This year's flu season is extra severe. Can you get it twice in one season?
The United States is currently facing the worst flu season in over 15 years, with cases surging in most states. Over 33 million Americans have gotten sick this season so far, and elevated flu activity is expected to continue in the coming weeks, experts say.
In early February, doctor visits and hospitalizations for flu hit the highest levels since the 2009-2010 flu season, during the height of the swine flu pandemic, according to the U.S. Centers for Disease Control and Prevention's latest FluView report.
The 2024-2025 flu season, which has caused an estimated 19,000 deaths so far, is now classified by the CDC as 'high severity.'
In the U.S., flu season typically starts in October and peaks between December and February. However, the timing and severity varies from year to year. The 2024-2025 flu season got off to a slow start and appears to be the most intense in over a decade. It coincides with surges of COVID, norovirus, and respiratory syncytial virus, which has been dubbed a 'quad-demic.'
As this flu season rages on, you may be wondering if it's possible to get flu twice in the same season. If you've already recovered from the flu, can you get it again and do you still need a flu shot? We spoke to experts to find out.
Yes, you can get the flu twice during the same season, experts say.
'Overall, it's possible but not incredibly likely,' Dr. Geeta Sood, assistant professor in the division of infectious diseases at Johns Hopkins University, tells TODAY.com.
Reinfection can happen because multiple strains of influenza are circulating during any given season — this why the annual flu shot includes three or four different strains.
There are four types of flu viruses (A, B, C and D), and subtypes or strains of each — which can mutate. Influenza A and B cause seasonal epidemics every winter, per the CDC.
Right now, the predominant strains circulating in the U.S. are flu A H1N1, flu A H3N2, and one influenza B strain. Over 95% of flu cases right now are influenza A, per the CDC.
'However, smoldering along is influenza B, and the B strains usually become more prominent toward the end of the flu season,' Dr. William Schaffner, professor of infectious diseases at Vanderbilt University School of Medicine, tells TODAY.com.
'So it is possible for someone to get influenza A and then a month or so later, get influenza B,' says Schaffner.
After you recover from the flu, you'll have some immunity against the strain of the virus you were infected with because the body develops antibodies that recognize and neutralize the virus to protect against future infection, per the CDC.
'You don't get lifelong immunity to flu after you get infected, but you get pretty good immunity for a while,' Dr. Edmund Milder, pediatric infectious disease specialist at Rady Children's Hospital-San Diego, tells TODAY.com.
Immunity from natural infection is thought to last around six months, depending on the person, but it can wane fairly quickly, says Sood.
Additionally, immunity against one strain of the flu may not protect you against another. "There is very little, if any, cross-protection from your antibodies from (influenza) A to B,' says Schaffner. 'There will be some cross-protection among two influenza A strains, for example, H1N1 and H3N2,' Schaffner adds.
So, can you get flu A or flu B twice in one season? Theoretically, yes. "It would be possible if you are unlucky enough to get it right at the start and are exposed to the same virus at the tail end of a long flu season and don't have enough protection,' says Milder.
If you do get the same type of flu twice, it'll probably be caused by different strains, says Milder — for example, you recover from H3N2 then contract H1N1. 'It's unlikely that you get the exact same strain of influenza twice in one season," Milder adds.
Some groups may be at higher risk of reinfection.
One such group is people who did not get the flu shot, the experts say. If an unvaccinated person gets the flu, they'll only develop antibodies against that strain, instead of having antibodies against the three or four strains included in the flu shot.
People ages 65 and over, children under 2 and people with weakened immune systems or underlying conditions are also more vulnerable, the experts note.
"If you are older, frail or immunocompromised, your immune system is not going to protect you as well after you've had a first infection, so those people are going to be more likely to get the second infection," says Schaffner.
Individuals who have a lot of contact with other people are also at higher risk. 'Flu viruses tend to spread pretty effectively in congregate settings, where people are close together,' says Milder. These include schools, nursing homes and health facilities.
'If you are a person who's always out and about, you're going to expose yourself more frequently,' Schaffner adds.
While it is possible to get flu twice in one season, if you develop respiratory virus symptoms after already recovering from the flu, it's more likely that you caught a different circulating illness, such as COVID-19, RSV, adenovirus, rhinovirus, parainfluenza and more, the experts say.
"The problem is it's almost impossible to tell them apart," says Sood. Many of these viruses cause similar symptoms, such as a sore throat, cough, fever, runny nose and a headache.
Flu does have some characteristic signs, such as severe body aches and a higher fever, but there's still a lot of overlap, says Sood.
The only way to know if you have influenza is by getting a diagnostic test from a health care provider, Schaffner adds.
Testing is important because it can allow for prompt treatment. "We have medications that might help, especially if you're high risk," says Milder. These include flu antivirals such as Tamiflu, which are most effective when taken within 48 hours of symptom onset.
"No, it's not too late, and I would recommend getting the flu shot if you haven't gotten it so far," says Milder.
Even if you've already had the flu, you can still benefit from vaccination "because of those other influenza strains out there," says Schaffner.
The 2024-2025 flu vaccines protect against three viruses: influenza A H1N1, influenza A H3N2 and an influenza B strain.
Significant flu activity, including surges of influenza B, can continue as late as May — so getting the flu shot now can offer protection for months.
"(The flu shot) is not perfect. You can still get the flu, but we know flu vaccination decreases hospitalizations, serious illness and death," says Milder.
You can also protect yourself from the flu by avoiding contact with sick people, wearing a mask in crowded indoor spaces and washing your hands frequently.This article was originally published on TODAY.com
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Zabriskie's group cited a study by Asa Leijonhuvfvud, MD, PhD, and colleagues reporting that women aged 30 years or older at the time of their first vaginal delivery had an increased incidence of POP surgery (13.9%; 95% CI, 12.8%-15.2%) compared with women younger than 30 years at first vaginal delivery (6.4%; 95% CI, 6.0%-6.8%). Additionally, cesarean delivery had a heightened protective effect in older mothers. Among women aged 30 years or older at first delivery, those with vaginal delivery had an 11-fold increased risk for POP surgery compared with those with cesarean delivery. The CDC reported 27.5 years as the mean age of US mothers at first birth in 2023, a record high for this country, and according to 2022 US Census Bureau data, the median age of mothers at first birth was 30 years. Vaginal childbirth at any age is a known risk factor for POP, and 12.5%-20% of women will receive surgical intervention for POP in their lifetimes. Among other findings in the literature review: • Anatomic POP remote from first vaginal delivery: In addition to carrying higher odds of symptomatic POP (eg, seeing or feeling a vaginal-area bulge) a study by C. Glazener and colleagues found primiparas aged 30-34 years had 149% greater odds for anatomic problems compared with those aged 24 years or younger; and women aged 35 years or older at first birth had 208% greater odds of anatomic POP vs women aged 24 years or younger. • POP and genital hiatus enlargement: Heather A. Rosett and colleagues found that genital hiatus enlargement (≥ 4 cm) at 8 weeks postpartum was independently associated with POP 1 year postpartum with a 3.3-fold increase in risk. Women with POP at 1 year postpartum were older. • LAM defects: Maternal age at first delivery is generally an accepted risk factor for LAM injury. Rohna Kearney and colleagues reported that primiparous women with LAM defect 9-12 months after first vaginal delivery were older than those with intact LAM (32.8 years vs 29.3 years). Not surprisingly, those with a major defect were older than those with a minor defect. • Age-related tissue impairment: Although Zabriskie's group found no research specifically addressing primiparous age and tissue defects, studies of cellular and tissue-level changes show that older women with pelvic floor muscle impairment have increased oxidative stress and differential gene expression of extracellular matrix proteins in pelvic floor muscle, the vaginal wall, and the uterosacral ligaments compared with older women without such impairment. Jill M. Rabin, MD Commenting on the review but not involved in it, Jill M. Rabin, MD, a professor at the Feinstein Institutes for Medical Research, Manhasset, New York, and codirector of the Advanced Clinical Experience in Obstetrics and Gynecology at the Zucker School of Medicine in Hempstead, New York, called it an 'amazing, well-written, and well-constructed' analysis. 'But it is not new or surprising that the aging process, with and apart from delivery, impacts the structure of muscle and connective tissue and the effectiveness of muscle contraction and support. This review, however, dissects the different elements to explain why we see more prolapse in women who deliver vaginally after 30.' Rabin noted that although cesarean delivery is protective against POP, it entails risks ranging from infection and hemorrhage to placental implantation in the scar and would only be recommended to prevent POP if a patient had predisposing genetic or clinical features. In her practice, she does not 'pathologize prolapse' for patients but she does teach them to maximize their core and pelvic muscle strength before, during, and after recovering from pregnancy and to maintain pelvic floor support between pregnancies. 'Core strength can reduce pressure on the pelvic organs,' she said, adding that at the cellular level, it's also important to support muscle cells with adequate protein intake and good hydration. Zabriskie and colleagues pointed to the need to identify the cellular, molecular, and transcriptomic differences brought on by age, as well as research to clarify the specific relationship between maternal age at first delivery and the onset and progression of pelvic support impairment. POP risk in younger mothers should also be studied. 'Future basic and translational research is essential to identify mechanisms of POP development, thereby enabling both strategies for identifying women at high risk for POP and novel therapeutic strategies that target these mechanisms to aid in pelvic floor tissue recovery postpartum and prevent POP development,' they concluded.
