updated 2/2/2009 1:09:52 PM ET 2009-02-02T18:09:52

Flu season is making a slow start this winter, with widespread illness in only two states — Virginia and New Jersey.

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"It's been kind of a ho-hum year," Dr. Nancy Cox, influenza chief at the Centers for Disease Control and Prevention, told a meeting of flu specialists Monday.

But don't get complacent: Influenza usually ramps up in February, long after many people have forgotten the fall's campaigns to get vaccinated. Last year, there was even a spike in March.

Indeed, while doctor visits for flu-like symptoms have been below normal all season, they did inch up each week in January, CDC data shows. Also, 14 states are reporting what CDC calls "regional activity," meaning flu is making people sick, just not as many statewide as is usual.

Concerns about flu fatique
Seasonal flu aside, specialists have another worry — bird flu: The global recession could threaten work to keep the deadly H5N1 strain in check in birds, which in turn limits its spread to people.

Last year, the World Health Organization recorded 44 human cases of H5N1, down from 88 the previous year. While bird flu's intensity can vary from year to year, the drop does reflect better control of the disease in poultry, from monitoring for infected birds worldwide to China's massive poultry vaccinations, said the WHO's Dr. Keiji Fukuda.

But China is experiencing what Fukuda called a spurt of bird flu that has sickened eight people in the past month, six of them in provinces that hadn't reported outbreaks among poultry.

While bird flu remains hard for people to catch, it has killed 254 people worldwide since 2003. Scientists have long warned that if not controlled in birds, it could mutate into an easier-to-spread form and possibly trigger the next influenza pandemic.

Fukuda warned against letting "flu fatigue" from years of pandemic preparations combine with the recession for cutbacks in key H5N1 control programs.

"There is some danger of backsliding among a number of countries," he said Monday.

The WHO still considers a pandemic "a matter of when," not if, Fukuda added, saying countries must keep watch for other new flu strains besides H5N1. Just in the last six weeks, two cases of people catching swine flu have been reported, one in South Dakota and one in Spain.

Copyright 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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