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  • Health experts say this flu season is likely to be severe.
  • Currently, Texas, Georgia, and Washington D.C. are all seeing high flu activity and it’s only the beginning of flu season.
  • Your best bet to avoid severe flu symptoms is to get the flu shot, but only half of Americans say they plan to get the vaccine.

Infectious disease experts expect this flu season to be a rough one.

The Southern Hemisphere just wrapped up its worst flu season in years, signaling that the Northern Hemisphere may soon battle a severe flu season.

Texas, Georgia, and Washington DC are already seeing unusually high flu activity for this time of year.

The majority of flu cases this season have been caused by influenza A H3N2, a strain that’s previously been associated with severe flu seasons.

While the flu shot appears to be a good match to the circulating strains, a recent survey found that nearly half of Americans don’t plan to get vaccinated against the flu this year.

What, exactly, this means for this year’s flu season has yet to be seen, but doctors suspect the country is ripe for flu to make a startling comeback.

Healthline asked four flu experts what to expect this influenza season. Here’s what they said.

Dr. Michael Chang, an infectious disease doctor at Memorial Hermann Health System in Houston, Texas

Dr. Susan Hassig, an epidemiologist and professor in the epidemiology department at Tulane University’s School of Public Health

Dr. Erica Johnson, an infectious diseases doctor who chairs the Infectious Disease Board of the American Board of Internal Medicine

Dr. Theodore Strange, a primary care physician and the Chair of Medicine at Staten Island University Hospital

Dr. Chang: Outpatient numbers of positive flu tests had started increasing a few weeks ago and has significantly ramped up in the last two weeks. This is earlier than typical to see a spike in flu cases. For Texas, we tend to see flu start to increase after the Thanksgiving holidays. It is too early to judge whether the cases are more severe so far though. It’s surprising since we have still had warm and/or fall weather, so most people aren’t thinking about the flu. Even for those planning to get vaccinated, many people haven’t received their seasonal influenza vaccination yet and so our region may be caught off guard. Unfortunately, many other parts of the country are likely to see their flu cases increase before people were planning to get vaccinated.

Dr. Strange: The influenza virus has been spreading around the United States for approximately a month or so. Texas and New York both have high flu activity likely from large population centers and large number of travelers. Having big states already with high activity likely portends to a very active and contagious flu season.

Dr. Chang: It’s difficult to predict precisely for each part of the country, but it’s reasonable to think that as cold weather sets in we will see increases in flu cases and other respiratory viruses. However, everyone should be prepared for the flu season to start several weeks earlier than usual.

Dr. Strange: The season usually begins in October, spikes and peaks in between December to February and slowly declines as winter ends and spring begins.

Dr. Johnson: This year’s flu shot composition does include protection for an influenza A H3N2 strain, as well as an influenza A H1N1 strain and two types of influenza B. The decision to include this H3N2 strain was based on the fact that this one matched the strain that circulated predominantly in the US during last year’s flu season.

Dr. Hassig: So far it appears the current flu shot is matching well to the circulating virus in the US, but uptake of the flu vaccine is still lower than we would like to see, especially in older populations. Vaccine uptake this year is important because the dominant flu strain appears to be one that tends to cause more severe disease, and in the past has been responsible for the higher death rates we see in some flu seasons.

Dr. Hassig: It was a bad (lots of severe disease) season in the southern hemisphere during their winter, and what they experience is often a good predictor of what will happen in the US.

Dr. Chang: The most recent Southern Hemisphere flu appeared to be “severe” flu season with more cases than several prior years. It appeared similar to, or even slightly worse than, the 2017-2018 season which was considered a high-severity season in the United States by the CDC. I anticipate we will see the same phenomenon here, especially as the flu season is starting earlier and many people haven’t been vaccinated yet.

Dr. Johnson: In the Southern Hemisphere, flu transmission generally occurs April to September, and this season, there was more flu activity in the Southern Hemisphere than in the prior two seasons. So it makes sense to be concerned that we may see more flu activity in the US this flu season as well.

Dr. Hassig: I am concerned that many Americans are not thinking about the threat that flu may pose in the US. Flu can cause severe disease and death in both the very young and the old.

Dr. Johnson: Not getting the flu vaccine may put that person at risk for more severe illness if they become infected with the influenza virus. And more severe flu illness can mean more lost days from work and school and more hospitalizations from complications of flu.

Dr. Strange: Not getting vaccinated increases the chances of spreading the disease and susceptibility of getting a more severe case of the illness and even death from the flu.

Dr. Chang: Since we haven’t had two “normal” flu seasons, many individuals’ immunity to seasonal flu will be decreased. Exposure to flu each season may help to bolster an individual’s immune response against next season’s flu. Since we have had relatively fewer flu cases, especially in 2020, it is possible and probable that we will likely see a higher rate of severe illness due to the flu this year especially in unimmunized individuals, exacerbated by traditionally low rates of flu vaccine coverage.

Dr. Hassig: I do think that coming out of the pandemic years with its various prevention measures (masks, focus on hand hygiene, staying home when sick) greatly reduced our natural interaction with influenza as well as Sars-CoV-2. With those measures now largely absent, coupled with the drop in routine health interactions, including routine vaccinations for kids and adults, sets us up for a potentially bad season as well. We are seeing rises in a wide range of respiratory diseases, in general, and there is no reason to think the flu will be any different.

Dr. Strange: The best ways to prevent and limit the effects if you do contract the flu is to get vaccinated starting now, hand washing, and wear a mask if concerned in areas that are crowded with limited air flow. Also, if you are sick with flu like symptoms, be smart and isolate from others especially with those at high risk.

Dr. Johnson: The best thing to do is to get your seasonal flu vaccine, and these are widely available now. It can take up to two weeks for the vaccine to be most effective after administration, and since the influenza virus is already circulating, it is best to do this as soon as possible.

Dr. Chang: While we hope the vaccine prevents infection with flu, we really want to minimize the risk of severe illness and severe outcomes. Flu vaccine is the best way to do that. Additionally, patients with any underlying conditions such as heart disease, diabetes, or lung conditions like asthma need to be sure that their conditions are well-controlled and that they are optimizing care for their other conditions. Finally, if you are sick or having symptoms, please try to stay home to minimize the risk of infecting others with your infection, whether it is the flu or something else!