Outbreak Outlook - National - October 28

We're in a bit of a lull, at least when it comes to ILI, Covid-19 and RSV. Enjoy!

Respiratory Diseases

ILI

So far, so good. Outpatient influenza-like illness remained stable with 2.1% of visits to the doctor for fever and cough or sore throat. Flu season won’t start until we hit 3%. The entire country is reporting minimal or low levels of activity, with the exception of Washington, D.C. at moderate.

Young children ages 0-4 are worse off at 6.6%, up from 6.4% last week. The 5-24 age group rose too, to 3.5%. Older age groups are all below 2%.

Wastewater concentration is minimal, too.

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COVID-19

Covid-19 is quiet right now. Wastewater activity is low nationally, and in every region, activity is either low or minimal.

The South is looking best, with most states enjoying low or minimal levels of wastewater concentration.

The Northeast is hanging out at the moderate level — I hope they come down a little more. The rest of the country is a mix of low and moderate.

We’re headed into the winter season, so I hope activity remains like this (or even improves further) before the usual winter wave.

Source: CDC

Visits to the emergency department for Covid-19 were down to 0.6% of all ED visits. The hospitalization rate has fallen to 1.4 hospitalizations per 100,000 population, which is about 3.5x smaller than it was in August.

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RSV & Other Respiratory Infections

RSV: Wastewater concentration is minimal. Not much activity happening yet — hope it stays like this.

Others: Common causes of cold- and flu-like symptoms are picking up steam. Parainfluenza has increased rapidly the past few weeks, and is now at a moderately high level. Adenovirus activity has also increased moderately. Human coronaviruses have started increasing as well, but remain at low levels.

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Stomach Bugs

No updates this week; there were reporting delays from my primary data source. I’ll try again next week.

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Food recalls

The following foods are being recalled because they are contaminated. Please check your cupboards and throw out any of these items:

New:

• Waffles and pancakes - many flavors and styles - sold under a very large variety of brand names, including numerous store brands, including 365 Organic, Best Choice, Good & Gather, Harris Teeter, H-E-B, Nature’s Promise, Publix, Trader Joe’s and Wegmans.

  • Given the size of this recall, if you have any variety of frozen/toaster waffles, Belgian waffles or pancakes in your freezer that you bought in the US or Canada, check this list. (more info)

• Prepackaged Chicken Street Taco Meal Kit produced by Sprouts Farmers Market (more info)

• Ready to eat meals and store-made deli items including chicken from a variety of grocery chains, including Albertsons, Safeway, Star Market, and others. (more info)

• Green onions sold under Church Brothers, Trader Joe’s and Imperial Fresh brand names (more info)

• Prepackaged sandwiches - Pepperjack Cheeseburger, Bacon Cheeseburger and The Gambler sold under the Dakota Tom’s brand name (more info)

Previously reported:

• Large variety of ready-to-eat meat and poultry products under different brand names, including Rao’s chicken alfredo and Michael Angelo’s grilled chicken piccata with penne pasta (more info)

• Enoki Mushrooms (more info)

• Bistro28 and Don Pancho Meal Kits containing chicken (more info)

• Happy Moose Tropical Roots and Strawberry Fields juice (more info)

• If you have food allergies, you may wish to review these FDA safety alerts and USDA alerts for foods with undeclared allergens.

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In other news

• The regional editions of Outbreak Outlook began today, available to paid subscribers.

  • To learn more about subscribing to regional editions, click here.

  • If you expected a regional edition in your inbox and did not receive it, check out these troubleshooting tips.

• A California-based produce company, Taylor Farms, has been linked to an E. coli outbreak affecting McDonald's, especially Quarter Pounder burgers. The outbreak has sickened at least 75 people across 13 states, with 22 hospitalizations. Taylor Farms issued a recall for peeled, whole, and diced yellow onions from its Colorado facility due to potential E. coli contamination, though the recall did not include McDonald’s products. Other fast-food chains, including Taco Bell, Pizza Hut, KFC, and Burger King, have also temporarily pulled onions from their menus as a precaution.

• The CDC now recommends a second dose of the 2024-2025 Covid-19 vaccine for people aged 65 and older, and those who are moderately or severely immunocompromised, six months after their first dose. The guidance also allows for additional doses for immunocompromised individuals, based on consultation with their healthcare provider. The update aims to boost protection against severe illness, especially for those with risk factors.

• In Missouri, a patient hospitalized with influenza A symptoms in August 2024 later tested positive for H5N1 bird flu, marking a rare human case with no known animal exposure. The CDC's investigation included serologic testing of seven close contacts—five healthcare workers and one family member—found no evidence of human-to-human transmission. The original patient and household contact showed limited immune responses, suggesting possible shared exposure.

• I continue to receive notes from readers about unusually high Mycoplasma pneumoniae activity. There is no surveillance system that tracks infections, so data is largely unavailable. This bacterium causes mild respiratory illness and “walking pneumonia,” with serious complications like severe pneumonia and asthma being rare. M. pneumoniae, spread via respiratory droplets, commonly affects crowded settings.