The Illawarra has recorded nearly 500 cases of influenza so far this year, potentially putting the region on track for its biggest flu season ever.
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According to NSW Health data, there have been 306 positive flu tests in the Illawarra Shoalhaven Local Health District already in May.
This is 16 per cent more than the number of cases found in all of May 2019, a particularly bad flu season, and almost 10 times the number of cases found in May 2017 - the worst year on record for flu cases and deaths in Australia.
The data also shows cases have been rising quickly this year, starting from a base of zero and then rising from just four cases in March to 166 cases in April.
With dozens of new cases being added daily, the total number of cases for May is on track to be well over double last month's figure.
Case numbers in 2019 followed a much steadier trajectory, roughly doubling each month until July, and the 2017 flu season didn't explode until mid-year.
ISLHD public health physician Dr Victoria Westley-Wise said the sharp rise in cases early in the season this year was concerning health officials.
"We've definitely got an early start to the flu season here, with a relatively high number of notifications and people going to the emergency departments and being hospitalised who have a flu-like illness," she said.
"Across the state those rates are really quite high, especially for this time of year and that is a real concern."
She said the proportion of flu tests turning up positive was increasing rapidly, as was the number of cases being recorded in the Illawarra each week.
"In NSW it was about five per cent of people tested who were positive a couple of week ago, but then last week it ramped up nearly double to 9.1 per cent," she said.
"Last week, we had 108 cases [in the Illawarra Shoalhaven], and the week before we had 87, and the week before that we had 47 - so it's more than a doubling in two weeks."
"The increase at the moment is very rapid - so where in the past we saw a doubling by month, this year we're talking about a doubling every week or two."
Dr Westley-Wise said Australia's closed borders and extra public health precautions due to the COVID-19 pandemic had mean there had been next to no flu in the past couple of years.
She said the removal of these measures, and a reduced immunity in the community were likely contributing to the higher numbers.
"We're very concerned about young kids getting very severe illness because they wouldn't have been exposed to any flu in their lifetime if they're less than about three-years-old," she said.
"Flu can be very serious, and you can get complications after the initial infection. People can need to be hospitalised and unfortunately people do die from flu."
Anyone over six months old is recommended to get the flu vaccine, but children under five and those over 65 are considered to be at very high risk and are offered a free vaccine.
Dr Westley-Wise said she did not know exact flu vaccine numbers for the region, but said the uptake of flu shots had been a little bit slow this year.
"Around this time of year is when we want people to start getting vaccinated," she said.
"With the data showing that the flu season has started earlier, people really need to get in there and get it now - the sooner the better."
"With winter coming up, we go inside more, we mix more indoors - and of course COVID hasn't gone away, so that's a concern."
COVID-19 cases - and deaths - continue to dwarf the influenza case numbers in the region, with the latest NSW Respiratory Surveillance Report showing almost 4000 people tested positive to coronavirus in the week ending May 7.
In that time there were three deaths from COVID-19 in the Illawarra Shoalhaven Local Health District.
In comparison, during the record breaking 2017 and 2019 flu seasons, the region's yearly case totals were 4883 and 4039 respectively.
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