Outbreak Outlook - National - November 20

News you can use for your Thanksgiving holiday

Nov 20, 2023

Welcome to the Thanksgiving edition of Outbreak Outlook! I’m grateful to be here with news you can use for a second holiday-slash-flu season. I won’t be sending out a data update next week due to the holiday. See you in December!

Thanksgiving Outlook

Currently, we're seeing a notable uptick in various respiratory illnesses. Influenza-like illness activity is surging, with some regions reporting rates much higher than what's typically observed at this time of year. For example, ILI activity in the Southern region has already reached levels usually seen in late December. RSV activity is also quite high, with activity levels nearing or at peak season in many areas. The Covid-19 situation is relatively stable but is still worth attention, with moderate levels of new hospitalizations.

I would definitely keep this in mind as you consider your plans for holiday travel and gatherings. I just returned from a trip and am really thankful I wore my KN95 mask at the airport and on the plane. There were quite a few people coughing and with runny noses, but hardly anyone else was wearing a mask.

Respiratory diseases

Influenza-like illness

Influenza-like illness (ILI) jumped this week to 3.5%, up from 3.0% last week. We’re about 4-6 weeks ahead of when we usually see this level of activity, meaning the current picture is more like what we see in late December. The number of flu-related hospitalizations is also increasing, but remains low.

By region: The map is not looking great. Eight states are already registering high levels of activity, and one (Louisiana) is in the very high category. The most affected states are all in the Southern region.

I’m almost positive we’ll see the dreaded purple color return to the map this year. Purple indicates the highest level of activity. Last year it was all over the map, but otherwise it’s fairly uncommon. The good news is that most states in other regions of the country remain green — for now.

By age: Activity in children ages 0-4 has now cleared 10%, meaning 1 in every 10 visits to the doctor is for fever and cough or sore throat. Activity in the 5-24 age group has also picked up quite a bit, now at 5.4%. Parents, expect some sick days in the weeks ahead. Older age groups are doing better, with levels under 2.5%.

Vaccine coverage: About a third (36%) of adults have received their flu shot. Among older adults, coverage is about 60%. This is comparable to where we normally are this time of year. Coverage usually tops out around 45% for adults.

Covid-19

Covid-19 hospitalization rates in the United States showed mixed regional trends, with activity rising in some areas and falling in others. Nationally, the hospitalization rate remained relatively flat over the past week, only changing from 5.3 to 5.4 admissions per 100,000 people. The uneven regional trends point to shifting hotspots rather than a uniform national trajectory. However, I expect activity to head upwards through January, as in years past.

The South saw a slight overall increase driven by inland states like Kentucky and Tennessee, while declines occurred in coastal states like Florida and North Carolina. The Midwest and West also had a mix of trends and patterns, but on the whole activity is rising.

Vaccine coverage: Only 15% of adults and 32% of older adults have received their annual Covid-19 vaccine. If you are one of the ~50% of people who say they intend to get the booster but haven’t done so yet, please get that on the calendar!

RSV

RSV activity is high and rising across the country, with PCR test positivity now at 11%. I consider this peak season, but it may last for several more weeks. The peak last year occurred at nearly 20% positivity. Definitely be cautious as you head into the holiday week ahead.

By region: However, the picture is quite varied across the U.S. Cases appear to be peaking or near-peak in parts of the South, which continues to lead the country with 19% test positivity. In contrast, the Midwest has a lower reported rate than the rest of the country, at 6.8%. Activity is picking up in every region, so even if your area is not currently heavily affected, it likely will be soon.

Vaccine coverage: Around 14% of older adults have received the RSV vaccine, which is on the market for the first time this year. While this isn’t great coverage, I don’t think it’s too bad considering how new the vaccine is and the limited public awareness of RSV compared to more widely discussed illnesses like Covid-19 and influenza.

Others

I’m monitoring several other respiratory viruses.

Human metapneumovirus, parainfluenza, and adenovirus are holding steady at low levels nationally.
Seasonal coronavirus levels also remain low nationally, but have been increasing a little each week for several weeks. This is the time of year when we expect to see sustained increases, so I anticipate that these numbers will keep moving upward in the next few weeks.

Norovirus

Norovirus PCR detection rates have hovered around 6% since mid-October, with the exception of last week when they rose over 7% before declining again this week - to 6.3%. However, we usually see an increase in cases in the fall/winter, so I expect to see rising rates in the coming weeks and months.

Cases in the Midwest, which had been driving the national rate, appear to be leveling off; rates in other regions are below the national average.

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:

More brands of pet food - dog, cat, and catfish food (more info here and here) (Note: this poses a risk to pets and to the people that care for them, since Salmonella can be acquired via handling of the contaminated pet food and/or contact with infected animals. Several human cases, including in infants, have been tied to the pet food.)
More brands of cantaloupe chunks and fruit mixes containing fresh cantaloupe (more info and here too)

Previously reported:

Tyson chicken nuggets (more info)
Multiple brands of eye drops (more info)
Multiple brands of Apple Cinnamon Fruit Puree (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

The FDA has approved a new over-the-counter diagnostic test for gonorrhea and chlamydia. The test allows people to collect samples at home and mail them in for analysis, saving patients a trip to the doctor. A healthcare provider will follow up if the test results are positive and treatment is needed, or if the results are invalid. Rates of both diseases are on the rise in the U.S., with more than 1.6 million cases of chlamydia and 700,000 cases of gonorrhea reported to the CDC in 2021.
The U.S. House of Representatives has passed a ban on federal funding for so-called ‘gain of function’ research on “potential pandemic pathogens” as an amendment to the HHS 2024 spending bill. It is not clear whether the amendment will make it into any bill passed by the Democratically-controlled Senate. Proponents of the policy argue that the ban will protect against the development of dangerous pathogens that could escape from a lab or be intentionally misused. Opponents feel that language is too vague (“potential pandemic pathogens” is undefined), which could chill important and low-risk virological research.
Veterinarians are reporting that an unidentified and potentially fatal respiratory virus is spreading among dogs in multiple states across the West and Midwest, including California, Indiana, and Colorado. There are over 200 cases in Oregon alone. Infected dogs have persistent coughing that does not respond to typical antibiotic treatment and can progress into pneumonia; tests for standard respiratory diseases are turning up negative. Other symptoms include sneezing, eye/nose discharge, and abnormal tiredness/lethargy.
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brown wooden board — Photo by Pro Church Media on Unsplash