The Indiana State Department of Health (ISDH) says nine more Hoosiers have died from flu-related illness. ISDH confirms a total of 31 flu-related deaths this season in a report released Friday.

15 cases were people age 65 years or older. ISDH says children under five, adults over 65 and people with chronic diseases like asthma or diabetes are at higher risk.

State Health Commissioner Kris Box says the flu season is well underway and she expects it will likely get worse in coming weeks.

“Essentially our flu season is high, we have a lot of people that are getting infected across the state,” Box says. “And what we have seen, is that our immunization is covering a lot of the strains of the virus that we are seeing.”

Influenza B is a particular concern. The strain, typically seen in late winter, showed up much earlier this season. It hits kids harder than adults.

Box says it is not too late for a flu shot.

ISDH also encourages people to wash hands, disinfect surfaces, and to cover their nose and mouth to best prevent the spread of the flu.

Contact Darian at dbenson@wfyi.org or follow her on Twitter at @helloimdarian.