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THURSDAY, Jan. 29 (HealthDayNews) -- The wave of influenza that had been characterized last month as an epidemic across the United States has waned considerably, with just one state reporting widespread flu.

Only Delaware reported widespread flu activity -- with "widespread" being defined as confirmed flu cases in at least half the regions of a state -- for the week ending Jan. 24, the Centers for Disease Control and Prevention reports in the Jan. 30 issue of its publication Morbidity and Mortality Weekly Report.

That's down from 38 states reporting widespread flu activity three weeks ago, and 45 states in mid-December.

"Clearly we are on the downward slope of this year's outbreak," said Tom Skinner, a CDC spokesman.

But Skinner noted that flu season lasts through March and warned against complacency.

"I think it's important for people to note that we should still see some flu here and there and some regional outbreaks," he said. "Flu's very unpredictable."

The CDC recommended flu shots for those at high risk for complications from influenza. They included healthy children ages 6 to 23 months, adults 65 and over; pregnant women in their second or third trimester during flu season, and people over 2 who have underlying chronic conditions.

In its weekly report, the CDC also said it received reports of 121 deaths associated with flu among children under 18 -- 72 of them under 5 years old and 33 under 2. Of these, the report said, 26 children, or about 21 percent, had had medical conditions that put them at increased risk for complications from the flu.

It remained unclear whether the number of flu-related deaths among children is higher than usual because the CDC lacked data on these deaths from previous years.

This flu season started early, and the virus struck every state -- hitting three-quarters of them hard, experts say. Anecdotal evidence suggests the flu has been particularly rough on children, the CDC has said. The jackrabbit start prompted an unusual surge in demand for the vaccine, creating a shortage, even though experts said the shot didn't contain an exact match for the strain of flu circulating in the U.S.

Last month, Dr. Julie Gerberding, the CDC director, declared the flu outbreak an "epidemic" after the number of states reporting widespread flu climbed to three dozen.

Like others, Dr. John Belko, chief of pediatric infectious disease at Long Island College Hospital in New York, said the decline in reports of widespread flu is by no means reason to take the threat lightly.

Belko said it's not too late to get vaccines, and though the supply has run short, 200,000 to 300,000 doses are still available, many of them at public health departments. Other medications to prevent the flu are also available, he said.

"I still expect to see sporadic outbreaks, but nothing like December," Belko said.

After an outbreak of the influenza A strain, he said cases of influenza B usually follow. That strain tends to be nastier and can cause worse muscular aches than influenza A.

Flu virus can cause illnesses from mild to severe, life-threatening complications. The flu infects about 10 percent to 20 percent of U.S. residents each year, and flu-related complications hospitalize an average of 114,000 and kill 36,000 annually, the CDC says.

Symptoms include fever (usually high), headache, tiredness, dry cough, sore throat, runny or stuffy nose, and muscle aches. Gastrointestinal symptoms, such as nausea, vomiting, and diarrhea, are more common among children than adults.

Flu spreads from person to person mainly in respiratory droplets of coughs and sneezes. Along with vaccines and prescription antiviral medication, the CDC recommends these steps to help prevent spread of flu:

• Avoid close contact with people who are sick. When you're sick, keep your distance from others to protect them. If possible, avoid work, school and errands when you're sick to help prevent others from catching your illness.
• Cover your mouth and nose with a tissue when coughing or sneezing.
• Wash your hands often to help protect you from germs.
• And avoid touching your eyes, nose or mouth. Doing so can spread germs.

More information

For more on the flu, check with the Centers for Disease Control and Prevention or the American Lung Association.

(SOURCES: John Belko, M.D., chief of pediatric infectious disease, Long Island College Hospital, New York; Tom Skinner, spokesman, Centers for Disease Control and Prevention, Atlanta; Jan. 30, 2004, Morbidity and Mortality Weekly Report)

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