A fifth Utahn is dead as a result of the novel influenza strain H1N1, in the midst of what the state epidemiologist calls a "very active outbreak in Utah."

A Salt Lake Valley Health official confirmed that a 58-year-old woman died Monday morning in a Salt Lake area hospital. SLVHD spokeswoman Pam Davenport said the woman had a "history of underlying health conditions that may have contributed to her death," which is typical but not always the case with influenza-related deaths.

Just over the weekend, the third and fourth Utah H1N1 deaths were confirmed. Both were individuals between the ages of 25 and 50 who had been hospitalized with H1N1. One clearly had underlying medical issues; with the other it was not clear, she said. A man, 21, died in May, and a minor died earlier this month.

Although health officials do not identify those who die, family members said the woman who died Saturday was Francine Rushton, 47. In a written statement, her family said Rushton and her mother became ill two weeks ago. The mother tested positive for H1N1, but Rushton's test came back negative twice. A third test, administered Wednesday when she was already hospitalized, confirmed type A influenza, and the CDC on Thursday confirmed it was H1N1, the so-called swine flu. The Deseret News was unable to reach the family for comment.

Jordan Valley Hospital, which administered the second test that came back negative, said it could not comment on the specific case because of confidentiality rules, but "we can confirm that all established CDC guidelines are followed" with treatment of any patient with suspected HIN1.

Death is most likely in those with chronic medical conditions, said Dr. Dagmar Vitek, medical director of SLVHD. Neither she nor state epidemiologist Dr. Robert Rolfs, who met with reporters Monday to discuss H1N1, would comment on individual cases. Rolfs noted that rapid-result tests are "not perfect" but said there is no set protocol that everyone uses. It's just one factor that can guide treatment choices.

The state reserves its own slower, more accurate testing for people who are hospitalized — which is a small percentage of those who are seeking medical care, including in emergency rooms. And with so many confirmed H1N1 cases — more than 700 as of last week — he said the state will begin to track only those who are hospitalized. The vast majority of those with H1N1 will get better on their own, without medical intervention, Vitek and Rolfs said.