PIERRE, S.D. (AP) — A South Dakota health official says nine people have died as a result of the flu so far this season.

State Epidemiologist Lon Kightlinger says this season’s flu activity is occurring earlier and at higher levels than in the past.

All of the people who died from the flu were over the age of 75.

The state has reported that 135 people have been hospitalized with the flu so far. There have been 469 confirmed cases in the state.

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