While the first wave of influenza has apparently subsided, area health professionals are now warning of a second peak likely to arrive in late January or February.
Recent figures indicate a possible uptick in cases, according to Elizabeth Healy, the infection preventionist at Avera Sacred Heart Hospital (ASHH) in Yankton.
“Yankton County has remained relatively low for influenza numbers,” she said. “But since influenza continues to rise and has not peaked, healthcare providers know our influx of patients and cases may still be coming.”
The number of flu-related hospitalizations has increased in recent days, Healy said.
“Avera Sacred Heart Hospital saw a cluster of hospitalizations early in the fall, and now, we’re seeing more hospitalizations as well,” she said.
The Yankton region has reflected national reports of a mutated strain of Influenza A (H3N2) this year, Healy said.
“Mutations are very normal for influenza, as it’s notorious for throwing curveballs,” she said.
“But this year’s changes were more substantial than usual — not enough to spark a pandemic, but enough to fuel a severe season. The timing of this mutation was also terrible, as it was after the flu vaccine formula was finalized in February (2025).”
In Hutchinson County, the Parkston area may be experiencing a rise in flu cases, according to Lindsay Weber, president and CEO of Avera St. Benedict Health Center.
She cited a recent finding for her hospital.
“Our testing positivity rate was 12%, and we have had one hospitalization,” she said. “However, we are hearing reports around the community of progressing illness, and we do anticipate more cases in the next week.”
Hutchinson County currently shows slightly fewer vaccinations this season compared to last year, according to South Dakota state epidemiologist Josh Clayton.
The flu season runs through May, and vaccination percentages are analyzed after the respiratory disease season, he added.
Earlier in the season, Hutchinson County reported a high positive test rate for flu, but the number of cases coming out of that finding was low because so few people were tested, he said.
Last month, the state Department of Health (DOH) reported its first two influenza deaths of the 2025-26 season. Both deaths were Minnehaha County residents who were age 65 or older.
An average of 40 South Dakotans’ deaths each year are reported as flu related, according to the state DOH.
The elderly and those with chronic health conditions are listed at higher risk if they contract the flu, but children are also vulnerable, Healy said.
“Children younger than 2 years old are also at an increased risk,” she said. “Nine influenza-associated pediatric deaths have already been reported in the United States.”
It’s not too late to receive a flu shot, but now is the time to do so, Healy said.
“Flu shots take about two weeks for full immunity, but as South Dakota usually peaks with flu in February and stretches into late March, there is still time to be protected,” she said. “Vaccination is your best defense against the flu.”
She also recommended staying at home and, if someone is sick, creating more ventilation in the home and wiping down commonly touched surfaces, such as doorknobs. Those who go out into the public can wear masks to protect themselves and others, she said.
“It is also important to stay active, such as going for a walk, getting quality sleep, avoiding alcohol and smoking, and eating healthy foods to protect your immune system during the winter months,” she said.
“You don’t need fancy, expensive supplements to stay healthy. When people are tired and stressed, they are more vulnerable to illnesses.”
Like South Dakota, two Nebraska health officials believe their influenza numbers are far higher than officially reported on the dashboard.
Colleen Hupke serves as executive health director of the Northeast Nebraska Public Health Department, which includes Cedar, Dixon, Thurston and Wayne counties.
“I was talking (this week) at a board meeting for our district. What we have for our numbers may be low compared to what it actually is,” she said.
“There are definitely more cases than officially recorded. I would estimate double or triple the number of cases that have been reported.”
The under-reporting could arise from various reasons, Hupke said.
In rural areas, hospitals and clinics may not have an electronic connection to the state for reporting data, or a positive flu test may not be reported for other reasons.
In other instances, flu patients may not go to the doctor or a clinic, she said. People may test themselves or their family members for results or just assume it’s the flu and remain at home for rest and recuperation, she added.
“We may have gotten away from the climate (of past years) where we’re not always testing like we did for COVID,” she said.
The northeast district has seen primarily Influenza A cases, Hupke said.
“It’s very similar in symptoms to other strains, but a lot of times it’s most likely a bit more severe, although Influenza B can also be severe,” she said. “People are feeling sicker than last year (with this particular strain).”
Influenza A often produces respiratory issues, headaches, congestion and coughing, Hupke said.
Those most at risk for complications with the flu are similar to COVID: people with underlying lung or heart conditions, the immuno-compromised and those with chronic conditions such as diabetes, cancer and asthma.
Hupke expects another round of flu ahead.
“We usually see it when we get to the end of January and into February,” she said. “That’s typically when it’s really cold and everybody stays indoors all the time. It’s also the basketball season when you get large crowds together indoors.”
In the North Central District Health Department, Elizabeth Parks sees similar – as well as different — flu aspects in what she called her “very rural and frontier area.”
Parks serves as the assistant director and public health nurse for the North Central Nebraska Health District. The cluster includes Antelope, Boyd, Brown, Cherry, Holt, Keya Paha, Knox, Pierce and Rock counties.
“Influenza A has been rising, which we see in the national trends, while Influenza B is pretty low numbers at this time,” she said.
Like her neighbors, Parks believes the actual flu numbers are much higher than officially reported, based on data such as school absentee numbers.
Her health district uses a unique method of collecting information – one station tracks wastewater that could provide an indication of disease-causing factors.
“Last week, influenza was trending in a direction we didn’t want to see,” she said.
The health district has seen patients with temperatures of 100 to 102 degrees, body aches, cough and fatigue, Parks said. Besides rest, she recommends electrolytes to help replace the lost sodium and potassium.
She expects a secondary peak in cases next month, following a downward trend after the holidays.
“Within the district, we’re seeing average rates so far, but we’re still in the early phases of it. During the next few weeks, if we get a more severe season, we hope we get through it,” she said.
“Luckily, we’re not seeing the figures that they’re experiencing nationally. Hopefully, we see nothing bad.”
States report “dash boards” with statistics for flu and other diseases. However, those figures may be lower than the actual figures.
“The difficult part sometimes about influenza is that people do not always seek medical care and laboratory tests, so the numbers may remain low on the state’s dashboard,” Healy said.
“But you hear about people missing work and kids missing school for several days due to illness. It’s assumed that it’s due to influenza.”
Also, the ASHH service area may lend itself to under-reporting cases, Healy said. The hospital serves a large geographical area, including surrounding South Dakota counties and parts of Nebraska.
As a result, the South Dakota Department of Health (DOH) website doesn’t always match what ASHH is seeing in its clinics and emergency departments, she added.
While the flu has grabbed headlines, COVID-19 remains a major concern, Healy said.
ASHH is currently seeing either the same or more cases of COVID compared to influenza, she said. People over 65 years old and those with co-morbidities are especially at risk for COVID.
COVID patients are experiencing different outcomes than before, Healy said. They don’t always present respiratory symptoms but may show significant weakness.
“COVID continues to remain a concern, and people at risk for complications should talk to their provider about a COVID vaccination,” she said.
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