Flu season is off to an early start in several states, including Missouri. Gene Terlizzi of the state department of health says nine times as many cases are reported so far this year compared to the average the last five years. She warns residents not to think they’re protected by last year’s flu shot. Strains of flu change every year, and vaccines change with them.

Terlizza says state health officials are not taking any unusual action yet – just urging people to wash their hands often, cover their mouths when they cough, don’t come to work sick, and get a flu shot. The Centers for Disease Control and Prevention says the last time flu season started this early was the winter of 2003-2004.