AP Photo/Sue Ogrocki

A public health nurse demonstrates drawing flu vaccine from a bottle at the Oklahoma City-County Health Department in Oklahoma City, Thursday, Jan. 10, 2013. Flu season in the U.S. has struck early and, in many places, hard. The Oklahoma State Department of Health reports a sharp increase in the number of confirmed flu cases and the number of flu-related deaths in the past week. (AP Photo/Sue Ogrocki) (January 16, 2013)

INDIANAPOLIS (AP) — Indiana health officials say the state's ongoing flu outbreak has claimed 27 lives, with 17 of those deaths reported during the past week.

Wednesday's flu update from the State Department of Health says 20 of the people who have died in Indiana had underlying medical conditions such as heart disease.

Two of the state's flu fatalities were under age 18.

The state health department says nine of the 27 people who have died in Indiana from flu-related causes had received flu vaccine shots.

The agency says it sent a newsletter to Indiana's long-term care facilities last week with suggestions on steps to decrease the spread of the flu and reminding them to offer staff and residents the flu vaccine.