NSW Health has warned the elderly to be on high alert for influenza as the season reaches its peak across the state.
Director of Communicable Diseases Dr Vicky Sheppeard said last month, 24 aged care facilities in NSW had reported influenza outbreaks.
"These outbreaks have affected 61 staff and 318 residents, 45 of whom have been hospitalised," Dr Sheppeard said.
Almost 2800 cases of confirmed influenza were notified across NSW in July.
High rates of flu activity were also reported in hospital emergency departments, especially in people over the age of 65.
The number of cases positively identified in the North Coast region is at its peak; however, it is not unusual for this time of year, says Paul Corben, director of public health for the Northern NSW Local Health District.
"The north coast is travelling at about average for the last five years, and almost exactly the same as this time last year," Mr Corben said.
"Those at high risk are people over 65, Aboriginal people, and pregnant women as well as people with weakened immune systems or living with a chronic condition," he said.
"If you're unwell, the advice is to stay away from public places until you get better."
He said the best approach to avoid the bug was to prevent infection through vaccination and goodhygiene.
Each year the influenza vaccine contains three different strains of influenza and is available free to people at greater risk of complications.
Free advice from Health Direct Australia service, 24-hours a day, on 1800 022 222.