Science
California braces for early, sharper flu season as virus mutation outpaces vaccine, experts say
California could see an early start to the annual flu season, as a combination of low vaccination rates and late mutations to the virus may leave the state particularly exposed to transmission, health experts say.
Already, there are warning signs. Los Angeles County recently reported its first flu death of the season, and other nations are reporting record-breaking or powerful, earlier-than-expected flu seasons.
Typically, flu picks up right after Christmas and into the New Year, but Dr. Elizabeth Hudson, regional physician chief of infectious diseases at Kaiser Permanente Southern California, said she expects increases in viral activity perhaps over the next two to three weeks.
“We’re expecting an early and likely sharp start to the flu season,” Hudson said.
Last year’s flu season was the worst California had seen in years, and it’s not usual for there to be back-to-back bad flu seasons. But a combination of a decline in flu vaccination rates and a “souped-up mutant” is particularly concerning this year, according to Dr. Peter Chin-Hong, an infectious diseases expert at UC San Francisco.
“That may translate into more people getting infected. And as more people get infected, a proportion of them will go to the hospital,” Chin-Hong said.
The timing of this new flu subvariant — called H3N2 subclade K — is particularly problematic. It emerged toward the end of the summer, long after health officials had already determined how to formulate this fall’s flu vaccine, a decision that had to be made in February.
H3N2 subclade K seems to be starting to dominate in Japan and Britain, Hudson said.
“It looks like a bit of a mismatch between the seasonal flu vaccine strains” and the new subvariant, Hudson said.
It remains unclear whether subclade K will reduce the effectiveness of this year’s flu shot.
In California and the rest of the U.S., “things are quiet, but I think it’s just a calm before the storm,” Chin-Hong said. “From what we see in the U.K. and Japan, a lot more people are getting flu earlier.”
Chin-Hong noted that subclade K is not that much different than the strains this year’s flu vaccines were designed against. And he noted data recently released in Britain that showed this season’s vaccines were still effective against hospitalization.
According to the British government, vaccinated children were 70% to 75% less likely to need hospital care, and adults were 30% to 40% less likely. Flu vaccine effectiveness is typically between 30% to 60%, and tends to be more effective in younger people, the British government said.
Even if there is some degree of mismatch between the vaccine and circulating strains, “the flu vaccine still provides protection against severe illness, including hospitalizations,” according to the Los Angeles County Department of Public Health.
“Public Health strongly encourages everyone who has not received the flu vaccine yet this year to receive it now, especially before gathering with loved ones during the holidays,” the department said in a statement.
But “while mismatched vaccines may still provide protection, enhanced genetic, antigenic and epidemiological … monitoring are warranted to inform risk assessment and response,” according to scientists writing in the Journal of the Assn. of Medical Microbiology and Infectious Diseases Canada.
Because the vaccine is not a perfect match for the latest mutated flu strain, Chin-Hong said getting antiviral medication like Tamiflu to infected patients may be especially important this year, even for those who are vaccinated. That’s especially true for the most vulnerable, which include the very young and very old.
“But that means you need to get diagnosed earlier,” Chin-Hong said. Drugs like Tamiflu work best when started within one to two days after flu symptoms begin, the U.S. Centers for Disease Control and Prevention says.
There are now at-home flu testing kits that are widely available for sale for people who are showing signs of illness.
Also worrying is how the flu has surged in other countries.
Australia’s flu season came earlier this year and was more severe than usual. The Royal Australian College of General Practitioners said that nation saw a record flu season, with more than 410,000 lab-confirmed cases, up from the prior all-time high of 365,000 that were reported last year.
“This is not a record we want to be breaking,” Dr. Michael Wright, president of the physician’s group, said.
Hudson noted Australia’s flu season was “particularly hard on children” this year.
L.A. County health officials cautioned that Australia’s experience isn’t a solid predictor of what happens locally.
“It is difficult to predict what will happen in the United States and Los Angeles, as the severity of the flu season depends on multiple factors including circulating strains, pre-existing immunity, vaccine uptake, and the overall health of the population,” the L.A. County Department of Public Health said.
The new strain has also thrown a wrench in things. As Australia’s flu season was ending, “this new mutation came up, which kind of ignited flu in Japan and the U.K., and other parts of Europe and Asia,” Chin-Hong said.
On Friday, Japan reportedly issued a national alert with flu cases surging and hospitalizations increasing, especially among children and the elderly, accompanied by a sharp rise in school and class closures. The Japanese newspaper Asahi Shimbun said children ages 1 through 9 and adults 80 and up were among the hardest-hit groups.
Taiwanese health officials warned of the possibility of a second peak in flu this year, according to the Central News Agency. There was already a peak in late September and early October — a month earlier than normal — and officials are warning about an uptick in flu cases starting in December and then peaking around the Lunar New Year on Feb. 17.
Taiwanese officials said 95% of patients with severe flu symptoms had not been recently vaccinated.
British health officials this month issued a “flu jab SOS,” as an early wave struck the nation. Flu cases are “already triple what they were this time last year,” Public Health Minister Ashley Dalton said in a statement.
In England, outside of pandemic years, this fall marked the earliest start to the flu season since 2003-04, scientists said in the journal Eurosurveillance.
“We have to brace ourselves for another year of more cases of flu,” Chin-Hong said.
One major concern has been declining flu vaccination rates — a trend seen in both Australia and the United States.
In Australia, only 25.7% of children age 6 months to 5 years were vaccinated against flu in 2025, the lowest rate since 2021. Among seniors age 65 and up, 60.5% were vaccinated, the lowest rate since 2020.
Australian health officials are promoting free flu vaccinations for children that don’t require an injection, but are administered by nasal spray.
“We must boost vaccination rates,” Wright said.
In the U.S., officials recommend the annual flu vaccine for everyone age 6 months and up. Those age 65 and up are eligible for a higher-dose version, and kids and adults between age 2 and age 49 are eligible to get vaccinated via the FluMist nasal spray, rather than a needle injection.
Officials this year began allowing people to order FluMist to be mailed to them at home.
Besides getting vaccinated, other ways to protect yourself against the flu include washing your hands frequently, avoiding sick people and wearing a mask in higher-risk indoor settings, such as while in the airport and on a plane.
Healthy high-risk people, such as older individuals, can be prescribed antiviral drugs like Tamiflu if another household member has the flu, Chin-Hong said.
Doctors are especially concerned about babies, toddlers and young children up to age 5.
“Those are the kids that are the most vulnerable if they get any kind of a respiratory illness. It can really go badly for them, and they can end up extraordinarily ill,” Hudson said.
In the United States, just 49.2% of children had gotten a flu shot as of late April, lower than the 53.4% who had done so at the same point the previous season, according to preliminary national survey results. Both figures are well below the final flu vaccination rate for eligible children during the 2019-20 season, which was 63.7%.
Among adults, 46.7% had gotten their flu shot as of late April, slightly down from the 47.4% at the same point last season, according to the preliminary survey results, which are the most recent data available.
“Before the COVID-19 pandemic, flu vaccination coverage had been slowly increasing; downturns in coverage occurred during and after the pandemic. Flu vaccination levels have not rebounded to pre-pandemic levels,” according to the CDC.
The disparaging of vaccinations by federal health officials, led by the vaccine-skeptic secretary of the U.S. Department of Health and Human Services, Robert F. Kennedy Jr., has not helped improve immunization rates, health experts say. Kennedy told the New York Times on Thursday that he personally directed the CDC to change its website to abandon its position that vaccines do not cause autism.
Mainstream health experts and former CDC officials denounced the change. “Extensive scientific evidence shows vaccines do not cause autism,” wrote Daniel Jernigan, Demetre Daskalakis and Debra Houry, all former top officials at the CDC, in an op-ed to MS NOW.
“CDC has been updated to cause chaos without scientific basis. Do not trust this agency,” Daskalakis, former director of the CDC’s National Center for Immunization and Respiratory Diseases, added on social media. “This is a national embarrassment.”
State health officials from California, Washington, Oregon and Hawaii on Friday called the new claims on the CDC website inaccurate and said there are decades of “high quality evidence that vaccines are not linked to autism.”
“Over 40 high-quality studies involving more than 5.6 million children have found no link between any routine childhood vaccine and autism,” the L.A. County Department of Public Health said Friday. “The increase in autism diagnoses reflects improved screening, broader diagnostic criteria, and greater awareness, not a link to vaccines.”
Hudson said it’s important to get evidence-based information on the flu vaccines.
“Vaccines save lives. The flu vaccine in particular saves lives,” Hudson said.
The sun had barely risen over the Pacific Ocean when a small motorboat carrying a team of Indigenous artisans and Mexican biologists dropped anchor in a rocky cove near Bahías de Huatulco.
Mauro Habacuc Avendaño Luis, one of the craftsmen, was the first to wade to shore. With an agility belying his age, he struck out over the boulders exposed by low tide. Crouching on a slippery ledge pounded by surf, he reached inside a crevice between two rocks. There, lodged among the urchins, was a snail with a knobby gray shell the size of a walnut. The sight might not dazzle tourists who travel here to see humpback whales, but for Mr. Avendaño, 85, these drab little mollusks represent a way of life.
Marine snails in the genus Plicopurpura are sacred to the Mixtec people of Pinotepa de Don Luis, a small town in southwestern Oaxaca. Men like Mr. Avendaño have been sustainably “milking” them for radiant purple dye for at least 1,500 years. The color suffuses Mixtec textiles and spiritual beliefs. Called tixinda, it symbolizes fertility and death, as well as mythic ties between lunar cycles, women and the sea.
The future of these traditions — and the fate of the snails — are uncertain. The mollusks are subject to intense poaching pressure despite federal protections intended to protect them. Fishermen break them (and the other mollusks they eat) open and sell the meat to local restaurants. Tourists who comb the beaches pluck snails off the rocks and toss them aside.
A severe earthquake in 2020 thrust formerly submerged parts of their habitat above sea level, fatally tossing other mollusks in the snail’s food web to the air, and making once inaccessible places more available to poachers.
Decades ago, dense clusters of snails the size of doorknobs were easy to find, according to Mr. Avendaño. “Full of snails,” he said, sweeping a calloused, violet-stained hand across the coves. Now, most of the snails he finds are small, just over an inch, and yield only a few milliliters of dye.
new video loaded: This Parrot Has No Beak, But Is at the Top of the Pecking Order
By Meg Felling and Carl Zimmer
April 20, 2026
For months now, menopausal women across the U.S. have been unable to fill prescriptions for the estradiol patch, a long-established and safe hormone treatment. The news media has whipped up a frenzy over this scarcity, warning of a long-lasting nationwide shortage. The problem is real — but the explanations in the media coverage miss the mark. Real solutions depend on an accurate understanding of the causes.
Reporters, pharmaceutical companies and even some doctors have blamed women for causing the shortage, saying they were inspired by a “menopause moment” that has driven unprecedented demand. Such framing does a dangerous disservice to essential health advocacy.
In this narrative, there has been unprecedented demand, and it is explained in part by the Food and Drug Administration’s recent removal of the “black-box warning” from estradiol patches’ packaging. That inaccurate (and, quite frankly, terrifying) label had been required since a 2002 announcement overstated the link between certain menopause hormone treatments and breast cancer. Right-sizing and rewording the warning was long overdue. But the trouble with this narrative is that even after the black-box warning was removed, there has not been unprecedented demand.
Around 40% of menopausal women were prescribed hormone treatments in some form before the 2002 announcement. Use plummeted in its aftermath, dipping to less than 5% in 2020 and just 1.8% in 2024. According to the most recent data, the number has now settled back at the 5% mark. Unprecedented? Hardly. Modest at best.
Nor is estradiol a new or complex drug; the patch formulation has existed for decades, and generic versions are widely manufactured. There is no exotic ingredient, no rare supply chain dependency, no fluke that explains why women are suddenly being told their pharmacy is out of stock month after month.
The story is far more an indictment of the broken insurance industry: market concentration, perverse incentives and the consequences of allowing insurance companies to own the pharmacy benefit managers that effectively control drug access for the majority of users. Three companies — CVS Caremark, Express Scripts and OptumRx — manage 79% of all prescription drug claims in the United States. Those companies are wholly owned subsidiaries of three insurance behemoths: CVS Health, Cigna and UnitedHealth Group, respectively. This means that the same corporation that sells you your insurance plan also decides which drugs get covered, at what price, and whether your pharmacy can stock them. This is called vertical integration. In another era, we might have called it a cartel. The resulting problems are not unique to hormone treatments; they have affected widely used medications including blood thinners, inhalers and antibiotics. When a low-cost generic such as estradiol — a medication with no blockbuster profit margins and no patent protection — runs into friction in this system, the friction is not random. It is structural. Every decision in that chain is filtered through the same corporate profit motive. And when the drug in question is an off-patent estradiol patch that has negligible profit margins because of generic competition but requires logistical investment to keep consistently in stock? The math on “how much does this company care about ensuring access” is not complicated.
Unfortunately, there is little financial incentive to ensure smooth, consistent access. There is, however, significant financial incentive to steer patients toward branded alternatives, or simply to let supply tighten — because the companies aren’t losing much profit if sales of that product dwindle. This is not a conspiracy theory: The Federal Trade Commission noted this dynamic in a report that documented how pharmacy benefit managers’ practices inflate costs, reduce competition and harm patient access, particularly for independent pharmacies and for generic drugs.
Any claim that the estradiol patch shortage is meaningfully caused by more women now demanding hormone treatments is a distraction. It is also misogyny, pure and simple, to imply that the solution to the shortage is for women’s health advocates to dial it down and for women to temper their expectations. The scarcity of estradiol patches is the outcome of a broken system refusing to provide adequate supply.
Meanwhile, there are a few strategies to cope.
- Ask your prescriber about alternatives. Estradiol is available in multiple formulations, including gel, spray, cream, oral tablet, vaginal ring and weekly transdermal patch, which is a different product from the twice-weekly patch and may be more consistently available depending on manufacturer and region.
- Consider an online pharmacy. Many are doing a good job locating and filling these prescriptions from outside the pharmacy benefit manager system.
- Call ahead. Patch shortages are inconsistent across regions and distributors. A call to pharmacies in your area, or a broader geographic radius if you’re able, can locate stock that your regular pharmacy doesn’t have.
- Consider a compounding pharmacy. These sources can sometimes meet needs when commercially manufactured products are inaccessible. The hormones used are the same FDA-regulated bulk ingredients.
Beyond those Band-Aid solutions, more Americans need to fight for systemic change. The FTC report exists because Congress asked for it and committed to legislation that will address at least some of the problems. The FDA took action to change the labeling on estrogen in the face of citizen and medical experts’ pressure; it should do more now to demand transparency from patch manufacturers.
Most importantly, it is on all of us to call out the cracks in the current system. Instead of repeating “there’s a patch shortage” or a “surge in demand,” say that a shockingly small minority of menopausal women still even get hormonal treatments prescribed at all, and three drug companies control the vast majority of claims in this country. Those are the real problems that need real solutions.
Jennifer Weiss-Wolf, the executive director of the Birnbaum Women’s Leadership Center at New York University School of Law, is the author of the forthcoming book “When in Menopause: A User’s Manual & Citizen’s Guide.” Suzanne Gilberg, an obstetrician and gynecologist in Los Angeles, is the author of “Menopause Bootcamp.”
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