YORK, P.A. --- In Pennsylvania, the Department of Health says the number of flu cases across the state continue to increase, significantly.
According to the Center for Disease Control, the commonwealth isn't alone.
Hawaii and Washington, D.C. are the only areas in the united states without widespread flu activity.
"We haven't seen that in a long time. So that means there is a lot of flu happening in a lot of places all at once," said Dr. Dan Jernigan with the CDC.
In York County alone, there have been 1,461 reported flu cases, which is the second highest in the state to Allegheny (4,134).
In total, Pennsylvania has 25,497 reported cases of the flu.
There have been 47 reported flu-related deaths in the commonwealth, so far, this season.
Of those 47 deaths, 36 are from people ages 65 and older and one pediatric death.
That's one of 30 pediatric deaths related to the flu, nation-wide, this season.
At the Lots of Love Early Learning Center in York, CEO Shannan Mosley said they've avoided any spread.
"We're hoping it's because of our preventative maintenance that we do on a daily basis to keep our kids as healthy as possible," said Mosley.
With 80 students, ages one to 12, Mosley said they push students to wash their hands when they come inside, whether that's from home or an outside activity.
"We teach them how to wash the whole way up...the fronts, the backs...we do that in a lesson," said Mosley.
She also said they sanitize their toys in sections once a week, clean table-tops after each meal and do deep cleanings every friday, including shampooing carpets.
When a student goes home sick, Mosley said they log it.
"If there was multiple students with a stomach ache, then we want to start paying attention. Is it something going around? Is it something we're cooking?" said Mosley.
She said they keep track of any consistent illnesses spreading the building to notify parents.
"If there's another student or multiple students sick in the classroom or even in the building, we send home a letter that tells about exposure to illness," said Mosley.
She said when they communicate with parents, their "most important" advice is to keep sick kids home to prevent any spread.
"It's heartbreaking to see the little ones struggling to breathe, especially when they have cold or flu," said Mosley.
The Department of Health says symptoms can come suddenly, including fever, headache, tirednss and congestion.
Officials also say it's not too late to seek preventative measures, such as getting a vaccine.