On every train car I rode this weekend, at least two to three people were coughing.

The super in my building has been in bed with a fever. Last week, coworkers were sniffling on Zoom.

All the data for New York—cases, hospitalizations, emergency department visits, wastewater—point to a smoking gun: the flu.

We’re heading into peak travel season during the holidays, and respiratory viruses are along for the ride (especially the flu).

So before we dive into your infectious disease “weather report” (plus a measles outbreak update in Rockland County),

I want to emphasize that it’s not too late to get your flu, Covid, or RSV shots. We’ve got a couple more months of higher virus activity ahead of us. Getting vaccinated now can still reduce your risk of infection and serious illness.

And quick heads up, I’ll be taking a break to recharge over the holidays, but I’ll be back in the new year with more updates, data, and public health guidance to help you navigate what’s ahead in New York. Okay, let’s get into it.

Infectious disease “weather report”

Flu: Continuing to increase sharply, and much faster than Covid or RSV. The most recent data show that cases and hospitalizations in the state have increased by 83% and 61%, respectively. Emergency department visits and hospitalizations for the flu in NYC are also rising, especially for kids.

Hospitalizations for respiratory viruses in New York. Figure from the NYSDOH Respiratory Surveillance Report. Annotations by YLE.

The flu shot is most important for young kids and infants, older adults, those who are pregnant, and people with conditions that put them at higher risk. (See specific guidance here.) During last year’s flu season, 26 kids, only one of whom was vaccinated, tragically died of the flu.

Unfortunately, flu vaccination coverage is lower this year compared with the same time last year, especially for kids:

• Coverage for children 0–18 years is down by 7.5%.
• Coverage for adults 19 and up is down by 1.4%.

The best thing to do right now is make sure the kids in your life, and you, are vaccinated. Anyone 6 months or older can get vaccinated for the flu.

RSV: Also increasing across the state, mostly in kids under age 4. Statewide, hospitalizations increased by 32%.

Hospitalizations for RSV in New York this season and last season. Figure from the NYSDOH Respiratory Surveillance Report. Annotations by YLE.

RSV vaccination has a little bit more nuance to it because there are different immunizations based on one’s age:

For older adults:

• One RSV shot is recommended for everyone 75 and older.
• People 50–74 with risk factors for severe disease should also get vaccinated.
• Only one dose is needed—this is not a yearly vaccine.

For infants:

• All infants should be protected, either by:
  • Vaccinating the pregnant parent between 32–36 weeks, or
  • Giving monoclonal antibodies (like nirsevimab or clesrovimab) to the baby after birth.
• Most infants only need one of these options.
• If the pregnant parent got the RSV shot during a past pregnancy, the baby should get monoclonal antibodies.

For young children (8 to 19 months):

• It’s recommended that kids with risk factors for severe disease also get monoclonal antibodies going into their second RSV season.
• Nirsevimab is the only recommended option for this age group.

Covid: Continuing to increase in New York slowly. Statewide, Covid hospitalizations increased by 23%.

Cases of respiratory viruses by New York county. Dark blue areas have the highest case rates. Figure from the NYSDOH Respiratory Surveillance Report.

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Measles is back in Rockland County

Rockland County is experiencing a measles outbreak. Twenty cases have occurred since October, bringing the total to 21 in 2025. All cases are in unvaccinated people, and mostly kids under 5.

Measles is one of the most contagious viruses we know: if one person has it, up to 9 out of 10 unvaccinated people around them will catch it too. It can also linger in the air for up to two hours after an infected person has left a room.

And it’s more than just a rash. At least four children in the Rockland County outbreak have been hospitalized, including one who was critically ill. Thankfully, all have since recovered. But it’s a reminder that measles is a serious illness. It can lead to pneumonia, brain swelling, and death, especially in children under 5, pregnant people, and those who are immunocompromised.

This is the county’s first outbreak since the large one in 2018–2019 (which saw more than 300 cases). Then, like now, measles took hold in communities with low MMR vaccination coverage. In some Rockland zip codes, less than 50% of eligible infants are vaccinated, far below the 95% needed for community protection.

Rockland County vaccination rates for 2 year-olds by zip code. Data as of January 1st, 2025. Figure from the New York State Department of Health.

The best thing to do right now is check the vaccination status of everyone in your family, and get up to date if needed. If you’re unsure whether you or your child is immune, talk to your healthcare provider. Immunity is confirmed with either two documented doses of the MMR vaccine or a blood test (titer) showing protection from past infection or vaccination.

Free MMR vaccines are available by calling the Rockland County Department of Health at 845-364-2497. The Spring Valley and Pomona clinics are also providing immunizations, as are local health care providers and local federally qualified health centers, such as Refuah Health or Sun River Health Care.

Bottom line

Flu is surging, RSV is rising, Covid is creeping up, and measles is back in Rockland. The good news? The best protection against all these is the same: vaccination. It’s not too late to get your flu, Covid, or RSV shots for this season, and to make sure that MMR vaccines are up to date.

Wishing you and your loved ones a relaxing, healthy, and joyful holiday season and New Year!

Love,

Your NY Epi

P.S. Some of you have asked about including Your Local Epidemiologist in your year-end charitable giving. I would be honored to have your support. YLE is a fiscally sponsored project of Social Good Fund, a California nonprofit corporation and registered 501(c)(3) organization, Tax ID (EIN) 46-1323531. You can make a tax-deductible donation online here.

If you need to send a paper check instead, the following is important: make the check out to Social Good Fund and write Your Local Epidemiologist in the memo. You can mail the check to: Social Good Fund, PO Box 5473, Richmond, CA 94805-4021.

And of course, you can always join us as a paid subscriber to support this work.

Dr. Marisa Donnelly, PhD, is an epidemiologist, science communicator, and public health expert. This newsletter exists to translate complex public health data into actionable insights, empowering New Yorkers to make informed and evidence-based health decisions.

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Respiratory Diseases

Influenza

Flu is ratcheting up quickly, but unevenly, across the Northeast. It is now high in several states, but remains low (though growing) in others.

New York and New Jersey are at the center of the wave.

Outpatient ILI in the states have risen to 7.8% and 8.0%, respectively, which is really quite high.

Emergency department (ED) visits have also increased sharply in both states, to 5.7% and 5.0%, respectively.

Hospitalizations in New York have increased to 8.1 hospitalizations per 100,000 people. New York City is seeing a rapid escalation as well: ED visits have jumped from 4.2% to 6.7% in the last week, and hospitalizations have also jumped.

Northeast: Outpatient influenza-like illness (%)

% of visits to the doctor that are for fever and cough or sore throat

Outpatient ILI data is not available for Connecticut, but its ED visits are on par with those in New York at 5.7%. Similarly, hospitalizations have increased sharply, to 9.5 hospitalizations per 100,000 people.

In Rhode Island, outpatient ILI is up to 6% and in Massachusetts, outpatient ILI activity is up to 4.2%. Both states reported notable increases in ED visits this past week, to 2.8% and 2.7%, respectively.

Northeast: ED visits for influenza (%)

% of visits to the emergency department that are for influenza

Activity still remains fairly low in several states, however. In Pennsylvania, outpatient visits are at 2.2% and ED visits, while increasing, are still low at 1.8%. ED visits in New Hampshire are also low at 1.8%. In Maine, outpatient ILI increased slightly this past week to 1.9%, and in Vermont, outpatient ILI is at just 1.4%. Both states have ED visits for flu at 1.2%.

*Please note: for a few states, outpatient ILI data was not in the centralized dataset used to create the graphics, but I was able to find the data directly from the state and have referenced it in-text here.

COVID-19

Covid-19 activity is increasing, with some states seeing much more activity than others. ED visits were stable or increasing in most states in the region, though they remain low overall, ranging from 0.4-0.8% of all ED visits. Wastewater activity dipped slightly this week, dropping from moderate to low wastewater activity. Nevertheless, activity remains more than double what it was back in November, and the overall trend still appears to be one of increasing activity.

Connecticut has the highest rate of ED visits in the region, at 0.8%, and wastewater activity there is also high and increasing. Hospitalizations have also started to catch up, and increased notably this past week, to 3.1 hospitalizations per 100,000 people. In Maine, wastewater activity is also high and increasing, but ED visits dipped slightly this week, to 0.5%.

Northeast: ED visits for Covid-19 (%)

% of visits to the emergency department that are for Covid-19

In New Hampshire, ED visits have increased to 0.73, and wastewater activity is moderate. Massachusetts also has moderate wastewater activity, and stable ED visits (0.63%).

In Rhode Island and Vermont, wastewater activity is low and decreasing, and ED visits declined in both states this past week. In Pennsylvania, ED visits increased slightly, and wastewater activity held roughly steady or declined slightly to low levels.

Forming an inverse of what is happening with flu, things are very quiet in both New York and New Jersey — wastewater activity is very low, and ED visits are very low and stable (at 0.4 and 0.5%, respectively). This is also the case in New York City, where ED visits for Covid-19 are very low at just 0.2%. However, hospitalizations increased slightly in New York, to 3.1 (though they held steady in New York City).

Northeast: Covid-19 wastewater concentration

Wastewater concentration of SARS-CoV-2

RSV

RSV remains unusually quiet for this time of year. Wastewater activity remains very low in most states in the region.

Connecticut is the only state with low (rather than very low) wastewater activity. But ED visits remain very low and stable in the state (at 0.15) and hospitalizations are flat, at 0.8 hospitalizations per 100,000 people.

ED visits remain <0.4% for all states in the region. There were slight increases in ED rates in Rhode Island, New York, and New Hampshire this last week. In New York, however, there has been an uptick in hospitalizations this past week, to 1.4 hospitalizations per 100,000 people.

In New York City, RSV remains very low and stable, at 0.3% of all ED visits. Hospitalizations have decreased slightly over the past few weeks, to 0.2%.

Northeast: ED visits for RSV (%)

% of visits to the emergency department that are for RSV

Other Bugs

• Adenovirus and parainfluenza are both past peak, but remain elevated.
• Human coronaviruses and human metapneumovirus remain fairly low, but are edging upward.
• Rhinoviruses/enteroviruses have decreased to moderate levels.

Stomach Bugs

Norovirus test positivity data was not updated this week. However, my back-up data source shows that norovirus wastewater activity is high, but decreasing slightly at the national level.

In the Midwest, Northeast, and South wastewater activity is high and increasing. In the West, wastewater activity is also high, but has dipped slightly.

Food recalls

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

New:

• Frozen raw shrimp sold under the Market 32 and Waterfront Bistro brand names, due to possible cesium-137 contamination (more info)
• Tamales, various flavors, in 4 count packs, sold by Primavera Nueva Inc. (more info)
• Salted Caramel Cluster Non-Dairy Frozen Dessert sold under the So Delicious label (more info)

Previously Reported:

• Town Food Service Equipment Co. Aluminum Saucepans, due to potential lead contamination (more info)
• Lucky Foods cinnamon powder, due to potential lead contamination (more info)
• Wegmans Deluxe Mixed Nuts Unsalted (more info)
• Grated Pecorino Romano cheese, sold under various labels, including Boar’s Head, Locatelli, Member’s Mark, Ambriola, and Pinna at major retailers, including Wegman’s (more info)
• Prairie Farms Gallon Fat Free Milk (more info)
• ByHeart Infant Formula due to potential botulism contamination (more info)

In other news

• ‘Tis the season for outbreaks to spread through schools. Wash your hands frequently, and best of luck getting through this disruptive period.
  • Gastrointestinal illness (likely norovirus) in Camden County, New Jersey. A large uptick in students reporting stomach bug symptoms (nausea, vomiting, stomach cramps) is occurring in Camden County. The affected school district is cleaning affected classrooms.
  • Stomach bug leads to second school closure in Medford, Massachusetts. After about 20% of students were absent on Monday, the school (pre-K and K-8) was closed Tuesday and Wednesday to clean the building and limit spread.
  • Flu causes closure in Portsmouth, New Hampshire. About 1/3 of students at Ellis School were out sick on Monday due to what is being identified as an influenza outbreak. It is not clear to me from the reporting if flu has been confirmed as the cause of many of the cases, or just a respiratory virus. The school closed on Tuesday to clean the building, and is asking parents to keep sick children at home until at least 24 hours after their symptoms subside to limit further spread.