Your Local Epidemiologist - The Dose, 11-10-26

Lots of news as usual from Dr Katelyn Jetelina at The Dose on such topics as COVID, the flu, measles, and more.

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Measles elimination decision brewing, where is the fall vaccination data, and good news you might have missed

The Dose (November 10), by Katelyn Jetelina

This week, a panel of experts is meeting behind closed doors to decide whether the U.S. has lost its measles elimination status. If we lose status (if I were a betting person, I would say we will), it will cause a lot of commotion. Below, I'll help you get ahead of it with what’s going on, what rumors to expect, and what’s next.

Also, fall viruses are doing what they always do: increasing on multiple fronts. That data shows that “sick season” is right around the corner. But where is the fall vaccination data?

Let’s dig in.

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Health “weather” report

Each week, physicians tally how many people they see with a fever plus a cough or sore throat. It’s called ILI (influenza-like illness), and it’s a good way to gauge the health “climate” in the U.S.

Right now, the number of people sick is still relatively low but climbing. Nationally, the rate is 2.8%, just below the 2.9% baseline that marks the start of respiratory season. The South and West are already above it, at 3.3% each, and young kids are getting hit the hardest.

ILI Activity, by season and by state. Source: CDC; Annotated by Your Local Epidemiologist.

When we look at the specific viruses, like the “big three,” here’s where we are:

1. Flu is here. Nationally, about 9% of flu tests are coming back positive, and hospitalizations are climbing in every region but one. The West Coast and the South are seeing the most activity, and the Northeast is beginning to pick up. The CDC reported three flu-associated child deaths so far in the 2026-2027 season. This will reach ~200 kiddos by season's end.

2. Covid-19 is in a holding pattern. Wastewater levels are moderate but hovering nationally. This is very odd, as typically levels decrease after summer before increasing again in December or January. At the state level, rates are truly a mixed bag.

    

   Wastewater levels of Covid-19. Source: CDC

3. RSV is starting its usual winter climb. Hospitalizations are climbing, mostly in kids under 5, and the South is furthest along. This is typically where the RSV season begins before it spreads North and West.

Where is the vaccination rate data?

CDC has not yet published vaccination rates for this fall season, which is highly unusual, since this data typically appears on the website in September or October. Not having this data publicly available is unacceptable. It also raises questions about why.

This data matters for many reasons: Hospitals typically use it to anticipate surges, ER wait times, and stretched staff. Health departments can use it to spot which neighborhoods are falling behind, so they can increase outreach to reach the people who need it. It also holds leadership accountable for vaccine access, communication, and outreach.

I hope people start making noise about it.

What this means for you: This is the sweet spot for getting fall vaccines. Reaching the ILI threshold for “sick season” also means I start wearing a mask in crowded indoor areas, like the airport. I just don’t have time to get sick; you probably don’t either.

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Spotlight: Measles elimination status is brewing behind closed doors

This week, an independent panel of eight experts meets to decide whether the U.S. loses its “elimination” status for measles, meaning the virus has spread continuously in the country for 12 months.

The clock began January 20, 2025, with the West Texas outbreak (February 1 in Mexico, which is also under review). The Pan American Health Organization (PAHO) pushed the review from April to November 2026 to allow time for genetic analysis. (It also falls after the midterms, and some suspect RFK Jr. or the administration influenced this.)

CDC and local health departments compiled the evidence, a U.S. expert committee reviewed it over the summer, and now the panel will advise the PAHO director, who makes the final call.

 

Figure by Your Local Epidemiologist, with support from Claude.

How are they making the decision?

The report is confidential, but PAHO reviews all the evidence together, and no single piece determines the outcome. The core question is whether the same strain of measles (same genotype and lineage) kept spreading for 12 months without a break.

Most of the evidence comes from two places:

1. Old-school detective work. Health departments interview sick people and trace who infected whom and where. This work is critical to understanding how illness spreads (and how to stop it). The challenge is that the trail often goes cold because people don’t want to be interviewed, they don’t remember, or they are impossible to contact. That is why #2 matters…

2. Whole-genome sequencing. Instead of relying only on interviews, this option looks at the virus’s genetic code in measles tests to see whether it has spread continuously for 12 months. Measles picks up a mutation every two to four transmissions between people, kind of like a typo copied (and added) every time a note gets passed along. By reading the virus’s entire genetic code, scientists can see its family tree and whether the Utah case is a “grandchild” of the Texas case (continuous spread) or a separate arrival from another country (a new introduction).

The panel also weighs other factors, including vaccination rates and the effectiveness of a country’s surveillance and outbreak response.

What will it mean?

Many, including me, expect the U.S. to lose elimination status. If that happens, it means measles is officially “endemic” again. The label is largely symbolic. It signals measles is spreading freely in unvaccinated pockets, and it means more preventable disease (more sick unvaccinated people, higher medical bills, and more kids missing school.)

It also means we need a plan to crawl back. I won’t hold my breath for RFK Jr.

What next?

We should know the decision within a week. Last year, PAHO announced Canada’s decision the Monday after the panel met. So I expect we’ll hear something next Monday, November 16. Brace for the headlines.

Also, brace for a fight over the social media narrative. This is where prebunking, learning a misleading argument before you see it, helps. You’re then much less likely to fall for it. It’s like a vaccine for misinformation: a small, weakened dose now builds resistance for later.

Here are a few misconceptions that I see coming:

• “This was caused by illegal immigrants.” (Scapegoating and a red herring.) Most imported cases are U.S. residents returning from international travel. Also, this isn’t really the point. An endemic status depends on whether it kept spreading after it arrived. Here is a YLE deep dive.

• “Canada lost it too.” (Whataboutism.) Yes, so did the UK. This isn’t just a U.S. centric problem, but it’s preventable, and that means we need to look inward, not just outward.

• “The MMR vaccine doesn’t work.” (Nirvana fallacy and base rate neglect.) Vaccines aren’t perfect, but this one is impressively effective (97%). The vast majority of measles cases are among the unvaccinated.

• “We all had measles as kids and it was fine.” (Survivorship bias.) The people saying this are the ones who survived. About one in five unvaccinated people who get measles are hospitalized, and people have died this year. This is preventable.

• “Measles only killed eight people this year. Why not focus on opioids?” (Relative privation.) Less deadly doesn’t mean unimportant, and public health can and should work on both.

But expect to see them in the other extreme, too:

• “We lost our status, so measles is everywhere.” (Hasty generalization.) Outbreaks are concentrated in communities with low vaccination rates. Not everyone faces the same risk, and raising the alarm when a community isn't at risk can do immense harm.

• “It happened under the current administration, so they caused it.” This one needs nuance. Kindergarten MMR coverage has been sliding below 95% for years. But leadership does shape how we respond as a country, where resources go, how agencies communicate, and how quickly we restore our status.

What this means for you: When the news drops, we’ll explain what it means and what it doesn’t, and answer some of your top questions.

For now, expect a very loud conversation. We all play a role in the information ecosystem. Also remember, if you’re up to date on vaccinations, your risk remains very, very low.

For more information, this deep explainer on measles elimination from Common Health Coalition is fantastic.

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Good news

• Overdose deaths keep falling. CDC estimates nearly 68,000 overdose deaths in the year ending March 2026, about 9,500 fewer than the prior year. The nuance: among counties with enough data, deaths rose in 430.

• Barbados eliminated mother-to-child HIV transmission. WHO certified the milestone, the result of years of sustained effort. This doesn’t mean HIV has been eliminated altogether in Barbados. It does mean, as UNICEF put it, that an HIV diagnosis during pregnancy in Barbados no longer has to mean transmission to a child. It worked because 98% of pregnant women got antenatal care, 98% were tested for HIV, and 98% of those with HIV received treatment.

• RSV vaccines are working in nursing homes. A JAMA Internal Medicine study of nearly 600,000 Medicare nursing home residents found vaccinated residents were 73% less likely to be hospitalized with RSV during the vaccine’s first season. This is a high-risk group, so the real-world data is encouraging. Those who got the vaccine were also 56% less likely to die of RSV. Thanks to Force of Infection for flagging this win!

Bottom line

Public health moves slowly. Flu, RSV, and Covid-19 follow patterns we can prepare for before they peak. Measles took years of missteps to resurge, and returning to elimination will take persistence. But progress is also possible.

Love, YLE

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Your Local Epidemiologist (YLE) comprises a team of experts, ranging from physicians to immunologists to epidemiologists to nutritionists, working together with one goal: to “translate” ever-evolving public health science so that people are well-equipped to make evidence-based decisions. The YLE suite of newsletters reaches over 475,000 people across more than 132 countries. This newsletter is free to everyone, thanks to the generous support of fellow YLE community members.

Dr Ruth Report 11-8-26

Here's more great reporting from Dr Ruth Ann Crystal, M.D.:

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Dr. Ruth Report, 11/8/26

3 US measles deaths this week, < 19% of multisymptom Long COVID patients improve by 3 years, H5N1 death in WA, doctors and nurses win big in the midterms, CAR-T may reset autoimmune diseases.

Ruth Ann Crystal MD

Influenza A is high in many places in the U.S., as is COVID. Here in the Bay Area, San Francisco’s test positivity for Influenza A is at 22.5% which is higher than last year’s peak.

Regarding COVID, JP Weiland and Mike Hoerger both show that there appears to be no lull between the late summer and the winter COVID waves. However, they disagree as to how many Americans are being infected with COVID every day. JP Weiland says that there are 230,000 new COVID infections daily, while Mike Hoerger says that there are more like 1,136,000 new COVID infections daily.

The large difference in daily case numbers appears to stem from how each modeler calculates their numbers. JP Weiland tweeted that he is basing his numbers on both WastewaterSCAN SARS-CoV-2 levels and Emergency Department visits for COVID, while Mike Hoerger bases his information on SARS-CoV-2 wastewater levels from both the CDC and from BioBot. I think that using wastewater and ED data is a stronger approach, so I feel that we may be closer to 230,000 new infections per day versus more than a million new cases daily.

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Acute COVID infections, General COVID info

Epigenetic aging during the COVID-19 pandemic: A prospective longitudinal study with prepandemic baseline data in children, adolescents, and adults | PNAS 11/3/26

• Authors say that the stress of the lockdowns during the beginning of the COVID pandemic accelerated epigenetic aging in both children and adults. However, they don’t discuss how getting infected and reinfected with COVID may also cause an increase in epigenetic aging.

Sex differences in inflammation, mitochondrial function and energy sensing during early recovery from COVID-19 in older adults | Nature 11/4/26

• Researchers at Charité in Berlin examined 36 older adults recovering from COVID infection and found that mitochondrial energy signaling was disrupted in both men and women following infection. Women in the cohort additionally exhibited elevated inflammatory markers and weakened antioxidant defenses, findings that may help explain the biological underpinnings of Long COVID.

Vaccines

The Durham County Department of Public Health reminds people that “protection from COVID-19 vaccines fades over time, & the virus that causes COVID-19 changes over time. Getting an annual COVID-19 vaccine provides new protection & reduces your risk of becoming seriously ill or dying from COVID-19.”

Global return-on-investment of COVID-19 vaccines in the first year of the vaccination programme: A model-based economic evaluation | PLOS Medicine 11/5/26

• A PLOS Medicine analysis estimates COVID vaccine development and delivery cost $79.4 billion in the first year, but the health and economic benefits were valued at $6.43 to $64.3 trillion. That’s roughly $60 to $809 returned benefit per dollar invested.

Who infected the reported cases? Evidence from 678,482 COVID-19 cases with identified infector collected in routine surveillance in the Netherlands, 2020-2022. | MedRxiv 11/2/26

• Investigators at the Netherlands’ RIVM examined 678,482 COVID transmission pairs and determined that vaccination lowered both an individual’s susceptibility to infection and their probability of subsequently transmitting the virus to others. The data further revealed that the majority of documented transmission events occurred among individuals who had not completed a full vaccination course.

Long COVID

Chronic Fatigue Was Neglected for Decades. Then Came Covid | Bloomberg 11/6/26

• A new article profiles Dr. Lucinda Bateman, who opened one of the first ME/CFS clinics after her sister, Shauna Bateman Horne, became bedridden with the disease. It also covers Rob Wüst’s finding of muscle damage after exercise in Long COVID patients with post-exertional malaise, and an Iwasaki and Putrino study showing that mice given antibodies from people with Long COVID develop the same symptoms.

Herpesvirus reactivation in COVID-19: clinical evidence, mechanistic insights, and research gaps | Frontiers in Immunology 10/19/26

• In a new review, Korean researchers looked at evidence showing that SARS-CoV-2 infection can trigger the reactivation of latent herpesviruses like Epstein-Barr virus (EBV), cytomegalovirus (CMV), and herpes simplex virus (HSV), which ordinarily remain dormant in the body for life. The review identifies dysfunction in T cells and natural killer cells as a likely mechanism through which these viruses escape immune control, and proposes this reactivation as a potential contributor to Long COVID.

Long COVID prevalence among U.S. adults: A state-level ecological analysis of associations with SARS-CoV-2 incidence, COVID-19 hospitalization rates, COVID-19 vaccine coverage, and multimorbidity | PLOS One 11/3/26

• CDC researchers examined Long COVID rates across 48 U.S. states and found that approximately 6.7% of American adults were affected in 2023. States where residents received COVID boosters at higher rates showed meaningfully lower Long COVID prevalence, a relationship that held up even when researchers accounted for other contributing factors.

Association of COVID-19 with neurodegenerative and neurological disorders in vaccinated and unvaccinated people | MedRxiv 11/1/26

• Researchers from the University of Bristol analyzed EHR data from 18.3 million adults and found that cognitive impairment remained elevated for a minimum of five years following COVID infection. The elevated risk was more pronounced among individuals who were unvaccinated or who required hospitalization due to COVID infection.

No objective evidence of neuropsychological deficits in people with subjective cognitive changes following COVID-19 infection | J Psychiatric Research

• UCSF and San Francisco VA researchers compared 32 adults who reported persistent subjective cognitive decline, such as worsening memory or concentration for over 12 weeks following a COVID infection to 34 adults who did not. Findings revealed that while these patients exhibited no objective neuropsychological deficits, cognitive complaints were strongly associated with higher levels of depression, anxiety, systemic inflammation (sCD14), and APOE-ε4, a genetic dementia risk marker.

Timing of Long COVID Improvement in Prospectively Followed RECOVER-Adult Participants | Annals of Internal Medicine 11/3/26

• In 1,019 RECOVER-Adult participants with probable Long COVID at 12 months, about half (50.1%) had sustained symptom improvement within three years and 27% reached complete remission. Recovery varied greatly by symptom pattern however: about 60% with smell or taste predominant illness improved, versus less than 19% who had Long COVID symptoms that affected multiple body systems. Placebo-controlled treatment trials are needed.

Disease-associated NK-cell state remodeling reveals transcriptional profiles predictive of clinical phenotypes | BioRxiv preprint 10/27/26

• Researchers at Peking University compiled a dataset of 1.2 million natural killer cells spanning 50 distinct diseases and used artificial intelligence to identify gene expression signatures capable of distinguishing 18 of those conditions, pointing toward potential new diagnostic biomarkers. Among the study’s notable findings, adaptive natural killer cells appeared at higher levels in Long COVID patients than in those experiencing acute COVID infection. Their NKceiver model predicted COVID severity with an AUROC 0.912.

H5N1

Yakima County, Washington, reports 2 more avian flu cases, 1 death | CIDRAP 11/2/26

• Yakima County, Washington, reports two people have been infected with H5N1 avian influenza, including a person who has died. The death was in an individual with underlying health conditions and is the first U.S. H5N1 death this year. The other new case is mild, and officials note that there has been no human-to-human spread. All 3 reported human H5N1 cases in Yakima county have been from contact with infected cattle on dairy farms.

JP Weiland infographic shows why H5N1 bird flu infections on mink farms in Utah are particularly worrisome. Minks have both α2,3 receptors like birds and α2,6 receptors like humans. They are a potential bridge host.

Measles

CDC Measles Update

As of November 5, 2026, the CDC reports 5,182 confirmed measles cases in the United States in 2026.

Sadly, three Americans died of measles this week, including an infant in New York, the state’s first measles death in 30 years. Two days later, Pennsylvania reported the death of an unvaccinated person in Jefferson County. A day after that, Wisconsin reported the death of an infant, the state’s first since 1990.

While two doses of the MMR vaccine are 97% effective at preventing measles infections, infants under 12 months are generally too young for their first routine MMR dose, so they depend on the vaccinated people around them for protection. When community MMR vaccine coverage falls below 95%, herd immunity weakens, and babies, unvaccinated people, and the immunocompromised can pay the ultimate price.

The Pennsylvania victim was reported to be a 21 year old woman who died of measles and complications of childbirth. Measles during pregnancy can be extremely dangerous for both mother and baby. In a small Namibian measles outbreak cohort, pregnant people with measles had about 6 times the risk of spontaneous abortion, 9 times the risk of fetal death, and nearly 10 times the risk of maternal death compared with pregnant individuals without measles.

• Child dies of measles in New York state for first time in 30 years | CIDRAP 11/3/26

• Pennsylvania reports another measles-related death, the 2nd in Jefferson County | CIDRAP 11/4/26

• Wisconsin reports its first measles death in decades, the third in the U.S. this week | NBC 11/5/26

• Maternal, Fetal, and Neonatal Outcomes Associated With Measles During Pregnancy: Namibia, 2009–2010 | Clinical Infectious Diseases 2014

Johns Hopkins US Measles Tracker:

 

There have been 667 new measles cases reported in just the last 2 weeks! The expected mortality rate from measles ranges from 1 to 3 deaths per 1,000 infections and there were 3 deaths reported this week. The true number of measles cases is probably significantly higher than reported, since many cases are never counted.

Ebola in Democratic Republic of Congo (DRC)

US CDC Ebola Update

• As of November 4, the CDC reports 10,741 confirmed cases of Ebola in the DR Congo, with 5,230 confirmed deaths from Ebola.

Islamist militants force Ebola patients to flee in deadly Congo raid | Reuters 11/6/26

• This week, Islamic State-linked militants raided a village in eastern DR Congo, killing at least 33 civilians and forcing Ebola patients to flee.

Two new candidate vaccines to join Ebola trial as treatment research advances | WHO 11/4/26

• WHO experts recommended adding two Ebola vaccine candidates, Oxford’s ChAdOx1 and Moderna’s mRNA-1469, to a clinical trial in DR Congo. They are the first vaccines designed specifically against Bundibugyo virus, the cause of the current Ebola outbreak. Vaccine results are expected in early 2027.

Government Health News

Medical Professionals Are Among the Winners of the Midterms | NY Times 11/4/26

• Democratic doctors and nurses were standout winners in the midterms this week, including Senate wins for pediatrician Dr. Annie Andrews and epidemiologist Dr. Abdul El-Sayed. Many centered their campaigns on opposing RFK Jr., and they may form a doctors’ caucus focused on affordability.

Four Kennedy Appointees to Powerful Health Panel Allowed to Keep Drug Stocks | NY Times 11/5/26

• Four of eight new Kennedy appointees to the U.S. Preventive Services Task Force were able to sign conflict-of-interest waivers allowing them to keep stock in drug and medical companies. Former task force leaders say such holdings would have disqualified them and could erode public trust.

Other news

Increased infant bleeding tied to lower acceptance of newborn vitamin K dose | CIDRAP 11/6/26

• “Two large studies published yesterday look at declining rates of newborns receiving the vitamin K birth injection and come to a grim conclusion—skipping the birth dose leads to an increase in infant bleeding… Nonreceipt of IM vitamin K was associated with greater than twice the risk of both intracranial [brain] bleeding during the first 6 months and death with a bleeding diagnosis during the birth hospitalization.”

Vitamin K Deficiency and Associated Bleeding in Infants | JAMA Pediatrics 11/5/26

CD19-CAR T-cell therapy resets the EBV+ autoreactive B cell repertoire in autoimmune disease | BioRxiv 11/2/26

• Could a type of CAR-T therapy put autoimmune diseases into remission? Stanford and Erlangen researchers used EBV-seq to profile EBV-infected B cells in 27 patients with autoimmune lupus, myositis, or systemic sclerosis. Twelve autoimmune patients received CD19 CAR-T therapy which cleared the pre-existing EBV-infected B cells and reset them to a naïve, non-autoreactive state, while Rituximab treatment left them intact. Sustained drug-free remission occurred in 8 of 12 CAR-T autoimmune patients versus 0 of 15 on Rituximab therapy.

Longer exposure to oestrogen linked to better vascular health in the brain | Karolinska Institutet News 11/5/26

• “Women who had a longer reproductive period and had used or are using hormone replacement therapy showed fewer signs of damage to the small blood vessels in the brain later in life.” The authors caution that the data are observational and self-reported, so they cannot support recommending hormone therapy for prevention.

Original study: Reproductive Lifespan and Hormonal Therapy in Relation to Later-Life Neurovascular Health in Community-Dwelling Older Women | Neurology 11/4/26

• In 352 Swedish women scanned at ages 70 and 75, a longer reproductive span and menopausal hormone therapy were linked to less small vessel disease in the brain.

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A pericyte-to-myofibroblast transition links APOE4 to cerebrovascular degeneration | Cell 9/24/26

• In APOE4 brains, pericytes convert into myofibroblasts driven by elevated TGF-β signaling. These cells deposit fibronectin, which promotes vascular amyloid buildup. Blocking TGF-β restored pericyte coverage and reduced fibrosis and amyloid in human iPSC-derived brain tissue and aged APOE4 mice. The authors caution that systemic TGF-β inhibition may carry safety concerns.

Programming immunity in situ: A new frontier of in vivo cell engineering | Science Immunology 11/6/26

A new review in Science Immunology covers in vivo cell engineering, where lipid nanoparticles or viral vectors program immune cells inside the patient instead of in a lab. Early trials in cancer and lupus show feasibility, though lupus B cell depletion proved temporary. Key hurdles are precise targeting, off-target delivery, immunogenicity, and controlling how long the engineered cells persist. Eric Topol commented on Bluesky, “We are at the beginning of a new and exciting era to be able to program our immune system in the body (in vivo). This new review @SciImmunology nails it.”

Health intel-sharing group warns industry in wake of cyberattack on French blood bank | NPR 11/6/26

• Health ISAC is warning healthcare organizations to lock down refrigeration and cold storage controllers after a wave of cyberattacks, including one on a vendor serving the French blood bank, which pushed storage temperatures dangerously high before staff caught it. Recommended steps include separating controllers from hospital IT, training staff for manual control, and keeping offline backups.

Hawaii patients may soon get prescriptions for fresh food from doctors | NBC 11/5/26

• Hawaii doctors may soon prescribe fresh food to 100,000-plus Medicaid patients. Starting as soon as January, recipients could get $50 to $55 weekly for fresh produce and proteins like ahi and chicken, easing diet-related illness while boosting local farms.

For Centuries, Cave Visitors Walked Right by 280 Ice Age Engravings. The Newly Discovered Rock Art Is Rewriting Catalonia’s Prehistory | Smithsonian Mag 11/6/26

• Tourists have visited the Cova de la Font Major since the 12th century, but it appears that they missed important prehistoric cave art. Researchers have now identified 280 Ice Age engravings, roughly 26,000 years old, in Catalonia’s Cova de la Font Major which shows that the region has a far richer Paleolithic history than previously thought.

An engraving of a horse, one of roughly 280 artworks found in the cave, is estimated to be 26,000 years-old. Josep Maria Vergès Bosch and Míriam Salas-Altès

Have a great week,

RuthAnn Crystal MD

The 3 Public Health Threats That Scare Michael Osterholm Most

This important article comes from CIDRAP on 10-28-26:

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The 3 public health threats that scare Michael Osterholm most—and 4 bonus frights

CIDRAP, Laine Bergeson, October 28, 2026

Halloween gives us plenty of imaginary threats to fear: ghouls, goblins, your neighbor trying to dress like Kid Rock, and the monster under the bed (which, admittedly, makes a compelling case for keeping your feet under the covers).

Infectious disease experts have a more consequential list, but what tops it isn’t usually what scares people most. Headlines about rare infections and unfamiliar diseases tend to ratchet up anxiety, but, say experts, some of the greatest dangers have become so familiar that we underestimate them. 

There are big gaps between what the public most fears and the threats that actually cause the most harm, says Director of the Center for Infectious Disease Research and Policy (CIDRAP) Michael Osterholm, PhD, MPH. “There's often a lot of confusion between what kills you versus what hurts you versus what concerns you versus what panics you.”

This Halloween, we asked Dr. Osterholm to outline the top three infectious disease threats that concern him the most and what people can do reduce their risk. And, in true Osterholm fashion, he provided four bonus scares.

Threat #1: Respiratory diseases

 

Influenza is so much a part of the fabric of fall and winter that most people barely register it as a threat. COVID-19, too, has receded in the public imagination, becoming just another illness we hope to avoid. And respiratory syncytial virus (RSV) often resembles a common cold, making it easy to overlook, despite it being the leading cause of hospitalization among infants in the United States and hitting older people hard as well. 

But familiarity doesn’t make these diseases innocuous. During the 2025–26 respiratory virus season, the CDC estimates there were up to 57 million flu illnesses, 390,000 flu-related hospitalizations, and 81,000 deaths. Before that, the 2024–25 flu season was the highest-severity flu season in more than a decade, with hospitalization rates up to  2.8 times higher than the historical median and 280 pediatric deaths—the most in any non-pandemic flu season since pediatric flu deaths became reportable in 2004.

COVID’s toll has declined considerably since the height of the pandemic, but the virus remains a substantial public health threat, especially for older adults, infants, pregnant women, and people with compromised immune systems. During the 2025–26 respiratory virus season, COVID was associated with an estimated 5.2 million to 14.6 million illnesses and as many as 2.7 million outpatient visits, 270,000 hospitalizations, and 48,000 deaths nationwide.

Infants and older adults are at the greatest risk for severe RSV-related disease. During the 2025–26 season, RSV caused an estimated 2.8 million to 5.8 million outpatient visits, 170,000 to 340,000 hospitalizations, and as many as 25,000 deaths.

“When you look at the morbidity and mortality each year in this country from respiratory diseases, it’s remarkable,” says Osterholm. The toll is particularly striking, he says, given the resources available in the United States. 

“When we see several hundred children dying in a year from an infectious disease in this country, we have to ask ourselves, ‘How could that happen?’” he says. “We're not living in a country that has unsafe water supplies or lack of medical care.”

Getting annual vaccinations against flu and COVID remain the best way to protect against severe disease. RSV immunizations offer protection for eligible groups. For guidance on who should receive immunizations and when, Osterholm directs people to the American Medical Association’s website, which compiles recommendations by age, medical status, and vaccine. 

One thing to remember, says Osterholm, is that the protection provided by different vaccines varies. For respiratory infections, for example, vaccines help protect against severe disease more than against infection itself.

“When you get to COVID and the flu in particular, you're talking about not necessarily protecting against infection. You get relatively low protection from those vaccines,” says Osterholm. “What’s really important is that they are very effective at reducing serious illnesses, hospitalizations, and deaths, and if you could have an infection that lays you up for a few days but doesn’t send you to the hospital or the ICU [intensive care unit], that's really worth it. And that's what those vaccines do.”

Threat #2: Antibiotic resistance

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If you were to do a quiz on antibiotic resistance [AMR] and offer $1 million to people who get all the answers right,” says Osterholm, “you could probably keep your million dollars.”

The problem of bacteria changing in ways that allow them to survive the medication designed to kill them doesn’t grab a lot of headlines. And it can feel like a diffuse, distant problem—something happening to other people or gathering momentum for a future catastrophe, rather than a threat that deserves attention now. 

“People forget how many people die every day in this country from antimicrobial-resistant infections,” says Osterholm. And mortality isn’t the only concern. Resistant infections make treatment more difficult, while the development of new antibiotics struggles to keep pace. 

According to the CDC’s Antimicrobial Resistance Threats Report, drug-resistant bacteria and fungi cause an estimated 9.7 million infections in the United States each year, up from an estimated 2.8 million in 2019. A 2022 study estimated that AMR directly caused 1.27 million deaths worldwide in 2019 and was broadly associated with 4.95 million deaths. 

More recent research, drawing on data submitted by more than 100 countries, found that one in six laboratory-confirmed bacterial infections were resistant to antibiotics in 2023.

As resistance spreads, treatment often requires more antibiotics. Yet antibiotic overuse can perpetuate the problem, creating conditions that favor resistant bacteria. For example, antibiotic overuse can disrupt the protective microbes in the gut, which makes the gut more susceptible to serious infections with pathogens like Clostridioides difficile (C diff), a potentially life-threatening infection of the colon. 

“It causes severe diarrhea and even potentially fatal diarrhea,” says Osterholm. C diffis estimated to cause half a million infections annually in the United States. 

Most cases of C diff happen while or shortly after taking antibiotics, notes the CDC—and most cases require treatment with specific antibiotics. It’s a cycle that illustrates the tricky balance in working responsibly with antibiotics. 

“This is a slow-motion crisis,” says Osterholm.

To help slow the spread of AMR, take only antibiotics and antimicrobials prescribed for you, and consult your practitioner before changing treatment, says CIDRAP Program Manager Elise Holmes, MPP. 

If a prescription is stopped, don’t save it for later or dispose of it in the sink, toilet, or your yard, where it may come in contact with the water supply, she continues. Seek out medication take-back programs, which are often available at local pharmacies.

Preventing infections also reduces the need for treatment. Staying current on recommended vaccinations, washing your hands, practicing food safety, and using safer-sex measures can help protect you, too, says Holmes. 

Taking steps to prevent infection when you travel warrants extra attention, she adds. Always follow the food and water precautions appropriate for your destination and, if you’re considering medical or dental care abroad, know that it may come with increased risks. 

Threat #3: Measles

 

Measles may seem like a disease that belongs to another era. But increasingly, it belongs to this one. 

As of late last week, US measles cases had reached 4,588, the highest annual total since 1991 and more than double last year’s total of 2,289. Pennsylvania accounts for nearly a third of the total, and experts have warned that the official counts likely underestimate the outbreak’s true size. 

“Pennsylvania is just one of what's going to be many,” says Osterholm.

Declared eliminated in the United States in 2000, measles is resurging because of a combination of its extraordinary contagiousness and growing gaps in protection. As many as nine in 10 susceptible people who have close contact with an infected person develop measles, and the virus can remain in the air—and infectious—for up to two hours after an infected person leaves a room. 

At the same time, vaccination rates are falling. Measles-mumps-rubella (MMR) vaccine coverage among US kindergarteners has dropped from 95.2% during the 2019–20 school year to 92.4% in the 2025–26 school year. Keeping such a contagious virus in check requires community vaccination coverage of roughly 95%.

Measles vulnerability extends beyond children. Measles is often incorrectly thought of as a childhood disease, but adults account for roughly 40% of cases this year and 67% of cases in Pennsylvania. What’s more, adult infections can be more severe: nationwide, adults have a 14% hospitalization rate, compared with 5% for kids and teens aged 5 to 19 years.

“For most of history, people either got measles and died or got measles and recovered and then had protective antibodies,” says Osterholm. Then, in the 1970s, as the measles vaccine became more commonplace, more people had protective antibodies without having to survive a bout of measles. 

Today, it’s different. 

“Beginning in the 1990s, we started to see this decision by new parents not to vaccinate their children. Initially, that number was relatively low, but it continued to grow,” says Osterholm. “Now those individuals who didn't get vaccinated and who didn't get natural infections are young adults who are susceptible to measles, and that’s a huge issue.”

Not only are those adults susceptible to measles, they’re of childbearing age. Measles can complicate pregnancy, increasing the risk of premature delivery, low birth weight, and pregnancy loss. It can also increase the risk of passing measles to the fetus, causing congenital measles, an infection acquired in utero that can cause severe illness or death in newborns. 

“Because pregnant women would have either had been vaccinated or would have previously had measles themselves before they were pregnant, they would have passed antibodies onto their unborn child, so this is a new phenomenon,” says Osterholm. 

Some people dismiss measles as “just a rash,” but that underestimates measles true dangers. The CDC estimates that one to three of every 1,000 children die from respiratory or neurologic complications of measles. And children and adults who recover aren’t out of danger. 

Measles can trigger immune amnesia, in which the immune memory cells are destroyed and survivors are vulnerable to infections they previously had protection against because of vaccination or infection. 

Another complication is acute disseminated encephalomyelitis, an inflammatory condition of the brain or spinal cord that occurs in approximately one in 1,000 cases. Measles can also cause subacute sclerosing panencephalitis, a deadly neuroinflammatory disease of the central nervous system that can appear seven to 10 years after an initial measles infection in patients who seemed fully recovered. 

The strongest protection against measles is vaccination. One dose of MMR vaccine is 93% effective at preventing measles; two doses are 97% effective. People unsure about their vaccination status should ask their healthcare provider whether they need a dose. This is especially important before travel or during a local outbreak. MMR vaccines can’t be given during pregnancy, so checking immune status before pregnancy is particularly important. 

If a person is exposed to measles, “it's all about quarantine,” says Osterholm. Those with a suspected case should call ahead to the clinic or emergency department before going in. 

More threats worth watching

The threats that warrant our attention don’t end there, says Osterholm. Four others should be on our radar for their potential to spread, the severity of the harm they can cause, and the gaps in our preparedness. 

Chronic wasting disease

Chronic wasting disease (CWD) is a fatal neurologic illness that affects cervids such as deer, elk, moose, caribou, and reindeer. No human infections have been confirmed, but some experts, including Osterholm, worry that CWD could jump species. Since CWD was first documented in 1967, it’s spread across North America and has now been documented in 37 states and five Canadian provinces—and with its expanding reach comes more opportunity for human exposures. 

he primary fear is that CWD could jump to humans through the consumption of venison or other infected meat. The infectious, misfolded proteins, called prions, that cause CWD are not confined to a deer’s brain and spinal cord. Prions have been detected in skeletal muscle, or the meat people eat. Continuing to eat deer meat without testing for prions is “a really dangerous, shortsighted activity,” says Osterholm. 

He points to “mad cow” disease (bovine spongiform encephalopathy) as a precedent. Some people who ate contaminated beef developed variant Creutzfeldt-Jakob disease, the human form of mad cow disease. In terms of preventing a similar scenario with CWD, he says, “I fear one day we're going to wake up and regret we hadn't done more” to prepare.

Rubella

Overall, cases of rubella have dropped dramatically since vaccination helped eliminate transmission in 2004. But concern about the infection, which is especially dangerous during pregnancy, is rising as US MMR vaccination rates decline. 

Rubella, sometimes called “German measles,” although it is caused by a different virus, can be mild in children and adults, but an infection during pregnancy can have severe consequences, including miscarriage, stillbirth, or congenital rubella syndrome (CRS), which can damage hearing, vision, and development. 

About 20,000 babies developed CRS, and approximately 2,100 newborns died, in the last major US rubella epidemic in 1964-65. Today, roughly 10 rubella cases are reported annually in the United States, most of them acquired when traveling or living abroad. 

Worldwide elimination is possible if enough people receive a rubella-containing vaccine, which is 97% effective at protecting against the virus. The CDC recommends that children receive two doses of the MMR vaccine and adults without immunity receive either one or two doses, depending on risk factors. Pregnant women who do not have evidence of immunity should be vaccinated immediately after giving birth.

Ebola

For people in North America, the threat level from the current Ebola outbreak in the Democratic Republic of Congo (DRC) is “extremely low,” says Osterholm. But the low domestic risk does not diminish the urgency of containing the outbreak. 

In early October, a man traveling to Kenya through the DRC and Uganda contracted Ebola and died, demonstrating the potential for the infection to cross borders. And the current outbreak is the largest ever in the DRC, with 10,091 reported cases and 4,891 confirmed deaths as of today. 

Researchers are investigating whether Ervebo, a vaccine approved against Zaire Ebola virus, offers protection against the Bundibugyo virus (the cause of the current outbreak). Researchers are also investigating Bundibugyo-specific vaccine candidates. 

The vast majority of Ebola transmission happens through bodily fluids, but experts such as Osterholm speculate on the possibility of airborne transmission—a scary prospect for public health. “We have enough information to know that it could possibly happen,” he says. “And how prepared are we to have that?”

Food safety

This summer’s cyclosporiasis outbreak, linked to iceberg lettuce grown in Mexico and distributed by Taylor Farms de Mexico, sickened at least 12,883 people in 21 states and resulted in at least 570 hospitalizations and two deaths. The outbreak, caused by the microscopic Cyclospora parasite, drove a surge in US cyclosporiasis cases—the CDC received reports of 19,883 lab-confirmed cases this summer, while during the same period in 2025, just 1,180 cases were recorded.

“Foodborne outbreaks often are small and limited relative to the size of the food supply,” says Osterholm. “But when they happen, they're a huge challenge. They can be deadly. They can cause disability. They cost lost hours of work or family time.”

The public health concern extends beyond contamination to the systems that help identify and prevent foodborne illness. During the Cyclospora outbreak, delayed federal communication left the public without timely guidance. “We’re so late to the game to get information out to the public,” Osterholm told CIDRAP News in July. “By the time we get any recommendations for reducing risk, the outbreak’s over.”

Meanwhile, the CDC's Foodborne Diseases Active Surveillance Network (FoodNet) program reduced required surveillance from eight pathogens to two, making the reporting of illnesses caused by Campylobacter, Cyclospora, Listeria, Shigella, Vibrio, and Yersinia optional. While FoodNet monitors disease trends more than directly detects outbreaks, its data can help experts assess if prevention efforts are working. 

Funding cuts to FoodNet and similar programs "would devastate our capacity to investigate outbreaks,” Craig Hedberg, PhD, a professor in the Division of Environmental Health Sciences at the University of Minnesota and codirector of the Minnesota Integrated Food Safety Center of Excellence, told CIDRAP News in August 2025. 

"The disturbing thing about cutting FoodNet funds is that it normalizes the idea that foodborne disease surveillance is expensive and unimportant," he said. "In fact, it is the foundation of our food safety system, and needs further investments, not restrictions."

Yet Another Assassination Attempt Stopped

The CBS headline mentions "Man with gun" while Fox News calls him "armed Venezuelan migrant". But the Department of Homeland Security gets the wording right. 

Naturally this thwarted assassin already had his excuse ready, but you know the only voice in his head was his own.

Thank goodness for DHS and the Secret Service. Will the socialist Dems try to eliminate those agencies, too?

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U.S. Secret Service Arrests Illegal Alien with Guns in Vehicle Near the White House

Release Date: November 6, 2026

"This criminal illegal alien, released into our country by the Biden Administration, claimed he heard voices in his head telling him to kill President Trump."

WASHINGTON – The United States Department of Homeland Security (DHS) released the following statement after U.S. Secret Service (USSS) officers arrested an illegal alien from Venezuela who had multiple guns in his vehicle near the White House and threatened to kill President Donald Trump.

On Thursday evening, November 5, Secret Service officers approached the suspect when they saw him acting suspicious in his car while parked on Constitution Avenue in Washington, D.C. When they confronted the suspect, he said that he heard voices in his head telling him to come to Washington, D.C. and kill President Trump. The officers then discovered that the vehicle had been reported stolen, and the suspect admitted to having weapons in his vehicle. Upon discovering three different firearms – including one rifle – as well as dozens of rounds of ammunition, the officers arrested the suspect.

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The weapons and ammunition retrieved from the suspect’s car, including an AR-15 style weapon, a Mac 10, and a Glock 43X 

The suspect, Ronny Yordrix Guanipa Chrinos, is an illegal alien from Venezuela.

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Ronny Yordrix Guanipa Chrinos 

Chrinos has been charged with carrying a rifle outside of a home or business, THREE counts of unlawful transportation of a firearm, THREE counts of unregistered firearms, THREE counts of unregistered ammunition, possession of certain dangerous weapons, carrying a pistol without a license, unauthorized use of a motor vehicle, theft, and receiving stolen property. Following his arrest, U.S. Immigration and Customs Enforcement (ICE) lodged a detainer for Chrinos with the U.S. Marshals Service, where he is currently in custody.

“Thanks to our brave Secret Service officers, this illegal alien with three firearms in his vehicle was arrested near the White House before he could harm anyone,” said Homeland Security Secretary Markwayne Mullin. “On top of threatening President Trump, he is an illegal alien from Venezuela who had no business being in our country in the first place. This is just an example of the incredible work done by the men and women of the Secret Service every single day as they put their lives on the line to protect our nation’s leaders. It’s an honor to work alongside Director Sean Curran and all of the patriots at the U.S. Secret Service.”

“This is the latest example of Secret Service personnel relying on extensive training and experience to deescalate a volatile situation that posed an imminent threat to our protectees and other Americans,” said U.S. Secret Service Director Sean Curran. “This incident reflects the heightened threat environment in which we operate, as well as the continued number of armed individuals who are drawn to the White House complex. While our personnel are trained to respond to situations like this and we remain confident in our tactics, we are alarmed by the increase in threat cases that continue to arise. The Secret Service will continue expanding our focus on proactively investigating and identifying individuals who make threats to our protectees, in order to disrupt threats before they arrive in Washington.”

Chrinos illegally entered the United States through Texas in March 2024 and was arrested by the U.S. Border Patrol. He was then RELEASED into the country by the Biden Administration.

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Helpful Information on COVID, Flu & RSV

This is a very good article which again makes me thankful that there are vaccines available and that I always get vaccinated. I wish everyone would.

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From Johns Hopkins Bloomberg School 11/4/26

What to Know About Flu, COVID-19, and RSV This Fall
Influenza activity is increasing, while RSV and COVID case numbers remain low.

By Morgan Coulson

As we head into the late fall and winter months, flu cases are beginning to rise in parts of the U.S., even as overall respiratory virus activity remains low. The CDC is predicting a relatively moderate respiratory virus season, similar to last year’s, when weekly hospitalizations from flu, COVID-19, and RSV peaked at around 16 per 100,000 people. 

But that’s no reason to put off vaccination, explains Andrew Pekosz, PhD, a professor in Molecular Microbiology and Immunology: “This is a good last call to get your influenza vaccination for this year, because vaccines work best when taken before the influenza season starts.” 

This season also brings a new option for some adults: a recently approved mRNA influenza vaccine for people ages 50 and older.  

“The hope is that the new mRNA vaccine will produce a better immune response against influenza and, therefore, provide better protection,” says Anna Durbin, MD, a professor in International Health and director of the Center for Immunization Research. 

In this Q&A, adapted from an October 29 media briefing, Pekosz and Durbin discuss emerging respiratory virus trends, what we know about this season’s vaccines, and how people can protect themselves and others as the season progresses. 

What is the current situation with influenza in the United States? 

Andrew Pekosz: Influenza activity is low but increasing, particularly in the western and southern U.S. This is early, but not unheard of. The cases seem to be driven by a variant of the H1N1 influenza virus, which has some new mutations compared with last year’s H1N1 virus. Those mutations allow it to escape some of the immunity in the population. However, data suggest this year’s influenza vaccine can recognize this variant. 

Influenza vaccines cover three different viruses, and usually different influenza viruses cause infections at the beginning and end of the flu season. So, even if you hear about a potential mismatch with the H1N1 component, it’s important to get the vaccine because the other two components look like they’re going to be pretty good matches for the viruses emerging early in the flu season. 

How well do this season’s COVID and RSV vaccines match the strains circulating now? 

AP: For COVID, we’re seeing low but steady activity. We expect another increase in cases sometime in December or January. 

We haven’t seen much RSV activity this year, which is somewhat unusual. However, I expect we’ll begin seeing RSV cases in the next couple of weeks. 

Now is the time to get your COVID and RSV vaccines, if you’re eligible, along with influenza and pneumococcal vaccines, to prepare for the respiratory virus season. Both the COVID and RSV vaccines are very good matches for the viruses currently circulating.

The RSV vaccine is recommended for a more limited group of individuals, particularly those ages 75 and older, as well as people with certain underlying conditions or who are immunocompromised. That vaccine has demonstrated very good efficacy over the past few years. [Note: The RSV vaccine is not currently an annual vaccine, per the CDC.] 

What’s the difference between the new mRNA flu vaccine and the traditional vaccine?  

Anna Durbin: Essentially, the mRNA vaccine enters your cells and instructs them to make the flu protein against which your body produces antibodies. The cells make that protein and then present it to your immune system, exposing the immune system to the protein, or antigen. 

Current traditional flu vaccines, by contrast, contain proteins that stimulate an immune response. Unlike mRNA vaccines, they don’t enter the cells in the same way to stimulate the broadest possible immune response. Traditional vaccines generate a good antibody response but may not stimulate other parts of the immune system as effectively as mRNA vaccines do. 

Which is more effective? 

AD: We don’t have data from the current flu season yet. However, the clinical trials used to support the mRNA vaccine’s approval showed that, in people ages 50 and older, it performed better than traditional vaccines. 

One important consideration is that adults ages 65 and older receive a higher dose of the traditional flu vaccines than younger people. The mRNA vaccine was not directly compared in clinical trials with those high-dose vaccines in people ages 65 and older. However, we know that the antibody responses generated by the mRNA flu vaccine in people ages 65 and older were at least as good as those generated by traditional flu vaccines. 

Until we get good real-world efficacy data from the flu season, we won’t know for sure. 

How is the mRNA vaccine different from a public health standpoint? 

AD: The advantage of an mRNA influenza vaccine is that it can be produced very quickly. For instance, if a new strain emerges over the summer, the [fall] vaccine [for that year] could potentially be changed to match it. 

Right now, the FDA holds a meeting every March to select which strains will be included in the influenza vaccine. That meeting happens so early because it takes a long time to produce traditional influenza vaccines. 

The hope with an mRNA vaccine is that we might be able to hold another meeting in July or August and update the vaccine if the circulating strains have changed. 

We’re not there yet. The agency is discussing and exploring that possibility, and I think a lot will depend on the evidence generated by this new mRNA influenza vaccine. 

How can a person tell whether they have the flu, COVID, a cold, or something else? 

AP: Usually, you can distinguish a cold from something more significant or serious by the effect it has on your ability to breathe and by the severity of your cough. If you have difficulty breathing, that can mean the infection is spreading deeper into your lungs. In that case, it may not be a common cold but one of the other respiratory viruses. 

There are some useful at-home testing kits that can help determine whether you're infected with influenza, RSV, or COVID-19. Knowing which virus you have is particularly important if you’re in a high-risk group for severe illness.  

Antiviral treatments are available for influenza and COVID-19, and they have been shown to reduce the duration of symptoms and the likelihood of developing severe illness. The key is that you need to start these antivirals soon after symptoms begin.  

Be proactive. Keep some at-home tests available, and if you test positive for one of these viruses, contact your pharmacy to make sure you can get the appropriate antiviral medication and begin taking it as soon as possible. 

What should immunocompromised people and adults ages 65 and older do this fall? 

AD: Immunocompromised people and adults older than 65 should get vaccinated.  

We also know from many studies that adults over 65 often get infected by their grandchildren and other children. Get young children vaccinated against influenza, not only for older adults’ protection but also because influenza can cause serious complications in children, including death. 

How long after vaccination does it take for protection to develop? 

AP: It takes about two weeks for influenza vaccine protection to reach its maximum level. That protection then lasts for several weeks to several months after vaccination. 

Getting vaccinated before influenza becomes widespread will provide the greatest protection against disease. 

What is the most important thing for primary care physicians to know about this flu season? 

AD: Influenza can be a very serious illness. The CDC reported almost 5,000 laboratory-confirmed influenza hospitalizations nationwide during the week ending October 17. This is the highest early-season hospitalization rate for mid-October since the 2010–2011 flu season. [The following week, ending October 24, that number rose to 6,100 hospitalizations nationwide, according to the CDC.] 

I think it’s really important, particularly for older adults who are at greater risk of severe influenza, to get vaccinated. 

What I tell my patients, and what I encourage other physicians to tell their patients, is that a flu vaccine is the best way to protect yourself against influenza, and to get vaccinated as soon as possible. 

Fewer people are getting the flu vaccine, or they are getting it later in the season. What is the impact of this? 

AD: We do think that, overall, fewer people are getting vaccinated against various diseases, which increases the risk of infection. Unfortunately, when fewer people get vaccinated, influenza can spread more easily, resulting in more infections and potentially serious consequences for people’s health. 

There are a lot of questions people have about vaccines, and there’s been a lot of misinformation circulating. I encourage people to talk with their physicians.

This Q&A was edited for length and clarity by Morgan Coulson, an editorial associate in the Office of External Affairs at the Johns Hopkins Bloomberg School of Public Health.