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Nearly half of US states are reporting widespread flu activity, up from 10 last week.
The recent cases are in three areas of eastern China, including the first Shanghai case in 9 months.
The visit to China in December did not involve areas of high risk or contact with ill people.
With peak likely still to come, concern heightens over H1N1 sickening middle-aged patients this season.
Fatal Alberta case reported last week involved unusual complications, including brain inflammation.
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CIDRAP - Center for Infectious Disease Research and PolicyOffice of the Vice President for Research, University of Minnesota, Minneapolis, MN
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