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Respiratory diseases

Influenza-like illness

As fall progresses, influenza-like illness (ILI) is ramping up but still remains low in most states.

Southern states are experiencing the earliest and most intense flu activity so far this season, with ILI rates in Southern states already approaching or exceeding regional baselines for this time of year.

Western states show more variability, with some like Hawaii nearing 5.5% ILI. New Mexico is also now in the “moderate” category. Much of the rest of the country has to enter the brunt of flu season, but it’s coming.

At the national level, young kids (still!) continue to experience the highest rates of influenza-like illness. Nearly 9% of doctor visits for children aged 0-4 involve symptoms like fever, cough, or sore throat. This rate compares to approximately 4% in the 5-24 age group and less than 2% in older age groups.

Although activity remains low in most states, if you haven’t gotten your flu shot yet, I would put that near the top of your list. I got mine last week!

Covid-19

At the national level, Covid-19 hospital admissions in the United States have been slowly declining over the past several weeks. In mid-October, weekly hospital admissions were around 16,200 compared to over 18,000 in late September. However, admissions still remain significantly above the summer lows below 10,000 per week.

Similarly, the percentage of emergency department visits for Covid-19 has also been trending down. In mid-October, Covid-19 accounted for 1.3% of emergency department visits nationally, declining from 1.7% in late September and 2% in mid-September. But this metric also remains higher than levels below 1% seen in early summer.

Although recent hospitalizations and emergency department burden have improved from their September highs, both indicators show the virus still circulating at moderately elevated levels as of mid-fall. We have yet to see admissions and ED visits related to COVID-19 fall to the very low rates observed a few months ago. The trend is heading in the right direction at the national level, but will likely remain elevated through the winter months.

RSV

We are well into RSV season now. 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 to be. All regions of the country are seeing increases, though the South remains most heavily affected.

RSV is a common respiratory virus that usually causes mild, cold-like symptoms, but can also lead to more severe illness like bronchiolitis and pneumonia, especially in infants and older adults. RSV is the most common cause of bronchiolitis and pneumonia in children under 1 year of age in the United States. Older adults are also at higher risk of severe illness.

This is the first year that shots are available to prevent severe RSV infection. They are available to older adults and infants (though there are reports that availability for the infant product is patchy).

Others

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

• Seasonal coronavirus and metapneumovirus activity remain low nationally, with no concerning increases. 
• Adenovirus seems to be drifting up, along with parainfluenza virus activity. Adenovirus commonly causes respiratory illnesses like the common cold, pneumonia, and bronchitis. Parainfluenza virus is a leading cause of croup in children.

Stomach bugs

Food safety reminders: To avoid foodborne illness when serving Halloween treats, perishable items like dips, cheese platters, and sweets with dairy fillings should not sit out at room temperature for more than two hours. Set these items over ice to keep them chilled. Also, keep hot foods like stews or chilies steaming hot, above 140°F. Make sure to promptly refrigerate all leftovers in shallow containers, and discard if not consumed after 3-4 days. Following food safety guidelines will help make Halloween free from the tricks of foodborne illness.

Norovirus

Norovirus (stomach bug) activity is starting to increase at the National level, with test positivity at 6.9%, up from 4.4% at the end of September. Most of this increase is driven by the Midwest (test positivity over 11%) and, newly, the Northeast. This is higher than its rates at this time for the past couple years, but remains below typical winter highs of around 20%.

Norovirus is highly contagious and can spread quickly through close contact. To reduce your risk, wash your hands thoroughly with soap and water, avoid contact with infected individuals, and disinfect contaminated surfaces. If you are sick, stay home and do not prepare food for other people to prevent the virus from spreading further.

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:

• Over the counter eye drops sold at CVS, Leader, Rugby, RiteAid, Target or Velocity Pharma (more info)
• WanaBana fruit puree pouches (more info)
• 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)

Previously reported:

• Bagged collard greens sold at Kroger (more info)
• Frozen, ready to eat carne asada burritos (more info)
• Ready-to-eat ham produced by Sunnyvalley Smoked Meats (more info)
• Ion and Restore brands Sinus Spray (more info)
• Organic Chicken and Beef Broth sold at Costco and Whole Foods (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 global effort to eradicate polio continues to experience setbacks. A fourth case of polio in Pakistan has been reported in a two-year-old child in the Gadap area of Karachi. It is the first instance of the disease in Sindh in three years. Last month, the poliovirus was detected in all environmental samples taken from Karachi. 
• Bulgaria has reported an outbreak of SARS-CoV-2 in farmed minks. Similar outbreaks have occurred in other countries over the past few years, including Denmark and the Netherlands. The concern with such outbreaks among densely packed farmed animals is that the virus may take on mutations and then spill back into the human population.