The number of Californians dying from influenza this flu season has passed 200. Last week, another 56 influenza-related deaths were confirmed for a total of 202, of which four have been children.

For California, another 41 deaths are under investigation. For the entire 2012-13 flu season, 106 people died from confirmed flu virus. And nationwide, the mortality in 122 U.S. cities continued to exceed the epidemic threshold.

Six of the deaths this year have occurred in Riverside County. Visits to Riverside County emergency departments for influenza-like illnesses were nearly 12 percent of all patients and up slightly from last week, while still above normal limits. Visits to physicians were slightly above normal levels.

Those at highest risk — the elderly, pregnant women, infants or those with other health conditions — who show flu symptoms are advised to contact their physician immediately in order to get the most effective treatment. Symptoms include fever, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches and fatigue.

Besides the flu, a Riverside County infant’s death from whooping cough (pertussis) was confirmed by California Public Health officials. This is the first whooping cough death in California since 2010.

Pertussis is cyclical with peaks in incidence every three to five years. California experienced a pertussis epidemic in 2010 when more than 9,100 cases, including 10 deaths, were reported. That’s more cases than had been reported in any year since the pre-vaccine era. After declining steadily from the peak in 2010, monthly case reports began increasing in mid-2013. Of the cases in 2013, 83 percent of reported pertussis cases were children younger than 18 years of age. Of these pediatric cases, 12 percent were infants younger than 6 months old.