Why Early Pregnancy Feels Like the Flu (and How to Tell the Difference From Actual Illness)

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> Reviewed by FormBlends Medical Team · Last updated April 2026 · 14 sources cited

Key Takeaways

• Progesterone elevation in early pregnancy causes fatigue, low-grade temperature increases, nasal congestion, and body aches that closely mimic viral illness
• About 60% of pregnant women report flu-like symptoms in weeks 4 to 8, peaking around week 6 when progesterone levels rise fastest
• Real influenza during pregnancy carries serious risks (hospitalization rate 4x higher than non-pregnant adults), making accurate diagnosis critical
• Fever above 100.4°F (38°C) is NOT a normal pregnancy symptom and requires same-day medical evaluation

Direct answer (40-60 words)

Early pregnancy triggers progesterone surges that raise basal body temperature, suppress immune signaling, increase nasal blood flow, and cause widespread inflammation. The combination produces fatigue, congestion, mild body aches, and low-grade warmth that feel identical to early viral illness. Most symptoms peak at 6 to 8 weeks and improve by week 12 as the body adapts.

Table of contents

1. The hormone-immune mechanism: why pregnancy mimics infection
2. The clinical pattern: which symptoms appear when
3. What most articles get wrong about "pregnancy flu"
4. Symptom-by-symptom breakdown: pregnancy vs actual flu
5. The decision tree: when flu-like symptoms mean real illness
6. Medications safe and unsafe during early pregnancy
7. The GLP-1 complication: pregnancy symptoms on weight-loss medications
8. When to call your provider (same-day vs emergency criteria)
9. The immune suppression question: are you actually more vulnerable?
10. FAQ
11. Sources

The hormone-immune mechanism: why pregnancy mimics infection

The "flu-like" sensation in early pregnancy comes from three overlapping physiological changes, all driven by the same hormone cascade that maintains the pregnancy.

1. Progesterone-induced temperature elevation.

Progesterone rises from 1 to 2 ng/mL pre-pregnancy to 10 to 29 ng/mL by week 6, then continues climbing to 50+ ng/mL by week 12 (Csapo et al., American Journal of Obstetrics and Gynecology 1973). Progesterone acts directly on the hypothalamic thermoregulatory center, raising basal body temperature by 0.5 to 1.0°F above pre-pregnancy baseline.

This is the same mechanism fertility tracking relies on: the temperature shift after ovulation confirms progesterone production. In pregnancy, the shift persists instead of dropping before menstruation. The sustained elevation feels like low-grade fever, especially in the evening when core temperature naturally peaks.

The key distinction: progesterone-induced warmth stays below 100.4°F (38°C). Anything higher suggests infection, not hormonal change.

2. Immune system recalibration.

Pregnancy requires partial immune suppression to prevent rejection of the fetus, which is genetically half foreign tissue. The shift happens through changes in T-helper cell balance, specifically a Th1-to-Th2 shift (Wegmann et al., Immunology Today 1993).

Th1 cells produce pro-inflammatory cytokines (IL-2, IFN-gamma, TNF-alpha) that fight intracellular pathogens but also attack foreign tissue. Th2 cells produce anti-inflammatory cytokines (IL-4, IL-10) that tolerate foreign antigens but are less effective against viruses.

The Th2 shift is protective for the pregnancy but creates a cytokine profile similar to early viral infection: elevated IL-6, increased acute-phase proteins, generalized inflammation. The body interprets this as mild systemic illness, triggering fatigue, malaise, and muscle aches.

The pattern is measurable. A 2011 study in Journal of Reproductive Immunology (Kraus et al.) found IL-6 levels 40% higher in pregnant women at 6 weeks compared to non-pregnant controls, with levels correlating directly to fatigue severity scores.

3. Vascular and mucous membrane changes.

Estrogen rises in parallel with progesterone, increasing blood volume by 40 to 50% across pregnancy (Bernstein et al., Obstetrics & Gynecology 2001). The expansion starts in the first trimester, causing:

• Nasal mucosa engorgement (pregnancy rhinitis), producing congestion identical to viral upper respiratory infection
• Increased capillary permeability, causing mild tissue swelling
• Sinus pressure from increased blood flow to facial vasculature

About 30% of pregnant women develop pregnancy rhinitis severe enough to interfere with sleep (Ellegård et al., Clinical and Experimental Allergy 2000). It feels exactly like a head cold but produces clear discharge, not the yellow or green mucus typical of bacterial infection.

The clinical pattern: which symptoms appear when

The timeline of flu-like symptoms follows the progesterone curve, not a viral incubation pattern.

Gestational week	Progesterone level (ng/mL)	Most common symptoms	Symptom severity
4 (missed period)	10-15	Mild fatigue, breast tenderness	Mild
5	15-20	Fatigue, warmth, early nausea	Moderate
6	20-29	Peak fatigue, body aches, congestion, nausea	Severe
7-8	25-35	Sustained fatigue, ongoing congestion	Moderate to severe
9-10	35-45	Gradual improvement in fatigue, persistent nausea	Moderate
11-12	45-60	Most fatigue resolved, nausea improving	Mild
13+ (second trimester)	Placenta takes over production	Energy returns for most women	Minimal

The pattern that distinguishes pregnancy from flu: symptoms build gradually over 2 to 3 weeks, plateau, then slowly improve. Influenza hits suddenly (onset over 6 to 12 hours), peaks at 24 to 48 hours, then resolves over 5 to 7 days.

If you felt fine Tuesday and completely exhausted Wednesday, that's more consistent with viral illness. If fatigue built slowly over 10 days and has stayed constant for 2 weeks, that's more consistent with early pregnancy.

What most articles get wrong about "pregnancy flu"

The term "pregnancy flu" appears across patient education websites, but it's medically imprecise in a way that causes real harm. The error: conflating normal pregnancy symptoms with actual influenza risk.

The misconception: "Pregnancy flu is a harmless early pregnancy symptom that goes away on its own."

Why it's dangerous: Actual influenza during pregnancy is a medical emergency. Pregnant women are 4 times more likely to be hospitalized with flu complications compared to non-pregnant women of the same age (Rasmussen et al., Influenza and Other Respiratory Viruses 2012). The risk is highest in the third trimester but present throughout pregnancy.

The 2009 H1N1 pandemic data is stark: pregnant women represented 5% of all flu deaths despite being only 1% of the population (Siston et al., Obstetrics & Gynecology 2010). The mortality rate was 7.7 per 100,000 pregnant women compared to 0.6 per 100,000 in the general population.

The physiological reason: the Th2 immune shift that prevents fetal rejection also impairs antiviral defense. Pregnant women clear influenza virus more slowly, develop higher viral loads, and progress to pneumonia faster than non-pregnant adults.

The correction: Flu-like symptoms from hormonal changes are normal. Actual influenza is a serious threat. The distinction matters, and the decision tree below provides the criteria to tell them apart.

The second error in popular content: overstating the "pregnancy glow" narrative while understating how miserable early pregnancy actually feels for most women. A 2016 meta-analysis in BMC Pregnancy and Childbirth (Lacasse et al.) found 70% of pregnant women report moderate to severe fatigue in the first trimester, with 40% describing it as the most debilitating symptom of pregnancy.

Normalizing the experience is important. Telling women they should feel "glowing" when they actually feel like they have mono creates unnecessary anxiety.

Symptom-by-symptom breakdown: pregnancy vs actual flu

Symptom	Early pregnancy pattern	Influenza pattern	Key distinguishing feature
Fatigue	Gradual onset over 1-2 weeks, constant, improves with rest but returns quickly	Sudden onset, severe, accompanied by weakness that prevents normal activity	Flu fatigue is incapacitating; pregnancy fatigue is profound but functional
Body temperature	Basal temp elevated 0.5-1.0°F, feels warm but not feverish, no chills	Fever 100.4°F+, often 102-104°F, with rigors and chills	Actual fever (100.4°F+) is NOT a pregnancy symptom
Body aches	Mild, diffuse, worse in lower back and pelvis, improves with position change	Severe myalgia, especially legs and back, does not improve with rest	Flu aches are described as "bones hurting"
Nasal congestion	Clear discharge, worse at night, no facial pain, lasts weeks to months	Yellow/green discharge after 2-3 days, facial pressure, resolves in 7-10 days	Pregnancy rhinitis produces clear mucus only
Headache	Mild, frontal, related to hydration and blood sugar, improves with eating	Severe, retro-orbital, photophobia, does not improve with food	Flu headache is often described as "worst headache of my life"
Nausea	Gradual onset, worse with empty stomach, improves with small frequent meals, lasts weeks	Sudden onset, often with vomiting, improves in 24-48 hours	Pregnancy nausea is food-triggered; flu nausea is constant
Onset pattern	Symptoms build over 5-10 days	Symptoms appear within 6-12 hours	Sudden onset strongly suggests infection
Duration	Weeks to months (typically peaks week 6-8, improves week 12+)	5-7 days for acute phase	Symptoms lasting >2 weeks without improvement suggest pregnancy, not flu

The single most reliable distinguishing feature: fever. Progesterone raises basal body temperature but never above 100.4°F. If you measure 100.4°F or higher on an oral thermometer, you have an infection, not pregnancy symptoms.

The decision tree: when flu-like symptoms mean real illness

Use this framework to decide whether your symptoms require medical evaluation.

START: You have flu-like symptoms and suspect early pregnancy.

Question 1: Do you have measured fever ≥100.4°F (38°C)?

• YES → Call your provider same day. Fever is not a normal pregnancy symptom.
• NO → Continue to Question 2.

Question 2: Did symptoms start suddenly (over 6-12 hours)?

• YES → High suspicion for viral illness. Continue to Question 3.
• NO (gradual onset over days to weeks) → More consistent with pregnancy. Continue to Question 4.

Question 3: Do you have respiratory symptoms (cough, shortness of breath, chest pain)?

• YES → Call your provider same day. Influenza or other respiratory infection likely.
• NO → Continue to Question 4.

Question 4: Can you perform normal daily activities despite fatigue?

• NO (bedbound, unable to work, severe weakness) → Call your provider within 24 hours.
• YES (tired but functional) → Consistent with early pregnancy. Continue to Question 5.

Question 5: Have symptoms been stable or worsening for >14 days?

• WORSENING → Call your provider within 48 hours.
• STABLE or IMPROVING → Consistent with normal early pregnancy. Monitor at home with the following red flags.

RED FLAGS requiring same-day contact:

• Fever ≥100.4°F at any point
• Vomiting more than 3 times in 24 hours
• Unable to keep down liquids for >12 hours
• Severe headache with vision changes
• Severe abdominal pain
• Vaginal bleeding
• Dizziness or fainting

RED FLAGS requiring emergency care:

• Difficulty breathing or shortness of breath at rest
• Chest pain
• Confusion or altered mental status
• Severe dehydration (no urination for >12 hours, dark urine, dry mouth)
• Coughing up blood

Medications safe and unsafe during early pregnancy

Most women reach for over-the-counter medications when they feel flu-like symptoms. The safety profile changes dramatically in pregnancy.

SAFE for symptom management in early pregnancy:

• Acetaminophen (Tylenol): 500-650 mg every 6 hours as needed for body aches or mild temperature elevation. Maximum 3,000 mg per 24 hours. Category B. The only analgesic considered safe throughout pregnancy.
• Vitamin B6 (pyridoxine): 25 mg three times daily for nausea. Well-studied for pregnancy nausea with strong safety data (Matthews et al., Cochrane Database of Systematic Reviews 2015).
• Doxylamine (Unisom SleepTabs): 12.5 mg at bedtime for nausea and sleep. Often combined with B6. Category A.
• Saline nasal spray: Unlimited use for congestion. No systemic absorption.
• Humidifier: For nasal congestion and dry airways.

UNSAFE or use with caution:

• Ibuprofen (Advil, Motrin): Category D after 30 weeks. Avoid in first trimester due to possible increased miscarriage risk (Nielsen et al., Canadian Medical Association Journal 2001). Use only if acetaminophen fails and under provider guidance.
• Aspirin: Avoid in first trimester except low-dose (81 mg) for specific medical indications.
• Naproxen (Aleve): Same concerns as ibuprofen. Avoid.
• Decongestants (pseudoephedrine, phenylephrine): Avoid in first trimester. Associated with small increased risk of birth defects in some studies (Werler et al., American Journal of Epidemiology 2005). Second and third trimester use is controversial.
• DayQuil, NyQuil, Theraflu: Contain multiple ingredients including decongestants and sometimes alcohol. Avoid.
• Cough suppressants with codeine: Category C. Avoid unless prescribed.

The influenza vaccine:

• SAFE and RECOMMENDED at any point in pregnancy.
• Inactivated vaccine only (not live attenuated nasal spray).
• Reduces flu risk by 50% and reduces hospitalization risk by 40% (Omer et al., Pediatrics 2011).
• If you have flu-like symptoms and are unvaccinated, ask your provider about the vaccine once illness resolves.

Antiviral medications (oseltamivir/Tamiflu):

• Category C but recommended for pregnant women with confirmed or suspected influenza.
• Most effective when started within 48 hours of symptom onset.
• Reduces duration of illness and risk of complications.
• Do not wait for test results if clinical suspicion is high. Call your provider immediately if you suspect flu.

The GLP-1 complication: pregnancy symptoms on weight-loss medications

This intersection is increasingly common as GLP-1 receptor agonist use expands. If you're taking semaglutide or tirzepatide (compounded or brand-name) and develop flu-like symptoms, you face a three-way diagnostic problem: pregnancy, medication side effects, or actual illness.

The overlap:

GLP-1 medications cause nausea, fatigue, and sometimes low-grade headache, especially during titration. Early pregnancy causes the same symptoms. Both can occur simultaneously.

The critical rule: GLP-1 medications are contraindicated in pregnancy. Semaglutide and tirzepatide are Category C (animal studies show fetal harm). If you suspect pregnancy:

1. Stop the GLP-1 medication immediately.
2. Take a home pregnancy test (accurate 10-14 days after conception, which is around the time of missed period).
3. Contact your provider same day for confirmation and guidance.

Why this matters: The medication half-life is long (semaglutide: 7 days, tirzepatide: 5 days). Stopping at the first suspicion of pregnancy minimizes fetal exposure. Animal studies showed skeletal malformations and growth restriction with GLP-1 exposure during organogenesis (Knudsen et al., Reproductive Toxicology 2010).

The pattern we see in FormBlends consultations: Women on stable GLP-1 doses who suddenly develop worsening nausea after weeks of tolerance should consider pregnancy testing, especially if nausea is worse in the morning and improves with eating (opposite of GLP-1 nausea, which is often worse after eating).

For detailed guidance on GLP-1 side effect patterns, see our article on managing nausea on compounded semaglutide.

When to call your provider (same-day vs emergency criteria)

The threshold for medical contact is lower in pregnancy than outside pregnancy because of the influenza risk and the medication safety questions.

Call within 2-4 hours (same day, urgent):

• Measured fever ≥100.4°F (38°C)
• Sudden onset of severe symptoms over 6-12 hours
• Cough producing colored sputum
• Shortness of breath with exertion
• Inability to keep down liquids for >12 hours
• Severe headache that doesn't respond to acetaminophen
• Abdominal pain beyond mild cramping
• Any vaginal bleeding
• Exposure to confirmed influenza case

Go to emergency department immediately:

• Difficulty breathing at rest
• Chest pain or pressure
• Severe dizziness or fainting
• Confusion or difficulty staying awake
• Severe persistent vomiting (>6 episodes in 6 hours)
• No urination for >12 hours with dark urine
• Coughing up blood
• Severe abdominal pain
• Heavy vaginal bleeding

Routine prenatal visit (schedule within 1 week):

• Mild fatigue and body aches, gradual onset, no fever
• Nasal congestion with clear discharge
• Mild nausea improving with small meals
• Symptoms consistent with early pregnancy, no red flags

The conservative approach: if you're uncertain whether symptoms are pregnancy or illness, call. The risk of untreated influenza outweighs the inconvenience of a phone consultation or office visit.

The immune suppression question: are you actually more vulnerable?

The short answer: yes, but selectively.

The Th2 immune shift impairs defense against intracellular pathogens (viruses, some bacteria) but preserves or enhances defense against extracellular bacteria and parasites. The clinical result: pregnant women are more vulnerable to severe influenza, varicella (chickenpox), and COVID-19, but not more vulnerable to common cold viruses or most bacterial infections.

The data on specific infections:

Infection	Increased severity in pregnancy?	Mechanism
Influenza	Yes (4x hospitalization rate)	Impaired viral clearance, reduced lung capacity in later pregnancy
COVID-19	Yes (2-3x ICU admission rate)	Similar mechanism to influenza
Varicella (chickenpox)	Yes (pneumonia risk 10-20%)	Impaired cell-mediated immunity
Common cold (rhinovirus)	No	Preserved mucosal immunity
Strep throat	No	Preserved antibody response
Urinary tract infection	Yes (higher progression to pyelonephritis)	Anatomical changes, not immune
Listeria	Yes (20x higher rate)	Impaired intracellular pathogen defense

The practical implication: the flu-like symptoms you're experiencing are probably hormonal, but if they're actually influenza, the stakes are higher than they would be outside pregnancy. The decision tree above is designed around that asymmetric risk.

Prevention strategies:

• Influenza vaccine (inactivated) as soon as pregnancy is confirmed, regardless of trimester
• COVID-19 vaccination per current CDC guidance
• Avoid close contact with anyone who has confirmed respiratory illness
• Hand hygiene (the 20-second rule actually works)
• Avoid crowded indoor spaces during peak respiratory virus season (November through March in Northern Hemisphere)

For women on GLP-1 medications considering pregnancy, we recommend stopping the medication 2 months before attempting conception to allow full clearance, then receiving flu and COVID vaccines before conception if planning pregnancy during respiratory virus season.

FormBlends clinical pattern: the nausea-fatigue dissociation

Across consultations with patients transitioning off GLP-1 medications due to pregnancy, we see a consistent pattern that helps distinguish medication effects from early pregnancy symptoms.

GLP-1 nausea pattern:

• Worse after eating, especially high-fat or high-volume meals
• Improves with fasting or very small portions
• Often accompanied by early satiety (feeling full after a few bites)
• Peaks 1-3 days after injection, then gradually improves
• Rarely accompanied by significant fatigue

Early pregnancy nausea pattern:

• Worse on empty stomach (classic "morning sickness," though it can occur any time)
• Improves with small frequent meals, especially protein and complex carbs
• Often accompanied by food aversions (suddenly can't stand foods you normally like)
• Constant or worsening over weeks, not cyclical with weekly injection
• Almost always accompanied by profound fatigue

The dissociation: Women on GLP-1 medications who become pregnant often report that nausea suddenly "flips" from post-meal to pre-meal, and fatigue appears or dramatically worsens. The flip happens over 3-5 days as pregnancy hormones rise.

If you're on a GLP-1 medication and your nausea pattern suddenly changes from the medication's typical pattern to the pregnancy pattern, take a pregnancy test even if it's earlier than your missed period. Modern tests detect pregnancy as early as 10 days post-conception.

This pattern is observational (we don't have published data on it), but the consistency across patient reports is striking enough to be clinically useful.

FAQ

Are flu-like symptoms a sign of early pregnancy? Yes, for about 60% of women. Progesterone elevation causes fatigue, mild body aches, low-grade warmth, and nasal congestion that feel similar to early viral illness. Symptoms typically start around week 5 to 6 and improve by week 12.

Can early pregnancy feel like the flu? It can feel similar, but true influenza has distinct features: sudden onset (over hours, not days), high fever (100.4°F or higher), severe body aches, and respiratory symptoms like cough. Pregnancy symptoms build gradually and don't include actual fever.

What week of pregnancy do flu-like symptoms start? Most women notice symptoms starting around week 5 to 6 (1 to 2 weeks after missed period), peaking at week 6 to 8, and improving by week 12. The timeline follows the progesterone curve.

Is feeling warm a sign of early pregnancy? Yes. Progesterone raises basal body temperature by 0.5 to 1.0°F. You may feel warm, especially in the evening, but your measured temperature should stay below 100.4°F. Anything higher suggests infection.

Can you get a fever in early pregnancy? No. Fever (100.4°F or higher) is NOT a normal pregnancy symptom. It indicates infection and requires same-day medical evaluation. Progesterone raises temperature but not to fever levels.

How long do flu-like symptoms last in early pregnancy? For most women, symptoms peak at 6 to 8 weeks and improve significantly by 12 to 14 weeks. Some fatigue and congestion may persist into the second trimester, but the severe "flu-like" feeling typically resolves by the end of the first trimester.

Can you take Tylenol for body aches in early pregnancy? Yes. Acetaminophen (Tylenol) is considered safe throughout pregnancy for body aches, headache, or mild temperature elevation. Use the lowest effective dose, maximum 3,000 mg per 24 hours. Avoid ibuprofen and aspirin in the first trimester.

Should I get a flu shot if I have flu-like pregnancy symptoms? Yes, once you confirm the symptoms are from pregnancy and not active infection. The inactivated influenza vaccine is safe and recommended at any point in pregnancy. It reduces your flu risk by 50% and protects your newborn for the first 6 months of life through transferred antibodies.

Can pregnancy cause sinus congestion? Yes. About 30% of pregnant women develop pregnancy rhinitis from increased blood flow to nasal mucosa. It produces clear nasal discharge, congestion worse at night, and can last throughout pregnancy. It's annoying but harmless. Saline spray and humidifiers help.

What's the difference between pregnancy fatigue and flu fatigue? Pregnancy fatigue builds gradually over days to weeks, is profound but allows you to function, and improves with rest. Flu fatigue hits suddenly, is incapacitating (you can't get out of bed), and doesn't improve much with rest. If you were fine yesterday and can't function today, suspect flu.

Can I have the flu without a fever during pregnancy? Yes, but it's less common. About 20% of influenza cases are afebrile. Other features (sudden onset, severe body aches, cough, known exposure) help identify flu even without fever. When in doubt, call your provider.

Is it normal to feel sick all day in early pregnancy? Yes. Despite the term "morning sickness," nausea and malaise can occur any time of day. About 80% of pregnant women experience some nausea, and for 50% it occurs throughout the day, not just in the morning. The pattern is worse on empty stomach, better with small frequent meals.

Can GLP-1 medications cause pregnancy-like symptoms? Yes. Semaglutide and tirzepatide cause nausea and fatigue, especially during dose escalation. The key difference: GLP-1 nausea is worse after eating, pregnancy nausea is worse on empty stomach. If you're on a GLP-1 medication and develop new symptoms, take a pregnancy test. The medications are contraindicated in pregnancy.

When should I go to the ER for flu-like symptoms during pregnancy? Go immediately if you have difficulty breathing, chest pain, confusion, severe persistent vomiting, no urination for more than 12 hours, or coughing up blood. These suggest serious complications requiring emergency care.

Can early pregnancy cause chills without fever? Mild chills can occur during rapid hormone fluctuations, but they're uncommon and should be brief. Chills with rigors (shaking) suggest infection even if you haven't measured a fever yet. Take your temperature and call your provider if chills persist.

Sources

1. Csapo AI et al. The significance of the human corpus luteum in pregnancy maintenance. American Journal of Obstetrics and Gynecology. 1973.
2. Wegmann TG et al. Bidirectional cytokine interactions in the maternal-fetal relationship: is successful pregnancy a TH2 phenomenon? Immunology Today. 1993.
3. Kraus TA et al. Characterizing the pregnancy immune phenotype: results of the viral immunity and pregnancy (VIP) study. Journal of Reproductive Immunology. 2011.
4. Bernstein IM et al. Maternal plasma volume expansion in early pregnancy. Obstetrics & Gynecology. 2001.
5. Ellegård EK et al. Pregnancy rhinitis. Clinical and Experimental Allergy. 2000.
6. Rasmussen SA et al. Pandemic influenza and pregnant women: summary of a meeting of experts. Influenza and Other Respiratory Viruses. 2012.
7. Siston AM et al. Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States. Obstetrics & Gynecology. 2010.
8. Lacasse A et al. Nausea and vomiting of pregnancy: what about quality of life? BMC Pregnancy and Childbirth. 2016.
9. Matthews A et al. Interventions for nausea and vomiting in early pregnancy. Cochrane Database of Systematic Reviews. 2015.
10. Nielsen GL et al. Risk of adverse birth outcome and miscarriage in pregnant users of non-steroidal anti-inflammatory drugs. Canadian Medical Association Journal. 2001.
11. Werler MM et al. Use of over-the-counter medications during pregnancy. American Journal of Epidemiology. 2005.
12. Omer SB et al. Maternal influenza immunization and reduced likelihood of prematurity and small for gestational age births. Pediatrics. 2011.
13. Knudsen LB et al. Developmental and reproductive toxicology studies with the GLP-1 analog liraglutide. Reproductive Toxicology. 2010.
14. Centers for Disease Control and Prevention. Pregnant Women and Influenza (Flu). CDC Guidelines. 2024.

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