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 DiseasesNote: Data in this week’s report covers the period including the Thanksgiving holiday. Disease surveillance data is always wonky during the holidays for various reasons. I have accounted for the disruption in my analysis, but if some data points are missing or seem implausible or unexpected, that is why. InfluenzaFlu is low regionally, but is still picking up, particularly in New York. Most states continue to report very low and fairly stable wastewater activity. ED visits range from 0.4% to 2.6%, with most states reporting rates <1%. New York has the highest activity in the region. Wastewater activity is moderate and the trend is going up (though it did decrease slightly this week). Outpatient influenza-like illness (ILI) visits increased to 4.2%, nearing the threshold of 4.5% for the start of flu season and substantially above last week’s 2.3%. Emergency department (ED) visits more than doubled to 2.6%, but hospitalizations held steady at a low 0.1 per 100,000 population. Northeast: Outpatient influenza-like illness (%)
% of visits to the doctor that are for fever and cough or sore throat
 In New York City, flu continues its rapid rise. I encourage residents and visitors to take note. ED visits for flu increased 112% over the week prior, rising to 3.3% of all ED visits. Hospitalizations have also risen sharply, to 1.3%, more than double the week before. In Connecticut, wastewater activity is low, but nearly doubled this past week. ED visits in the state also jumped to 1.9%. Hospitalizations remain very low, but did increase a bit this past week, from 0.2 to 0.5 hospitalizations per 100,000 people. Wastewater activity is very low but increasing in New Jersey and Massachusetts. Similarly, ED visits in both states are low but increasing (to 1.8% and 1.0%, respectively). In Maine, flu remains very low but is increasing. Outpatient ILI increased to 1.2%, and ED visits increased to 0.5%. Similarly, ED visits are at just 0.4% in Vermont but are increasing. In Pennsylvania, wastewater activity is very low and stable, outpatient ILI visits held steady at 1.5%, and ED visits increased slightly to 0.8%. Northeast: ED visits for influenza (%)
% of visits to the emergency department that are for influenza
 COVID-19Covid-19 activity remains low, but unfortunately there are signs of increases. We’ve got an unusual degree of conflicting data this week: wastewater activity is going one way, and ED visits are going the other. We typically see wastewater increasing first, followed by ED visits (a lagging indicator) second. However, right now we’re seeing the opposite: wastewater is decreasing and ED visits are increasing. My current hypothesis is that the increase in ED visits is not “real.” The Thanksgiving holiday may have disrupted care-seeking behavior (a fancy way of saying whether and how people decide to visit the doctor or emergency department vs toughing it out at home). However, it is wintertime, so a true rise in activity would not be shocking. I will use next week’s surveillance data to untangle what’s really going on. Wastewater activity is low and decreasing in Maine, Pennsylvania, and Connecticut, and remains very low and stable or declining in New Hampshire, Massachusetts, Rhode Island, New Jersey, and New York. Vermont is the outlier when it comes to wastewater activity: it is the only state in the region with high and increasing activity. Northeast: Covid-19 wastewater concentration
Wastewater concentration of SARS-CoV-2
 However, ED visits increased in every state except Vermont — the one state with high wastewater activity. In Vermont, ED visits decreased to 0.61%. ED visits range from 0.36% in New York to 0.66% in Connecticut. Northeast: ED visits for Covid-19 (%)
% of visits to the emergency department that are for Covid-19
 Severe illness is consistent, however: hospitalizations decreased in both Connecticut (to 1.6 per 100,000 people) and New York (to 1.2). RSVRSV remains quite low in the region. Wastewater activity is very low in all states in the region. Activity increased in Pennsylvania, decreased in New York, Connecticut, and Massachusetts, and held steady everywhere else. ED visits are very low, ranging from 0% in Maine to 0.25% in New Jersey. Rates went slightly up or held steady in New Jersey, Massachusetts, New York, Pennsylvania, Connecticut, Vermont and Maine. They decreased ever so slightly in Rhode Island and New Hampshire. Hospitalizations are very low, but increasing in New York (to 0.3 hospitalizations per 100,000 people) and Connecticut (to 0.2). Northeast: ED visits for RSV (%)
% of visits to the emergency department that are for RSV
 Other BugsTime to stock up on tissue boxes and your preferred over-the-counter meds. There are an assortment of infections circulating right now that cause cold- and flu-like illness.
Stomach BugsNorovirus is quite active. Test positivity nationally was at 11.6% this past week, roughly on par with the week before. This is the time of year when norovirus is expected to just keep rising. To avoid infection, wash your hands frequently with soap and water (hand sanitizer is not particularly effective at killing norovirus) and avoid touching your face. Test positivity is highest in the West: 13.5%. This is closely followed by the South, which reported a test positivity of 13.2%. However, I would take the results from the Southern region with a grain of salt this week: the total number of tests reported is about half that reported the week before, making it hard to directly compare this week’s results to the prior weeks’. I am guessing this is just a delay in reporting and by next week we should have a clearer picture. In the Midwest, test positivity is steadily rising and is now at 12.5%. In the Northeast, activity is middling at 5.9% but has been slowly and jaggedly rising over the past couple months. 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
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DECEMBER 7– 84 YEARS AGO TODAY AT 2 PM EASTERN TIME. THE ATTACK ON PEARL HARBOR STARTED
Out of the Sun
The Arizona engulfed, December 7, 1941 Pearl Harbor
Out of the sun they came
Birds of death blazen with red suns raining fiery havoc on Battleship Row.
One by one, ruthless planes dove, destroyed to their nation’s shame.
Thunderous explosions scattered fiery death on Sunday dawn’s glow.
Flames belched from hull of stricken Arizona, America’s pride,
Hicham Field pilots raced to planes to defend
Their birds crippled on ground by Zeros’ glide
Gunners in turrets on ships floundering filled skies with flack din.
In search of aircraft carriers, the marauders could not find,
Ruthlessly strafed and bombed leaving Pearl
In smoking ruin. Ships sunk, burning as raiders flew back into dawn’s Sun
The day of infamy had been ignited in the Zeros’ swirl.
The Attack Begins 8 AM December 7, 1941
As America listened a world away, somber FDR
Spoke of this day that will live in infamy.
America must never forget its Pearl Harbor Scar
When an unsuspecting America slept in complacency.
To the 2,403 perishing that day under merciless bombs
Hails of bullets, terror of torpedo out of nowhere
America must remember forces against our freedoms
Relentlessly work always to surprise with deadly bombs’ glare.
Vigilance is the price of freedom always to be defended
By dark forces in far off places we have offended.
Against those who would destroy our republic from within
The answer is not curtailing freedom at home rather it to champion.
The USS Arizona lies in Pearl’s waters, bleeding the lives
Of her men through the eerie eternal slick marking the rusting hulk.
Beneath Pearl’s waters, the blood of free people oozes from the shadowy bulk,
Bleeding forever, freedom’s spirit living forever in lost lives remembered.
She never rests.
Note: The Pearl Harbor attack started 84 years ago today 2 PM Eastern Standard Time.
The aftermath is dramatically depicted at http://www.history.navy.mil/photos/events/wwii-pac/pearlhbr/pearlhbr.htm
DECEMBER 6—GOVERNOR HOCHUL SIGNS LAW ESTABLISHING PROPERTY TAX EXEMPTIONS FOR NY SENIORS–NOT AUTOMATIC — TOWNS CITIES COUNTIES WOULD HAVE TO AUTHORIZE EXEEMPTIONS LOCALLY
Governor Kathy Hochul signed legislation that enhanced real property tax exemptions for New York seniors. Legislation S5175A/A3698A allows localities to provide a real property tax exemption for senior citizens who meet the income eligibility limits, among other criteria, up to 65 percent percent of the assessed valuation of their properties.
“No New York senior should lose their home because they can no longer afford their property taxes,” Governor Hochul said. “By signing this legislation, we are working to make New York more affordable for our seniors on fixed incomes and empowering them to age in place, at home, in the communities they know and love.”
The bill will give localities the option to offer real property tax exemptions of up to 65 percent to seniors living below the maximum income eligibility level set by the locality.
Prior to, the maximum percentage of exemption local governments have been able to offer senior citizens was set at 50 percent and has not been raised in decades. Increasing the exemption from 50 percent to 65 percent could translate into savings of up to $300 annually for the average senior.
New York State Office for the Aging (NYSOFA) Acting Director Greg Olsen said, “Governor Hochul is coming through yet again on making New York more affordable for individuals and their families. Property taxes, especially for those on fixed incomes, can often be difficult to afford. With more than 1.8 million older adults who own their own homes, this important law will continue to help older adults remain in the homes and communities of their choice and keeping their vast contributions within New York State.”
This legislation builds on Governor Hochul’s affordability agenda, which includes:
- Middle-Class Tax Cut: Approximately 8.3 million New Yorkers will benefit from decreased tax rates, bringing middle-class taxes to their lowest levels in 70 years.
- Child Tax Credit Expansion: The Child Tax Credit is increasing to up to $1,000 per child under the age of four and up to $500 for school-aged children, starting in 2026.
- Inflation Refund Checks: Eligible New Yorkers have received up to $200 per person or $400 per family, reaching 8.2 million people.
- Free School Meals: All K-12 students now have access to free breakfast and lunch, saving families up to $1,600 per child annually.
DECEMBER 5– HEALTH NEWS FROM WASHINGTON: “THE UNITED STATES TOOK A STEP BACKWARD IN VACINE POLICY TODAY” DR. KATELYN JETELINA REPORTING
The two-day meeting of ACIP—the committee that once guided evidence-based U.S. vaccine policy before being upended under RFK Jr.—just wrapped.
And… it was something else. Disgraceful. Unprepared. Dysfunctional. Incompetent. Terrifying. Embarrassing. Opaque.
Our children deserve better. Period.
In the end, the committee voted to move America back to pre-1991 (35 YEARS AGO) by removing the universal vaccination recommendation for the Hepatitis B infant dose despite no new evidence of harm and ignoring clear benefits.
They also recommended that parents ask clinicians for an antibody blood test to determine the need for subsequent doses, even though there’s no evidence that this works.
This ultimately shifts the burden to clinicians and parents and abdicates the responsibility of the recommending body.
While not the most catastrophic outcome, this change is going to have real consequences— with babies and families paying the price.
Where this goes from here depends on what happens next.
If confusion dominates headlines and clinical practice and falsehoods fill the void, the consequences will be serious.
But if we respond the way we saw many do today—pushing back with clarity, authority, evidence, coordination, and grassroots strength—the harm can be contained and minimized.
What actually happened and what it means to you
I’ll spare you the presentations.
Over the past two days, The Evidence Collective (TEC) counted more than 60 (we lost count after this) falsehoods, distortions, and outright lies being megaphoned from one of the nation’s highest committees. The potential damage from that alone is staggering. (The TEC debunk report is HERE; it was truly a herculean effort.)
However, there were also decisions made on your behalf. Two recommendations passed:
- Vote 1 (translation):
- If the mother is Hep B-positive, get the birth dose. If Hep B status is unknown, get the birth dose. If Hep B-negative, shared clinical decision-making about the birth dose. If the patient chooses to delay, delay for at least 2 months.
- Interpretation: This changes the universal birth dose recommendation to a risk-based one, reverting us to pre-1991.
- This decision was not evidence-based. Hep B vaccine has one of the most well-established safety records of any vaccine. During the meeting, decades of favorable risk/benefit priorities were replaced by pseudoscience, baseless skepticism, and by non-experts.
- Implications: We can expect to see hundreds of babies in the next decade who would otherwise not have contracted deadly chronic liver disease because of this change.
- Importantly: If you do want a vaccine at birth, even if you don’t test positive, you still can (and should) get it and will be covered by insurance.
- Vote 2 (translation): Parents can ask their clinicians whether to get an antibody blood test before Hep B vaccine doses 2 and/or 3.
- Interpretation: As written, the recommendation is deeply confusing. The biggest issue: scientists do not know what antibody level guarantees long-term protection for babies, especially after just one dose. So the test can’t reliably tell families whether their child is actually protected.
- Implications: Using a blood test to decide on Hep B vaccination means another infant blood draw, another appointment, and added costs for the health system and potentially for families.
- And while the recommendation suggests insurers should cover this testing, ACIP has no authority over anything beyond immunization policy.
- There’s also a practical concern: skipping Hep B doses 2 and 3 could disrupt how other routine infant vaccines are given, since many are bundled together (like DTaP and Hib). Under-immunized babies are at higher risk for preventable chronic liver disease.
- Importantly: You can choose the standard 3-dose Hep B infant series and be confident that your baby is protected, without any extra blood draws.
A lot of us are exhausted and, unfortunately, our work is not done.
There will be increasing confusion about evidence-based vaccination options for parents, clinicians, hospital systems, and schools.
This will decrease vaccination coverage, leading to more disease and unnecessary suffering. Use your networks and voices to make sure new parents and clinicians are empowered to make evidence-informed decisions.
Why this didn’t become catastrophic — and what gives me hope
As a nation, we should strive for excellence, but the votes could have been even worse. The committee seriously considered removing the Hep B vaccine altogether or delaying it until the teen years. That didn’t happen—not because of this panel or its so-called “gold-standard evidence”—but because people, both inside and outside the room, refused to let ideology steamroll infants’ health. Their clarity, persistence, expertise, and coordination made a real difference.
A nationwide, grassroots effort leading up to this meeting helped protect science and parental choice:
- Hep B working-group experts pushed back hard against proposals like removing the Hep B vaccine altogether, keeping discussions grounded in Americans’ freedom to access vaccines.
- Pre-bunking teams and communication networks prepared the public and providers for falsehoods, educating them on the playbook and what to expect and to anticipate questions, concerns, and confusion.
- Professional organizations put hours and hours and hours of work into reviewing the evidence in a balanced way, studying the impact of votes, outlining the implications of different votes, and coordinating across disciplines.
At the meeting, pushback was also on display:
- Individuals spoke up within ACIP: There were two ACIP members—Meissner and Hibbeln—who pushed back hard on the unbalanced presentation of science, the unseriousness of the presentations, and the ridiculousness of the votes. “There were so many statements that I disagree with, it’s hard to be succinct,” Meissner said. I’m thankful they were there.
- CDC scientists, working under impossible conditions, weren’t allowed in the room to present evidence, yet coordinated behind the scenes to protect the science. They also spoke up during the meeting. For example:
- Adam Langer—CDC’s lead on Hep B—did a truly heroic job. He was exactly what this country needed in that moment. He stood up, clearly laid out what evidence we do and don’t have, and reminded everyone that the U.S. is not Denmark. He acknowledged ACIP’s arguments, leveled with them, and then steered the discussion back to why we were there in the first place. It was a masterclass in redirecting and keeping the meeting on track. Someone please send this man some cookies.
- Clinicians, professional societies, and trusted messengers were ready in real time to counter misleading narratives and explain the real risks and benefits to patients.
- People like Jason Goldman at the American College of Physicians and other liaisons took every opportunity to deliver concise information when they were called upon.
Amid the dysfunction, a broad, determined coalition refuses to let ideology win.
The courage, teamwork, and clear voices proved that the scientific community and the public are not powerless.
They can still protect children’s health when institutions fail.
The people have far more power than we sometimes think.
Bottom line
The United States took a step backward in vaccine policy today,
which will have implications ranging from confusion to preventable liver disease and deaths.
But another important thing was on display: a huge grassroots effort refusing to let ideology override science. Do not come between public health, clinicians, and children’s health. We are fiercely devoted to them.
Love, YLE
Your Local Epidemiologist (YLE) is founded and operated by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, wife. YLE is a public health newsletter that reaches over 435,000 people in more than 132 countries, with one goal: to translate the ever-evolving public health science so that people are well-equipped to make evidence-based decisions. This newsletter is free to everyone, thanks to the generous support of fellow YLE community members.