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The 13 Worst Places in America for Flu in 2018

While predicting where the flu will strike is tricky business, experts tend to look to the previous season to predict that next—and last year's outbreak was a doozy. Here's where the flu struck early and spread widely last year.

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Predicting the flu

Scientists make predictions about the flu long before flu season even hits, including:

  • Which strains of the “influenza virus” are most likely to spread and cause illness in the upcoming flu season(so that vaccines can be developed to protect against the top three or four) and
  • Where people will be hit hardest (both in terms of numbers of illnesses and severity of illness).

They’re able to make their educated guesses using information from surveillance centers around the world, which analyze flu virus samples from patients. Here’s what else you need to know about the flu.

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Last year was one of the worst in years

Scientists predicted last year’s flu season would be the worst in years. They were right. The Centers for Disease Control and Prevention (CDC) characterized the 2017-2018 influenza season as “high severity” based on the number of people visiting doctors and hospitals with flu-like illness, hospitalizations for flu, and geographical concentrations of flu in various regions. Because flu predictions are made based on the previous season, many medical experts worry that this year could be even worse.

Sick businesswoman with seasonal winter flu blowing her nose in a tissue as she sits at her desk in a warm thick woollen scarfstockfour/Shutterstock

Guess what’s coming this season…

While the CDC can’t yet make an official prediction regarding this flu season’s severity, they can say, based on prior years’ reports, that flu activity will most likely increase starting in October and November and peak between December and February, although flu has been reported as late as May. As far as where flu will hit the hardest and when, the CDC recommends looking at last season’s “FluView” interactive state-by-state, week-by-week flu report. FluView is updated for the public between early October and late May, although flu surveillance continues all year long at surveillance centers. Here are some observations that may be worth noting.

Couple sick at home on the

No state is “safe”

Flu activity was so widespread last season that in mid-January, the CDC held a briefing on the topic, during which it was stated that “flu is everywhere in the United States…. and this is the first year [in over a decade] we had the entire continental United States” showing widespread flu activity all at the same time. Here’s what not to do if you want to make sure your flu vaccine is effective.

A woman suffering from flu in

The first places to get hit: Hawaii, Oklahoma

Hawaii and Oklahoma were the first states to report flu outbreaks: Their first reports were for the week ending October 10, 2017—week one of the flu season. Here are the myths that you shouldn’t believe about flu vaccines.

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Next in line: Oregon, Massachusetts, Iowa, Alabama, South Carolina, and Georgia

In the second and third weeks of the 2017-2018 flu season, Oklahoma and Hawaii were joined by these states in reporting local flu outbreaks. However, the following week, none of those states had local or regional outbreaks, and only Georgia and Iowa reported local flu activity.


Many coastal areas had early trouble

  • By mid-January: All of the New England states, all the Mid-Atlantic states, and all of the Pacific coast states were reporting flu activity, with widespread cases hitting Massachusetts.
  • By late January: Only 11 states weren’t reporting flu activity, five in the Southeast (West Virginia, Mississippi, Louisiana, Georgia, and Tennessee) along with Kansas, Missouri, Nebraska, South Dakota, Montana, and Wisconsin.
  • By late February: The lone holdout was West Virginia.
Sick woman checking the result of the thermometertommaso79/Shutterstock

The first areas to report widespread flu

In the last week of December, North Carolina reported that flu was widespread across the state, followed by Maryland, Massachusetts, California, and Iowa.

healthcare, medicine, flu and treatment concept - cup of tea, paper wipes and thermometer with pillsSyda Productions/Shutterstock

The first states to taper off

Widespread flu outbreaks continued to hit all states throughout March; the first ones to show a decline in cases included: West Virginia, Alabama, Mississippi, Florida, Indiana, and Georgia. Here’s how you might be making your flu (or cold) even worse.

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Relatively speaking, the safest state is Hawaii

Hawaii’s 2017-2018 flu season was significantly less severe than the national average, as you can see on the graph regarding influenza-like-illness reports in Hawaii: Although the state reported sporadic cases throughout the season and had the longest flu season of any state, Hawaii also had the fewest cases. Even more remarkable: Hawaii had fewer deaths from flu and zero flu deaths of children. By comparison, there were 172 pediatric flu deaths across the country during the season, the highest number in years. Tragically, 80 percent of those deaths could have been prevented with a flu vaccine; the CDC recommends a flu shot for everyone over six months of age. Next, read about the surprising ways you can prevent the flu.

Lauren Cahn
Lauren Cahn is a New York-based writer whose work has appeared regularly on Reader's Digest, The Huffington Post, and a variety of other publications since 2008. She covers health, fitness, yoga, and lifestyle, among other topics. An author of crime fiction, Lauren's book The Trust Game, was short-listed for the 2017 CLUE Award for emerging talent in the genre of suspense fiction.