Seasonal flu is now widespread in Pennsylvania, and Carbon County hospitals are prepared for the onslaught, according to U.S. Centers for Disease Control and Prevention.

The state Department of Health reports there were 1,159 confirmed cases of seasonal flu between Sept. 29 and Dec. 21.Those are only confirmed cases, reported when patients have a flu test done.Confirmed cases "are only a fraction of the actual burden of illness occurring in the commonwealth at any given time. This is because most persons with the flu (even those who seek health care) are diagnosed presumptively and do not have lab tests performed to determine the cause of illness and some people do not go to the doctors when they are ill," according to the Department of Health.Carbon County's Blue Mountain Health System spokeswoman Lisa Johnson reports 10 cases."The Gnaden Huetten campus had seven confirmed positive cases and Palmerton Hospital had three confirmed positive cases. We have seen an increase the earliest was Dec. 16. As of Dec. 22, flu symptoms had increased in both emergency rooms," she said.Johnson said prescriptions for Tamiflu also increased for adult cases.According to the state Department of Health, between Sept. 29 and Dec. 21, Monroe County has had reported 11 cases, all Type A, and Schuylkill County has had 14 Type A and one Type B.Seasonal flu activity in Pennsylvania appears to be highest in the western and central areas of the state: Blair County has had 79 cases, and Butler County has had 76, and Allegheny County, 72 cases.Questions loom about whether this season's outbreak will reach the record highs posted last year.With the hike in reported cases, the state is now classifying the flu as "widespread" the highest prevalence level up from "sporadic" flu activity observed during early December.The classification means more than 50 percent of regions in a state are reporting flu activity. Ten states, including Pennsylvania, New York and Massachusetts, reported widespread flu activity, according to the Centers for Disease Control and Prevention."We expect the flu activity to continue to increase," said Ram Nambiar, M.D., acting director of the state Department of Health's Bureau of Epidemiology."We usually see (flu activity) peak at the end of January, beginning of February, so we still have a little bit of time."The spike in flu activity comes several weeks earlier than the rise in reported cases seen from 2006-07 to 2011-12 save 2009-10. But it lags behind the 2012-13 season, when hospitalizations nationwide for flu-related complications reached record highs and deaths attributed to pneumonia and influenza hit levels not touched in nearly a decade, the CDC found.Last season's severe outbreak hit Pennsylvania's elderly population the hardest. They accounted for more than 70 percent of the state's flu-related hospitalizations and 90 percent of the deaths, state officials said."Last year's flu activity started a little bit earlier, but we are still so early on in the season we don't know how strong it's going to be," Dr. Nambiar said.Despite the spike in cases, it's not too late for people who haven't gotten a flu shot to get one now, said Joseph C. Koval, M.D., medical director for clinical performance at Geisinger Community Medical Center. Because the vaccine takes about 10 days to two weeks to become fully effective, he said. It's critical to get one soon ahead of the anticipated late January peak in activity.The CDC recommends people consult their doctors before getting a flu shot, especially those with a severe allergy to chicken eggs. At GCMC, providers performed 62 flu tests through Friday, with only two returning as positive for influenza A, he said."We've had less flu activity than we had last year," Koval said. "But it's unknown when the peak will come and how bad it will be."The Department of Health estimates that 600,000 to 1.2 million Pennsylvanians will get the flu each year, with 200 to 2,000 dying from flu-related complications.Michael Iorfino of the The Times-Tribune, Scranton, contributed to this story.