Respiratory Diseases

Influenza-like illness

Flu is going up, up, up. Activity is growing quickly for nearly every state.

At the national level, outpatient visits for influenza-like illness (ILI) increased to 4.1% and growth is picking up. (As a reminder, outpatient ILI is the percentage of visits to the doctor that are for fever and cough or sore throat.)

To put this in context, the past several years, the peak for outpatient ILI has been around 6-8%, so we likely still have a ways to go. Test positivity has also sharply risen in the past week, from 8.5% to 14.8%.

At the state level, more than a dozen states, primarily in the Midwest and West, are still at minimal or low activity, seven at moderate levels, and more than a dozen at high or very high levels. Remember that more state level data is available in the regional editions.

Children and young adults have had really steep increases in outpatient ILI visits this past week, as I forecasted in last week’s report. About 11.2% of outpatient visits for those aged 0-4 this past week were for ILI, as were about 7.6% for those aged 5-24. Outpatient visits are also increasing for older age groups, though not quite as steeply. If you need a reminder of how to prepare for and manage mild illness at home, I have a post I share every year with tips and tricks.

Severe illness is also rising. ED visits jumped to 2.8% this past week, with increases reported in all four regions. And hospitalizations have risen to 3.5 hospitalizations per 100,000 people.

Sadly, three children are reported to have died from influenza so far this year. Last season was particularly severe, with 288 pediatric deaths. For adults ages 65+, 54 deaths have been reported so far this season. The flu vaccine is the best way to protect against severe illness. If you have not gotten your shot yet, it is not too late.

COVID-19

Covid-19 remains low nationally, but is increasing. Wastewater activity held roughly steady nationally this past week after a few weeks of increases. ED visits increased slightly to 0.5%.

The Midwest is the only region that saw a (slight) increase in wastewater activity, which just tipped across the line from low to moderate activity. In the Northeast, activity dipped slightly this past week, dropping back out of moderate activity into low activity, and in the South, activity also decreased and remains very low. In the West wastewater remains very low, and after a slight increase last week is now lower than it has been at any point in 2025.

Hospitalizations remain low (at 1.3 hospitalizations per 100,000 people) but have increased slightly for the past few weeks.

RSV & Other Bugs

RSV: Activity continues to increase, slowly. However, it remains below-average for this time of year.

Test positivity increased this past week, to 3.4%. ED visits held steady at 0.3%. Emergency department visits have risen to 3% among the youngest children (aged 0-4), who are most seriously affected by RSV. The rate was more than double this at this time last year.

Hospitalizations held steady this past week at 0.7 hospitalizations per 100,000 people. For the 0-4 age group, hospitalizations also held roughly steady, at 6.4.

Other bugs:

Adenovirus and parainfluenza are both past peak, but remain elevated.
Human coronaviruses and human metapneumovirus remain fairly low, but are edging upward.
Rhinoviruses/enteroviruses have decreased to moderate levels.

Norovirus

Norovirus test positivity data was not updated this week. However, my back-up data source shows that norovirus wastewater activity is high, but decreasing slightly at the national level.

In the Midwest, Northeast, and South wastewater activity is high and increasing. In the West, wastewater activity is also high, but has dipped slightly.

Food recalls

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

New:

Frozen raw shrimp sold under the Market 32 and Waterfront Bistro brand names, due to possible cesium-137 contamination (more info)
Tamales, various flavors, in 4 count packs, sold by Primavera Nueva Inc. (more info)
Salted Caramel Cluster Non-Dairy Frozen Dessert sold under the So Delicious label (more info)

Previously Reported:

Town Food Service Equipment Co. Aluminum Saucepans, due to potential lead contamination (more info)
Lucky Foods cinnamon powder, due to potential lead contamination (more info)
Wegmans Deluxe Mixed Nuts Unsalted (more info)
Grated Pecorino Romano cheese, sold under various labels, including Boar’s Head, Locatelli, Member’s Mark, Ambriola, and Pinna at major retailers, including Wegman’s (more info)
Prairie Farms Gallon Fat Free Milk (more info)
ByHeart Infant Formula due to potential botulism contamination (more info)

In other news

Major retailers continued to sell ByHeart infant formula after recall issued. The FDA has sent warning letters to several major retailers about failures to remove recalled ByHeart infant formula from their shelves. The products were linked to an infant botulism outbreak that has led to the hospitalizations of at least 51 infants in 19 states. FDA investigators visited retail locations and found that infant formula remained for sale in dozens of states for weeks, despite repeated contact with the companies. This included at Target stores in 30 states, Walmart stores in 21 states, Kroger stores in 10 states, Albertsons stores in 11 states.
Possible threats to vaccine schedule. Several media outlets, including Washington Post and CNN, reported that the Trump administration is considering changing the childhood vaccine schedule to more closely align with Denmark’s schedule, which has a narrower set of recommendations. This action would presumably happen outside the usual process at ACIP.
A year of change. In related news, I joined two colleagues for a conversation about the changes unfolding in public health, and what it means for the future. You can read our discussion in the New York Times (gift link). As always, I want to hear your thoughts and concerns and priorities. I’m particularly curious about what more I can do to be helpful during this time of change. Leave a comment or reply to this email to reach me.