• Visits to doctors for influenza-like illness (ILI) continued to increase in the United States, and overall, are higher than levels expected for this time of the year.

• Total influenza hospitalization rates for laboratory-confirmed influenza are higher than expected for this time of year for adults and children. And for children 5-17 and adults 18-49 years of age, hospitalization rates from April – October 2009 exceed average flu season rates (for October through April).

• The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Report has increased and now exceeds what is normally expected at this time of year. In addition, 19 flu-related pediatric deaths were reported this week; 16 of these deaths were confirmed 2009 H1N1 and 3 were unsubtyped influenza A and likely to be 2009 H1N1. A total of 76 laboratory confirmed 2009 H1N1 pediatric deaths have been reported to CDC since April.

• Thirty-seven states are reporting widespread influenza activity at this time. They are: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Texas, Tennessee, Virginia, Washington, and Wyoming. Any reports of widespread influenza activity in September and October are very unusual.

• Almost all of the influenza viruses identified so far are 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine, and remain susceptible to the antiviral drugs oseltamivir and zanamivir with rare exception.

You may have the flu if you have some or all of these symptoms:

* fever
* cough
* sore throat
* runny or stuffy nose
* body aches
* headache
* chills
* fatigue
* sometimes diarrhea and vomiting

What should I do if I get sick?

If you get sick with flu-like symptoms this flu season, you should stay home and avoid contact with other people except to get medical care. Most people with 2009 H1N1 have had mild illness and have not needed medical care or antiviral drugs and the same is true of seasonal flu.

However, some people are more likely to get flu complications and they should talk to a health care provider about whether they need to be examined if they get flu symptoms this season. They are:

* Children younger than 5, especially children younger than 2
* People 65 and older
* Pregnant women
* People who have:
o Cancer
o Blood disorders (including sickle cell disease)
o Chronic lung disease [including asthma or chronic obstructive pulmonary disease (COPD)]
o Diabetes
o Heart disease
o Kidney disorders
o Liver disorders
o Neurological disorders (including nervous system, brain or spinal cord)
o Neuromuscular disorders (including muscular dystrophy and multiple sclerosis)
o Weakened immune systems (including people with AIDS)

Also, it’s possible for healthy people to develop severe illness from the flu so anyone concerned about their illness should consult a health care provider.

There are emergency warning signs. Anyone who has them should get medical care right away.
What are the emergency warning signs?

In children

* Fast breathing or trouble breathing
* Bluish skin color
* Not drinking enough fluids
* Not waking up or not interacting
* Being so irritable that the child does not want to be held
* Flu-like symptoms improve but then return with fever and worse cough
* Fever with a rash

In adults

* Difficulty breathing or shortness of breath
* Pain or pressure in the chest or abdomen
* Sudden dizziness
* Confusion
* Severe or persistent vomiting

Do I need to go the emergency room if I am only a little sick?

No. The emergency room should be used for people who are very sick. You should not go to the emergency room if you are only mildly ill.Photo of sick child If you have the emergency warning signs of flu sickness, you should go to the emergency room. If you get sick with flu symptoms and are at high risk of flu complications or you are concerned about your illness, call your health care provider for advice. If you go to the emergency room and you are not sick with the flu, you may catch it from people who do have it.

Are there medicines to treat 2009 H1N1?

Yes. There are drugs your doctor may prescribe for treating both seasonal and 2009 H1N1 called “antiviral drugs.” These drugs can make you better faster and may also prevent serious complications. This flu season, antiviral drugs are being used mainly to treat people who are very sick, such as people who need to be hospitalized, and to treat sick people who are more likely to get serious flu complications. Your health care provider will decide whether antiviral drugs are needed to treat your illness. Remember, most people with 2009 H1N1 have had mild illness and have not needed medical care or antiviral drugs and the same is true of seasonal flu.

How long should I stay home if I’m sick?

CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other things you have to do and no one else can do for you. (Your fever should be gone without the use of a fever-reducing medicine, such as Tylenol®.) You should stay home from work, school, travel, shopping, social events, and public gatherings.

What should I do while I’m sick?

Stay away from others as much as possible to keep from making them sick. If you must leave home, for example to get medical care, wear a facemask if you have one, or cover coughs and sneezes with a tissue. And wash your hands often to keep from spreading flu to others.