The Centers for Disease Control (CDC) says the level of H1N1 activity across the United States has dropped for the fourth straight week, indicating that the second wave of H1N1 in the United States has peaked.

In its weekly update on flu activity, the CDC reported that:

• The number of states experiencing widespread flu cases during the week that ended Nov. 21 had fallen to 32, down from 43 states the week before and a high of 48 states in late October.
• Influenza-like illnesses accounted for 4.3 percent of all visits to doctor's offices during the week, down from nearly double that proportion in October.

Yet, officials warned that the number of people getting infected with the H1N1 virus remains high, and cases could surge again. Therefore, federal health officials are trying to avoid creating the impression that the outbreak is over.

"We're far from being out of the woods," said Thomas Skinner, spokesman for the CDC. "There's still a lot of flu out there. And we wouldn't be surprised to see another uptick in activity as we approach the end of December and beginning of January, when kids come back from Christmas break."

Other experts argue that if there is another surge, it will be relatively mild because most people will have either been exposed to the virus or will have received the H1N1 vaccine.

Thus, federal officials urge people to continue seeking the H1N1 vaccine, despite the current drop in H1N1 influenza cases. According to a Dec. 1 article in the Washington Post, more than 60 million doses of vaccine have become available and officials are predicting millions more will be shipped to states in the coming weeks.

In the meantime, people should protect themselves by:

• Covering your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. If you don’t have a tissue, cough or sneeze into your elbow or shoulder; not into your hands.
• Disinfecting surfaces by wiping them down with a disinfectant according to the directions on the product label.
• Washing your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.
• Avoiding touching your eyes, nose or mouth. Germs spread this way.
• If you are sick with flu-like illness (fever with sore throat and/or cough), CDC recommends staying home for at least 24 hours after your fever is gone except to get medical care or for other necessities.

For more on stopping the spread of H1N1, please visit www.fluandhealth.com or the CDC’s H1N1 information page.

(Ralph Morris, M.D., M.P.H., is a preventive health and public health physician, and a member of the Water Quality and Health Council)

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