Flu season is off to an unusually early start, with wastewater surveillance, emergency department data and local health departments from Virginia to California all indicating increased virus activity.
An earlier-than-usual rise does not guarantee a worse season, but on nearly every surveillance measure — and in a growing list of states — the virus is proliferating.
Eight notes:
1. Thirty-eight states are seeing a “high” level of influenza A in wastewater, according to Wastewater SCAN, a dashboard developed by Stanford (Calif.) University. The 12 states still at a “low” level are clustered in the Midwest: Kansas, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Ohio, Nebraska, North Dakota, South Dakota and Wisconsin.
2. As of Oct. 14, influenza A concentrations normalized by PMMoV reached 38.37 in wastewater nationwide — nearly 19 times the 2.055 recorded on the same day in 2025.
3. Clinical surveillance is still catching up to the wastewater data. No state reached high or very high flu activity in the CDC’s latest FluView report, and influenza-like illness held at 1.8% of outpatient visits, below the 3.1% baseline. The CDC said early season activity is running higher than usual for this point in the fall but remains within expected seasonal variation, with the West Coast leading.
4. Pennsylvania logged 806 flu cases Oct. 4-10, up 385% from 166 in the same week last year. State officials describe activity as low but slightly increasing.
5. In Virginia, about 0.6% of emergency department visits during the week ending Oct. 10 were diagnosed with flu — more than five times the 0.11% recorded a year earlier. Statewide emergency and urgent care flu visits jumped 27% in one week, from 839 to 1,069, with children ages 5 to 17 having the highest number of positive lab tests for influenza.
6. Flu arrived in North Carolina’s Triangle region roughly seven weeks earlier than the past two seasons, the earliest of any post-pandemic season, Spectrum News reported Oct. 16, citing Epic Research data.
Chapel Hill, N.C.-based UNC Health confirmed 31 new flu cases and four admissions in the past week, while Raleigh, N.C.-based WakeMed has logged 214 positive cases and 30 admissions since August. Daniel Park, MD, an emergency physician and associate chief medical officer for pediatrics at UNC Children’s Hospital, told Spectrum News the hospital’s ER is “always at capacity.”
7. Douglas County, Neb., recorded a 61% week-over-week jump — 50 flu cases for the week ending Oct. 10, up from 31 — and more cases in the first 10 days of October than in any full October over the previous nine seasons, NBC affiliate WOWT reported. Most cases are H1N1, “a really good match to the vaccine,” Justin Frederick, DrPH, deputy health director of the Douglas County Health Department, told the station.
8. Officials across states are urging residents to get vaccinated by the end of October, noting the shot takes about two weeks to take full effect. El Paso County, Colo., is “seeing an earlier rise in higher numbers of flu,” public health official Haley Zachary told CBS affiliate KKTV, after the state reported its first pediatric flu death of the season. In Kentucky, where cases are running above last year’s level, EDs are already treating flu-like illness earlier than usual, CBS and The CW affiliate WKYT reported.
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