State public-health officials reported four more H1N1 deaths in Iowa on Wednesday. The victims are from Dubuque, Polk, Mills, and Monona Counties, according to the Iowa Department of Public Health. Three of them had factors that increased the chance of complications from the flu strain.

The four adult deaths come one day after the Public Health Department reported the first Iowa child had died from H1N1 in October. The child also had factors that increased the risk of experiencing complications from H1N1.

The Public Health Department has confirmed 11 H1N1-related deaths, including 10 adults.

“While school-age children have been most affected by the H1N1 virus over the past several weeks, surveillance is starting to show an increase in adult illness,” said Patricia Quinlisk,the medical director for the Public Health Department.

To prevent the spread of H1N1, public-health officials recommend people wash hands often, cover coughs and sneezes with a tissue or arm, and stay home if not feeling well.

— by Brian Stewart