Southern states are grappling with an early jump in flu cases, public health officials reported this week.

“This is the earliest regular flu season we’ve had in nearly a decade, since the 2003-2004 flu season,” said Thomas Frieden, M.D., the director of the Centers for Disease Control and Prevention in a conference call Monday.

Tennessee, Mississippi, Alabama, Louisiana and Texas have reported high levels of flu activity, officials said. During flu season, the peak times generally come after the year-end holidays, or even as late as February or March. The earlier beginning of the season means that many adults who may have it on their “to-do” list haven’t received the vaccine yet.

While around 48% of those over six months of age received a flu shot last year, it’s estimated up to 90% of healthcare workers opt for the vaccine, officials said, though that percentage is widely recognized as significantly lower in long-term care settings.

Around 24,000 Americans die each year from complications from the flu, according to the CDC.