Outbreak Outlook - National - November 6

flu, Covid-19 and RSV all up...

Nov 06, 2023

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Respiratory diseases

Influenza-like illness

We’re getting closer to crossing the threshold that marks the onset of flu season. (As measured by activity. By the calendar, we’ve already entered flu season.) In the week ending October 28, 2.7% of visits to the doctor were for fever and cough or sore throat, up from 2.5% the week prior. This is on the high end of what we normally see in early November, but is much lower compared to last year’s strange season.

There is substantial regional variation in ILI activity. Multiple states across the Southern region now rate as “moderate.” New Mexico, Alaska and Puerto Rico also have moderate or high levels of activity. The rest of the country has low or minimal levels of activity, but I do expect that to change in the weeks to come as the season ramps up.

Young kids are, as usual, most affected. Among children ages 0-4, 9% of visits to the doctor were for ILI symptoms, up from 8% two weeks ago. In comparison, doctor visits for ILI symptoms was significantly lower in older age groups: only 4.2% in the 5 to 24 age range, and for adults above 24, the rate was even lower, at 2% or less.

Covid-19

For the last few weeks, I’ve been reporting on signs that Covid-19 activity may be poised to make a comeback. After summer activity peaked in early September, we enjoyed about two months of declining activity. But more recently, I’ve seen reversals in certain states that made me wonder if a new round of activity was beginning.

That is now quite clear in the data: the number of new hospital admissions for Covid-19 has plateaued, and secondary indicators like emergency department visits and test positivity have also leveled out. I now think that we are entering another period of increased activity, though it’s still early enough that I could be wrong.

This pattern is most evident in the Midwestern region, where hospitalizations and test positivity are clearly ticking up in multiple states. The largest jump in hospitalizations is among adults age 70+. New hospital admissions in that age group has now exceeded this summer’s peak (but remains far below previous peaks).

RSV

The RSV season continues. No new data was published this week, so the most recent info available is what I reported on in last week’s newsletter. As I noted then, PCR test positivity at the national level is 6.3%, which is much lower than this time last year, but much higher than where I want it to be. All regions of the country are seeing increases in RSV, though the South is the most heavily affected.

RSV typically causes mild cold-like symptoms, but it can also cause severe illness, including pneumonia. Infants and older adults are at higher risk of more severe complications from the disease. Each year in the United States, 58,000-80,000 children under the age of five are hospitalized and 60,000-160,000 adults 65 or older are hospitalized due to RSV.

This is the first year that vaccines for RSV have been available to help protect infants and older adults. High demand for the RSV vaccine for infants has led the CDC to update its recommendation to prioritize vaccination for those infants at greatest risk of developing a severe form of the disease. Note that the RSV vaccine for infants is separate from the one for older adults; the vaccine for older adults is not experiencing a shortage.

Others

I’m monitoring several other respiratory viruses. Here’s the current status:

The seasonal coronaviruses (a cause of the common cold) remains low nationally.
National data on metapneumovirus, adenovirus, and parainfluenza from the CDC have not been updated since October 21. At that time, metapneumovirus activity was low, and adenovirus and parainfluenza appeared to be on a slight upward trajectory. Biofire data suggests that adenovirus is continuing to increase slightly, but does not show a similar increase for parainfluenza.

Norovirus

Norovirus (stomach bug) is bouncing around. Activity remains high-and-climbing in the Midwest, but the rest of the country looks fine. PCR test positivity is now 6%, down slightly from 6.5% last week. Norovirus has a knack for taking down everyone in a home when it shows up, thanks to its incredibly efficient transmission. So I’m quite happy to see it stay away! Keep up the handwashing, in any case.

Food recalls

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

New this week:

Multiple brands of eye drops, including some new brands added since last week (more info)
Multiple brands of Apple Cinnamon Fruit Puree, including some new brands added since last week (more info)

Previously reported:

Fresh diced onion products by Gills Onions (more info)
Enoki mushrooms by Qilu Enterprise (more info)
Lobster by Greenhead Lobster (more info)
Ready-to-eat beef and chicken meatballs from Phu Huong Food Company (more info)
Bagged collard greens sold at Kroger (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

This is the first year that vaccines are available to help reduce the risk of three major causes of severe respiratory illness: influenza, Covid-19, and RSV (for infants and older adults). The CDC has come out with guidance on how to think about timing these vaccines.
- Getting multiple vaccines at the same visit is safe and may be easiest to fit into your schedule.
- If you choose to get your vaccines at separate visits, there is no minimum waiting period between them.
A plan to reauthorize long-term spending for the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) failed to pass the U.S. Congress last week. The program spans over 50 countries and has saved over 25 million lives since it was created in 2003 and has long garnered bipartisan support for its international works supporting activities to prevent, test, and treat HIV/AIDS. If Congress does not reauthorize the program soon, many of the organizations that rely on US funding may have to reduce or eliminate services. This would significantly threaten the substantial gains that have been made against HIV/AIDS in the past two decades since the program’s creation.
A contract dispute has led to the suspension of one-quarter of Covid-19 wastewater testing sites in the United States. The CDC is seeking to replace its longtime contractor, Biobot, with Verily, a subsidiary of Google's parent company. However, Biobot has formally protested the contracting decision, delaying the transition. In the meantime, approximately 400 testing sites that are covered by the contract are closed. (Approximately 1,200 not covered by this contract remain active). Wastewater testing has become critical for tracking the spread of Covid-19 in the US, as many people have stopped testing for Covid or are testing at home and not reporting results. It is unclear how great an impact the loss of these sites will have on our ability to understand how Covid-19 is spreading within the country.