Health officials are encouraging people to use bug spray and mosquito-control efforts as West Nile virus season is off to its earliest and worst start in over two decades.

The Centers for Disease Control and Prevention said Wednesday that it had confirmed at least 48 cases — 38 of them severe — as of June 30. Since 2004, the average number of cases reported to the CDC by the end of June is around 10. Federal health officials said 23 states have reported finding West Nile virus, the most in 10 years.

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