I’m glad to be able to put good news in your inbox this week. Influenza-like illness (ILI) activity fell again this week, to 2% of outpatient visits for fever and cough or sore throat. We’ve seen continued declines week over week for about six weeks now. Even young children, whose ILI activity has remained stubbornly high the entire season, declined from 7.3% to 6.9% during the last reporting period.

There are now zero (!) jurisdictions with high ILI activity. New York City and Washington D.C. both dropped into the “moderate” category after many weeks in “high.” NYC is still seeing quite a bit of flu B, but it’s not driving much of a wave. I’m hoping it will be quiet until fall, when the next flu season begins again.

Covid-19 activity also continues to decline nationwide. Around 94,000 cases were reported in the last week, down from 101,000 the week before. Hospitalizations have also steadily declined. There are no regional hotspots, but there is a constellation of counties with increased activity, including parts of Southern California, southern Texas, Missouri and the Carolinas. Big picture though, Covid-19 trends look good.

First, the good news. Seasonal coronavirus activity has fallen dramatically, with the exception of CoVNL63 which continues to bounce around. Seasonal coronaviruses mostly cause the common cold. RSV activity is low, and its cousin metapneumovirus is also settling down. Both cause more severe respiratory illness, particularly in older adults and infants.

On the other hand, parainfluenza activity and adenovirus activity remain elevated. Parainfluenza causes flu-like symptoms, as the name suggests. Adenovirus infections cause a range of symptoms depending on the strain, from cold-like illness to lower respiratory infection to gastrointestinal distress. We don’t have great surveillance for either pathogen, but several sources indicate they remain active.

Norovirus must have heard me last week when I said it was finally fading. Activity is back up this week. The Southern region is looking good, but the other three big regions are still struggling to turn the corner.

For new readers, more on preventing norovirus: The biggest concern with norovirus is preventing dehydration. This is especially important in children and older adults, who dehydrate quickly. I keep Pedialyte powder packets in the pantry, because they take up less space and have a longer shelf life than bottles of liquid rehydration products. Water, broth, popsicles, diluted juice, sports drinks, etc. are also good options. Don’t fall behind by waiting until dehydration sets in. Encourage frequent sips from the onset of illness.

Norovirus spreads very easily between people through the “fecal-oral” route. To stop it from spreading, wash your hands thoroughly after using the bathroom and before eating or preparing food. I also use hand sanitizer while I’m in public like after I use self-checkout at the grocery store or when I use public transportation, but you should know that hand sanitizer is not as effective against norovirus as hand washing. Be sure to wash your hands properly when you get home. Most importantly, stay home if you have vomiting or diarrhea. 

Food recalls

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

New this week:

• Ground cumin from Lipari Foods (more info).
• Ready-to-eat salad products with chicken and ham (more info). This is in addition to the recalls that Fresh Express, Publix and Fresh from Meijer announced recently (more info, more info). See also the Revolution Farms salad recall (more info). I’m not feeling great about pre-packed salad products right now overall.

Reported in the last month:

• Raw flour (no brand identified yet). Unbaked flour is a common source of Salmonella food poisoning. Do not consume unbaked flour. (more info)
• Frozen organic strawberries and tropical fruit mix sold to Costco, Trader Joe’s, Aldi, KeHE, Vital Choice Seafood, and PCC Community Markets. (more info)
• If you have food allergies, you may wish to review these FDA safety alerts for foods with undeclared allergens.

In other news

• A spring bivalent booster is now available to people who are immunocompromised or over the age of 65. Federal officials approved the move last week. The authorization is an option for people who may benefit, not a blanket recommendation for anyone in those eligibility groups. There are also several new changes to the definition of what it means to be “up to date” on covid vaccinations. People who are getting vaccinated for the first time are considered up to date after one bivalent dose. The two-dose monovalent series that many of us got back in 2020 is no longer offered. Several additional changes were made to the children’s vaccine schedule. Your Local Epidemiologist has more on both updates.
• The Public Health Emergency is ending on May 11. Remember to order your at-home covid tests before then. Private insurance and Medicare will cover eight per person per month until the emergency ends. You can order them at pharmacies like CVS. While you’re there, pick up your preferred over the counter medicines to treat fevers, colds and dehydration. There was a big run on these products during the tripledemic and I heard of many families that had to go without during times of need. Might as well get some now, so you have it in stock for next time.
• Group A strep (GAS) activity may finally be dying down. The UK Health Security Agency reported that scarlet fever infections have returned to the normal levels for this time of year. The bacteria that causes scarlet fever also causes strep throat and, rarely, more invasive disease like necrotizing fasciitis. Invasive group A strep infections have also declined, but activity remains slightly elevated over normal levels. This winter was one of the worst on record, contributing to persistent shortages of common antibiotics. The U.S. does not have readily available data on GAS activity, but I expect we largely follow U.K. trends.
• In case you missed it, I am moving “This week in outbreaks” to a monthly schedule during the summer months. I’ll continue to keep an eye on Covid-19, which has flared in the summer in years past. Weekly updates will begin again when flu season resumes in October. In the meantime, you’ll still hear from me most weeks with other commentaries and analysis.
• My weekly Q&A in the New York Times is out, this time on H5N1. There is also an essay by author David Quammen.