Getting the flu can be as simple as a handshake.

“It’s actually contagious 24 hours before you even start having symptoms. So you need to be very careful during these winter months with really good handwashing, cover your mouth when you cough, cough into your elbow," said family nurse practitioner Genevieve Romano-Helm.

If the virus gets on your hand from a cough or a sneeze, then you shake someone else’s, you’ve already spread the germs.

“Flu is transferred from droplets. So from speaking, from coughing, from breathing, you kind of have a six-foot bubble around you where your own secretions go out on," said Romano-Helm.

Documented flu cases are on the rise in the state. This year’s season began three weeks earlier than past years. The state has seen more than 20,000 lab confirmed cases.

“What usually happens is there is one strain of flu that’s prevalent throughout the whole flu season. And then we’ll get waves of the other strains throughout that season as well. But this season we are seeing all four at the same time," said Romano-Helm. “We’re thinking that instead of having it all spread out over the flu season they’re all popping up at the beginning and that’s what’s bringing in the higher numbers."

According to the CDC, nationwide there have been 13 million estimated cases of the flu. They also estimate there have been more than 6,000 deaths.

Health professionals say it’s not too late to get a flu vaccine, even though we are mid-season.