DES MOINES, Iowa (AP) — Iowa officials are reporting outbreaks of two wintertime viruses, norovirus and the flu.

Experts say flu and norovirus are often mistaken for each other even though their symptoms differ. Flu viruses tend to cause coughing, sneezing, body aches and fevers. Noroviruses tend to cause vomiting and diarrhea.

The Iowa Public Health Department also says a second confirmed flu victim has been reported — an elderly man with underlying health conditions in central Iowa. The state’s first confirmed flu death this season was recorded Dec. 19.

The department’s medical director, Patricia Quinlisk, told The Des Moines Register that she’s particularly concerned because of a rare occurrence this flu season: All four main flu strains are circulating in the state.

Quinlisk says it’s not too late to get a flu shot.