Andrea Coker knew something was wrong last week as soon as her son woke up. The thermometer confirmed it – a fever of 105.7 degrees.

“I’d never seen a fever that high before,” said the Harford County mother, who was so alarmed she took her 13-year old son Ethan to the emergency room. She learned that he — and a bit later, his 15-year-old brother Liam — had the flu. “We got hit very hard.”

The Cokers’ children could be a warning, as Maryland’s annual flu season is returning in earnest, with a new variant and lower vaccination rate that could make the next few months an especially miserable time, experts warn.

Influenza, particularly influenza A, is characterized by fever plus congestion and lethargy. Doctors and health officials say infections likely gained a foothold during Thanksgiving gatherings and are being fueled by the same new flu variant behind the current surge in Europe.

The experts predict flu infections will rise for six to eight more weeks, making for another bad flu season just after the last particularly terrible one for kids.

Seven children died in Maryland last year and 288 died nationwide. That was the most in a regular flu season since national tracking began in 2004, reflecting a resurgent post-COVID virus and fewer vaccinated people.

Health experts say vaccinations have only dropped further this season. That’s likely in part due to critical and evolving federal guidance for vaccines for respiratory infections like flu and COVID-19. Experts also see a range of threats, including public health funding cuts and the dismantling of U.S. and international bodies that work to prevent infectious diseases.

“I see a perfect storm for vaccine-preventable diseases,” said Dr. William Moss, professor in epidemiology and executive director of the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health.

With flu, experts are watching a variant called subclade K that is responsible for most current cases, said Andrew Pekosz, an influenza researcher and professor of immunology also at the Johns Hopkins Bloomberg School.

It’s too soon to say if it’s actually leading to more severe cases, said Pekosz. He and other experts say vaccination may not prevent infections by the variant, but will likely make cases less severe.

The CDC still recommends everyone 6 months and older be vaccinated for flu, though uptake is dropping even in Maryland. Records show only about a quarter of the state has been vaccinated this season, compared with about a third last season.

“Vaccines work; nothing about the science has changed,” said Dr. Theresa Nguyen, chair of pediatrics at Greater Baltimore Medical Center in Towson.

She said lately she’s been having more conversations with parents about the safety and efficacy of the flu and COVID vaccines and the preventive treatment for RSV, though flu is the only respiratory illness currently flooding the emergency room and her office.

Officially, flu cases in Maryland remain low, but data collected by the Maryland Department of Health lags by more than a week, and Nguyen expects the dashboard to catch up. Data is based on voluntary reporting of flu-like symptoms in patients at hospitals, urgent care or doctors’ offices.

Last year, that system found flu led to 8,133 hospitalizations and 215 adult and 7 pediatric deaths in Maryland, but the total number of cases can be difficult to track because most ill people never get tested or seek medical care.

Coker, a Baltimore County teacher, says her class also has been hard-hit. And while she’s sympathetic to their discomfort and their parents’ need to work, she’s still hoping families spare the rest of the class by following the rules to stay home when sick. Children must be fever-free for 24 hours and alert before returning to school.

She’s also counting on her vaccination to help her stay healthy this season after tending to her kids.

“I can literally feel air on my face whenever the children cough,” Coker said.

For those children who develop flu symptoms, experts say:

• Use acetaminophen or ibuprofen to control high fevers;
• Encourage kids to drink to stay hydrated;
• Stay home while sick;
• Avoid the emergency room unless the fever doesn’t subside or the child has trouble breathing or has asthma or another serious condition;
• And seek a prescription within 48 hours of symptoms for Tamiflu, an antiviral, for those at risk for complications.