Thanksgiving Outlook
Respiratory virus activity low for most of the country, but flu and RSV are picking up
Respiratory Diseases
Influenza-like illness
We are in better shape than we normally are at this point in the year; current influenza activity is low for most of the country. However, we are in a period of transition. Indicators of flu activity are increasing for most of the country, and I expect that trend to continue through the rest of this month and far into December.
Keep in mind that the data reported here cover the period up until November 15th. The present situation will likely be a little more advanced than the data suggest, so keep that in mind as you head into your Thanksgiving celebrations. This will be particularly true for children, who are seeing the most rapid increases.
Outpatient visits for influenza-like (ILI) activity continue to drift upward (reaching 2.3%), though we remain below the 3.1% threshold for the start of flu season.
ILI is increasing primarily among those aged 0-4 and 5-24 years old, which is typical. During peak season, this metric reaches into the teens (e.g., last year the 0-4 age group peaked at 18%).
Emergency department (ED) visits increased in most states this past week, with the Southern region experiencing the most activity and the strongest growth. The Midwest is in the best shape, with very little flu going around. Nationwide, hospitalizations for flu remain low, but did increase slightly this past week to 0.7 hospitalizations per 100,000 people.
I reported last week that H3N2 is predominating, and that a new subclade called K is circulating widely. That observation was true again this week. Around 72% of the specimens subtyped were H3N2, and more than half of those were the K lineage. This suggests that we may have another big flu season, which aligns with what other countries (e.g., UK, South Korea) are reporting.
COVID-19
The return of wastewater data confirms what other indicators have been suggesting: Covid-19 activity is very low right now in all four regions of the country.
Trips to the Emergency Department are low and stable at 0.3% of all ED visits. Hospitalizations are low at 0.9 hospitalizations per 100,000.
However, there are early signs that we may be entering a new period of increases shortly. More than a dozen states have estimated reproduction rates above 1, which means activity is increasing. These states are primarily clustered in the center of the continental US (from South Dakota down to Texas and Louisiana) as well as a few scattered in the upper Midwest and Northeast (including Pennsylvania and Massachusetts).
I’m not worried yet, but it will be something to keep an eye on.
RSV & Other Bugs
RSV remains low but is on the rise. Most states now have reproduction rates above 1 (meaning activity is increasing), and test positivity has increased to 1.9%. RSV wastewater activity remains very low in most states. However, activity has risen to low levels in Louisiana and moderate levels in Florida.
ED visits have doubled in the past week (though they remain very low at 0.2% of all ED visits). They are highest in the Southern region, and lowest in the Midwest.
Norovirus
My primary noro data source did not update this week, but the secondary source shows moderate and increasing wastewater activity.
In the South, activity is high and increasing rapidly. Activity is moderate and rising in the Midwest and Northeast. Activity remains low, but is gently increasing in the West.
Norovirus spreads very easily and is a common foodborne illness. With Thanksgiving this week, try to avoid preparing any food or drinks for others if you’ve had noro symptoms recently (you can transmit the virus readily for several days after symptoms dissipate), wash hands frequently with soap and water, and avoid dipping hands into communal plates.
Food recalls
The following foods are being recalled because they are contaminated. Please check your cupboards and throw out any of these items:
New:
Vampire Slayer Garlic Cheddar, sold by Face Rock Creamery exclusively at the Face Rock Flagship store in Oregon (more info)
Organic Supergreens Powder Mix and Organic Moringa Leaf Powder sold under Food to Live label (more info)
Organic Moringa Leaf Powder sold under Africa Imports label (more info)
Previously Reported:
ByHeart Infant Formula recall reported last week has expanded to include more batches due to potential botulism contamination (more info).
Peach salsa sold under the Snowfruit label (more info)
First and Last tomato sauces, distributed in Connecticut and Massachusetts (more info)
Oven Dried Fish distributed to customers of African Food on Wheels in the Bronx, NY only (more info)
In other news
Highly pathogenic avian influenza (HPAI) continues to spread among poultry flocks; airborne spread should be considered as one potential transmission route. A recent article by ProPublica examines increasing evidence that HPAI may be spreading between nearby farms via airborne routes via windborne dust and feathers. Their reporting reveals that while the USDA largely attributes new infections to wild-bird introductions, detailed satellite, meteorological and genetic analysis shows farms downwind of known infected sites were far more likely to contract the virus. USDA stated that it has not closely investigated whether airborne spread is occurring. If it is, it would likely require a rethinking of the current approach to containment, including potentially a closer consideration of poultry vaccination.
The CDC website is now providing misleading information on vaccines. The website has been edited to allude to a link between vaccines and autism. HHS Secretary RFK Jr. confirmed on Friday in an interview that he had personally requested the changes. Among other changes, the website now states that, “The claim ‘vaccines do not cause autism’ is not an evidence-based claim because studies have not ruled out the possibility that infant vaccines cause autism.” Dozens of carefully-conducted, large-scale studies, across three decades, have failed to find any causative link between vaccination and autism. There is simply no credible evidence that vaccines cause autism, and there is an abundance of evidence about the protective benefits of vaccination.
Botulism linked to ByHeart Whole Nutrition infant formula has led to the hospitalization of at least 31 infants. Cases have been reported in 15 states. Infant botulism is caused from ingestion of Clostridium botulinum spores that then produce a toxin. Symptoms of infant botulism can take up to several weeks after ingestion to develop, and include difficulty feeding, constipation, a weak or altered cry, and lack of head control. ByHeart formula is under recall (see the Food Recalls section), and should be discarded. Any items that may have touched the formula should be washed thoroughly with hot soapy water or in a dishwasher.
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Catlin, you and your family have a wonderful Thanksgiving. Thank You for your dedication to health and science. 💕
In appreciation for your work! Enjoy your holiday!