Outbreak Outlook - National - Nov 11
Covid and ILI remain low, but norovirus is high in some areas of the country.
Respiratory Diseases
Influenza-like illness
Influenza-like illness (ILI) is creeping up, as expected, at this time of year. Around 2.4% of outpatient doctor's visits were for fever, cough, or sore throat during the last week, up from 2.2% the week prior.
On the bright side, we are likely still several weeks away from crossing the 3% threshold that marks the beginning of the flu season. There's still time to get your vaccine if you haven't already.
On the less bright side, ILI in young children is accelerating quite rapidly. Outpatient ILI in children ages 0 to 4 jumped from 7.0% to 7.5% this last week. ILI in school-age children (ages 5 to 24) remained flat at 3.8%. All older age groups are under 2%.
All states remain in the lower or minimal categories with the exception of the District of Columbia, which has jumped up to the high category. DC often leads states in high influenza-like illness. And although activity remains low in the Southern region, activity there is higher than other areas of the country. That region will likely be the first to enter the moderate category. This, too, is typical; the South often experiences new epidemiological trends first before activity spreads to other regions.
COVID-19
Covid-19 activity is fairly quiet. Wastewater activity is low and stable nationally. Wastewater activity declined slightly in the Northeast, South and West.
Activity is highest in the Midwest, where activity has been rising slightly over the past two weeks. Despite these increases, it remains low overall.
Very few people are ending up at the ED with Covid-19—just 0.5% of all ED visits nationally this past week. ED rates were stable or declining in all reporting states - no states reported significant increases. Hospitalizations are also low at 1.1 hospitalizations per 100,000 people, and decreased again this past week.
RSV & Other Bugs
RSV: RSV activity remains low across the country. There are some early signs that activity is beginning to pick up, but only barely.
Other bugs: Several causes of colds and flu-like symptoms are showing signs of increased activity:
Parainfluenza continues to rise, though the rate of increase is slowing, suggesting we may be nearing a peak.
Both adenoviruses and human coronaviruses are showing small but steady week-over-week increases.
Rhinoviruses/enteroviruses are holding steady at a high ~28% test positivity.
Stomach Bugs
After going up, up, up, norovirus has dipped slightly, to 10.8% test positivity nationally. Norovirus test positivity remains highest in the South, followed by the West, Midwest, and—with far lower rates—the Northeast.
Food recalls
The following foods are being recalled because they are contaminated. Please check your cupboards and throw out any of these items:
New:
Soft ripened cheeses, including brie, sold under multiple brand names, including Aldi, La Bonne Vie, and Glenview Farms (more info)
Prepackaged turkey sandwiches with spreadable brie sold under multiple brand names (more info)
Ready-to-eat poultry and meat products sold by Yu Shang Food, including pork belly, beef shank, and whole chicken (more info)
Previously reported:
Enoki mushrooms sold by HH Fresh Trading Corp (more info)
Kirkland Signature Smoked Salmon (more info)
Gourmet Cafe Chicken Caesar Salad Bowls sold by Fresh Express (more info)
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)
If you have food allergies, you may wish to review these FDA safety alerts and USDA alerts for foods with undeclared allergens.
In other news
Former President Donald Trump has been reelected. The outlook for public health is troubling. Robert F. Kennedy, Jr. is contributing to the incoming administration’s health portfolio, including advising on selections for top appointees to key positions like HHS Secretary, CDC Director, and FDA Commissioner. RFK Jr. has expressed interest in taking action against municipal water fluoridation. He has a long history of anti-vaccine activities. There has also been talk of major restructuring to CDC and FDA, though the specifics of that are not clear.
Most public health authorities reside at the state and local level, and major changes to the federal agencies would require Congressional action. For these reasons, I am reluctant to speculate about what these priorities will mean in practical terms, but I will certainly be watching closely.
A recent study in California found that unvaccinated children are at a significantly higher risk of developing multisystem inflammatory syndrome in children (MIS-C) following Covid-19 infection. The research found that among children aged 12 to 17, unvaccinated individuals were 22.9 times more likely to develop MIS-C compared to their fully vaccinated peers. In the 5 to 11 age group, unvaccinated children had a 3.3 times higher risk.
The CDC has expanded avian influenza testing to include asymptomatic farm workers exposed to infected poultry or cattle, following a serology study revealing a 7% infection rate among farm workers. The study, conducted from June to August 2024, involved 115 workers in Colorado and Michigan, with eight testing positive for H5 avian influenza antibodies. In response, the CDC now recommends testing any workers who were exposed, including those with no symptoms. Tamiflu prophylaxis is recommended for those with high-risk exposures and inadequate PPE. Nationwide, 46 cases of H5N1 infection have been reported in humans.
Canada’s British Columbia Ministry of Health has reported the province's first human case of H5 avian influenza. A teenager from the Fraser Health region, with no recent travel history, developed severe symptoms in early November 2024 and is currently hospitalized. Initial testing at the BC Centre for Disease Control's Public Health Laboratory returned a positive result for H5 avian influenza; confirmatory testing is underway. This marks the first presumed human case of H5 avian influenza acquired in Canada this year.
This is a notable development for several reasons. First, severe illness in a young person is uncommon in influenza infection. Second, although the epidemiological investigation is ongoing, early reports do not include mention of contact with farm animals. As we enter the months when seasonal influenza picks up, this long-standing H5 situation will be one I am watching closely.
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