Welcome to this week’s Northeastern regional 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 DiseasesInfluenzaFlu activity is still underway in the Northeast, as in the rest of the country. The region has not yet shown a clear, consistent sign of peak. New Jersey leads the region in outpatient influenza-like illness (ILI) at 4.8%, essentially flat from last week. Emergency department (ED) visits there rose to 2.3%, one of the larger week-over-week ED increases in the region. New Hampshire saw a meaningful jump in ILI, rising to 4.0% from 3.3% last week, making it the second most active state. ED visits there held roughly flat at 2.7%. Northeast: Outpatient influenza-like illness (%)
% of visits to the doctor that are for fever and cough or sore throat
Massachusetts ticked up to 3.6% ILI and 1.7% for ED visits. New York also climbed modestly, with ILI at 3.2% and ED visits at 1.0%. Hospitalization rates in New York held flat at 1.7 per 100,000. Vermont is showing some improvement, with ILI falling to 3.1% and ED visits declining to 3.7%, though ED visits there remain the highest in the region. Maine also eased slightly on both ILI and ED visits. Rhode Island saw ILI drop notably, from 3.2% to 2.4%, though ED visits paradoxically rose from 0.9% to 1.5%, a divergence worth watching. Pennsylvania continued to climb on both measures, with ILI up to 2.3% and ED visits to 2.1%. Connecticut does not have ILI data this week. ED visits rose to 1.9% and hospitalization rates ticked up to 1.6 per 100,000, up from 1.3 last week. Northeast: ED visits for influenza (%)
% of visits to the emergency department that are for influenza
COVID-19Covid-19 activity in the Northeast is fine but not great. ED visits are low and broadly flat/slowly declining, but wastewater signals are still a bit all over the place, making it hard to assess trends. I’m including wastewater here as I know many readers rely on it, but I encourage you to put more weight on the ED numbers and trends. New Hampshire is seeing clear improvement, with ED visits falling to 1.0% and wastewater declining significantly. Maine also improved on both ED visits, which dropped from 1.2% to 0.7%, and wastewater. Massachusetts eased on both measures as well. Vermont saw ED visits rise to 0.8% and wastewater tick up. New Jersey saw modest increases in both ED visits and wastewater. Pennsylvania ED visits edged up slightly despite declining wastewater. Rhode Island saw ED visits fall but wastewater rose sharply. Most notably, New York saw wastewater rise considerably this week, even as ED visits held essentially flat at 0.5%. Hospitalization rates there eased slightly to 2.9 per 100,000, the highest in the region among states with available data. Connecticut ED visits declined slightly to 0.8% but wastewater was essentially flat and hospitalizations held at 2.5 per 100,000. RSVRSV activity is rising across much of the Northeast, with ED visits up in most states and wastewater signals elevated in several. Vermont and New Hampshire lead the region in ED visits at 1.1% and 1.0% respectively, both up from last week. Massachusetts rose to 0.9% for ED visits. Connecticut, Rhode Island, and New Jersey are all around 0.6%, with Connecticut hospitalizations declining slightly to 3.5 per 100,000. New York ED visits held essentially flat but hospitalizations rose to 3.2 per 100,000, up from 2.6 last week. Pennsylvania and Maine are at the lower end of the region for ED visits. NorovirusNorovirus activity is still rising in the Northeast, with test positivity nearing 16%. This is typically peak or just past peak season, so I’m hoping we’ll see improvements soon. 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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MARCH 3–YOUR LOCAL EPIDEMIOLOGIST OBSERVES
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Hep B vaccine rates declining, RSV is having a late surge, more disease=more economic cost, AI and triage, and the U.S. surgeon general
The Dose (March 3)
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Somehow, it’s already March! And there’s a lot unfolding right now at the intersection of society and health. I’ve been especially thinking about Iranians—including my own family—and hoping we can all take a moment to listen, learn, and show support. If you’re looking for a place to start, I highly recommend the book All the Shah’s Men.
In the health world, we have flu hanging on, RSV making a surprisingly late appearance, and falling vaccination rates that will cost us more than most people realize. Plus, a reader question worth unpacking: Does the surgeon general actually need an MD?
Here’s what’s going on and, most importantly, what it means for you.
She grew up unvaccinated, she’s an immunologist, and she’s our colleague.
YLE’s own Liz Marnick published an op-ed in the NYT on Friday. I know I’m biased, but it’s a must read. Liz shares her story of growing up unvaccinated, hard conversations with her mother, and going on to study the immune system. And yet, when it came time to vaccinate her own child, she paused:
“In that one exhausted moment, what was loudest in my head was not the science I knew well. It was the stories I had heard growing up.”
Her message: shame doesn’t work. Please read it; it’s a masterclass in approaching this moment with empathy.
Disease “weather” report
This respiratory season just won’t quit. Flu activity is holding steady. One strain (flu B) is rising while another (flu A) is falling, and together they’re canceling each other out. That kind of plateau is unusual; most seasons follow a smoother up-and-down curve. But the timing isn’t surprising. In bad flu years, activity has stayed above epidemic levels well into mid-March.
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Source: NREVSS
What is unusual is that RSV infections and hospitalizations continue to climb. It’s incredibly late in the season for RSV to show its teeth. Babies are most at risk.
What this means for you: It’s not too late to get your vaccines!
For RSV: If your infant received monoclonal antibodies (like Nirsevimab) this season, they’re likely still protected. Most monoclonal antibodies fade quickly, but the RSV ones were specifically engineered to last longer. Nirsevimab has a half-life of about 70 days—meaning the amount in the body decreases by half roughly every 70 days. Even so, studies show protective levels can persist for more than a year. So even doses given early in the season should still be providing coverage.
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RSV NAb GMC through day 361 by treatment and medically attended, diagnostic-confirmed RSV infection. Source: Nature. Annotated by Your Local Epidemiologist.
AI tools aren’t ready to triage you… yet
People want more control over their own health. Health care is expensive, hard to access, and appointments aren’t always easy to get. There is a lot of promise for AI, and people are already using it for their health: 230 million people ask ChatGPT health questions every week. So if AI tools could reliably help people decide when to seek care, that would be a big deal.
But a new study suggests we’re not there yet.
Researchers published a study last week in Nature Medicine testing ChatGPT Health, a new consumer health AI tool, on a basic but critical task: triage. Given a set of symptoms, could it correctly tell you whether to stay home, schedule a routine appointment, get seen urgently, or go to the ED?
The results were mixed, and concerning at the extremes:
- For people who didn’t need a doctor at all, it sent them to one 65% of the time. A waste of time and money.
- For routine visits, it correctly recommended seeing a doctor 95% of the time.
- For people who needed emergency care, it only recommended the ED about half the time. It handled classic emergencies well, like allergic reactions or stroke, but struggled to recognize how sick someone was about to become, like the early stages of a diabetic complication.
- More detailed medical data improved accuracy, but adding irrelevant information confused it. For example, when normal lab results were included alongside a note that a patient was suicidal, ChatGPT got it wrong. That’s obviously deeply concerning.
What this means for you: For straightforward health questions, AI tools can genuinely help and can certainly supplement a visit with a clinician. Add more details for more accuracy, but proceed with caution and certainly do not use it for emergency health issues.
And so it begins: Hep B birth vaccine rates are going off a cliff
One of the biggest open questions right now is how far vaccination rates will fall in the current climate before they level off and begin to climb again. Tracking vaccination rates in the United States is surprisingly difficult because we do not have a single, centralized, easily accessible system like countries such as Denmark do. Instead, data are fragmented across states and systems.
Still, early numbers are starting to come in, and the picture is not encouraging.
A group of researchers analyzed de-identified medical records from 2016–2025 to track hepatitis B vaccination trends. They asked: How far have we drifted from the expected path?
It turns out, quite a lot. For every 100 live births, 10 fewer newborns received the hepatitis B vaccine than models predicted. The decline began in late 2024 and now appears to be accelerating. (Note: The study period ended before RFK Jr. made the unilateral decision to stop recommending the hepatitis B vaccine for all newborns. That means the downward trend will continue.)
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Source: Rothman et al., 2026
This is unsurprising in a way, but very concerning. I would love to see the findings repeated using other data sources. Unfortunately, this research is brief, and the methods aren’t described in great detail. But clearly, we aren’t going in the right direction in protecting babies’ health and wellness.
What this means for you: Continue to follow the AAP immunization schedule, which includes the hepatitis B birth dose. If you have questions, talk to your pediatrician.
- If you’re navigating Hep B birth dose conversations with parents, what questions about routine immunizations are you getting? Do you believe this trend given what you’re seeing on the ground? Drop in the comments below.
- Remember, YLE has this one-pager that includes the recent routine childhood immunization changes and reminders on why we vaccinate for these diseases, like Hepatitis B, in the first place. Feel free to print and distribute!
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More measles = more economic cost
Infectious diseases mean people stay home sick and miss out on work, and health care bills are higher. They are also expensive for public health departments to combat. They’re not just a health problem. They’re an economic problem.
Thanks to a Common Health Coalition report, the U.S. now has economic numbers tied to declining MMR vaccination rates.
A 1% annual decline in MMR vaccination rates would lead to:
- More suffering. Specifically, more than 17,000 measles cases, 4,000 hospitalizations, and 36 preventable deaths each year.
- Major economic costs. On average, one measles case costs the U.S. health system $76,000. With the projected number of cases over 5 years, the estimated cost would be $1.5 billion. This breaks down to:
- $41 million in medical costs (i.e., medical bills)
- $947 million in outbreak responses (e.g., contact tracing, community outreach, surveillance)
- $510.4 million in lost productivity and missed work costs
Childhood immunization is as essential to health system stability as it is to community health.
Importantly, this isn’t inevitable. It can be stopped. This report included solutions highlighting that everyone, from health insurers to health departments to clinicians, has a role to play.
What this means for you: As vaccine rates continue to decline, costs will be borne by you, your state, and your health insurance companies. Continue to urge your insurance company to cover routine childhood immunizations at no cost.
- For those advocating for immunizations with local, state, or federal decision-makers, be sure to include economic costs. This can be compelling to those who prioritize budgets and resource allocation, since framing immunization as a cost-saving investment (rather than just a health measure) can be persuasive.
Question grab bag
“Serious question: Shouldn’t the surgeon general have a license to practice medicine?”
Short answer: Yes.
Most people know the surgeon general as “America’s doctor,” which is essentially a megaphone for public health. They have delivered landmark messages like those linking smoking to cancer. That role alone demands real expertise and credibility, but I would argue someone with a PhD in public health could do that as easily as an MD.
The lesser-known reason is that the surgeon general commands the Commissioned Corps of the U.S. Public Health Service, a uniformed branch of 6,000 officers deployed into national emergencies, like hurricaines and disease outbreaks. The corps requires its own officers to hold an active, unrestricted medical license and complete residency training. This means that if Casey Means is confirmed as surgeon general (a big if right now), she would be responsible for enforcing standards she doesn’t meet.
In case you missed it
- CA YLE Matt’s colon cancer screening PSA.
- NY YLE Marisa on the blizzard and police response to mental health crises.
- And a measles brief for Christian communicators in an attempt to break echo chambers.
Bottom line
Stay healthy, neighborly, and safe out there.
Love, YLE
Your Local Epidemiologist (YLE) is founded and operated by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, wife, and mom of two little girls. YLE reaches more than 425,000 people in over 132 countries with one goal: “Translate” the ever-evolving public health science so that people will be well-equipped to make evidence-based decisions. This newsletter is free to everyone, thanks to the generous support of fellow YLE community members. To support the effort, subscribe or upgrade belo
MARCH 2–WESTCHESTER COUNTY WEBSITE LAUNCHES TODAY
LAUNCHES TODAY
(White Plains, NY) – Starting today, March 2, Westchester County Government has officially transitioned its website domain from westchestergov.com to WestchesterCountyNY.gov reinforcing the County’s commitment to transparency, security and public trust.
The previous web address will automatically redirect to the new .gov site to ensure a seamless experience for residents, businesses and partners.
Westchester County Executive Ken Jenkins said: “This is about clarity, credibility and public confidence. When residents visit a .gov website, they know they are accessing official government information. Moving to WestchesterCountyNY.gov aligns us with federal standards and strengthens trust in how we communicate with the public. Our goal is simple: make it easier for people to know they are in the right place.”
What is Changing
- The County’s official website address will now be WestchesterCountyNY.gov
- The previous address, westchestergov.com, will redirect automatically
What is not Changing
- County services and programs
- Department pages and content
- Online forms and resources
- How residents access services
The online experience remains the same — only the web address is new.
The transition is part of a broader modernization effort to ensure the County’s digital presence reflects best practices in government communications and cybersecurity.
Westchester County Communications Director Catherine Cioffi said: “When the .com domain was originally selected decades ago, it was viewed as modern and forward-thinking. Today, however, it can create confusion about what is official government information. Additionally, there is also now a federal requirement that government entities use a .gov domain, and that mandate was a key driver behind the County’s recent rebranding efforts which removed the website address from our logo. Most importantly, while the address is changing, the content and services residents rely on every day remain exactly where they expect them to be.”
Westchester County Chief Information Officer Marguerite Beirne said: “Cybersecurity has been a top strategic priority of the Department of Information Technology for years. Transitioning to a secure, verified .gov domain further strengthens our digital infrastructure and ensures residents can confidently access trusted County information in an increasingly complex online environment.”
FEBRUARY 28–PRESIDENT TRUMP’S MESSAGE TO THE IRANIAN PEOPLE FRIDAY EVENING
This is a transcript of remarks President Donald Trump delivered early this morning on today’s air strikes on the Islamic Republic of Iran, a joint operation with Israel dubbed “Operation Epic Fury.”
A short time ago, the United States military began major combat operations in Iran. Our objective is to defend the American people by eliminating imminent threats from the Iranian regime, a vicious group of very hard, terrible people. Its menacing activities directly endanger the United States, our troops, our bases overseas and our allies throughout the world.
For 47 years, the Iranian regime has chanted “Death to America” and waged an unending campaign of bloodshed and mass murder, targeting the United States, our troops and innocent people in many, many countries.
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Among the regime’s very first acts was to back a violent takeover of the U.S. Embassy in Tehran, holding dozens of American hostages for 444 days.
In 1983, Iran’s proxies carried out the Marine barracks bombing in Beirut that killed 241 American military personnel. In 2000, they knew and were probably involved with the attack on the USS Cole. Many died. Iranian forces killed and maimed hundreds of American service members in Iraq.
The regime’s proxies have continued to launch countless attacks against American forces stationed in the Middle East in recent years, as well as U.S. naval and commercial vessels in international shipping lanes. It’s been mass terror, and we’re not going to put up with it any longer.
From Lebanon to Yemen, and Syria to Iraq, the regime has armed, trained and funded terrorist militias that have soaked the earth with blood and guts. And it was Iran’s proxy, Hamas, that launched the monstrous Oct. 7 attacks on Israel, slaughtering more than 1,000 innocent people, including 46 Americans, while taking 12 of our citizens hostage.
It was brutal. Something like the world has never seen before.
Iran is the world’s number one state sponsor of terror, and just recently killed tens of thousands of its own citizens on the street as they protested.
It has always been the policy of the United States, in particular, my administration, that this terrorist regime can never have a nuclear weapon. I’ll say it again: They can never have a nuclear weapon.
That is why, in Operation Midnight Hammer last June, we obliterated the regime’s nuclear program at Fordow, Natanz and Isfahan.
After that attack, we warned them never to resume their malicious pursuit of nuclear weapons, and we sought repeatedly to make a deal. We tried. They wanted to do it. They didn’t want to do it. Again, they wanted to do it. They didn’t want to do it. They didn’t know what was happening. They just wanted to practice evil.
But Iran refused, just as it has for decades and decades, they rejected every opportunity to renounce their nuclear ambitions, and we can’t take it anymore.
Instead, they attempted to rebuild their nuclear program and to continue developing long range missiles that can now threaten our very good friends and allies in Europe, our troops stationed overseas, and could soon reach the American homeland.
Just imagine how emboldened this regime would be if they ever had, and actually were armed with, nuclear weapons as a means to deliver their message.
For these reasons, the United States military is undertaking a massive and ongoing operation to prevent this very wicked, radical dictatorship from threatening America and our core national security interests. We are going to destroy their missiles and raze their missile industry to the ground. It will be totally, again, obliterated.
We’re going to annihilate their navy. We’re going to ensure that the region’s terrorist proxies can no longer destabilize the region or the world and attack our forces and no longer use their IEDs or roadside bombs, as they are sometimes called, to so gravely wound and kill thousands and thousands of people, including many Americans.
And we will ensure that Iran does not obtain a nuclear weapon. It’s a very simple message. They will never have a nuclear weapon.
This regime will soon learn that no one should challenge the strength and might of the United States Armed Forces. I built and rebuilt our military in my first administration, and there is no military on earth even close to its power, strength or sophistication.
My administration has taken every possible step to minimize the risk to U.S. personnel in the region. Even so, and I do not make this statement lightly, the Iranian regime seeks to kill. The lives of courageous American heroes may be lost and we may have casualties. That often happens in war. But we’re doing this not for now. We’re doing this for the future, and it is a noble mission.
We pray for every service member as they selflessly risk their lives to ensure that Americans and our children will never be threatened by a nuclear armed Iran. We ask God to protect all of our heroes in harm’s way, and we trust that, with his help, the men and women of the armed forces will prevail. We have the greatest in the world, and they will prevail.
To the members of the Islamic Revolutionary Guard, the armed forces and all of the police, I say tonight that you must lay down your weapons and have complete immunity, or in the alternative, face certain death. So lay down your arms. You will be treated fairly with total immunity, or you will face certain death.
Finally, to the great, proud people of Iran, I say tonight that the hour of your freedom is at hand. Stay sheltered. Don’t leave your home. It’s very dangerous outside. Bombs will be dropping everywhere. When we are finished, take over your government. It will be yours to take. This will be, probably, your only chance for generations.
For many years, you have asked for America’s help, but you never got it. No president was willing to do what I am willing to do tonight. Now you have a president who is giving you what you want, so let’s see how you respond.
America is backing you with overwhelming strength and devastating force. Now is the time to seize control of your destiny and to unleash the prosperous and glorious future that is close within your reach. This is the moment for action. Do not let it pass.
May God bless the brave men and women of America’s Armed Forces. May God bless the United States of America. May God bless you all. Thank you.












