Minnesota health officials say an outbreak of early flu strains has contributed to the deaths of six people.

There were 60 cases of flu-like illness reported to the state last week. That’s a five-fold increase from the week before. Seventy-four percent of the past week’s hospitalizations were in the Twin Cities area, but southwestern Minnesota saw one hospitalization.

The Department of Health says the flu continues to spread statewide, with cases reported in every region. It has hit children particularly hard. They have a a higher than usual share of the 262 flu-related hospitalizations reported so far this season, although none of the deaths involved children.

Health officials say some schools are missing as many as one-fifth of their students.

(The Associated Press contributed to this report.)