France steps up Mali operation, Africans try to catch up

BAMAKO (Reuters) - France hit Islamist rebels in Mali with fresh air strikes and deployed armored cars on Tuesday, stepping up its intervention in the West African state as regional allies struggled to accelerate their plans to send in troops.

Paris has poured hundreds of soldiers into Mali and carried out air raids since Friday in the northern half of the country, which was seized last year by an Islamist alliance combining al Qaeda's north African wing AQIM with Mali's home-grown MUJWA and Ansar Dine rebel groups.

Western and regional states fear the insurgents will use Mali's north, a vast and inhospitable area of desert and rugged mountains the size of Texas, as a base for attacks on the African continent and also in Europe.

West African defense chiefs were meeting in the Malian capital Bamako on Tuesday to approve plans for speeding up the deployment of 3,300 regional troops, foreseen in a United Nation-backed intervention plan to be led by Africans. France sent its forces into Mali last week to block a surprise southwards push by the rebels.

Speaking during a visit to the United Arab Emirates, President Francois Hollande said French forces carried out further air strikes overnight in Mali "which hit their targets".

"We will continue the deployment of forces on the ground and in the air," Hollande said. "We have 750 troops deployed at the moment and that will keep increasing so that as quickly as possible we can hand over to the Africans."

A column of French armored vehicles rumbled into the dusty riverside capital overnight. The vehicles, which had driven up from a French base in Ivory Coast, were expected to move northwards eventually towards the combat zone.

France's defense ministry has said it plans to deploy 2,500 soldiers in its former colony to bolster the Malian army and work with the intervention force provided by the ECOWAS grouping of West African states.

Hollande saw the ECOWAS deployment taking "a good week".

There are some concerns that a delay in following up on the French air bombardments of Islamist bases and fuel depots with a ground offensive could allow the insurgents to slip away into the desert and mountains, regroup and counter-attack.

The rebels, who French officials say are mobile and well-armed, have shown they can hit back, dislodging government forces from Diabaly, 350 km (220 miles) from Bamako on Monday.

Foreign Minister Laurent Fabius, accompanying Hollande, said the offensive against the Malian rebels could take some time, and the current French level of involvement could last weeks.

Gulf Arab states would also help the Mali campaign, Fabius added, and there would be a meeting of donors for the operation most likely in Addis Ababa at the end of January.

QUESTIONS OVER READINESS

ECOWAS mission head in Bamako Aboudou Toure Cheaka said the West African troops would be on the ground in a week. Their immediate mission would be to help stop the rebel advance while preparations for a full intervention plan continued.

The original timetable for the 3,300-strong U.N.-sanctioned African force - to be backed by western logistics, money and intelligence services - did not initially foresee full deployment before September due to logistical constraints.

Senegal, Burkina Faso, Niger, Nigeria and Guinea have all offered troops. But regional powerhouse Nigeria, which is due to lead the mission, has cautioned that even if some troops arrive in Mali soon, their training and equipping will take more time.

Nigerian President Goodluck Jonathan told foreign diplomats in Abuja late on Monday that the Nigerian contingent would be in Mali before next week. "We can no longer surrender any part of the globe to extremism," he said.

But Sub-Saharan Africa's top oil producer, which already has hundreds of peacekeepers in Sudan's Darfur and is fighting a bloody and difficult insurgency at home against Islamist sect Boko Haram, could struggle to deliver on its troop commitment.

One senior government adviser in Nigeria said the Mali deployment was stretching the country's military.

"The whole thing's a mess. We don't have any troops with experience of those extreme conditions, even of how to keep all that sand from ruining your equipment. And we're facing battle-hardened guys who live in those dunes," the adviser said, asking not to be named because of the sensitivity of the subject.

Security experts have warned that the multinational intervention in Mali, couched in terms of a campaign by governments against "terrorism", could provoke a jihadist backlash against France and the West, and African allies.

U.S. officials have warned of links between AQIM, Boko Haram in Nigeria and al Shabaab Islamic militants fighting in Somalia.

Al Shabaab, which foiled a French effort at the weekend to rescue a French secret agent it was holding hostage, urged Muslims around the world to rise up against what it called "Christian" attacks against Islam.

"Our brothers in Mali, show patience and tolerance and you will win. War planes never liberate a land," Sheikh Ali Mohamud Rage, al Shabaab's spokesman, said in an audio statement posted on the rebel-run www.somaliamemo.net website

The ECOWAS deployment plan is being fast-tracked following a plea for help by Mali's government after mobile columns of Islamist fighters threatened last week the central Malian garrison towns of Mopti and Sevare, with its key airport.

U.N.: THOUSANDS FLEE FIGHTING

French Prime Minister Jean-Marc Ayrault said France's goals were to stop the rebels, to "safeguard the existence of Mali".

U.S. officials said Washington was sharing information with French forces in Mali and considering providing logistics, surveillance and airlift capability.

"We have made a commitment that al Qaeda is not going to find anyplace to hide," U.S. Defense Secretary Leon Panetta told reporters as he began a visit to Europe.

French intervention has raised the risk for eight French hostages held by al Qaeda allies in the Sahara and for 30,000 French expatriates living in neighboring, mostly Muslim states. Concerned about reprisals at home, France has tightened security at public buildings and on public transport.

The U.N. said an estimated 30,000 people had fled the latest fighting in Mali, joining more than 200,000 already displaced.

U.N. Secretary-General Ban Ki-moon welcomed on Monday the French-led military intervention in Mali and voiced the hope that it would halt the Islamist assault.

Amnesty International said at least six civilians were killed in recent fighting in the town of Konna, where French aircraft had earlier bombarded rebel positions, and called on both sides to spare non-combatants.

France, which has repeatedly said it has abandoned its role as the policeman of its former African colonies, convened a U.N. Security Council meeting Monday to discuss the crisis.

French U.N. Ambassador Gerard Araud told reporters after the meeting that the United States, Canada, Belgium, Denmark and Germany had also offered logistical support for France's Mali operation.

(Additional reporting by Elizabeth Pineau and Raissa Kasolowsky in Abu Dhabi; Felix Onuah in Abuja and Tim Cocks in Lagos; Abdi Sheikh in Mogadishu; Michelle Nichols Louis Charbonneau at the United Nations; Richard Valdmanis in Dakar; Writing by Pascal Fletcher; editing by David Stamp)

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Extended smoking ban takes effect

SINGAPORE: The extended smoking ban in public areas kicked in on Tuesday.

The National Environment Agency (NEA) said it will step up spot checks by about 70 per cent after three months, which is some 8,000 additional hours per month.

In a spot check at Toa Payoh MRT station on Tuesday, seven smokers were caught in an hour for smoking where they were not supposed to.

Smokers are now not allowed to light up at the common areas of all residential buildings, covered linkways and walkways, overhead pedestrian bridges, as well as within a five-metre radius of bus shelters.

For the first three months of the new ban, the NEA said it will take on a more advisory approach.

But come April 15, first time offenders will be fined S$200, while repeat offenders could be fined as much as S$1,000.

Eileen Yap, a NEA inspector, said: "We realise that the public in general are not aware of such bans and the awareness level is not so high in the beginning, so in these three months, NEA will be advising smokers and we'll be working with the community in general to create awareness, so that everyone can have cleaner air."

Smokers hope the NEA will exercise some flexibility when it comes to enforcing the ban.

A smoker, who did not reveal his name, said: "We can't be smoking outside when it's raining or pouring. So they have to fine tune the balance. They probably have to list down under what circumstance it's forgivable, or if there is a second chance, or if not they have to find a solution - a sheltered smoking area for example."

Last year, some 4,000 smokers were caught flouting the rules. This is 800 cases, or 17 per cent less than in 2011.

- CNA/xq

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Hurriyat decries Army chief's stand on AFSPA

SRINAGAR: Moderate Hurriyat Conference led by Mirwaiz Umar Farooq said on Tuesday Army chief General Bikram Singh's stand on AFSPA was like "rubbing salt into the wounds" of Kashmiri people.

"Gen Singh's statement on AFSPA is like rubbing salt into the wounds of Kashmiris. The controversial law which gives sweeping powers to seven lakh armed forces stationed in the Valley has made life difficult for the people," Hurriyat said in a statement.

Gen Singh had on Monday said there should be no dilution in AFSPA.

The spokesman said the Army chief's statement was an indication of the aggressive policy adopted by the Centre in "crushing the peaceful movement of Kashmiris by use of force".

"On one hand, the government claims that situation is peaceful and it is making the atmosphere conducive for dialogue process, while on the other hand there is clear contradiction between the civilian authorities and Army on the sweeping powers to the armed forces," the spokesman said.

He said the tension between India and Pakistan along the line of control was a result of Kashmir issue.

The spokesman said unless Kashmir issue is resolved, there will be no end to tension along the borders and peace in the region shall remain elusive.

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Hospitals crack down on workers refusing flu shots

CHICAGO (AP) — Patients can refuse a flu shot. Should doctors and nurses have that right, too? That is the thorny question surfacing as U.S. hospitals increasingly crack down on employees who won't get flu shots, with some workers losing their jobs over their refusal.

"Where does it say that I am no longer a patient if I'm a nurse," wondered Carrie Calhoun, a longtime critical care nurse in suburban Chicago who was fired last month after she refused a flu shot.

Hospitals' get-tougher measures coincide with an earlier-than-usual flu season hitting harder than in recent mild seasons. Flu is widespread in most states, and at least 20 children have died.

Most doctors and nurses do get flu shots. But in the past two months, at least 15 nurses and other hospital staffers in four states have been fired for refusing, and several others have resigned, according to affected workers, hospital authorities and published reports.

In Rhode Island, one of three states with tough penalties behind a mandatory vaccine policy for health care workers, more than 1,000 workers recently signed a petition opposing the policy, according to a labor union that has filed suit to end the regulation.

Why would people whose job is to protect sick patients refuse a flu shot? The reasons vary: allergies to flu vaccine, which are rare; religious objections; and skepticism about whether vaccinating health workers will prevent flu in patients.

Dr. Carolyn Bridges, associate director for adult immunization at the federal Centers for Disease Control and Prevention, says the strongest evidence is from studies in nursing homes, linking flu vaccination among health care workers with fewer patient deaths from all causes.

"We would all like to see stronger data," she said. But other evidence shows flu vaccination "significantly decreases" flu cases, she said. "It should work the same in a health care worker versus somebody out in the community."

Cancer nurse Joyce Gingerich is among the skeptics and says her decision to avoid the shot is mostly "a personal thing." She's among seven employees at IU Health Goshen Hospital in northern Indiana who were recently fired for refusing flu shots. Gingerich said she gets other vaccinations but thinks it should be a choice. She opposes "the injustice of being forced to put something in my body."

Medical ethicist Art Caplan says health care workers' ethical obligation to protect patients trumps their individual rights.

"If you don't want to do it, you shouldn't work in that environment," said Caplan, medical ethics chief at New York University's Langone Medical Center. "Patients should demand that their health care provider gets flu shots — and they should ask them."

For some people, flu causes only mild symptoms. But it can also lead to pneumonia, and there are thousands of hospitalizations and deaths each year. The number of deaths has varied in recent decades from about 3,000 to 49,000.

A survey by CDC researchers found that in 2011, more than 400 U.S. hospitals required flu vaccinations for their employees and 29 hospitals fired unvaccinated employees.

At Calhoun's hospital, Alexian Brothers Medical Center in Elk Grove Village, Ill., unvaccinated workers granted exemptions must wear masks and tell patients, "I'm wearing the mask for your safety," Calhoun says. She says that's discriminatory and may make patients want to avoid "the dirty nurse" with the mask.

The hospital justified its vaccination policy in an email, citing the CDC's warning that this year's flu outbreak was "expected to be among the worst in a decade" and noted that Illinois has already been hit especially hard. The mandatory vaccine policy "is consistent with our health system's mission to provide the safest environment possible."

The government recommends flu shots for nearly everyone, starting at age 6 months. Vaccination rates among the general public are generally lower than among health care workers.

According to the most recent federal data, about 63 percent of U.S. health care workers had flu shots as of November. That's up from previous years, but the government wants 90 percent coverage of health care workers by 2020.

The highest rate, about 88 percent, was among pharmacists, followed by doctors at 84 percent, and nurses, 82 percent. Fewer than half of nursing assistants and aides are vaccinated, Bridges said.

Some hospitals have achieved 90 percent but many fall short. A government health advisory panel has urged those below 90 percent to consider a mandatory program.

Also, the accreditation body over hospitals requires them to offer flu vaccines to workers, and those failing to do that and improve vaccination rates could lose accreditation.

Starting this year, the government's Centers for Medicare & Medicaid Services is requiring hospitals to report employees' flu vaccination rates as a means to boost the rates, the CDC's Bridges said. Eventually the data will be posted on the agency's "Hospital Compare" website.

Several leading doctor groups support mandatory flu shots for workers. And the American Medical Association in November endorsed mandatory shots for those with direct patient contact in nursing homes; elderly patients are particularly vulnerable to flu-related complications. The American Nurses Association supports mandates if they're adopted at the state level and affect all hospitals, but also says exceptions should be allowed for medical or religious reasons.

Mandates for vaccinating health care workers against other diseases, including measles, mumps and hepatitis, are widely accepted. But some workers have less faith that flu shots work — partly because there are several types of flu virus that often differ each season and manufacturers must reformulate vaccines to try and match the circulating strains.

While not 100 percent effective, this year's vaccine is a good match, the CDC's Bridges said.

Several states have laws or regulations requiring flu vaccination for health care workers but only three — Arkansas, Maine and Rhode Island — spell out penalties for those who refuse, according to Alexandra Stewart, a George Washington University expert in immunization policy and co-author of a study appearing this month in the journal Vaccine.

Rhode Island's regulation, enacted in December, may be the toughest and is being challenged in court by a health workers union. The rule allows exemptions for religious or medical reasons, but requires unvaccinated workers in contact with patients to wear face masks during flu season. Employees who refuse the masks can be fined $100 and may face a complaint or reprimand for unprofessional conduct that could result in losing their professional license.

Some Rhode Island hospitals post signs announcing that workers wearing masks have not received flu shots. Opponents say the masks violate their health privacy.

"We really strongly support the goal of increasing vaccination rates among health care workers and among the population as a whole," but it should be voluntary, said SEIU Healthcare Employees Union spokesman Chas Walker.

Supporters of health care worker mandates note that to protect public health, courts have endorsed forced vaccination laws affecting the general population during disease outbreaks, and have upheld vaccination requirements for schoolchildren.

Cases involving flu vaccine mandates for health workers have had less success. A 2009 New York state regulation mandating health care worker vaccinations for swine flu and seasonal flu was challenged in court but was later rescinded because of a vaccine shortage. And labor unions have challenged individual hospital mandates enacted without collective bargaining; an appeals court upheld that argument in 2007 in a widely cited case involving Virginia Mason Hospital in Seattle.

Calhoun, the Illinois nurse, says she is unsure of her options.

"Most of the hospitals in my area are all implementing these policies," she said. "This conflict could end the career I have dedicated myself to."

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Online:

R.I. union lawsuit against mandatory vaccines: http://www.seiu1199ne.org/files/2013/01/FluLawsuitRI.pdf

CDC: http://www.cdc.gov

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

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Golden Globe Moments: A Night of Laughs, Surprises

Let's finally bury this idea that women can't be funny once and for all. Fey and Poehler were undeniably hilarious throughout the Globes, so much so that many fans on Twitter demanded more of them during the ceremony. From their opening bit -- Poehler: "Meryl Streep is not here tonight, she has the flu. And I hear she's amazing in it." -- to their pseudo drunk heckling of best TV comedy actress winner Lena Dunham, they were radiant, energetic, and above all, funny. More please.

Foster made her acceptance of the Cecil B. DeMille lifetime achievement award a coming out, of sorts. She first shocked the audience by leading them to think that she was about to make a huge public statement about her sexuality. Instead, she said she was single, adding "I already did my coming out in the stone age."

"Now, apparently, I'm told that every celebrity is expected to honor the details of their private life with a press conference ... You guys might be surprised, but I'm not Honey Boo Boo child," she said, to a flurry of laughter and applause.

"If you had been a public figure from the time that you were a toddler ... then maybe you too might value privacy above all else," she said. "Privacy."

But Foster did specifically thank her ex-partner Cydney Bernard, with whom she has two kids. Both boys gestured to her from the audience.

She also implied that she was retiring from acting when she said she would not be returning to the Globes stage or any stage. "It's just that from now on, I may be holding a different talking stick," Foster said, bringing many in the audience to tears.

But backstage, Foster clarified to reporters that she was not retiring from acting. "Oh that's so funny," she responded to reporters. "You couldn't drag me away. And I'd like to be directing tomorrow."

It takes a lot to make Hollywood star struck. Bill Clinton did it when he strutted on stage to introduce a clip of "Lincoln," which was up for best drama. He brought the crowd of A-listers to its feet and commended the 16th president. "We're all here tonight because he did it," he said of Lincoln's battle to end slavery.

If there was any doubt that Lena Dunham wasn't Hollywood's next big thing, it was obliterated Sunday night. The star and creator of HBO's "Girls" went home with two awards, best actress in a TV comedy and best TV comedy. Her heartfelt acceptance speech for best actress struck a chord: "This award is for everyone who feels like there wasn't a place for her," she said. "This show made a space for me."

Jessica Chastain won the Globe for best actress in a drama for "Zero Dark Thirty." She offered a moving tribute to director Kathryn Bigelow, the first woman to win a best director Oscar who failed to get a nomination for that award this year, though "ZDT" was up for a slew of other awards, including best picture. "I can't help but compare my character of Maya to you," Chastain said to Bigelow. "When you make a film that allows your character to disobey the conventions of Hollywood, you've done more for women in cinema than you take credit for."

Blame it on nerves, the spirit of spontaneity, or the a-a-a-a-alcohol (apologies to Jamie Foxx), but Jennifer Lawrence's acceptance speech was a tad insulting to a Hollywood icon, if totally hilarious. "Oh what does it say?" she asked, looking at her trophy. "I beat Meryl." She meant Meryl Streep, who was also up for the award.

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Decision on immunity for U.S. troops by year-end: Karzai

KABUL (Reuters) - A decision on immunity for U.S. troops staying in Afghanistan after the 2014 planned withdrawal will be made by the end of the year, Afghan President Hamid Karzai said on Monday.

"The issue of immunity is under discussion (and) it is going to take eight to nine months before we reach agreement," Karzai told a news conference in the capital, Kabul, after returning from meetings with U.S. President Barack Obama in Washington.

The Afghan government rejected an initial U.S. proposal regarding the question of immunity and a second round of negotiations will take place this year in Kabul, he said.

Those negotiations could involve Afghanistan's Loya Jirga, a "grand assembly" of political and community leaders convened for issues of national importance, he added.

When asked if security would deteriorate in Afghanistan after the withdrawal of the NATO-led force, Karzai replied: "By no means... Afghanistan will be more secure and a better place."

The Obama administration has been considering a residual force of between 3,000 and 9,000 troops in Afghanistan to conduct counterterrorism operations while providing training and assistance for Afghan forces. But the administration said last week it did not rule out a complete withdrawal after 2014.

The United States is insisting on immunity from prosecution for any U.S. troops that remain.

(Reporting By Hamid Shalizi, writing by Amie Ferris-Rotman and Dylan Welch; Editng by Robert Birsel)

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Public hospitals adopt multi-pronged strategy to avoid overcrowding

SINGAPORE: Minister for Health Gan Kim Yong in a written reply to Parliament said public hospitals adopt a multi-pronged strategy to actively manage patient loads and bed occupancy.

Mr Gan was replying to Member of Parliament for Marine Parade GRC, Associate Prof Fatimah Lateef.

She asked Mr Gan how are overcrowding and high bed occupancy rates handled in the restructured hospitals.

Mr Gan said the multi-pronged strategy includes right-siting care, active intervention to safeguard patient safety during the wait for admission and optimising the use of resources.

To right-site care, hospitals review and discharge patients who are medically stable to allow new patients to be admitted.

For patients waiting at the emergency departments for admission, hospitals deploy inpatient medical teams to initiate prompt medical assessment and definitive care at the emergency department.

To optimise the use of resources, subsidised patients may be placed in private wards for a short duration if subsidised wards are full and these patients continue to pay subsidised rates.

Some stable patients are also transferred, with their consent, to hospitals with higher available capacity to help spread the load across the system.

The Health Ministry is also working with existing institutions to add capacity in the short term.

In addition, hospitals also tap on the capacity in the private sector to meet their needs.

- CNA/fa

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India lodges strong protest against Pak actions

JAMMU: India lodged a strong protest on Monday against the ceasefire violations by Pakistan along the Line of Control (LoC) and made it clear to it that the Army reserves the right to retaliate at the place and time of its choosing in case heinous acts of mutilation of soldiers' bodies recur.

The Army's position was conveyed at a brigadier-level flag meeting between the two sides at Chakan-Da-Bagh crossing-point in Poonch sector of Jammu region.

During the 30-minute meeting that took place in the backdrop of mounting tensions over repeated ceasefire violations by Pakistan and beheading of one of the two Indian soldiers last week, the Indian representative expressed grave concern over the barbaric act by Pakistani troops in the ambush in Mendhar sector.

"Indian Army lodged a strong protest against the heinous mutilation of our deceased soldier's bodies, pointing out that it was against the tenets of the Geneva Convention as also in contravention to all established norms of soldierly behaviour.

"It was conveyed to the Pakistan delegation that such a dastardly and cowardly act is totally unacceptable and is a premeditated attempt to undermine the ceasefire agreement of 2003, which can lead to further escalation," the Indian side said.

An official release said after the meeting that it was conveyed in no uncertain terms that repetition of such acts will not be tolerated.

"The Indian Army reserves the right to retaliate at the place and time of our own choosing in case they recur," the release said echoing the Army Chief Gen Bikram Singh's statement in Delhi ahead of the flag meeting.

The Army chief had also said that the Indian side will take up with Pakistan the issue of return of the head of Lance Naik Hemraj, one of the two soldiers killed by Pakistan on January 8.

On its part, the Pakistan delegation leader denied their involvement in the incident and any ceasefire violation by their troops.

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Flu more widespread in US; eases off in some areas

NEW YORK (AP) — Flu is now widespread in all but three states as the nation grapples with an earlier-than-normal season. But there was one bit of good news Friday: The number of hard-hit areas declined.

The flu season in the U.S. got under way a month early, in December, driven by a strain that tends to make people sicker. That led to worries that it might be a bad season, following one of the mildest flu seasons in recent memory.

The latest numbers do show that the flu surpassed an "epidemic" threshold last week. That is based on deaths from pneumonia and influenza in 122 U.S. cities. However, it's not unusual — the epidemic level varies at different times of the year, and it was breached earlier this flu season, in October and November.

And there's a hint that the flu season may already have peaked in some spots, like in the South. Still, officials there and elsewhere are bracing for more sickness

In Ohio, administrators at Miami University are anxious that a bug that hit employees will spread to students when they return to the Oxford campus next week.

"Everybody's been sick. It's miserable," said Ritter Hoy, a spokeswoman for the 17,000-student school.

Despite the early start, health officials say it's not too late to get a flu shot. The vaccine is considered a good — though not perfect — protection against getting really sick from the flu.

Flu was widespread in 47 states last week, up from 41 the week before, the Centers for Disease Control and Prevention said on Friday. The only states without widespread flu were California, Mississippi and Hawaii.

The number of hard-hit states fell to 24 from 29, where larger numbers of people were treated for flu-like illness. Now off that list: Florida, Arkansas and South Carolina in the South, the first region hit this flu season.

Recent flu reports included holiday weeks when some doctor's offices were closed, so it will probably take a couple more weeks to get a better picture, CDC officials said Friday. Experts say so far say the season looks moderate.

"Only time will tell how moderate or severe this flu season will be," CDC Director Dr. Thomas Frieden said Friday in a teleconference with reporters.

The government doesn't keep a running tally of adult deaths from the flu, but estimates that it kills about 24,000 people in an average year. Nationally, 20 children have died from the flu this season.

Flu vaccinations are recommended for everyone 6 months or older. Since the swine flu epidemic in 2009, vaccination rates have increased in the U.S., but more than half of Americans haven't gotten this year's vaccine.

Nearly 130 million doses of flu vaccine were distributed this year, and at least 112 million have been used. Vaccine is still available, but supplies may have run low in some locations, officials said.

To find a shot, "you may have to call a couple places," said Dr. Patricia Quinlisk, who tracks the flu in Iowa.

In midtown Manhattan, Hyrmete Sciuto got a flu shot Friday at a drugstore. She skipped it in recent years, but news reports about the flu this week worried her.

During her commute from Edgewater, N.J., by ferry and bus, "I have people coughing in my face," she said. "I didn't want to risk it this year."

The vaccine is no guarantee, though, that you won't get sick. On Friday, CDC officials said a recent study of more than 1,100 people has concluded the current flu vaccine is 62 percent effective. That means the average vaccinated person is 62 percent less likely to get a case of flu that sends them to the doctor, compared to people who don't get the vaccine. That's in line with other years.

The vaccine is reformulated annually, and this year's is a good match to the viruses going around.

The flu's early arrival coincided with spikes in flu-like illnesses caused by other bugs, including a new norovirus that causes vomiting and diarrhea, or what is commonly known as "stomach flu." Those illnesses likely are part of the heavy traffic in hospital and clinic waiting rooms, CDC officials said.

Europeans also are suffering an early flu season, though a milder strain predominates there. China, Japan, the West Bank, the Gaza Strip, Algeria and the Republic of Congo have also reported increasing flu.

Flu usually peaks in midwinter. Symptoms can include fever, cough, runny nose, head and body aches and fatigue. Some people also suffer vomiting and diarrhea, and some develop pneumonia or other severe complications.

Most people with flu have a mild illness. But people with severe symptoms should see a doctor. They may be given antiviral drugs or other medications to ease symptoms.

Some shortages have been reported for children's liquid Tamiflu, a prescription medicine used to treat flu. But health officials say adult Tamiflu pills are available, and pharmacists can convert those to doses for children.

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Associated Press writers Dan Sewell in Cincinnati, Catherine Lucey in Des Moines, and Malcolm Ritter in New York contributed to this report.

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Online:

CDC flu: http://www.cdc.gov/flu/index.htm

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Poisoned Lottery Winner's Kin Were Suspicious

Urooj Khan had just brought home his $425,000 lottery check when he unexpectedly died the following day. Now, certain members of Khan's family are speaking publicly about the mystery -- and his nephew told ABC News they knew something was not right.

"He was a healthy guy, you know?" said the nephew, Minhaj Khan. "He worked so hard. He was always going about his business and, the thing is: After he won the lottery and the next day later he passes away -- it's awkward. It raises some eyebrows."

The medical examiner initially ruled Urooj Khan, 46, an immigrant from India who owned dry-cleaning businesses in Chicago, died July 20, 2012, of natural causes. But after a family member demanded more tests, authorities in November found a lethal amount of cyanide in his blood, turning the case into a homicide investigation.

"When we found out there was cyanide in his blood after the extensive toxicology reports, we had to believe that ... somebody had to kill him," Minhaj Khan said. "It had to happen, because where can you get cyanide?"

In Photos: Biggest Lotto Jackpot Winners

Authorities could be one step closer to learning what happened to Urooj Khan. A judge Friday approved an order to exhume his body at Rosehill Cemetery in Chicago as early as Thursday to perform further tests.

Lottery Winner Murdered: Widow Questioned By Police Watch Video

Moments after the court hearing, Urooj Khan's sister, Meraj Khan, remembered her brother as the kind of person who would've shared his jackpot with anyone. Speaking at the Cook County Courthouse, she hoped the exhumation would help the investigation.

"It's very hard because I wanted my brother to rest in peace, but then we have to have justice served," she said, according to ABC News station WLS in Chicago. "So if that's what it takes for him to bring justice and peace, then that's what needs to be done."

Khan reportedly did not have a will. With the investigation moving forward, his family is waging a legal fight against his widow, Shabana Ansari, 32, over more than $1 million, including Urooj Khan's lottery winnings, as well as his business and real estate holdings.

Khan's brother filed a petition Wednesday to a judge asking Citibank to release information about Khan's assets to "ultimately ensure" that [Khan's] minor daughter from a prior marriage "receives her proper share."

Ansari may have tried to cash the jackpot check after Khan's death, according to court documents, which also showed Urooj Khan's family is questioning if the couple was ever even legally married.

Ansari, Urooj Khan's second wife, who still works at the couple's dry cleaning business, has insisted they were married legally.

She has told reporters the night before her husband died, she cooked a traditional Indian meal for him and their family, including Khan's daughter and Ansari's father. Not feeling well, Khan retired early, Ansari told the Chicago Sun-Times, falling asleep in a chair, waking up in agony, then collapsing in the middle of the night. She said she called 911.

"It has been an incredibly hard time," she told ABC News earlier this week. "We went from being the happiest the day we got the check. It was the best sleep I've had. And then the next day, everything was gone.

"I am cooperating with the investigation," Ansari told ABC News. "I want the truth to come out."

Ansari has not been named a suspect, but her attorney, Steven Kozicki, said investigators did question her for more than four hours.

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