Spokane County and Whatcom County have reported four cases each. Kitsap County and Mason County have each reported three cases. Two cases have been reported in Island County and Skagit County. One case each has been reported in Douglas County, Grays Harbor County, Jefferson County, Kittitas County and Lewis County. An additional case, that of a cruise ship worker, is counted at the state level only. September 19, 2009, the Washington department of health stopped counting individual cases of A/H1N1 influenza, and only counting hospitalizations and deaths from A/H1N1. As of July 22, there have been 276 reported cases. In November 2009, it was confirmed a West Virginia pediatrician had confirmed A/H1N1 influenza twice, once in July, and again in October. This is very rare, but does occur sporadically, according to the CDC. As of July 22, 2009, Wisconsin has 5,147 confirmed cases, including 3,278 in Milwaukee. most of which are in the southern and south-eastern region of the state. So far, cases have been confirmed in 24 counties, however Milwaukee, Dane, Waukesha, and Columbia have the majority of the cases, with 706, 90, 54, and 52 respectively. As of May 24, 2009, Wisconsin currently has the most confirmed cases of swine flu in the United States. On June 1, 2009, it was confirmed that a Milwaukee resident with underlying health issues died from the virus. Two Wisconsin residents have died from the virus. As of Friday June 12, 2009 there were 3,008 confirmed and probable cases and one death in Wisconsin reported by the CDC. As of Friday June 19, 2009 the CDC reported no change of these numbers. As of Friday, June 12, 2009, the largest city in Wisconsin, Milwaukee, reported the second death and 1,883 confirmed cases of swine flu. As of Tuesday, June 16, 2009, the city of Milwaukee reported the third death related to the novel flu and more than 2,000 confirmed cases in Milwaukee. As of Thursday, June 18, 2009, Milwaukee reported 2,618 confirmed cases. The CDC update seems not to reflect the rising of case toll from 1,883 (June 12) to 2,618 (June 18) in the city of Milwaukee. Dane County reported 300 confirmed cases as of Thursday June 18, 2009. Columbia County reported 68 confirmed cases as of June 5, 2009. As of August 27, 2009, the Wyoming Department of Health reported 171 lab-confirmed cases of H1N1.