The flu epidemic of 2017-2018 continues to be active in all states except Hawaii, according to the Centers for Disease Control and Prevention (CDC), and a spokesman says the flu season has not yet peaked, and it may not do so for “many more weeks.”

As of January 26, 37 children have died. There have been 11,965 confirmed cases of influenza-related hospitalizations since October 1. The number of actual cases may be much higher because many victims do not see a doctor and those who do see a doctor may not be tested.

“Hopefully, we are in the peak currently since the data is a week behind, or that it peaks soon,” Kristen Norlund, spokeswoman for the agency told CNN. “Regardless, there is a lot of flu activity happening across the country and likely many more weeks to come.”

Hospitalizations have risen every week and as of January 26, there are 41.9 per 100,000 people. Alicia Fry, MD, of the CDC, told ABC News,“More than 8 percent of all deaths in the country are from flu and pneumonia – the highest we’ve seen this year.”

This is the first flu season in the past 15 years in which all the mainland states have reported outbreaks or activity in the same week.

Dr. Dan Jernigan Director of the Influenza Division of the National Center for Immunization and Respiratory Disease at the agency, told CNN, Influenza “activity became widespread within almost all states and jurisdictions at the same time” and it “has now stayed at the same level . . . for three weeks in a row with 49 states reporting widespread activity for three weeks. We often see different parts of the country light up at different times, but in the past three weeks the entire country has been experiencing lots of flu all at the same time.”

During the 2014-2015 influenza season, the dominant strain of Influenza A was the H3N2 subtype which is active this year, but there are more hospitalizations and deaths now. According to Jernigan, no one knows how or when this season will end.

This year’s influenza vaccine has been estimated to be only 30 percent effective. However, it can lower the severity and shorten the duration of the illness. The CDC urges anyone who is not immunized to get the shot. Nordlund says, “It’s still not too late to get vaccinated, as we’re starting to see some Influenza A (H1N1) and Influenza B.” She said it is important for people to get early care if they think they have influenza or are at risk for complications. Anyone who is pregnant, over age 65 and children under five are at the most risk and should be immunized immediately if they have not had the shot.

Symptoms include persistent fever, muscle aches that don’t respond to over-the-counter medications, weakness, fatigue, dry cough, headache, runny nose, sore throat, warm flushed skin, and pain around the eyes. Influenza symptoms develop fast, unlike cold symptoms which have a more gradual onset. Medical attention is needed right away if someone has trouble breathing or shortness of breath, severe vomiting, chest pain and pressure, severe body pain, sudden dizziness, and confusion.

“Influenza and its complications disproportionately affect people who are 65 and older. They account for 80 percent of deaths,” according to Dr. William Schaffner, an infectious disease specialist at Vanderbilt University. Those with underlying illnesses such as heart and lung disease or diabetes are also at risk, whether over or under age 65.

There are three ways people succumb to influenza:

• Pneumonia is the most common cause of death. The virus causes the lungs to become inflamed leading to pneumonia.
• Sepsis is an overwhelming reaction by the immune system to the invading virus. Too many proteins called cytokines are created by the inflammatory process. It is a life-threatening response to an infection.
• The risk of a heart attack is elevated for 10 days or so after being exposed to the virus.

Children under age five are at higher risk and those under age one are particularly in danger. Children are likely to be the first in the family to bring it home because of school attendance and play activity with friends. Their immune systems have not developed completely, so immunizations are not as effective as they are with adults. They may develop secondary infections such as bacterial infections, pneumonia, ear infections, sinusitis, and meningitis. They are also prone to diarrhea and vomiting, which can lead to dehydration, another life-threatening condition. If the child recovers and then gets worse again, a bacterial infection may be setting in.

Rest, drink plenty of fluids, and avoid others is the general advice given. An anti-viral such as Tamiflu or Relenza should be taken within 48 hours of onset. However, there have been spotty reports of Tamiflu shortages around the country.

No one knows when this epidemic will end. Hopefully, the peak has been reached and the number of victims will taper off.