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This season, the flu came early. The CDC has reported seeing more severe influenza, as well as cases stemming from a strain of the virus not included in the vaccine.

June Stanley, MSN, FNP, RN, knew this year's flu season would be bad when her first laboratory confirmation of influenza came Nov. 21.

"We usually don't see it until February," said Stanley, a nurse at the student health center at California Polytechnic State University, San Luis Obispo. "I felt so bad for the students, because this hit around midterms, and then they'd be going into finals."

Epidemiologists cannot draw broad conclusions about this year's flu until the season ends in the spring. Certainly, the situation seems worse: During the last week in December 2002, no states reported widespread flu activity. During the last week of December, 42 states reported widespread activity.

But nurses agree on at least one thing: This season, the flu came early. Around Thanksgiving, the CDC reported seeing more severe influenza, as well as cases stemming from a strain of the virus not included in the vaccine.

The CDC and media coverage kept the number of cases and severity of the flu in the public eye, said Pam Axelson, MSN, NP, RN, nurse manager of the Adult Immunization and Travel Clinic at the San Francisco Department of Public Health.

Soon, there was a run on the vaccine.

"We had lines around the building for about a week," Axelson said. "We had to have people from other offices in the health department come monitor the door. People waited in line three hours to get a flu shot."

By the end of the week, Dec. 12, her office had administered 5,000 doses and was officially out of vaccine.

"This will be the first year we've ever run out," she said. "Most years, we're getting rid of 2,000 doses at the end of the year."

Anecdotal evidence suggests this year's flu also may be more virulent.

For example, during December, Stanley and the health center staff administered IVs for dehydration from nausea and vomiting; treated gastroenteritis, high fever and cough; and remedied secondary acute infections like new colds and pneumonias.

"We had a lot of myalgias-where every little hair follicle hurts," she said. One patient came to the health center after an anatomy class. Between sessions of vomiting, he described pain at his "bifurcation of the main stem of the bronchia."

"He was right!" Stanley said.

Stanley also contracted the flu, despite a late vaccination. She suffers from asthma, and did not recover for two weeks.

Risk groups

As someone with a chronic medical condition, Stanley is at high risk for complications from the flu, according to the CDC. Adults older than 65-the population in which 90 percent of flu-related fatalities occur-pregnant women and children aged 6 months to 23 months make up the other three high-risk categories. The CDC recommends these people get the vaccine as a priority.

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