1,270 (22 per 100K)
--- Pneumonia deaths: 20,770 (359 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 6% of all deaths
- Worst flu season: 2014-2015 (3,383 deaths, 59 per 100K, 7% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 32 (0.6 per 100K, 6.1% of all deaths in the season)

During the 2019–2020 flu season, 73 pregnant and 14 postpartum women were hospitalized with the flu—the most since the Wisconsin Department of Health and Services began tracking that data. Three children also died from the flu that season.

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#40. Washington DC

- Total flu and pneumonia deaths, 2013-2020: 2,635 (385 per 100,000 population)
--- Flu deaths: 67 (10 per 100K)
--- Pneumonia deaths: 2,568 (375 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 7.5% of all deaths
- Worst flu season: 2019-2020 (898 deaths, 131 per 100K, 15.3% of all deaths in the season)
- Deaths recorded so far in 2020-2021: Data not available

About 36,000 residents of Washington D.C. come down with the flu each year. For the 2020–2021 flu season, DC Health has teamed up with Walgreens and CVS Pharmacy to provide free flu shots at public testing sites to children and adults who are 12 and older.

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#39. California

- Total flu and pneumonia deaths, 2013-2020: 150,868 (385 per 100,000 population)
--- Flu deaths: 5,113 (13 per 100K)
--- Pneumonia deaths: 145,755 (372 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 8.1% of all deaths
- Worst flu season: 2019-2020 (27,651 deaths, 71 per 100K, 9.5% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 125 (0.3 per 100K, 5.9% of all deaths in the season)

Wildfires in California could exacerbate illness in people with both flu and COVID-19 during the 2020–2021 flu season. Wildfire smoke inhalation can also cause similar symptoms to both diseases, which could increase congestion in hospitals and at testing sites.

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#38. Louisiana

- Total flu and pneumonia deaths, 2013-2020: 18,208 (390 per 100,000 population)
--- Flu deaths: 639 (14 per 100K)
--- Pneumonia deaths: 17,569 (377 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 5.7% of all deaths
- Worst flu season: 2019-2020 (4,576 deaths, 98 per 100K, 8.9% of all deaths in the season)
- Deaths recorded so far in 2020-2021: Data not available

In the 2019–2020 season, the flu season began early in Louisiana. In mid-October of 2019, it was the only state to report high levels of flu activity.

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#37. Arizona

- Total flu and pneumonia deaths, 2013-2020: 27,349 (394 per 100,000 population)
--- Flu deaths: 1,023 (15 per 100K)
--- Pneumonia deaths: 26,326 (379 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 6.7% of all deaths
- Worst flu season: 2019-2020 (6,543 deaths, 94 per 100K, 9.4% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 29 (0.4 per 100K, 5.3% of all deaths in the season)

In an attempt to increase flu vaccinations for the 2020–2021 season, the Arizona Department of Health Services and the Arizona Partnership for Immunizations launched the first Influenza College Challenge. Four universities will compete to log the highest percentage of students who have received the flu vaccine by the end of January.

 

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#36. Montana

- Total flu and pneumonia deaths, 2013-2020: 4,170 (400 per 100,000 population)
--- Flu deaths: 296 (28 per 100K)
--- Pneumonia deaths: 3,874 (372 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 6% of all deaths
- Worst flu season: 2014-2015 (657 deaths, 63 per 100K, 6.6% of all deaths in the season)
- Deaths recorded so far in 2020-2021: Data not available

During the 2014–2015 flu season in Montana—the state’s deadliest season since 2013—four counties in the state reported less than five cases of influenza. The highest number reported in one county was 736 cases.

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#35. Wyoming

- Total flu and pneumonia deaths, 2013-2020: 2,422 (416 per 100,000 population)
--- Flu deaths: 120 (21 per 100K)
--- Pneumonia deaths: 2,302 (396 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 7.1% of all deaths
- Worst flu season: 2017-2018 (412 deaths, 71 per 100K, 8.3% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 3 (0.5 per 100K, 7.9% of all deaths in the season)

During the 2017–2018 season, Wyoming experienced a record number of flu-related outbreaks, hospitalizations, and deaths. Flu case numbers peaked in the state during the week ending Feb. 3, 2018, but it continued to report high levels of flu activity until April of that year.

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#34. Maryland

- Total flu and pneumonia deaths, 2013-2020: 25,042 (417 per 100,000 population)
--- Flu deaths: 783 (13 per 100K)
--- Pneumonia deaths: 24,259 (404 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 7.2% of all deaths
- Worst flu season: 2019-2020 (5,112 deaths, 85 per 100K, 9% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 28 (0.5 per 100K, 4.6% of all deaths in the season)

During the 2018–2019 season, a third of all reported flu-related visits to health care providers were for children 0–4. Adults 65 and older accounted for only 5% of these visits.

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#33. Delaware

- Total flu and pneumonia deaths, 2013-2020: 4,002 (421 per 100,000 population)
--- Flu deaths: 159 (17 per 100K)
--- Pneumonia deaths: 3,843 (405 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 6.3% of all deaths
- Worst flu season: 2019-2020 (679 deaths, 72 per 100K, 6.8% of all deaths in the season)
- Deaths recorded so far in 2020-2021: Data not available

In 2015, flu and pneumonia were the eighth leading cause of death in Delaware. Combined, they ranked higher than both kidney disease and sepsis, but just lower than diabetes.

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#32. New Jersey

- Total flu and pneumonia deaths, 2013-2020: 37,492 (422 per 100,000 population)
--- Flu deaths: 1,020 (11 per 100K)
--- Pneumonia deaths: 36,472 (411 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 7% of all deaths
- Worst flu season: 2019-2020 (11,451 deaths, 129 per 100K, 12.5% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 28 (0.3 per 100K, 4.2% of all deaths in the season)

For the 2019–2020 flu season, the Centers for Disease Control and Prevention updated its map of influenza-like illness activity to include three new levels of “very high” activity because New Jersey and New York City reported activity surpassing what the prior map was capable of reflecting. However, the true number of influenza cases was probably obscured by COVID-19 cases.

 

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#31. Illinois

- Total flu and pneumonia deaths, 2013-2020: 54,607 (426 per 100,000 population)
--- Flu deaths: 1,865 (15 per 100K)
--- Pneumonia deaths: 52,742 (411 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 7.1% of all deaths
- Worst flu season: 2019-2020 (10,845 deaths, 85 per 100K, 9% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 55 (0.4 per 100K, 4.9% of all deaths in the season)

To stress the importance of getting a flu shot in preparation for the 2020–2021 flu season, the Illinois Department of Public Health partnered with local health organizations to create the #SleeveUp campaign. The campaign encourages people who get the flu shot to celebrate by posting on social media with the hashtag.

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#30. New Hampshire

- Total flu and pneumonia deaths, 2013-2020: 5,735 (427 per 100,000 population)
--- Flu deaths: 290 (22 per 100K)
--- Pneumonia deaths: 5,445 (405 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 6.6% of all deaths
- Worst flu season: 2014-2015 (899 deaths, 67 per 100K, 7.3% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 4 (0.3 per 100K, 2.3% of all deaths in the season)

During New Hampshire’s deadliest listed flu season from 2014–2015, the number of deaths the state reported remained below the epidemic threshold except for the week ending Feb. 7, 2015, and the week ending April 18, 2015. That season saw the state’s highest number of deaths attributed to influenza in a season since it began tracking flu deaths in 1997.

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#29. Florida

- Total flu and pneumonia deaths, 2013-2020: 88,425 (429 per 100,000 population)
--- Flu deaths: 2,511 (12 per 100K)
--- Pneumonia deaths: 85,914 (417 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 6.3% of all deaths
- Worst flu season: 2019-2020 (20,707 deaths, 101 per 100K, 9.1% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 100 (0.5 per 100K, 5.5% of all deaths in the season)

During the 2019–2020 season, primary and secondary schools reported 137 influenza outbreaks, which accounted for about 45% of outbreaks in the state. Day care facilities reported the second highest at 40 outbreaks, accounting for about 13% of flu outbreaks in the state.

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#28. New Mexico

- Total flu and pneumonia deaths, 2013-2020: 9,132 (436 per 100,000 population)
--- Flu deaths: 365 (17 per 100K)
--- Pneumonia deaths: 8,767 (419 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 7% of all deaths
- Worst flu season: 2013-2014 (1,317 deaths, 63 per 100K, 7.6% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 2 (0.1 per 100K, 2.2% of all deaths in the season)

During the 2013–2014 season, hospitalization rates due to the flu were highest in children 0–4. However, only one child died of the flu that year. More than 70% of flu and pneumonia deaths occurred in people 65 and older.

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#27. Connecticut

- Total flu and pneumonia deaths, 2013-2020: 15,729 (439 per 100,000 population)
--- Flu deaths: 721 (20 per 100K)
--- Pneumonia deaths: 15,008 (419 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 7.2% of all deaths
- Worst flu season: 2019-2020 (2,631 deaths, 73 per 100K, 7.8% of all deaths in the season)
- Deaths recorded so far in 2020-2021: Data not available

Three waves of the flu struck Connecticut during the 2018–2019 season. The state saw little influenza B type activity, and two of the waves were of one influenza A subtype and two of another subtype.

 

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#26. Nevada

- Total flu and pneumonia deaths, 2013-2020: 12,914 (442 per 100,000 population)
--- Flu deaths: 318 (11 per 100K)
--- Pneumonia deaths: 12,596 (431 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 7.6% of all deaths
- Worst flu season: 2019-2020 (2,700 deaths, 92 per 100K, 9.8% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 20 (0.7 per 100K, 9.4% of all deaths in the season)

During the 2019–2020 flu season in Nevada, children 0–4 represented nearly a third of influenza-like illness cases. Young people 5–24 accounted for nearly another third.

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#25. North Carolina

- Total flu and pneumonia deaths, 2013-2020: 45,724 (450 per 100,000 population)
--- Flu deaths: 2,069 (20 per 100K)
--- Pneumonia deaths: 43,655 (430 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 7.2% of all deaths
- Worst flu season: 2014-2015 (7,247 deaths, 71 per 100K, 8% of all deaths in the season)
- Deaths recorded so far in 2020-2021: Data not available

Of the 218 flu and pneumonia deaths in North Carolina’s 2014–2015 flu season, 180 were in people 65 and older. An additional 20 were in those 50–64, and there were only two pediatric deaths.

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#24. Ohio

- Total flu and pneumonia deaths, 2013-2020: 52,615 (452 per 100,000 population)
--- Flu deaths: 2,218 (19 per 100K)
--- Pneumonia deaths: 50,397 (433 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 6.2% of all deaths
- Worst flu season: 2014-2015 (8,489 deaths, 73 per 100K, 7.2% of all deaths in the season)
- Deaths recorded so far in 2020-2021: Data not available

During the 2014–2015 flu season in Ohio, one person tested positive for a novel H1N1 variant. That person worked with livestock, including swine, but reported having no direct contact with swine the week before symptoms began and died from complications after infection.

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#23. Michigan

- Total flu and pneumonia deaths, 2013-2020: 45,598 (458 per 100,000 population)
--- Flu deaths: 1,835 (18 per 100K)
--- Pneumonia deaths: 43,763 (439 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 6.6% of all deaths
- Worst flu season: 2019-2020 (8,910 deaths, 89 per 100K, 8.2% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 38 (0.4 per 100K, 4.4% of all deaths in the season)

Michigan’s goal for the 2020–2021 flu season is to vaccinate 4,469,151 residents against the flu. As of Oct. 10, it was at about 31% to goal with 1,366,728 people vaccinated. For comparison, nearly 10 million people live in Michigan.

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#22. Missouri

- Total flu and pneumonia deaths, 2013-2020: 27,919 (458 per 100,000 population)
--- Flu deaths: 1,411 (23 per 100K)
--- Pneumonia deaths: 26,508 (435 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 6.5% of all deaths
- Worst flu season: 2014-2015 (4,482 deaths, 74 per 100K, 7.3% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 25 (0.4 per 100K, 5.9% of all deaths in the season)

The region of Missouri that reported the highest rate of flu cases during the state’s deadliest flu season from 2014–2015 was the southeast region of the state, followed by the central region. One child died during the season.

 

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#21. Pennsylvania

- Total flu and pneumonia deaths, 2013-2020: 58,850 (460 per 100,000 population)
--- Flu deaths: 2,536 (20 per 100K)
--- Pneumonia deaths: 56,314 (440 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 6.3% of all deaths
- Worst flu season: 2019-2020 (9,865 deaths, 77 per 100K, 6.9% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 63 (0.5 per 100K, 4.9% of all deaths in the season)

The county in Pennsylvania that reported the most flu cases during the 2019–2020 season was Allegheny County with 13,891 cases. Although Philadelphia County has a higher population, it only logged 7,760 cases.

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#20. Kansas

- Total flu and pneumonia deaths, 2013-2020: 13,493 (464 per 100,000 population)
--- Flu deaths: 809 (28 per 100K)
--- Pneumonia deaths: 12,684 (436 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 7.1% of all deaths
- Worst flu season: 2013-2014 (1,994 deaths, 69 per 100K, 7.8% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 21 (0.7 per 100K, 7% of all deaths in the season)

During the 2013–2014 flu season in Kansas, 11% of 52 people who were infected with one influenza subtype had received a flu vaccination. Of seven who tested positive for a second subtype, 29% had been vaccinated.

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#19. Nebraska

- Total flu and pneumonia deaths, 2013-2020: 8,923 (468 per 100,000 population)
--- Flu deaths: 509 (27 per 100K)
--- Pneumonia deaths: 8,414 (442 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 7.7% of all deaths
- Worst flu season: 2014-2015 (1,396 deaths, 73 per 100K, 8.2% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 3 (0.2 per 100K, 2.8% of all deaths in the season)

Douglas County in Nebraska reported 3,507 laboratory-confirmed cases of influenza during the 2014–2015 season—the most since at least the 1999–2000 flu season. That season, the median age of death due to flu in the state was 82.

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#18. Vermont

- Total flu and pneumonia deaths, 2013-2020: 2,935 (470 per 100,000 population)
--- Flu deaths: 194 (31 per 100K)
--- Pneumonia deaths: 2,741 (439 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 7.2% of all deaths
- Worst flu season: 2013-2014 (529 deaths, 85 per 100K, 9.6% of all deaths in the season)
- Deaths recorded so far in 2020-2021: Data not available

Vermont recorded 60 flu outbreaks during the 2019–2020 season. There were 39 of those outbreaks at schools or universities and 17 occurred at long-term care facilities.

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#17. Alabama

- Total flu and pneumonia deaths, 2013-2020: 23,179 (476 per 100,000 population)
--- Flu deaths: 736 (15 per 100K)
--- Pneumonia deaths: 22,443 (461 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 6.3% of all deaths
- Worst flu season: 2019-2020 (4,374 deaths, 90 per 100K, 7.5% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 24 (0.5 per 100K, 8.2% of all deaths in the season)

Alabama has published a list of 10 precautions to take in preparation for the upcoming flu season. Along with common advice such as getting vaccinated and washing hands frequently, the list also recommends stockpiling supplies and creating an office emergency plan so your workplace knows what to do in case of a flu pandemic.

 

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#16. South Carolina

- Total flu and pneumonia deaths, 2013-2020: 24,114 (487 per 100,000 population)
--- Flu deaths: 1,091 (22 per 100K)
--- Pneumonia deaths: 23,023 (465 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 7% of all deaths
- Worst flu season: 2019-2020 (4,561 deaths, 92 per 100K, 8% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 12 (0.2 per 100K, 4.1% of all deaths in the season)

Widespread flu activity lasted in South Carolina for 11 weeks during the 2017–2018 flu season. The elderly were particularly affected; those 65 and older accounted for 57% of hospitalizations and 72% of deaths associated with the flu.

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Chayanin Wongpracha // Shutterstock

#15. North Dakota

- Total flu and pneumonia deaths, 2013-2020: 3,696 (491 per 100,000 population)
--- Flu deaths: 173 (23 per 100K)
--- Pneumonia deaths: 3,523 (468 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 8.3% of all deaths
- Worst flu season: 2013-2014 (542 deaths, 72 per 100K, 8.8% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 4 (0.5 per 100K, 11.8% of all deaths in the season)

During the 2013–2014 flu season in North Dakota, the age range of people who came down with the flu was 2 weeks to 109. The median age of people with reported flu was about 30.

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Stefan Malloch // Shutterstock

#14. Massachusetts

- Total flu and pneumonia deaths, 2013-2020: 33,916 (497 per 100,000 population)
--- Flu deaths: 1,278 (19 per 100K)
--- Pneumonia deaths: 32,638 (478 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 8.3% of all deaths
- Worst flu season: 2019-2020 (6,862 deaths, 100 per 100K, 10.4% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 47 (0.7 per 100K, 7% of all deaths in the season)

For the 2020–2021 flu season, Massachusetts will require all children above the age of 6 months who attend child care or school at any level to get vaccinated against the flu. The state made this requirement to help prevent flu cases from surging during the COVID-19 pandemic. Children and college students without a medical or religious exemption will need to get vaccinated by Dec. 31, 2020.

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#13. Iowa

- Total flu and pneumonia deaths, 2013-2020: 15,588 (498 per 100,000 population)
--- Flu deaths: 928 (30 per 100K)
--- Pneumonia deaths: 14,660 (468 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 7.4% of all deaths
- Worst flu season: 2014-2015 (2,497 deaths, 80 per 100K, 8.2% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 15 (0.5 per 100K, 5.3% of all deaths in the season)

Medicap Pharmacy, which has 22 locations in central Iowa, is offering a promotion in the state to encourage flu shots during the 2020–2021 season. For each person that gets a flu shot at one of the pharmacy’s Iowa locations between Sept. 23 and Nov. 23, the pharmacy will donate 12 meals to a local food bank.

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fizkes // Shutterstock

#12. Indiana

- Total flu and pneumonia deaths, 2013-2020: 33,168 (500 per 100,000 population)
--- Flu deaths: 1,372 (21 per 100K)
--- Pneumonia deaths: 31,796 (479 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 7.3% of all deaths
- Worst flu season: 2019-2020 (5,926 deaths, 89 per 100K, 8.4% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 19 (0.3 per 100K, 5.2% of all deaths in the season)

To encourage vaccinations against the flu, Indiana has started the “Join Blue, Prevent the Flu!” information campaign. The figurehead of the campaign is Blue, a blue horse that also serves as the mascot of the Indianapolis Colts football team.

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hxdbzxy // Shutterstock

#11. Rhode Island

- Total flu and pneumonia deaths, 2013-2020: 5,510 (521 per 100,000 population)
--- Flu deaths: 303 (29 per 100K)
--- Pneumonia deaths: 5,207 (493 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 7.8% of all deaths
- Worst flu season: 2019-2020 (932 deaths, 88 per 100K, 8.6% of all deaths in the season)
- Deaths recorded so far in 2020-2021: Data not available

The State of Rhode Island Department of Health requires that health care facilities report the percentage of their health care employees who get vaccinated against the flu each year. The type of health care facility with the highest percentage of workers vaccinated was, for the 2018–2019 flu season, kidney disease treatment centers at about 97%. The lowest was freestanding emergency care facilities with 50% vaccinated.

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#10. New York

- Total flu and pneumonia deaths, 2013-2020: 103,194 (526 per 100,000 population)
--- Flu deaths: 3,550 (18 per 100K)
--- Pneumonia deaths: 99,644 (508 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 9.2% of all deaths
- Worst flu season: 2019-2020 (27,690 deaths, 141 per 100K, 14.1% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 155 (0.8 per 100K, 6.9% of all deaths in the season)

For the 2020–2021 flu season, the New York State Department of Health will require every nursing home resident and hospital patient who has flu or COVID-19 symptoms, or who has been exposed to either disease, to be tested for both. Of that population, those who died and were suspected of having either disease must be tested for both within 48 hours of dying.

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Canva

#9. Hawaii

- Total flu and pneumonia deaths, 2013-2020: 7,590 (534 per 100,000 population)
--- Flu deaths: 242 (17 per 100K)
--- Pneumonia deaths: 7,348 (517 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 9.7% of all deaths
- Worst flu season: 2016-2017 (1,306 deaths, 92 per 100K, 11.6% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 3 (0.2 per 100K, 3.5% of all deaths in the season)

Hawaii faces influenza year-round because of high levels of tourism and its tropical climate. The state can experience a very different flu season from the contiguous U.S. states and sometimes has different subtypes of viruses circulating and peaking in different months.

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Julian Rovagnati // Shutterstock

#8. Maine

- Total flu and pneumonia deaths, 2013-2020: 7,272 (546 per 100,000 population)
--- Flu deaths: 399 (30 per 100K)
--- Pneumonia deaths: 6,873 (516 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 7.2% of all deaths
- Worst flu season: 2018-2019 (1,239 deaths, 93 per 100K, 8.3% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 11 (0.8 per 100K, 5% of all deaths in the season)

The Maine Department of Health and Human Services proposed a new requirement on Oct. 6, 2020, for health care facility employees to get vaccinated against the flu. If the rule passes, flu will join chickenpox, hepatitis B, measles, mumps, and rubella as diseases that health care workers must get vaccinated against.

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S.Castelli // Shutterstock

#7. South Dakota

- Total flu and pneumonia deaths, 2013-2020: 4,749 (549 per 100,000 population)
--- Flu deaths: 257 (30 per 100K)
--- Pneumonia deaths: 4,492 (520 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 8.6% of all deaths
- Worst flu season: 2014-2015 (769 deaths, 89 per 100K, 9.7% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 2 (0.2 per 100K, 6.3% of all deaths in the season)

In South Dakota’s deadliest season listed from 2014–2015, the earliest case of the season was the first week of October, and its latest was toward the end of August. Of the 63 deaths due to flu that season, 87% were people 65 and older.

 

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Tomsickova Tatyana // Shutterstock

#6. Tennessee

- Total flu and pneumonia deaths, 2013-2020: 36,887 (555 per 100,000 population)
--- Flu deaths: 1,416 (21 per 100K)
--- Pneumonia deaths: 35,471 (533 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 7.6% of all deaths
- Worst flu season: 2013-2014 (5,267 deaths, 79 per 100K, 8.3% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 34 (0.5 per 100K, 5.4% of all deaths in the season)

As Tennessee entered the 2020–2021 flu season, it set a new record on Oct. 19, 2020, for a one-day high in new COVID-19 cases with 3,317 recorded cases. Despite the surge, Gov. Bill Lee still opposed a mask mandate across the state.

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#5. Arkansas

- Total flu and pneumonia deaths, 2013-2020: 17,194 (575 per 100,000 population)
--- Flu deaths: 659 (22 per 100K)
--- Pneumonia deaths: 16,535 (553 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 7.6% of all deaths
- Worst flu season: 2017-2018 (2,619 deaths, 88 per 100K, 8.1% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 23 (0.8 per 100K, 8.2% of all deaths in the season)

Arkansas residents can get vaccinated against the flu at local health units free of charge. To limit the burden of a possible “twindemic,” Gov. Asa Hutchinson called for Oct. 27, 2020, to be an elective day of prayer for divine help to manage COVID-19.

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SARINRA // Shutterstock

#4. Mississippi

- Total flu and pneumonia deaths, 2013-2020: 17,300 (579 per 100,000 population)
--- Flu deaths: 452 (15 per 100K)
--- Pneumonia deaths: 16,848 (564 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 7.6% of all deaths
- Worst flu season: 2019-2020 (3,883 deaths, 130 per 100K, 10.7% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 24 (0.8 per 100K, 10.2% of all deaths in the season)

In 2017, the eighth leading cause of death in Mississippi was flu and pneumonia, killing 782 people. That year, flu and pneumonia killed more people than homicide and drug overdoses combined.

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Yupa Watchanakit // Shutterstock

#3. Oklahoma

- Total flu and pneumonia deaths, 2013-2020: 23,434 (598 per 100,000 population)
--- Flu deaths: 932 (24 per 100K)
--- Pneumonia deaths: 22,502 (574 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 8.4% of all deaths
- Worst flu season: 2019-2020 (3,834 deaths, 98 per 100K, 9.3% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 14 (0.4 per 100K, 8.1% of all deaths in the season)

As of Oct. 17, 2020, Oklahoma had already reported 17 hospitalizations due to flu for the 2020–2021 flu season. During the 2019–2020 season, 3,400 Oklahoma residents were hospitalized with influenza.

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santypan // Shutterstock

#2. Kentucky

- Total flu and pneumonia deaths, 2013-2020: 27,995 (630 per 100,000 population)
--- Flu deaths: 1,091 (25 per 100K)
--- Pneumonia deaths: 26,904 (606 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 8.4% of all deaths
- Worst flu season: 2014-2015 (4,305 deaths, 97 per 100K, 9.1% of all deaths in the season)
- Deaths recorded so far in 2020-2021: 6 (0.1 per 100K, 2.9% of all deaths in the season)

The University of Kentucky has mandated that all on-campus students must get vaccinated against the flu by Nov. 1, 2020. This is the first time that the university has made such a requirement.

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Silarock // Shutterstock

#1. West Virginia

- Total flu and pneumonia deaths, 2013-2020: 12,568 (687 per 100,000 population)
--- Flu deaths: 495 (27 per 100K)
--- Pneumonia deaths: 12,073 (660 per 100K)
--- During 2013-2020 flu seasons, flu and pneumonia caused: 7.9% of all deaths
- Worst flu season: 2014-2015 (2,114 deaths, 116 per 100K, 9.1% of all deaths in the season)
- Deaths recorded so far in 2020-2021: Data not available

For the week ending Oct. 10, 2020, West Virginia reported a surge in influenza cases with a jump from minimal to moderate activity. Iowa is the only other state that reported above minimal flu activity for that week, which is early in the 2020–2021 flu season.

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