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

Respiratory Diseases

ILI

Most states in the region are doing fine with ILI, with a few exceptions.

New York City leads the Northeast with 4.6% outpatient ILI (up from 4.2%). NYC often has the highest activity in the region, so this pattern is familiar. New Jersey follows with 4.2% ILI (down slightly from 4.4%) and minimal wastewater activity.

New York (excluding NYC) reports 2.2% ILI with minimal wastewater activity, while Pennsylvania shows 1.6% ILI with minimal wastewater levels.

The northern New England states show much lower activity levels. Maine reports 1.6% ILI (down from 1.7%) with minimal wastewater activity, while Vermont is at 1.0% ILI with minimal wastewater levels. New Hampshire maintains 1.3% ILI with minimal wastewater activity.

Connecticut is reporting 2.4% ILI and minimal wastewater activity, while Rhode Island shows 1.4% ILI with moderate wastewater levels and a significant decrease from the previous week.

COVID-19

Wastewater activity is minimal in the Northeast, with a SARS-CoV-2 concentration lower than at any other point in the past year. Severe illness primarily held steady at low levels.

Wastewater activity is minimal in New York, New Jersey, and low in Vermont, New Hampshire, Massachusetts and Connecticut. In Maine, wastewater activity is still coming down from the late summer wave and has now decreased to moderate levels. In Rhode Island, activity increased to moderate levels a couple weeks ago, and remained stable this past week.

The exception to this generally calm picture is Pennsylvania, where activity increased by 4-fold in the past week, moving from low to high activity. It’s too soon to know what to make of this anomalous spike.

Severe illness primarily held steady at very low levels this past week. Trips to the ED remained at minimal levels (<1.5%) in most states in the region. There were very small increases in ED visits in Maine and New Hampshire. However, it is too soon to tell whether these increases represent the start of an increasing trend or just some transient fluctuations, though the lack of an increase in wastewater activity in these states suggests it may be the latter. Hospitalizations held steady

in New York, at the fairly low level of 2.5 hospitalizations per 100,0000. Hospitalizations also held steady in Connecticut this past week at 2.0; it is now roughly back to where it was before the late summer wave.

RSV

Not much happening with RSV just yet.

Connecticut reports 0.8 per 100,000 and New York shows 0.7 per 100,000, both with concurrent increases in wastewater activity. These are very low levels of hospitalization. Rhode Island is showing very high wastewater activity but no reported hospitalization data.

The remaining northeastern states, including Pennsylvania, Vermont, Maine, New Hampshire, and New Jersey, maintain minimal wastewater activity levels with very low hospitalization rates. New Hampshire showed a marked decrease in wastewater levels, while others remained relatively stable.

Other Bugs

The spread of many viruses that cause cold- and flu-like illness continues.

• Parainfluenza viruses are fairly elevated, and at 5.9% test positivity are roughly three-quarters of the way to hitting their highest rate in the past year.
• Rhinoviruses/enteroviruses continue to remain quite elevated, at 27% test positivity. Test positivity has been hovering between ~25-30% since September.
• Adenoviruses have increased to 3.7% test positivity, which is fairly elevated. In the past five years, test positivity has tended to peak between 4-5% (with the exception of 2023, when it got up to 8%).
• Human coronaviruses continued the same slow and steady week-over-week increase they’ve been on for the past two months. Test positivity is elevated but not particularly high (it is currently about half of its peak rate of the past year).

Stomach Bugs

Norovirus rates remain very low in the region, at 2.5% test positivity. If you’re traveling to other parts of the country for Thanksgiving, keep in mind that norovirus rates are high in every other region. To help reduce the chance of acquiring the virus, wash your hands frequently with soap and water (alcohol-based hand sanitizers are of little use against norovirus) and avoid touching your face.

Food recalls

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

New:

• Super brand dried cinnamon powder (more info)
• Bagged carrots, full size and baby, sold at multiple retailers – this was previously reported, but it expanded to carrots sold under several additional brand names this past week (more info)
• Fabalish Kickin’ Carrot Falafel Bites (related to the carrot recall above) (more info)
• Gaines Family Farmstead Chicken Chips for Dogs. While not for human consumption, humans may be infected by Salmonella if they do not adequately wash their hands or contaminated surfaces after handling the product (more info)
• Hollywood Feed Carolina Raised Chicken Chips [for Dogs]. Same as above (more info)

Previously reported:

• Soft ripened cheeses, including brie, sold under multiple brand names, including Aldi, La Bonne Vie, and Glenview Farms (more info)
  • Prepackaged turkey sandwiches with spreadable brie sold under multiple brand names (more info)
• Ready-to-eat poultry and meat products sold by Yu Shang Food, including pork belly, beef shank, and whole chicken (more info)
• If you have food allergies, you may wish to review these FDA safety alerts and USDA alerts for foods with undeclared allergens.

In other news

• As of November 15, 2024, New Brunswick, Canada is experiencing a significant measles outbreak, with 44 confirmed cases, most of which involve individuals aged 19 or younger. This surge has contributed to Canada’s annual measles case count reaching 100, the highest in five years. The outbreak, traced to an initial case reported on October 24 involving international travel, has been confined to Health Zone 3, encompassing Fredericton and parts of the Upper Saint John River Valley. In response, Public Health has organized vaccination clinics and is urging residents to ensure their immunizations are current to curb further transmission.
• BIRD FLU CONCERNS IN PENNSYLVANIA
• Pennsylvania will require H5N1 testing for milk starting Nov. 26 under a quarantine order signed by the state’s Agriculture Secretary. Milk tankers from Pennsylvania farms will be tested at least every 14 days, either at in-state processors or by farmers and cooperatives for out-of-state shipments. Positive tests will trigger quarantines and surveillance testing in affected zones. Developed with industry input and free for farmers, the program complements a forthcoming USDA bulk milk surveillance initiative aimed at mapping virus presence and enforcing biosecurity measures.