Tuesday, September 22, 2026

Measles in Adults (Yes, Really.)

I will never understand why adults who should know better continue to be so apathetic and lackadaisical about getting vaccinated.

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"On a recent rainy day, my kids and I were running through our list of rainy-day activities when laser tag came up. Then they asked, "Mama, will you play with us?" 

"Huh? Laser tag is a kids' activity (or so I thought). I called the place to ask, and it turns out adults are allowed and it's apparently very popular with them. I had no clue, because every laser tag invitation that has ever come through my house had a cartoon on it and a request to RSVP for an 8-year-old’s party. It hadn't occurred to me that it was an option for me.

"Measles has a similar problem. Nearly everything the public hears about it involves children, whether it's the childhood schedule, kindergarten vaccination rates, school exclusions, or babies who are too young for their first dose. Much of the media attention on Pennsylvania's outbreak has centered on the two infants who died in August. That attention is warranted, since those deaths are tragic, babies don't typically get their first measles, mumps, and rubella (MMR) vaccine dose until 12 months, and children under 5 are hospitalized at some of the highest rates of any age-group. 

"When children are the only people we picture with measles, though, adults process it the same way I did laser tag, as something that isn't meant for them, and this year's data show otherwise. 

4 in 10 US measles cases this year are in adults

"According to CDC's latest data, 38% of confirmed measles cases in 2026 (1,305 of 3,471) are in people 20 and older, up from 29% in 2025. Adults are being hospitalized at a rate of 12%, about the same as children under 5 years (13%) and three times the rate for school-aged kids and teens (4%). They account for 156 of this year's 301 measles hospitalizations, or just over half. In Pennsylvania, the hardest-hit state, the share is even higher. About seven in 10 cases this year are in people 18 and older, and the largest single age-group is 25 to 49. 

"This week, Pennsylvania reported its third and fourth measles-associated deaths of the year, in a 40-year-old woman in Jefferson County and an 18-year-old in Mifflin County who died of acute disseminated encephalomyelitis, a rare neurologic condition that can follow measles. Neither was vaccinated. The last time the US reported four measles deaths in a single year was 1992. One of last year's three deaths was also involved an adult, in New Mexico, so three of the seven US measles deaths reported since the start of 2025 were in people 18 or older.

"The Jefferson County coroner listed the woman's cause of death as respiratory failure due to measles, chronic obstructive pulmonary disease, and asthma. His office noted that many people think of measles as a childhood illness, when in fact it can cause severe complications at any age. Chronic conditions like hers are common among adults and become more so with age, and plenty of people are inside a higher-risk category without knowing it, because nobody has ever told them their condition counts.

Why more adults are getting measles, and why it can hit them hard

"Before the vaccine arrived in 1963, measles was largely a disease of young children, because nearly everyone caught it early in life. Once vaccination became widespread, people who were never vaccinated could grow up without encountering the virus, since the vaccinated people around them kept it away. Kindergarten MMR coverage has fallen from 95.2% in 2019-2020 to 92.4% last school year, measles has been reported in 47 jurisdictions, and those still-susceptible adolescents and adults are now being exposed for the first time.

"Adulthood is also a riskier time to have measles than most people assume. The risk of severe complications, including pneumonia and brain inflammation, is highest in children under 5 and adults over 20. Measles during pregnancy raises the risk of miscarriage, preterm birth, and low birth weight. Measles can also cause immune amnesia, a temporary loss of immune protection against infections the body had already fought off, that can last months to years. 

"A 2019 case report from Dresden, Germany describes two adults who came to the emergency department with measles. A 40-year-old man with pneumonia recovered in 12 days. A 55-year-old woman improved quickly at first and then, within days, lost the ability to organize her daily activities, dress herself, or start a conversation, and she needed neurologic rehabilitation. Neither had vaccination records. 

"The authors urged fellow clinicians to consider measles in adults who show up with a fever and a rash. That reminder is just as (if not more) important today with measles cases rapidly climbing.

Adults tune out messages that seem to be about someone else's kids

"My last piece was about how a message focused on older adults and the immunocompromised signals to people outside those categories that the disease isn't about them. Framing measles as a childhood disease does the same thing to adults. 

"Adults who hear measles news as a story about other people's children have no reason to look for their own records, to ask about a second vaccine dose before an international trip, or to think of measles when they come down with a fever and a rash and head to a crowded waiting room. Many adults also assume that whatever they received as kids still protects them, and for some of them, that isn't the case.

What to do if you're not sure you're protected

  1. If you were born before 1957, you're presumed immune, because nearly everyone was infected during childhood before vaccines were available. Healthcare workers are the exception and should check with their employer.
  2. If you have written records of two doses given after your first birthday (and at least 28 days apart), you're considered protected, and you don't need another dose or a blood test to confirm it. Two doses are about 97% effective, and one dose is about 93% effective. (Absolutely incredible.)
  3. If you were vaccinated from 1963 to 1967, you may have received an inactivated (killed) version of the vaccine that was withdrawn because it didn't protect well. Fewer than 1 million people received it, but most don't know which type they received. If that's what you got, or you don't know, talk to your clinician about being revaccinated.
  4. If you have one documented dose (which is common for people who were kids before the second dose was recommended in 1989), that's considered enough for most adults. Two doses are recommended for college students, healthcare personnel, international travelers, people with HIV, and close contacts of immunocompromised people. Health departments sometimes recommend a second dose for adults in outbreak areas, and yours will say so if it applies to you.
  5. If you have no records and no idea, try your state's immunization registry, your parents, your childhood doctor's office, and old school, college, military, or employer files. If nothing turns up, CDC recommends getting an MMR dose and says there's no harm in getting another dose if you may already be immune.
  6. A blood test for antibodies (a titer) is the other option, but for most adults the extra dose makes more sense. The titer adds a step (since a low result sends you back for the vaccine anyway), and it can add lab fees and copays. It also gives an incomplete picture, because it measures only the antibodies circulating in your blood and says nothing about the memory cells that are a big part of lasting protection. Commercial tests can also miss low levels of vaccine-induced antibodies, so a vaccinated person can get a low reading and still be protected. (Titers still have a place for people who can't get a live vaccine and for jobs or schools that require them.)
  7. MMR is a live vaccine, so it isn't given during pregnancy or to people with severely weakened immune systems. If you're planning a pregnancy, check your status beforehand and wait a month after vaccination before trying to conceive. If you’ve been exposed to measles and can’t confirm that you’re protected, call your clinician right away. An MMR dose within 72 hours of exposure may give some protection, or at the very least, a milder illness. If you can’t be vaccinated, or if you’re at high risk of severe infection, immune globulin can lower your risk if it's given within six days of exposure.
  8. If you think you have measles, call ahead so the clinic can keep you out of the waiting room.

"The MMR vaccine is on the childhood schedule, and it's also available to adults at many pharmacies, often without an appointment. I found out laser tag was an option for me only because my kids asked, so consider this me asking you. 

"As for laser tag, we ended up staying in, popping some popcorn, and watching Enola Holmes, because nobody felt like getting out of pajamas. It's in my future, though, and I'll let you know how badly I lose."

Your Local Epidemiologist-The Dose, 9-22-26

I got my new COVID shot (mNEXSPIKE) today and have gotten the flu and pneumonia vaccines in the past two weeks. They're available, if you're willing to be vaccinated.

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Your Local Epidemiologist 9-22-26

Katelyn Jetelina, Sep 22, 2026

I practically live at the airport these days, so for better or worse, I can tell when behaviors shift. Yesterday, it was obvious: More coughing, mask wearing, kids wiping noses on whatever was closest.

Fall sick season isn’t officially here (although Covid definitely is) but its stirring. There is a problem, though: federal disarray is slowing the rollout of fall vaccines and monoclonal antibodies. So access to protection is tougher than it should be right now. The good news is there are things we can do, including a resource below.

Here’s what’s going on in the world of health and what it may mean to you.


Disease “weather” report

Is Covid-19 peaking? Yes and no

The data story for Covid-19 right now is definitely region-specific. The magnitude and direction of the wave differ depending on where you live:

  • The West is definitely having a wave right now, and it’s not letting up.

  • The Midwest and Northeast are also still growing, but the wave’s height is lower than it was last winter and last summer.

  • The South seems to have peaked, after having a mild summer wave.

Covid-19 wastewater levels, by region. Source: Biobot
Emergency department visits that are increasing, decreasing, or staying the same. Source: CDC

What this means for you: We are in the middle of a Covid-19 wave and it’s still worth getting vaccinated, especially if you’re high risk.

Norovirus: Starting to increase again

Norovirus—think puking, diarrhea, and misery—is starting to increase again, and right on schedule. Norovirus season is pretty long, so we should expect illness to peak in early spring.

This pathogen is a booger: it is very contagious, primarily spreads through contaminated surfaces, such as doorknobs and toys, and it’s also really hard to kill with cleaning products because it has a protective membrane.

Number of norovirus tests coming back positive. Source: CDC.

What this means for you: If you have the stomach bug, use a separate bathroom in your house and wear a mask if possible. Hand sanitizer doesn’t kill it—soap and water are your best bet.

Measles: The PA outbreak is much bigger than you think

In pretty astounding and depressing news, Pennsylvania reported its fourth measles-associated death in its outbreak. This marks the most measles deaths in the U.S. since 1992. (No, the CDC still hasn’t acknowledged a single death on its website, which is astounding in and of itself.)

The state has reported nearly 800 cases, but measles typically causes 1 to 3 deaths per 1,000 unvaccinated cases. So… how does that math make sense?

It comes down to the denominator. Confirmed cases are the cases we know about; there are a whole lot of cases that are never recorded. In fact, for every reported case, there are about 10 cases not reported. This is especially true when community members are hesitant to engage with public health and health care systems, making case investigation and testing difficult.

So, the “true” PA outbreak is likely 1,300-4,000 cases.

Of course, there’s another possibility: this could simply be a statistical anomaly. Three deaths among a few hundred cases isn’t impossible—it’s just extremely rare. We’ve seen similar situations before. In 1991, for example, an outbreak in Philadelphia caused 1,400 cases and 9 pediatric deaths. In that case, religious leaders discouraged medical care, relying on prayer instead.

What this means for you: Whether this is an undercount or an outlier, one thing is clear: we are in new, unsettling territory. Here is a YLE deep dive on 10 FAQs on MMR and Measles Protection. No, you likely don’t need an MMR booster.


Spotlight: Why you may be having a hard time finding fall vaccines

Respiratory vaccines—for flu, RSV, and Covid-19—should be available at no cost this fall. But the federal government has created snags, so you may not be able to access them yet.

Here’s what’s going on.

RSV monoclonal antibodies: Low stock

RSV is a big deal for kiddos; just ask any mom who has had to sit with their baby in the hospital. In fact, it’s the leading cause of hospitalizations for kiddos (see graph below).

Source: CDC ACIP slide from 2024.

But this year, clinics and hospitals are ordering fewer doses of monoclonal antibodies—shots that protect babies under 8 months from RSV—than needed. They’re worried they’ll get stuck with the bill if insurance doesn’t cover it.

  • Why? CDC’s vaccine advisory group (ACIP) normally updates its recommendations as medical evidence evolves, but under RFK Jr., that process has completely stalled. Meanwhile, new science shows more high-risk babies should get this shot, so AAP updated its recommendation, but CDC recommendations are still stuck in last year. Since insurance follows the CDC, not the AAP, physicians aren’t sure whether insurance will cover the extra babies.

Covid-19 vaccines: Delays and access problems

Two things are happening on the Covid-19 front:

  • Adults in a handful of states will have trouble getting them at pharmacies. Most states have decoupled from federal guidance, so most Americans can get a Covid-19 vaccine at a pharmacy. However, this isn’t the case in a handful of states, like Louisiana. (Sorry I don’t have a full state list because it’s changing every day; many are trying to actively fix this). More than 80% of people get their Covid-19 vaccines at pharmacies.

  • Pediatric vaccine delays everywhere: The Vaccines for Children, a federal program that purchases more than half of childhood vaccines in the U.S., requires sign-off before they can actually ship them to states. This approval is being held up at the CDC Director level for reasons that are very unclear (and potentially concerning if delivery is stopped for political reasons). This means it’s unlikely your kid can get a Covid-19 vaccine at this time.

Flu: Running normally

  • People are getting vaccinated (including my kids!), and insurance coverage (private and public) is fine, including for the new mRNA vaccine.

There is still time to iron out these snags, but if things don’t get sorted by October, I will really start worrying about those at high risk, family disruptions (like missing school), and hospital capacity this fall and winter.

What this means for you: Don’t give up finding protection for you and your family. Have patience with your physician and pharmacy office; these snags are above their pay grade.

That said, bottom-up advocacy helps. If you have trouble, voice your concerns to your physician’s office, insurance company, pharmacy manager, or whoever is in charge to ensure they are aware of the problem. Eventually, the systems will hear it.


Good news

  • Silver lining in the PA measles outbreak: more families are getting protected. The number of people getting vaccinated has nearly doubled. In August 2026 alone, more than 46,000 MMR vaccines were administered, double the typical monthly rate of about 25,000. While I wish we didn’t live in a reactive society, it’s the reality, and I will take this as a win!

  • Malaria vaccines are working at scale. After decades of failed attempts, two vaccines are now part of routine childhood immunization in 25 African countries. Malaria kills ~600,000 people a year, mostly kids under five, so it’s great to hear that Burkina Faso saw a 32% drop in total cases after rollout and Cameroon reported a 17% drop. The one worry: funding cuts are already causing spikes in cases in a few countries, even as the vaccine expands elsewhere.

  • Worth watching: scientists are fighting NIH grant censorship. Researchers backed by the ACLU filed a class-action suit (Sept 16) alleging NIH uses a 235-keyword blacklist to flag already peer-reviewed grants for termination. This suit asks a judge to order the NIH to restore the funding cuts, which could mean money flowing back into research.


Grab bag: Resource for faith communities

“This may seem way out of scope, but my pastor is interested in sharing information about fall vaccines. Do you have any tips or resources that I could give him?”

I love this!!! It’s important that vaccine information isn’t approached as a deficit here (people don’t need more data and facts) but rather is aligned with their value systems. For many people, science and faith are not opposing forces, but complementary ways of understanding the world. The two can, and often do, coexist without requiring the rejection of medical or scientific evidence.


That’s your public health news you can use for the week! Get your fall vaccines as you’re able, wash those hands, and keep looking for the good news—it’s out there.

Love, YLE


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.

Monday, September 21, 2026

Rabbi: "Unhinged, Obsessive Loathing of Israel is Corrupting US Values"

U.S. values have been going downhill for years. Just look at things like the hatred of ICE and the police; and the so-called "teen takeovers" that are out of control; a mother celebrated for strangling to death her children; illegal aliens and coddled criminals murdering innocent people; and on and on.

Rabbi Ammiel Hirsch is right about the Jew-hatred and Israel-hatred which have always been here, but which exploded right after the October 7, 2023 Hamas pogrom against Israel. Rather than protest against the brutality of Hamas, these insane people protested against Israel and we Jews in an unapologetically brazen way you had rarely heard in the past. I had never heard antisemitism expressed so openly and blatantly before, and because I always wear a Star of David, I now feel threatened enough to keep a self-defense tool handy. 

I doubt it will get better any time soon, especially now with the evil Democrat Socialists trying to get into power and using hatred of Jews and Israel as part of their sick platform.  They don't even try to hide it any more.  So-called NYC "Mayor" Mandani openly called for Netantahu's arrest.  Some of these "leaders" would have been at home in Nazi Germany.  Still it's good for American Jews to know that men of decency like Rabbi Hirsch have our back.

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The Times of Israel 9-21-26

Ammiel Hirsch warns that if Jew-hatred is allowed to spread, ‘it is not only Jews who will pay the price, America will too’; says Jewish voters should only back politicans ‘who support us’

NEW YORK — Rabbi Ammiel Hirsch, a leading voice in the US Reform community, in his Yom Kippur sermon on Monday called on Jews to hedge their support for politicians, urged young Jews to take leadership roles amid rising hostility in the US, and warned that hatred of Israel was corrupting the US.

“My advice to the Jewish community is to support only politicians who support us and our liberal vision for America. Do not give to organizations that in the past may have allied with us, but so betrayed us after October 7,” he said.

Hirsch is a leader in the Reform movement in North America and the senior rabbi of the Stephen Wise Free Synagogue in Manhattan, one of the city’s most prominent Reform institutions.

He has consistently pushed for continued attachment to Israel, and opposed anti-Zionist activity, in recent years, as the Reform community, the largest denomination in the US, has contended with discrimination, anti-Zionist activism and hostile politics.
In his Yom Kippur speech, he drew a continuity between historical persecution of Jews and contemporary discrimination, saying, “To be a Jew is to be part of a nation that others seek to harm.”
“While pervasive anti-Jewish hostility is not new, it is new to us. We grew up in what has been described as the ‘Golden Age’ of American Jewry,” he said, according to a transcript shared with The Times of Israel before the speech. “It is this clear and obvious change that has so unnerved us.”
Jews are targeted in hate crimes far more than any other group in New York City, with at least 229 confirmed antisemitic hate crimes so far this year, according to NYPD data.
Hirsch warned that hatred of Israel and animosity toward Jews in politics, the intellectual sphere and online were damaging US society. Other Jewish leaders, such as the historian Deborah Lipstadt, have repeatedly warned that antisemitism is a harbinger of societal deterioration.
“Jew-hatred is harming America. We are not only worried about ourselves. We are worried about the country we love,” Hirsch said. “Unhinged and obsessive loathing of Israel is corrupting American values. If allowed to spread, it is not only Jews who will pay the price. America will too.” 
Hirsch called on Jews to “stay and fight” for the US, New York and the US Jewish community through protesting, advocacy, lobbying and political activity.
“Do not be enslaved to political tribes. The hatred exists on both the right and the left,” he said.
The speech came amid a fraught political season for centrist Jews. Most American Jews, and a large majority of Reform Jews, are Democrats. The party’s turn against Israel has put many Jewish Democrats in a bind as they navigate their allegiance to the party and the left with concerns about Jewish community welfare.
The Michigan Democratic Senate candidate Abdul El-Sayed, for example, has unnerved Jews with his harsh criticism of Israel, alliance with the extremist streamer Hasan Piker, and comments including the perceived justification of an attempted terror attack on a synagogue.
His candidacy, which could determine the Senate majority, has roiled Jews in the state. Some have called on the party to agree to a list of “nonnegotiable” principles about Jewish safety, others have broken with their past allegiance to the party, and some have urged the community to vote for El-Sayed.
In New York, anti-Zionist politicians have won a series of elections for the House and local office. Darializa Avila Chevalier, who attended a celebratory rally on October 8, 2023, won her House primary earlier this year for the district adjacent to the synagogue.
“We should continue to support causes that promote the general welfare of all Americans,” Hirsch said. “But before you donate your time or financial resources, inquire, research and ask these agencies what are their views of Jews, Israel and October 7.”
He called on younger Jews to assert themselves “on the field of ideas and values.”
Polls have found that younger American Jews are more critical of Israel, in a break from the older generations, while other young Jews have taken on leadership roles amid the turmoil in areas like the nearby Columbia University.
“You have the opportunity to be a great generation. Challenging times bring out strengths we never knew we had. Be heroic,” Hirsch said. “Join the struggle. Do not sit it out. That is as good a definition of a hero as anything –- a person who, when needed, cannot sit it out.”
In an interview, Hirsch said he did not view his call to withhold political support as controversial.
“That’s what politics is about. You support people who have your values and want to further your values, and you oppose people who oppose your values,” he said.
He added that he was non-partisan, was not “telling people how to vote,” acknowledged that voters are motivated by an array of issues, and viewed antisemitism as a problem on both the left and the right.
“It places on those members of the American Jewish community who are supportive of candidates an extra obligation to speak the truth to their own, to rebuke their own,” he said. “I don’t think it’s ever good politics for an electoral group to be taken for granted, and I don’t think that’s good politics for American Jews either.”
He described hatred of Israel as “unhinged and obsessive and reflexive,” and echoing antisemitic tropes by treating the Jewish state as “opposing everything that you think is good and noble.”
Such antisemitism, in every society where it has occurred, has damaged the society itself, he said.
Hirsch added that Israel, despite its “challenges,” is an American ally, part of the Western world and “confronting forces that seek to destroy the West.”
“Israel is fighting the civilizational struggle of those who seek to break down Western civilization,” he said. “Obsessive hatred and unhinged hatred — it’s opposed to reason and pluralism, which form the heart of Western civilization.”

COVID "Under The Radar"

According to an epidemiologist in this article, COVID has been flying under the radar because measles and food recalls have been overshadowing it.

But if you've been paying attention to COVID news, you'd be able to see that COVID cases have been rising. It's because too many people don't bother to pay attention to COVID that it's now coming as a surprise to them.  They still think COVID is either a conspiracy plot or just a cold, and that the COVID vaccine is responsible for sickness and death.

I've been paying close attention to COVID since 2020, have gotten every COVID vaccine on my own, and I'll be going to get the newest shot in a week or so. Everyone should do the same.

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COVID cases are on the rise—here’s what you need to know

The virus is currently most prevalent in California and the southern U.S., but experts expect it to go national in the coming weeks

Scientific American 9-21-26, by Meghan Bartels, edited by Claire Cameron

"Temperatures are dropping, and days are shortening, and that means we’re again barreling toward respiratory illness season. To kick things off, COVID infections are already on the rise.

"The virus has been flying somewhat under the radar. “With the measles outbreaks that we’re seeing and all the foodborne illnesses that we’ve seen, the numbers of cases of COVID have not caught the attention of everyone the way they have in previous years,” says Jodie Guest, an epidemiologist at Emory University.

"Nevertheless, now is the time to think about what’s happening with COVID and how to best protect yourself.

How high are current COVID rates?

"According to wastewater surveillance, levels of SARS-CoV-2, the virus that causes COVID, have been steadily increasing nationwide since July, with the starkest upticks in the western and southern U.S. These are in line with what experts have seen in recent years, however.

"Importantly, in places where rates of the virus are higher, indicators of serious illness aren’t rising yet, says Peter Chin-Hong, an infectious disease physician and a professor of medicine at the University of California, San Francisco. Typically, he says, there’s an increase in rates of the virus in wastewater, then positive tests and then hospitalizations from infections. In recent months, the first two have happened, but the third hasn’t appeared yet.

What COVID variants are circulating?

"Nearly half of current SARS-CoV-2 specimens represent closely related descendants of a strain called XFG. That might help explain the low hospitalization rates to date, Chin-Hong says; XFG first arose in early 2025 and has dominated infections for more than a year, meaning that most people’s immune systems probably have some familiarity with the viruses currently circulating.

"Earlier this year experts worried about a mutation-rich variant officially designated BA.3.2 and nicknamed “Cicada.” But those fears are quieted now, and nothing new seems to be brewing yet. “We don’t have a blockbuster new variant like we’ve had in previous years,” Chin-Hong says.

What about vaccines?

"Every vaccinated person reduces the spread of the virus. “We are all part of the support system for keeping people healthy from COVID,” Guest says.

"For people without underlying risk factors, COVID infections are not outright dangerous but remain deeply unpleasant, Guest and Chin-Hong say. Symptoms remain wide-ranging, including fever, congestion, fatigue and gastrointestinal issues, with severe symptoms lasting up to a week, Guest says. Infection is also continuing to trigger long COVID, although incidence is difficult to measure.

"This year’s updated vaccines are targeted to XFG variants, suggesting that immunization should be particularly protective. As in recent years, both mRNA and protein vaccines are available, and vaccination should be fully covered by health insurance despite continuing legal chaos surrounding the federal committee whose recommendations typically guide insurance companies.

"Experts recommend getting a shot by mid-October, although people at higher risk may want to act faster, and there’s no such thing as too early. “Now is a great time to get a COVID vaccine—now is perfect,” Guest says. “But any time you get it is the right time.”

"Guest and Chin-Hong encourage everyone older than six months of age to be vaccinated.

"Parents should note that very young children will need a doctor’s appointment for vaccination and that there are reported delays in supplying the federal Vaccines for Children program, which covers one of every two kids. Despite these hurdles, vaccinating children—particularly those under two years old—is a key priority, given their increased risk of severe infection and lack of prior immunity. “It’s like 2020 for a child,” Chin-Hong says.

"Other particularly vulnerable people include those over 65, those with compromised immune systems and pregnant people, whose vaccination will also protect children who are too young to be immunized themselves.

Are there other medications targeting COVID?

"A key new development in the COVID landscape for this year is the approval of Xocova, also known as ensitrelvir. This five-day, seven-pill regime can reduce the likelihood of infection after exposure to the virus, although experts say it shouldn’t take the place of vaccination.

"Two key caveats are that Xocova is not approved in the U.S. for children under age 12 and that it may interact with certain medications such that others shouldn’t use it. Although it requires a prescription, people can work with their doctors to have some on hand in case they need it, Guest says.

"In addition, for people who do get infected with COVID, Paxlovid may be prescribed for those with moderate or mild symptoms who may be at risk of more severe disease. The drug stops the virus from multiplying in the body, effectively constraining its severity."

Dr. Ruth Report 9-20-26

As always, Dr. Ruth Ann Crystal has compiled an amazing amount of information and statistics to help us navigate COVID and other diseases.

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Dr. Ruth Report, 9/20/26

COVID in the air of 98% of airport samples, Gut dysbiosis tracks Long COVID onset, Bezisterim helps Long COVID subgroup in Phase II, Kennedy renews vaccine attacks, HHS delays kids' COVID shots.

The current COVID wave may have peaked. Mike Hoerger estimates that 1 in 92 people in the United States is currently infected with COVID. However, in many places, the risk is much higher. For example, in Texas 1 in 25 people is infected, in California 1 in 27 people, and in Nevada and Mississippi 1 in 17 people is infected with COVID as of September 5. On the interactive PMC19 map, you can look up wastewater levels for SARS-CoV-2 by county. If a county is in burgundy, it means that >1 in 30 people are infected with COVID.

The updated COVID vaccines are available in pharmacies. Being physically inactive or having asthma qualifies a person for the vaccine. See the Vaccines section below for more information. It is important to layer protection against COVID (and other viruses) especially during periods of high levels in wastewater. Using KN95 or N95 masks, air filters, and testing, as well as staying home when you are sick can protect you and others from COVID and other viruses.

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Acute COVID infections, General COVID info

Airport air sampling captures COVID, influenza viruses | CIDRAP 9/17/26

  • “Air sampling at four US airports in 2023 and 2024 detected SARS-CoV-2, the virus that causes COVID-19, in over 98% of samples and influenza A in over 17%.” Influenza levels were found during flu season, but COVID was noted year round.

Progressive Post-Acute Gut Microbiome Disruption Following SARS‑CoV‑2 Infection in Mice | bioRxiv 9/19/26

  • “This study demonstrates that SARS-CoV-2 infection produces a series of long-lasting alterations across the gut microbiome, extending beyond the period of acute viral replication in the lung. Microbial and functional pathway analyses across multiple time points revealed a trajectory of progressive dysbiosis over a period that coincides with the development of PCC [Long COVID] symptoms… Microbiome-targeted interventions, such as prebiotics and probiotics, may thus aid in recovery from COVID-19, mitigating the risk of PCC and improve immune resilience.”

Secreted ORF8 reprograms macrophages to enhance SARS-CoV-2 infection of lung epithelial cells | Science Advances 9/18/26

  • Scientists from the Gladstone Institutes discovered that the SARS-CoV-2 protein ORF8 triggers macrophages to upregulate ACE2 expression, effectively turning these immune cells into additional targets for viral infection. In mouse models, disrupting ORF8 signaling lowered viral loads while also decreasing both lung inflammation and fibrosis, suggesting this protein may be a viable therapeutic target. “Blocking the interaction between ORF8 and IL-17RA stops the cycle of macrophage infection, death, and inflammation that is at the root of this problem.”

Pediatrics

Post-acute symptom persistence following SARS-CoV-2, RSV, and influenza in children | OVID 9/11/26

  • A retrospective cohort study shows that more than 1 in 5 children experience post-viral illness after infections with RSV, SARS-CoV-2, and influenza. “While overall post-acute prevalence was comparable [21 to 24%] across the 3 viruses, symptom profiles differed markedly: RSV-related post-acute morbidity was dominated by respiratory and feeding difficulties in young infants; SARS-CoV-2 predominantly produced neurocognitive and systemic complaints in school-aged children; and influenza was characterized by sustained systemic symptoms.”

Immunocompromised

Convalescent plasma for persistent symptomatic COVID-19 infection in immune-suppressed patients – a case series | Infectious Medicine 9/2026

  • A study of 23 immunosuppressed patients with prolonged symptomatic COVID infection found that combining convalescent plasma with antiviral therapy led to clinical improvement in 22 of those patients. Improvements were observed across multiple measures of disease severity including fever, supplemental oxygen requirements, and markers of systemic inflammation.

Vaccines

A New COVID Vaccine Is Here (Without Much Fanfare). When Should You Get It? | KQED 9/15/26

  • “In the absence of any federal guidelines, the California Department of Public Health issued its own recommendations on Friday about who should absolutely seek out the new COVID-19 shot. State health officials’ strongest recommendations are for everyone age 65 and older, those with risk factors that increase their chances of getting severe COVID-19, pregnant people, children age 6 to 23 months and healthcare workers.” The updated vaccine protects against the main variant circulating now.

Covid-19 vaccines delayed for about half of US children as access through federal program stalls | CNN 9/17/26

  • Three weeks after the FDA approved updated COVID vaccines, the CDC has yet to open ordering through Vaccines for Children, a program covering about half of US kids. HHS says procurement decisions are being finalized, leaving states and families waiting.

New NIH research center on vaccine harms takes shape | Science 9/15/26

  • The National Institutes of Health (NIH), under RFK Jr, is establishing a research initiative called MOSAIC to investigate persistent symptoms that some individuals experience following vaccination, drawing on both clinical records and genomic data. “Clinical researchers will probe complications that can arise after immunization, but some worry about political influence.”

Effectiveness of 2025 bi-annual COVID-19 vaccination campaigns against hospitalisation in England | medRxiv 9/18/26

  • The UK Health Security Agency analyzed over 41,000 spring and 35,000 autumn hospital tests and found that 2025 COVID vaccines delivered peak protection against hospitalization at 5 to 9 weeks post vaccination. The JN.1 spring vaccine reduced hospitalization risk by 55% and the KP.2 autumn vaccine by 48% at that peak window, with effectiveness declining thereafter.

Association of mRNA SARS-CoV-2 vaccination with fatigue and functional recovery in patients with post-acute sequelae of COVID-19 (PASC) | Expert Review of Vaccines 9/18/26

  • Hannover Medical School in Germany conducted a retrospective study of 174 Long COVID patients, finding that among 148 matched participants, mRNA COVID vaccination showed no association with greater fatigue or reduced exercise capacity across a 3 to 6 month follow up period. Vaccinated and unvaccinated patients alike demonstrated measurable improvement in outcomes over time.

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Antiviral treatments

Structural basis of diverse antibody recognition of conserved coronavirus spike S2 epitopes that contribute to protective immunity | bioRxiv 9/16/26

  • Researchers isolated the S2 antibody ch.007 from a 71 participant cohort of COVID convalescent donors and found that despite minimal neutralization of SARS-CoV-2 in laboratory cell cultures, mice treated with ch.007 survived COVID infection with no detectable live virus remaining in the lungs. When the antibody was modified to eliminate its binding to Fc receptors, the protective effect was completely abolished, indicating that immune cell engagement rather than direct viral neutralization drives the observed protection.

Long COVID

BioVie Announces Topline Results from Phase 2 ADDRESS‑LC Trial Evaluating Bezisterim for the Treatment of Neurological Symptoms Associated with Long COVID | BioVie Press Release 9/15/26

  • Finally, some hopeful news. Bezisterim is an oral, small molecule that can cross the blood-brain barrier and acts as an anti-inflammatory insulin sensitizer by binding extracellular signal-regulated kinase (ERK). According to BioVie, it selectively inhibits inflammation driven by ERK, NF-κB, and TNF-α without disrupting their homeostatic functions. It is being tested in Alzheimer’s disease, Parkinson’s disease, and Long COVID brain fog and fatigue.

  • This week, BioVie reported that in a 203-participant Phase 2 trial, bezisterim did not outperform placebo in the entire Long COVID population. However, pre-specified Long COVID subgroups with elevated fatigue, post-exertional malaise, and/or cognitive impairment showed statistically significant improvements on multiple outcome measures with bezisterim. These benefits will be tested in a Phase 3 trial before conclusions about clinical benefit for Long COVID can be made.

🧠 Cognitive fatigue is related to reduced cerebral perfusion and sustained attention in patients with post COVID-19 condition: An fMRI study | NeuroImage: Reports Dec 2026 (9/12/26)

  • A team from the Karolinska Institutet in Sweden scanned 22 adults with Long COVID and 19 matched controls using fMRI during a 20 minute vigilance task. Those with Long COVID had lower overall brain blood flow, with significantly lower blood flow in brain regions including the right inferior occipital gyrus, left postcentral gyrus, and the right middle cingulate cortex. Long COVID patients had slower and more variable reaction times, and a significant increase in self reported fatigue (p = 0.004).

Fig. 3. Group differences in cerebral blood flow (CBF) between Long COVID patients and controls

Haptoglobin Phenotypes Stratify Post-Exertional Cognitive Dysfunction Associated with Altered Cerebral Oxygenation and Metabolic Signatures in Long COVID | Int J Molec Sci 8/4/26

  • Haptoglobin genotype may help stratify Long COVID patients. In a study of 44 people with Long COVID versus 20 recovered controls, Hp2 carriers showed worse fatigue, physical function, and post-exertional symptoms than Hp1-1 individuals. Hp1-1 carriers showed higher post-exertional cerebral oxygen extraction in the right hemisphere, while Hp2 carriers had distinct metabolic shifts, including lower citric acid, isethionate, and glucosamine, linked to weaker cognitive performance.

Long COVID’s brain fog finally has a biological explanation: Dopamine loss | Fortune 9/14/26

  • Fortune magazine reported on this Canadian study from July 2026 showing evidence of dopamine system injury in the brains of people with Long COVID.

Fatigue Among Adults Age 18 and Older: United States, 2024 | CDC National Health Statistics Reports 9/3/26

  • The CDC National Center for Health Statistics, drawing on data from 31,917 American adults, found that the share of people experiencing frequent fatigue increased from 13.5% in 2022 to 16.6% in 2024. Among those affected, more than half reported difficulties across three or more areas of daily functioning and 36% faced limitations in their ability to work. It sounds like these people could have Long COVID, even if they don’t realize it.

A Systems Microbiology Framework for Reproducible Multi-Dataset Omics Integration with Application to Long COVID | Frontiers in Systems Biology 9/19/26

  • Researchers from the Netherlands examined 394 samples across 5 datasets and identified a reproducible 7 gene signature associated with Long COVID. “ The value of this result lies not in the novelty of individual genes, but in the reproducible emergence of a coordinated immune–metabolic expression pattern across datasets. Dysregulation of IL6R, SOCS3, and ARG1 is consistent with sustained cytokine signaling and compensatory immune suppression, while reduced ECHS1 expression points to altered mitochondrial fatty acid oxidation, a feature reported in post-viral fatigue and inflammatory syndromes.”

Functional plasticity of the olfactory network following functional septorhinoplasty in persistent COVID-19-related olfactory dysfunction: an fMRI study | medRxiv 9/17/26

  • Researchers at University College London found that 8 patients with persistent COVID related smell loss showed measurable brain network plasticity following nasal surgery. Patients who gained greater nasal airflow after the procedure demonstrated increased activity specifically in the orbitofrontal cortex and frontal olfactory regions, suggesting the brain can reorganize its smell processing circuits when sensory input is restored.

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Measles

CDC Measles Update

  • As of September 17, 2026, 3,471 confirmed measles cases were reported in the United States in 2026.

  • Four unvaccinated people have died of measles in Pennsylvania (2 babies died in August, and a teen and an adult died in September), but the CDC still has not posted any measles deaths to their website for 2026.

  • According to Reuters, the CDC “is reevaluating” ​how ⁠it classifies measles deaths.

Pennsylvania Department of Health Measles Dashboard

  • 767 measles cases with 93 new cases in the last 7 days

  • 20% hospitalization

  • 4 measles deaths

California health department notifies of measles exposure from unvaccinated Amtrak passenger | KTVU 9/19/26

  • The California Department of Public Health (CDPH) notified the public after an unvaccinated Amtrak passenger who is now hospitalized with measles, exposed riders to measles while traveling by train and bus across the United States and through six California counties between September 12 and 14. Health officials urge anyone who may have been exposed to check their MMR vaccination status and watch for fever or rash through 21 days after exposure.

Johns Hopkins US Measles Tracker:

  • There have been 3,568 measles cases in the United States in 2026, including 341 new cases in the last 2 weeks.

Ebola in Democratic Republic of Congo (DRC)

Sept 18, 2026 DRC Ebola Update:

  • The tally reports 7,614 confirmed Ebola cases, including 1,864 recoveries and 3,676 deaths. 909 patients are in isolation or hospitalized, and contact tracing has reached 87.8%.

Government Health News

RFK Jr. headlines sold-out anti-vaccine conference alongside Andrew Wakefield | Ars Technica 9/14/26

  • Health and Human Services Secretary Robert F. Kennedy Jr. delivered a keynote address at a conference hosted by Children’s Health Defense, the anti-vaccine group he once led. He appeared alongside Andrew Wakefield, the doctor stripped of his medical license after a fraudulent, retracted study falsely linking the MMR vaccine to autism. Kennedy cast doubt on vaccine safety and suggesting, without evidence, that vaccines underlie chronic illness, and told the group he will “stay in this fight.” The appearance came amid the worst U.S. measles outbreak in decades, one driven largely by unvaccinated people.

White House Moves to Take Control of N.I.H. Grants | NY Times 9/20/26

  • White House officials are drafting an executive order that would let an outside panel veto NIH grants conflicting with Trump’s political agenda, escalating tension between OMB director Russell Vought and NIH director Jay Bhattacharya. The move follows Trump’s frustration over stalled pressure on Harvard and comes amid ongoing lawsuits over NIH grant terminations and free speech.

In a waste of money, the Pentagon announced mandatory low-testosterone screenings for male troops age 30 and older.

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Other news

EBV reactivation priming of the peripheral immune system in Multiple Sclerosis relapse | Nature Medicine 9/17/26

  • Researchers at Brigham and Women’s Hospital studied 135 participants and found that B cells displayed elevated Epstein Barr virus LMP1 RNA, increased gp350 positive cells, and expansion of CD11c positive age associated B cells weeks to months before a multiple sclerosis (MS) relapse occurred. These findings establish that EBV reactivation within B cells precedes clinical MS attacks, connecting viral activity and genetic susceptibility as upstream drivers of disease flares.

An adult proteomic signature associated with very low birth weight and chronic disease risk | Med (Aghaeepour lab) 9/16/26

  • People born at very low birth weight (VLBW, <1.5 kg) have elevated risks of chronic disease as adults. A new study from Stanford used machine learning to identify a proteomic signature for VLBW which outperformed birth weight at predicting 370 adult diseases. The signature also tracked adult diseases in people born at normal birth weight, showing that it may have a much broader relevance, but further studies and external validation are needed.

Liquid biopsy for early detection of pancreatic ductal adenocarcinoma | Nature Medicine 9/16/26

  • In a prospective study, the PANXEON exosome-based biomarker, a blood test combining a 10-miRNA signature with CA19-9, was tested in 1,785 people across four countries. “When combined with carbohydrate antigen 19-9 levels, this blood assay demonstrated a sensitivity of 86.8% for stage I–II PDAC, false-positive rates of 3.2% in low-risk controls and 15.6% in high-risk controls in the testing cohort.”

‘Stomach bugs’ send protective immune cells rushing from gut to brain | Nature 9/17/26

  • University of Cambridge researchers discovered that intestinal infections in mice triggered CD4+ T cells to migrate from the gut to the borders of the brain, where the cells established durable immunological memory. Upon reexposure to the same pathogen, these resident immune cells mounted a rapid defensive response, suggesting the gut and brain share a coordinated long term protective mechanism.

Anti-seizure drug fights aggressive childhood brain tumors, Stanford Medicine-led study shows | Stanford Medicine 9/17/26

  • Levetiracetam (Keppra), an existing anti-seizure drug, slowed diffuse midline glioma (DMG) tumor growth in mice by cutting the tumors’ electrical connections to healthy neurons. Children with these tumors who received Levetiracetam also lived longer per retrospective review of medical records. The team is planning clinical trials.

  • Original study in Nature:

    Levetiracetam therapeutically targets GABAergic synapses in diffuse midline glioma | Nature Medicine (Monje lab) 9/17/26

Levetiracetam blocked GABAergic synaptic signals from neurons to diffuse midline glioma (DMG) cells, slowing tumor growth in mice. The effect was tumor-specific and does not act through the drug’s seizure-control mechanism. Hemispheric gliomas like glioblastoma did not respond to the medication.

Surgeon draws cartoons on kids’ bandages to make the experience less scary | CNN 1/18/20

  • Pediatric surgeon Dr. Robert Parry hand-draws original illustrations on his young patients’ bandages after procedures. Disney characters and sports logos are the most popular requests, and parents say the gesture really eases some of the stress for kids around surgery.

Photo: Akron Children’s Hospital

Have a great week,

Ruth Ann Crystal MD