Welcome to the Southern edition of Outbreak Outlook! It is only available to paid subscribers. If you wish to become a paid subscriber and access region-specific information, please click the Subscribe now button below. Thanks for reading! -Caitlin

Respiratory Diseases

Influenza

It’s rough out there. This flu season has been intense, and activity remains very high across the South.

South Carolina still leads the South in outpatient influenza-like illness (ILI) at 14.8% in the most recent week, though down from 17.0% the week prior. Emergency department visits also decreased to 10.7% from 12.7%, bringing needed relief to the state.

Tennessee follows with elevated ILI at 11.4% in the most recent week, decreasing from 12.7%. Emergency department visits declined to 7.4% from 8.3%, while hospitalizations showed a significant drop to 7.2 per 100,000 from 12.3.

District of Columbia and Virginia show increasing activity. The District's outpatient ILI rose to 10.7% from 9.9%, though emergency department visits decreased slightly to 7.4% from 7.8%. Virginia's outpatient ILI increased notably to 9.2% from 7.9%, with emergency department visits also rising to 10.9% from 9.6%.

Texas, Maryland, and Georgia are seeing mixed trends. Texas saw outpatient ILI decrease to 8.8% from 10.8%, with emergency department visits falling to 9.1% from 11.9%. Maryland's outpatient ILI increased to 8.6% from 6.9%, with rising emergency department visits (11.1% from 9.3%) but declining hospitalizations (17.0 per 100,000 from 22.2). Georgia showed slight decreases in outpatient ILI to 8.2% from 8.4%, with emergency department visits declining to 6.1% from 6.8% and hospitalizations dropping to 8.9 per 100,000 from 11.7.

The remaining southeastern states showed mostly declining trends. Mississippi and North Carolina both reported outpatient ILI at 7.8%, with Mississippi decreasing from 8.4% and North Carolina increasing slightly from 7.5%. North Carolina's hospitalizations dropped sharply to 7.4 per 100,000 from 20.5. Arkansas (7.6% from 7.9%), Louisiana (7.5% from 8.2%), Alabama (7.1% from 7.4%), and Florida (6.9% from 7.6%) all showed decreasing ILI trends.

The mid-Atlantic and central southern states reported lower but variable activity. Oklahoma remained stable at 6.7% from 6.6%, while Kentucky increased to 6.2% from 4.3%. West Virginia showed a notable increase to 4.9% from 3.1%, with emergency department visits jumping to 9.9% from 6.2%. Delaware reported the region's lowest outpatient ILI at 4.3%, up from 3.6%, though emergency department visits remained elevated at 11.1%.

COVID-19

Covid-19 wastewater activity is high in the South, though it decreased slightly this past week in many states. Severe illness remains fairly low and stable in most states.

Most states reported high or very high wastewater activity, and activity is trending upward in about half the region. First, where it is increasing: in Tennessee, Delaware, and Kentucky activity is very high and increasing. Activity has not been this high in any of these states since the late summer wave. Wastewater activity is also high and increasing in Georgia and Oklahoma, and is stable in Alabama and Louisiana. It is moderate and increasing in West Virginia.

Activity is high but on the decline in Arkansas, South Carolina, and North Carolina. In Mississippi and Texas, activity is moderate and decreasing, and is it is low and decreasing in Florida and Virginia. (Washington, DC did not report data this past week.)

Emergency department visits remain minimal and stable in most states. However, rates have increased to low levels in Kentucky and Delaware, and remain minimal but are increasing in Georgia. Similarly, hospitalizations are stable and fairly low in most states. The exceptions are West Virginia (6.2 hospitalizations per 100,000 people), Mississippi (4.5), and Kentucky (5.2), where hospitalizations are more elevated and increasing.

RSV

Data were not updated this week.

Stomach Bugs

Data were not updated this week, so nothing to report here.

Food recalls

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

New:

• Menma Ajitsuke Prepared Bamboo Shoots sold under Choshiya brand name (more info)
• Canned Tuna sold under Genova, Van Camp’s, H-E-B, and Trader Joe’s brand names (more info)

Previously reported:

• Alfalfa sprouts sold under the Jack and the Green Sprouts brand name (more info)
• Aleppo Tahini Sesame Paste (more info)
• DJ's Boudain sausage links (more info)
• Blue Ridge Beef Natural Mix [for dogs] (more info). While not for human consumption, humans may be infected with Salmonella if they do not adequately wash their hands or contaminated surfaces after handling the product.
• 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

• A measles outbreak in Texas's Gaines County has rapidly expanded to 48 confirmed cases since late January, with the majority concentrated in Gaines County (42 cases) and several cases reported in neighboring counties. All affected individuals are either unvaccinated or have unknown vaccination status, with most cases occurring in children aged 5-17 years old who developed symptoms within the past three weeks. The outbreak has resulted in 13 hospitalizations, and health officials anticipate more cases.