Health officials say flu is more widespread across the nation, but the number of hard-hit states has declined.
Flu season started early this winter, and includes a strain that tends to make people more sick.
The Centers for Disease Control and Prevention Friday said flu was widespread in 47 states last week, up from 41 the week before. But many cases may be mild.
The only states without widespread flu are California, Mississippi and Hawaii. The hardest hit states dropped to 24 from 29.
So far, 20 children have died from the flu. There is no running tally of adult deaths, but the CDC estimates that the flu kills about 24,000 people in an average year.
Experts say it's too early to say if this is a bad year for flu.
In Alabama, State Health Office Don Williamson says flu season started earlier than a year ago and there are more cases. But he said it's not out of line with some of the busiest years during the last decade.
Williamson said at a news conference Friday that Alabama's flu season took off in November and the most common type has been influenza A, which is covered by this season's flu shot.
State health department officials can't say how many cases have been reported, but Williamson said 12 percent of the visits to Alabama doctors' offices in late December were for flu-like symptoms. That's nearly double the highest point a year ago.
Rosemary Blackmon of the Alabama Hospital Association said emergency rooms around the state have been full, but have handled it.