North Dakota Department of Health officials said Thursday the number of influenza cases in the state has climbed to more than 700, and officials only expect it to get worse.

Local emergency rooms and clinics are still being flooded with patients suffering from symptoms of influenza, officials said. Some facilities stopped testing every patient with symptoms of influenza because of a dwindling supply of testing agents, which could limit doctors' ability to give patients antiviral medications.

"We were told if we continued to use them at the pace we were, we would run out," said Dr. Craig Lambrecht, a Medcenter One emergency doctor who also is a Health Department medical officer.

As of Thursday, 706 influenza cases were reported, which surpasses last year's 653 total cases. At this time last year, only two cases were reported.

Grand Forks County has the most influenza cases in the state so far this year with 112. Burleigh County followed with 109 and Cass County with 90.

"This is the most cases I have seen at this time of the year," said Larry Shireley, state epidemiologist. "I would say this has a good chance of being the worst season ever since I've been here."

State officials said there haven't been any confirmed deaths related to influenza, but Shireley said they are checking into a couple of deaths to see if influenza was a factor.

Lambrecht said although he's seen a large number of people with symptoms of influenza, he hasn't seen a lot of patients with secondary complications, such as pneumonia. That could be a reason North Dakota hasn't had any reported deaths, Shireley said.

Both Medcenter and St. Alexius Medical Center posted signs in their entrances, reminding people to wash their hands and wear masks if they have symptoms. Neither facility has limited visitation hours, but Lambrecht said he expects to see that down the road.

Local walk-in clinics also have been hit with an increased patient load. Mid Dakota Clinic CEO Mike Tomasko said the walk-in clinic at Mid Dakota has 25 percent to 30 percent more patients than it normally sees. He said despite the increase, doctors have been able to keep patients moving through to keep the waiting time down.

"Having it (the increase in patients) this early is unusual," Tomasko said. "After Christmas is when we usually see it pick up."

Health department officials said North Dakota's limited supply of vaccine is being shifted to areas in the state that ran out and from the public to private sector.

Because of the vaccine shortage, the state is recommending children 6 to 23 months and children under age 9 with underlying medical conditions only get one dose of the vaccine. The vaccine was licensed to be given in two doses.

Shireley said it's hard to say how effective a single dose will be in children, but the new recommendation will allow more children who are at high risk to be vaccinated.

The state ordered 1,000 additional doses of the vaccine for children that would arrive in January, but it's uncertain whether they will receive that many, Shireley said.

Because of the limited supply of vaccine, the state recommends flu shots only be given to people who are considered high risk. Children 6 to 23 months of age, people with underlying medical conditions, pregnant women who are 14 weeks or more along and people aged 65 and older are considered high risk.

Healthy people aged 5 to 49 can get a nasal spray vaccination called FluMist, which is still widely available. Because it is new this year, insurance companies weren't covering the nasal spray, which usually costs more than $50. But with the vaccine shortage, Aetna and Signa health insurance companies have agreed to cover the costs, Shireley said.

The state also has talked with Blue Cross Blue Shield about covering the cost of the FluMist.

(Reach reporter Sheena Dooley at 250-8225 or sheenadooley@ndonline.com.)