Flu Is Showing Up Early This Year. Here's What Nurses Should Watch

Flu usually spends October warming up. This year it showed up ahead of schedule. CDC’s latest weekly surveillance report says early-season influenza activity is running higher than it typically does at this point in the year, almost all of it one strain, and concentrated on the West Coast. The numbers are still low. But for nurses, “early” matters more than “low”: it means flu patients arrive before many patients and staff have had this season’s vaccine.

What happened

On October 9, 2026, CDC published FluView for the week ending October 3. Its summary: seasonal influenza activity remains low but is increasing across multiple surveillance indicators, and early-season activity is higher than typically observed at this time of year, while still within expected seasonal variation.

The numbers behind that call:

• Lab positivity: 3.6% of specimens tested by clinical labs were positive for flu (1,435 of 39,317). Influenza A made up 97.0% of those positives.
• One strain dominates: of 127 influenza A viruses subtyped by public health labs, 125 (98.4%) were A(H1N1)pdm09 and 2 were A(H3N2).
• West Coast first: regional positivity ranged from 1.7% in HHS Region 2 to 9.5% in Region 9, with the highest activity in Region 9 (Arizona, California, Hawaii, Nevada) and Region 10 (Alaska, Idaho, Oregon, Washington).
• Clinics and hospitals: influenza-like illness was 1.8% of outpatient visits, below the national baseline of 3.1%. Hospitals reported 3,334 lab-confirmed flu admissions for the week, and adults 65 and older had the highest admission rate.

CDC’s broader respiratory data, also updated October 9, rounds out the picture: flu is increasing in many parts of the country but remains low, COVID-19 is elevated in some regions but declining nationally, and RSV is very low in most areas.

Why it matters at the bedside

An early, H1N1-heavy start puts the pressure on the first hours of care, before anyone has a test result. Four things carry most of the weight.

Screen at the door. CDC’s healthcare infection-control guidance calls for asking about respiratory symptoms at check-in, offering a facemask to anyone with symptoms, and seating symptomatic people as far from others as possible. In triage, fever with cough or sore throat, body aches and sudden fatigue should prompt the question.

Isolate on suspicion, not on confirmation. Droplet precautions start when flu is suspected. The patient goes in a private room (or a cohort plan worked out with infection control), staff wear a facemask on entry and remove it and perform hand hygiene on exit. Precautions continue for 7 days after illness onset or until 24 hours after fever and respiratory symptoms resolve, whichever is longer. Aerosol-generating procedures change the gear: a fitted N95, eye protection, gown and gloves, and an airborne infection isolation room when feasible.

Watch the antiviral clock. CDC recommends oral oseltamivir as soon as possible for anyone with suspected or confirmed flu who is hospitalized, severely ill or at higher risk for complications, regardless of vaccination status and without waiting for lab confirmation. Benefit is greatest within 48 hours of symptom onset, but hospitalized and severely ill patients are still treated after that window. If the order is slow to come, the nurse who documented symptom onset is the one who can flag it.

Know who is high risk. Adults 65 and older (already leading this week’s admission rate), young children, pregnant patients, residents of long-term care, and people with chronic heart, lung, kidney or metabolic disease or immunosuppression are the patients most likely to develop pneumonia and other complications.

What it means for nursing students and the NCLEX

Flu is one of the most reliable infection-control items on the exam, and this season is a clean example of why the rules exist. The tested facts:

• Influenza is droplet plus standard precautions: surgical mask, private room or cohort. Airborne precautions are for TB, measles and varicella.
• Oseltamivir works best within 48 hours of symptoms, but a hospitalized or high-risk patient is treated regardless of timing.
• Annual vaccination is recommended for everyone 6 months and older.
• The live attenuated nasal vaccine is not for pregnancy or immunocompromise; the inactivated shot is.
• A patient with flu who becomes short of breath again after starting to improve should be assessed for secondary bacterial pneumonia.

What to do now

• Get vaccinated if you have not yet. CDC says most people should ideally be vaccinated before the end of October.
• Offer the vaccine to eligible patients at discharge and in clinic, and document refusals.
• Ask every patient with respiratory symptoms when symptoms started, and chart it. It drives the antiviral decision.
• Mask and isolate on suspicion. Do not wait for the swab.
• If you are a student, review droplet versus airborne precautions before your next clinical day.