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Welcome to the Northeast 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 DiseasesInfluenzaThis flu season is brutal. Flu and influenza-like illness (or ILI, which looks only at symptoms) are very high nationwide, and outpatient ILI is higher in the Northeast at 10.6% than in any other region. More than 1 in 10 visits to the doctor in the Northeast this past week were for fever, cough, or sore throat. Every state in the region reported high or very high and increasing emergency department (ED) visits this past week. Outpatient influenza-like illness (%)
% of visits to the doctor that are for fever and cough or sore throat
 Extra precautions to reduce infection are warranted right now, including masking, washing hands regularly, running an air filtration device at home if someone is sick, and avoiding large crowds. New York is likely at or just past peak, but it’s not entirely clear. Outpatient ILI increased again this week, to a super high 14.4%, but the increases were smaller this week, which suggests we’re nearing peak. Same for ED visits, which increased slightly to 9%. Hospitalizations are very high at 21.7 hospitalizations per 100,000 people. In addition, the Center for Forecasting and Outbreak Analytics estimates that New York state is past peak (see the map below). In New York City, ED visits for flu actually decreased slightly, to 7.9%, suggesting we may be just past peak there. Hospitalizations have declined slightly as well. Queens and the Bronx have highest levels of activity as measured by ED visits. Northeast: ED visits for influenza (%)
% of visits to the emergency department that are for influenza
There are sharp increases in flu elsewhere across the region. More than 1 in 10 ED visits in New Jersey are for flu (10.9%), as are nearly 1 in 10 in Massachusetts (9.7%) and New Hampshire (9.5%). In Connecticut, ED visits increased again to 11.8% — above last year’s peak of 9.1%. Hospitalizations, however, decreased substantially this past week, from over 20 to 6.2; it is unusual to see a swing this large in hospitalizations, so I am wondering if there was a delay in data due to the holiday. The Center for Forecasting and Outbreak Analytics estimates that all these states (except NH, no estimate there) are past peak (see the map below). Increases, increases, and more increases. In Rhode Island, ED visits increased to 8.5%, while in Maine, outpatient ILI more than doubled to 8.1%, and ED visits increased to 6.5%. In Pennsylvania, outpatient ILI increased to 4.7%, and ED visits for flu jumped to 6.8%. In Vermont, flu remains at more moderate levels, but is increasingly rapidly, with ED visits more than doubling in the past week to 5.1%. The Center for Forecasting and Outbreak Analytics estimates that all these states are still seeing increases in activity. CFA’s Influenza Trends
Influenza trend estimates from the CDC’s Center for Forecasting and Outbreak Analytics, as of December 30, 2025.
 One other thing: I don’t love wastewater as a surveillance approach to influenza, but for what its worth, wastewater concentration of influenza is still rising across the region. I wanted to include this data this week despite my misgivings because I think it weighs against “calling” the peak. Northeast: influenza wastewater concentration
Wastewater concentration of influenza
 COVID-19In case the flu respiratory activity was not enough, Covid-19 activity is also moderately high. Wastewater activity is right on the border between moderate and high activity, having dipped very slightly this past week. ED visits increased in nearly all states in the region this week (except Rhode Island), with all states reporting rates between 0.6 and 1.3%. Wastewater activity is very high and rising in Massachusetts and Connecticut. Both states also reported increases in ED visits this past week to ~1.1%. However, hospitalizations decreased a bit in Connecticut (to 1.5 hospitalizations per 100,000 people). Northeast: Covid-19 wastewater concentration
Wastewater concentration of SARS-CoV-2
 In New Hampshire, wastewater activity is high and increasing (incomplete data), and ED visits increased to 1.22%. In Maine, activity is high — about where it was during the late summer wave — but it didn’t increase much this past week. ED visits, however, did and are now the highest in the region at 1.26%. In Rhode Island, wastewater activity held steady at moderate levels, alongside ED visits. In Pennsylvania, wastewater activity was moderate and stable, and ED visits increased to 1.24%. In New York, ED visits are the lowest in the region, at 0.64%, but are increasing, along with wastewater activity (though data are incomplete), and hospitalizations (3.6). Wastewater activity is low in New Jersey and Vermont, and while ED visits remain relatively low in these states, they increased nonetheless. Northeast: ED visits for Covid-19 (%)
% of visits to the emergency department that are for Covid-19
 RSVRSV is moderate and rising in the Northeast, with ED visits at a little under 0.4%. Most states in the region reported increases in ED visits this past week, with the exception of Massachusetts (which decreased to 0.35%) and Maine (where it held stead at 0.04%). Rates are highest in New Jersey, where ED visits have risen to a moderate 0.65%. In comparison, last year’s RSV season peaked at about double that rate. ED visits more than doubled in the past week in Rhode Island, to 0.45%. New Hampshire, Pennsylvania, New York, Connecticut, and Vermont all reported increases to between 0.26 and 0.41%. Despite the increase in ED visits, hospitalizations in New York, dipped slightly this week, to 1.3 hospitalizations per 100,000, and more substantively in Connecticut, to 0.5. Northeast: ED visits for RSV (%)
% of visits to the emergency department that are for RSV
 Other Bugs
Stomach BugsData did not update yet, so I am repeating what I said in the national edition a few days ago: Norovirus continues its upward climb. In the Midwest, Northeast, and South, norovirus wastewater activity is high and rising. In the West, wastewater activity remains more moderate, but is also rising. Noro is extremely contagious — this is where hand washing regularly (with soap and water, hand sanitizer is not particularly effective), avoiding touching your face, avoiding communal bowls of food/drink, and wiping down surfaces with soap and water or a diluted bleach solution can really help with prevention. Food recallsThe following foods are being recalled because they are contaminated. Please check your cupboards and throw out any of these items: New:
Previously Reported:
In other news NEWN YORK REJECTS ALL RECENT AND UNILATERAL CHANGES IN CDC IMMUNIZATION SCHEDULE!
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