Flu cases spiked in Alaska at the end of December and into January, with the state-recorded count triple the number from the beginning of the season.
Despite escalation, health officials say this may not be the height of flu season just yet and are continuing to urge all groups of Alaskans, from the high-risk to the healthy, to get vaccinated.
"We haven't peaked, we don't think," said Donna Fearey, state nurse epidemiologist. "We expect to see further increase in activity."
More than 680 Alaskans have been reported to have the flu since the infection popped up, like clockwork, in October. Alaska is one of at least 35 states where widespread flu activity is reported, according to the federal Centers for Disease Control.
This year the virulent H1N1 strain, or so-called swine flu, reemerged as the culprit behind most flu cases nationwide. The two adult Alaskans who died from the flu at the end of December both had H1N1, state health officials said.
H1N1 puts a younger spin on flu, infecting mostly the young and middle-aged. Unlike in the 2009 pandemic, this season's flu vaccine does cover the strain.
"The scary thing about the flu is it's the young, healthy athlete that can also get sick," said Dr. Mary Ann Foland of Primary Care Associates, a family medicine group with associated urgent care clinics.
Foland said she has seen a lull in flu cases over the past week and a peak back in mid-December. If the season's flu behaves as it has in the past, she expects a second boost in February or April.
People can suffer achy muscles, high fever and difficulty breathing for up to seven days, she said. Foland said she's even seen some vaccinated patients infected but with milder symptoms.
"We're encouraging people who don't want to miss a week of work to go and get their flu shot," Foland said.
Some of the most vulnerable are Alaska Natives.
A study by state health departments after the 2009 flu outbreak found that Alaska Natives and American Indians had a death rate four times that of all other racial and ethnic groups combined.
Both medical and social factors put Natives at an increased risk for contracting the flu, said Dr. Rosalyn Singleton, immunization program director for the Alaska Native Tribal Health Consortium.
Historically, Alaska Natives have a higher rate of underlying medical conditions such as lung disease, diabetes, congestive heart failure and obesity, all of which heighten the chances of hospitalization and death from influenza, she said.
Crowded homes, a lack of running water and poor indoor air quality in rooms with wood stoves also aid in spreading the infection.
"We need to identify people in those risk categories and try to make sure they are protected," Singleton said.
The Alaska Native Medical Center hosted an immunization clinic in its hallways earlier this year and vaccinated about 800 people, she said.
Erica Lambers, infection prevention manager at Maniilaq Health Services in Kotzebue, said public health nurses travel to the region's 11 villages weekly to administer checkups and flu shots.
With a high immunization rate, she said, fewer than five flu cases have been reported in the area this season.
"We've seen very little flu this year," Lambers said. "So, knock on wood."
At the Anchorage School District, nurses and volunteers vaccinated more than 17,000 students at free clinics between October and the end of December, said Nancy Edtl, the district's head of health care.
It's slightly below the district's goal of 19,000 but well above the 9,000 students vaccinated last year, Edtl said.
Edtl said the district still sends a few students home each week with flu-like symptoms but it's a significant drop from years prior.
"In the schools where they've had very low turnout for the vaccine, you'll have six to eight kids in a day with influenza," Edtl said. "Almost all of the cases are in the kids that did not get immunized for the flu vaccine."
Edtl said parents who still want their child vaccinated should alert the school's nurse.
Reach Tegan Hanlon at firstname.lastname@example.org or 257-4589.
By TEGAN HANLON