Outbreak Outlook - National - Jan 4
Flu very high, Covid-19 and RSV rising
Quick editorial note: Just like last week, CDC is data is delayed due to the holiday, so I am providing an update today based on data from a subset of states. I will be back with the regional newsletters later this week, once national data has updated.
Respiratory Diseases
Influenza-like illness
Flu is very high. In many states this past week, more than 1 in 10 trips to the ED were for flu-like illness. Many states are nearing peak activity, and a few appear to be past peak.
South
Flu is very high and rising in the South. Nearly 1 in 10 ED visits is due to flu in Texas. For those aged 5-11, a very high 28% of ED visits is due to flu, closely followed by ~25% for those aged 0-1 and those aged 0-4. In Maryland, 11.3% of ED visits are due to ILI, and 1 in 3 tests are coming back positive for flu. In Alabama, flu continues its very steep rise, and now accounts for nearly 1 in 10 visits to the ED. In Kentucky, ED visits are high and rising (7%), and hospitalizations more than doubled this past week to 5% of all admissions.
West
Range of activity across the West. In Colorado, nearly 1 in 10 ED visits are due to flu, as are more than 1 in 10 hospital admissions (13.3%). This is far higher than last year’s peak of 8.6% of hospital admissions. Flu is also very high and rising in Alaska, with ILI at 13%, and in Idaho, outpatient visits for flu climbed to 12%.
Hawaii may have passed its peak — test positivity and ED visits both declined this week. However, rates are still very high: flu accounted for 8.5% of ED visits, and hospitalizations continue to climb (6.2% of all admissions).
In contrast, despite steep increases, flu is still below the seasonal threshold in Montana, with ILI accounting for just 2.3% of ED visits.
Midwest
Still climbing. Flu is very high in Illinois, accounting for 8.2% of ED visits and 5.3% of hospitalizations. It is steeply rising in Kansas, doubling this past week to 6.2% of ED visits. There was a sharp increase in hospitalizations in Ohio this past week, though overall flu hospitalizations remain fairly low.
Northeast
High activity, with a few states at or just past peak. In New Jersey, 1 in 10 ED visits are due to flu, surpassing the peaks of the prior two seasons. Test positivity is slowing down though, suggesting that the state is at or near peak. 3.1% of ED visits for flu are resulting in hospitalizations — about double as many at last year’s peak.
In New York, activity may have hit and passed peak: new cases decreased this past week across the state. And in New York City, ED visits for flu decreased slightly, to 7.9%.
In Pennsylvania, ED visits nearly doubled this past week, to 6.8%. And in Maine, flu activity is on par with last year’s peak — 12% of ED visits are due to ILI. In Massachusetts, activity is also high and rising, with 9.6% of ED visits due to flu.
COVID-19
Covid-19 remains low, but is rising. In Alabama, ED visits have increased slightly for the past several weeks, but are still very low, at 0.5%. Similarly, in Hawaii, ED visits have more than doubled, rising from 0.1 to 0.3% in the past week, and test positivity jumped from 0.5% to 1.2%. And in New York it has steadily risen to 1% of ED visits. Covid is also low but increasing in Colorado, Idaho, Kentucky, Illinois, Maryland, Massachusetts, New Jersey, Ohio, Pennsylvania,
Covid-19 looks to be a bit more active in Maine, where ED visits with Covid-19-like illness have risen to 3.4%. Similarly, in Montana, Covid-19 cases are nearly on par with the previous two peaks of the past year (in March and September). And in Kansas, Covid-19 is about has high as it has been at any point in the past year. ED visits are up to 1.3% (they peaked at 1.4% last February).
Activity remains low and stable in Alaska and Texas.
RSV
RSV is moderate and rising. This is the case in Hawaii, where ED visits are at 0.5%, and in Texas, where rates are up to ~0.7%. In Alabama, RSV is increased slightly to 0.7% of ED visits, and in New Jersey to 0.6%. Hospitalizations in New Jersey are now equivalent to last year’s peak (0.3% of ED visits).
In Alaska, the number of people testing positive for RSV has increased notably over the past couple weeks — from 53 in mid-December up to 112 this past week. It is now high enough to have reached the state’s seasonal baseline for elevated activity. Similarly, in Montana, it is has surpassed the threshold for statewide circulation, and is now at 4.2% test positivity.
RSV continues to slowly rise in Colorado (~0.2% of ED visits), Kansas (0.2% of ED visits), New York City (~0.4% ED visits), and Pennsylvania (0.4% of ED visits).
RSV remains low and flat in Idaho and Massachusetts.
Norovirus
Norovirus continues its upward climb. In the Midwest, Northeast, and South, norovirus wastewater activity is high and rising. In the West, wastewater activity remains more moderate, but is also rising.
Noro is extremely contagious — this is where hand washing regularly (with soap and water, hand sanitizer is not particularly effective), avoiding touching your face, avoiding communal bowls of food/drink, and wiping down surfaces with soap and water or a diluted bleach solution can really help with prevention.
Food recalls
The following foods are being recalled because they are contaminated. Please check your cupboards and throw out any of these items:
New:
Nothing new this week.
Previously Reported:
There is a big recall of hundreds of products — from Airhead candies to meat to Splenda packets — that passed through a single distributor and were sold to over 50 stores, primarily in Minnesota and Indiana. I strongly urge you to check out the list of stores (here) and if you’ve shopped at one of them recently, check out the much longer list of items that are being recalled (here)
Country Vet Biscuits & Heartland Harvest Dog Biscuits [for dogs] are being recalled for potential contamination with Salmonella. Salmonella can sicken both pets who consume the treats, and humans who handle the products (or who touch surfaces the items touched). (more info)
Forward Farms Grass-Fed Ground Beef (more info)
Frozen raw shrimp sold under the Market 32 and Waterfront Bistro brand names, due to possible cesium-137 contamination (more info)
Lucky Foods cinnamon powder, due to potential lead contamination (more info)
ByHeart Infant Formula due to potential botulism contamination (more info)
In other news
More than 2,000 cases of measles confirmed in the US in 2025. According to the CDC, 2,065 cases of measles were confirmed in 2025, which is the highest reported rate since 1992, nearly a decade before elimination was achieved in 2000. 11% of all cases have required hospitalization, but for children under the age of 5, 1 in 5 cases required hospitalization. Tragically, 3 children have died. As the year closes out, there is ongoing community spread in South Carolina, and in Utah/Arizona. Measles is vaccine preventable; increasing vaccination rates is essential to stop further illness.
Stomach bugs are spreading on both land and sea. A Celebrity Cruises ship, returned to Fort Lauderdale, after an 8-day trip on December 28, with more than 100 reported cases of a gastrointestinal illness (likely norovirus). Stomach bugs spread very well in settings with lots of people, particularly those that share food sources, such as schools, prisons, and yes, cruise ships. This time of year, all it takes is one person bringing on
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As always, excellent information and very helpful. I have seen an aol article about increase in the candida auris problem, and I hope you might be able to comment about that soon.
As always, thank you so much for this important information!