The statement seemed to offer an assurance that other vaccines were not subject to the new restrictions. “Changes regarding seasonal vaccines like COVID and influenza do not change the Department’s policy or messaging regarding childhood immunizations,” it read.
This flu season, the health department has reportedly canceled standard vaccination events and clinics. On social media, the department has avoided mentioning flu shots in posts about the flu, instead advising people to wash their hands and cover their coughs.
While Louisiana is seeing an early surge in influenza, the rest of the country is on an upward trend in what appears to be a normal-looking season so far. Nationally, the percentage of doctor visits that were for ILIs is 3.8 percent, with the upswing in ILI activity similar to what was seen in the 2019–2020 flu season at this point in the year. At the peak of flu seasons, the percentage of visits for ILIs usually tops out around 7 percent to 8 percent.
US ILI activity charted by week across several flu seasons Credit: CDC
Two children died last week of flu, bringing the season’s total pediatric deaths to four. In the 2023–2024 season, 206 children died with influenza-associated disease. Most of the deaths occurred in early 2024.
COVID-19 is also ramping up a winter wave. While standard disease burden indicators—hospitalization and deaths—are low, they’re trending positive. Wastewater surveillance, meanwhile, is showing a steep incline, with levels of the virus being detected at “moderate” levels.
The Louisiana resident infected with H5N1 bird flu is hospitalized in critical condition and suffering from severe respiratory symptoms, the Louisiana health department revealed Wednesday.
The health department had reported the presumptive positive case on Friday and noted the person was hospitalized, as Ars reported. But a spokesperson had, at the time, declined to provide Ars with the patient’s condition or further details, citing patient confidentiality and an ongoing public health investigation.
This morning, the Centers for Disease Control and Prevention announced that it had confirmed the state’s H5N1 testing and determined that the case “marks the first instance of severe illness linked to the virus in the United States.”
In a follow-up, the health department spokesperson Emma Herrock was able to release more information about the case. In addition to being in critical condition with severe respiratory symptoms, the person is reported to be over the age of 65 and has underlying health conditions.
Further, the CDC collected partial genetic data of the H5N1 strain infecting the patient, finding it to be of D1.1. genotype, which has been detected in wild birds and some poultry in the US. Notably, it is the same genotype seen in a Canadian teenager who was also hospitalized in critical condition from the virus last month. The D1.1. genotype is not the same as the one circulating in US dairy cows, which is the B3.13 genotype.
Once infectious material gets into the water, disinfection systems that aren’t working properly or are inadequate can allow pathogens to gush from every nozzle. Splash pads aren’t unique in having to handle sick children in poopy swim diapers—but they are unique in how they are regulated. That is, in some places, they’re not regulated at all. Splash pads are designed to not have standing water, therefore reducing the risk of young children drowning. But, because they lack standing water, they are sometimes deemed exempt from local health regulations. Before 2000, only 13 states regulated splash pads. Though many states have since added regulations, some did so only after splash pad-linked outbreaks were reported.
Downpour of disease
The primary method for keeping recreational water free of infectious viruses and bacteria is chlorinating it. However, maintaining germ-killing chlorine concentration is especially difficult for splash pads because the jets and sprays aerosolize chlorine, lowering the concentration.
Still, in most splash-pad linked outbreaks, standard chlorine concentrations aren’t enough anyway. The most common pathogen to cause an outbreak at splash pads is the parasite Cryptosporidium, aka Crypto. The parasite’s hardy spores, called oocysts, are extremely tolerant of chlorine, surviving in water with the standard chlorine concentration (1 ppm free chlorine) for over seven days. (Other germs die in minutes.) In splash pads that might not even have that standard chlorine concentration, Crypto flourishes and can cause massive outbreaks.
In 2023, the CDC recommended new health codes that call for “secondary disinfection” methods to keep Crypto at bay, including disinfection systems using ozone or ultraviolet light. Another possible solution is to have “single-pass” splash pads that don’t recirculate water.
In all, to keep splash pads from being geysers of gastrointestinal parasites and pathogens, various changes have to happen, the CDC experts say.
“Prevention of waterborne disease outbreaks at splash pads requires changes in user behavior; recreational venue code updates; and improved venue design, construction, operation, and management of facilities,” they conclude. But it should all start with keeping kids from sitting on jets and drinking the water.
Slivered onions are the likely source of the multi-state E. coli outbreak linked to McDonald’s Quarter Pounder burgers that continues to grow, the Centers for Disease Control and Prevention announced Wednesday.
Onions were one of two primary suspects when the CDC announced the outbreak on October 22, with the other being the beef patties used on the burgers. But onions quickly became the leading suspect. The day after the CDC’s announcement, McDonald’s onion supplier, Taylor Farms, recalled peeled and diced yellow onion products and several other fast food chains took onions off the menu as a precaution. (No other restaurants have been linked to the outbreak to date.)
According to the CDC, traceback information and epidemiological data collected since then have all pointed to the onions and, according to McDonald’s, state and federal testing of the beef patties has all come back negative.
In the CDC’s update Wednesday, the agency reported that 15 more people were identified as sickened in the outbreak, including five who were hospitalized. In all, that brings the outbreak to 90 cases, including 27 hospitalizations and one death, which collectively span 13 states.
All the newly reported illnesses had onsets prior to the October 23 onion recall. The most recent illness onset was October 16. Additional illnesses may be reported, as it can take three to four weeks to link illnesses to an outbreak.
“Due to the product actions taken by McDonald’s and Taylor Farms, the CDC believes the continued risk to the public is very low,” the agency said in a media alert.
McDonald’s says that Quarter Pounders—without onions—will return to the menus of affected restaurants this week. Prior to the recall, 900 restaurants had received onions from Taylor Farms, including in Colorado, Kansas, and Wyoming, as well as portions of Idaho, Iowa, Missouri, Montana, Nebraska, Nevada, New Mexico, Oklahoma, and Utah.
The 26 new cases represent a 50 percent increase in the case count from October 22, bringing the total to 75 cases. With the new cases, health officials also reported 12 more hospitalizations, including one new adult case of hemolytic uremic syndrome (HUS), a severe complication to an E. coli O157:H7 infection. Three more states are also newly affected: Michigan, New Mexico, and Washington.
In all, the outbreak now stands at 75 cases, including 22 hospitalizations and two cases of HUS, across 13 states. The number of deaths linked to the outbreak remains at one. The most recent illness onset for the cases identified so far is October 10.
The states with cases now include: Colorado (26 cases), Montana (13), Nebraska (11), New Mexico (5), Utah (5), Missouri (4), Wyoming (4), and Michigan (2), and one case each in Iowa, Kansas, Oregon, Washington, and Wisconsin.
The source of the outbreak has not yet been confirmed, but investigators have focused on the beef patties and slivered onions used on McDonald’s Quarter Pounders. McDonald’s immediately pulled the popular burger off the menu and paused distribution of the slivered onions from affected restaurants when the CDC announced the outbreak Tuesday. McDonald’s considered the affected areas to be Colorado, Kansas, Utah, and Wyoming, as well as portions of Idaho, Iowa, Missouri, Montana, Nebraska, Nevada, New Mexico, and Oklahoma.
Onions recalled and destroyed
On Wednesday, one of McDonald’s onion suppliers, Taylor Farms, recalled peeled and diced yellow onion products. Taylor Farms told Bloomberg earlier this week that its testing had not turned up E. coli, but that it decided to issue the recall anyway.
On Thursday, Yum Brands—owner of KFC, Pizza Hut, and Taco Bell—followed that lead, saying it, too, would remove fresh onions from its chains’ menus at some locations, according to Reuters. Restaurant Brands International, owner of Burger King, also did the same.
“We’ve been told by corporate to not use any onions going forward for the foreseeable future,” Maria Gonzales, the on-duty manager inside a Burger King in Longmont, Colorado, told Reuters on Wednesday. “They’re off our menu.”
As of Thursday, the case count in the E. coli outbreak remained at 49 people in 10 states. Of those, 10 were hospitalized, including a child with a life-threatening complication. One older person in Colorado has died.
The states with cases include: Colorado (26 cases), Nebraska (9), Utah (4), Wyoming (4), and one case each in Iowa, Kansas, Missouri, Montana, Oregon, and Wisconsin.
McDonald’s removed Quarter Pounders and slivered onions from restaurant menus in Colorado, Kansas, Utah, Wyoming, and portions of Idaho, Iowa, Missouri, Montana, Nebraska, Nevada, New Mexico, and Oklahoma. In a statement, McDonald’s said that for these restaurants, its onions are “sourced by a single supplier that serves three distribution centers. The fast-food giant continues to serve other beef burgers and diced onions at impacted locations.
So, in all, Missouri’s case count in the H5N1 outbreak will stay at one for now, and there remains no evidence of human-to-human transmission. Though both the household contact and the index case had evidence of an exposure, their identical blood test results and simultaneous symptom development suggest that they were exposed at the same time by a single source—what that source was, we may never know.
California and Washington
While the virus seems to have hit a dead end in Missouri, it’s still running rampant in California. Since state officials announced the first dairy herd infections at the end of August, the state has now tallied 137 infected herds and at least 13 infected dairy farm workers. California, the country’s largest dairy producer, now has the most herd infections and human cases in the outbreak, which was first confirmed in March.
In the briefing Thursday, officials announced another front in the bird flu fight. A chicken farm in Washington state with about 800,000 birds became infected with a different strain of H5 bird flu than the one circulating among dairy farms. This strain likely came from wild birds. While the chickens on the infected farms were being culled, the virus spread to farmworkers. So far, two workers have been confirmed to be infected, and five others are presumed to be positive.
As of publication time, at least 31 humans have been confirmed infected with H5 bird flu this year.
With the spread of bird flu in dairies and the fall bird migration underway, the virus will continue to have opportunities to jump to mammals and gain access to people. Officials have also expressed anxiety as seasonal flu ramps up, given influenza’s penchant for swapping genetic fragments to generate new viral combinations. The reassortment and exposure to humans increases the risk of the virus adapting to spread from human to human and spark an outbreak.
Measles, whopping cough, polio, tetanus—devastating and sometimes deadly diseases await comebacks in the US as more and more parents are declining routine childhood vaccines that have proved safe and effective.
The vaccination rates among kindergartners have fallen once again, dipping into the range of 92 percent in the 2023–2024 school year, down from about 93 percent the previous school year and 95 percent in 2019–2020. That’s according to an analysis of the latest vaccination data published today by the Centers for Disease Control and Prevention.
The analysis also found that vaccination exemptions rose to an all-time high of 3.3 percent, up from 3 percent in the previous school year. The rise in exemptions is nearly entirely driven by non-medical exemptions—in other words, religious or philosophical exemptions. Only 0.2 percent of all vaccination exemptions are medically justified.
The new stats mean that more parents are choosing to decline lifesaving vaccines and, for the fourth consecutive year, the US has remained below the 95 percent vaccination target that would keep vaccine-preventable diseases from spreading within communities. In fact, the country continues to slip further away from that target.
Based on data from 49 states plus the District of Columbia (Montana did not report data), 80 percent of jurisdictions saw declines in vaccinations of all four key vaccines assessed: MMR, against measles, mumps, and rubella; DTaP, against diphtheria, tetanus, and pertussis (whooping cough); VAR, against chickenpox; and polio.
Vulnerable kids
Coverage for MMR fell to 92.7 percent in 2023–2024, down from 93.1 percent in the previous school year. That means that about 280,000 (7.3 percent) kindergartners in the US are at risk of measles, mumps, and rubella infections. Likewise, DTaP coverage fell to 92.3 percent, down from 92.7 percent. Polio vaccination fell to 92.6 percent from 93.1 percent, and VAR was down to 92.4 percent from 92.9 percent.
If you’re going to eat a bear, make sure it’s not rare.
You’d be forgiven for thinking that once the beast has been subdued, all danger has passed. But you might still be in for a scare. The animal’s flesh can be riddled with encased worm larvae, which, upon being eaten, will gladly reproduce in your innards and let their offspring roam the rest of your person, including invading your brain and heart. To defeat these savage squirmers, all one must do is cook the meat to at least 165° Fahrenheit.
But that simple solution continues to be ignored, according to a report today in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report. In this week’s issue, health officials in North Carolina report that rare bear meat was served at a November 23 gathering, where at least 22 people ate the meat and at least 10 developed symptoms of a worm infection. Of the 10, six were kids and teens between the ages of 10 and 18.
The infection is from the roundworm Trichinella, which causes trichinellosis. While the infection is rarely fatal, the nematodes tend to burrow out of the bowels and meander through the body, embedding in whatever muscle tissue they come across. A telltale sign of an infection in people is facial swelling, caused when the larvae take harbor in the muscles of the face and around the eyes. Of the 10 ill people in North Carolina, nine had facial swelling.
Local health officials were onto the outbreak when one person developed flu-like symptoms and puzzling facial swelling. They then traced it back to the gathering. The report doesn’t specify what kind of gathering it was but noted that 34 attendees in total were surveyed, from which they found the 22 people who ate the rare meat. The 10 people found with symptoms are technically considered only “probable” cases because the infections were never diagnostically confirmed. To confirm a trichinellosis infection, researchers need blood samples taken after the person recovers to look for antibodies against the parasite. None of the 10 people returned for blood draws.
California’s infections bring the country’s total number of affected herds to 255 in 14 states, according to the USDA.
In a new release Thursday, California health officials worked to ease alarm about the human case, emphasizing that the risk to the general public remains low.
“Ongoing health checks of individuals who interact with potentially infected animals helped us quickly detect and respond to this possible human case. Fortunately, as we’ve seen in other states with human infections, the individual has experienced mild symptoms,” Tomás Aragón, director of California’s Department of Public Health, said. “We want to emphasize that the risk to the general public is low, and people who interact with potentially infected animals should take prevention measures.”
The release noted that in the past four months, the health department has distributed more than 340,000 respirators, 1.3 million gloves, 160,000 goggles and face shields, and 168,000 bouffant caps to farm workers. The state has also received 5,000 doses of seasonal flu vaccine earmarked for farm workers and is working to distribute those vaccines to local health departments.
Still, herd infections and human cases continue to tick up. Influenza researchers and other health experts are anxiously following the unusual dairy outbreak—the first time an avian influenza is known to have spilled over to and caused an outbreak in cattle. The more opportunities the virus has to spread and adapt to mammals, the more chances it could begin spreading among humans, potentially sparking an outbreak or even a pandemic.
Enlarge/ A warning sign outside a laboratory testing the H5N1 bird flu virus at The Pirbright Institute in Woking, UK, on Monday, March 13, 2023.
More than a month after a person in Missouri mysteriously fell ill with H5-type bird flu, investigators in the state are still identifying people who became ill after contact with the patient, raising questions about the diligence of the ongoing health investigation.
On September 6, Missouri’s health department reported the state’s first human case of H5-type bird flu, one that appears closely related to the H5N1 bird flu currently causing a nationwide outbreak among dairy cows. But the infected person had no known contact with infected animals—unlike all of the other 13 human cases identified amid the dairy outbreak this year. Those previous cases have all occurred in dairy- or poultry-farm workers. In fact, Missouri has not reported bird flu in its dairy herds nor recent poultry outbreaks.
Given the unexplained source of infection, health investigators in the state have been working to track the virus both backward in time—to try to identify the source—and forward—to identify any potential onward spread. The bird flu patient was initially hospitalized on August 22 but recovered and had been released by the time the state publicly reported the case.
In an update Friday, September 27, the Centers for Disease Control and Prevention relayed that Missouri officials have now identified four more health care workers who experienced mild respiratory illnesses after caring for the person with bird flu. None of the four workers were tested for flu at the time of their illnesses and all have since recovered.
Testing new cases for antibodies to H5N1
The four newly identified cases bring the total number of health care workers who fell ill after contact to six. Missouri investigators had previously identified two other health care workers who developed mild respiratory symptoms. One of those workers was tested for flu around the time of their illness—and tested negative. But the other, like the four newly identified cases, was not tested. That person has since submitted a blood sample to test for bird flu antibodies, which would indicate a previous infection.
In addition, a household contact of the bird flu patient also fell ill at the same time as the patient, suggesting a possible common source of the infection.
The illnesses are concerning, given the fear that H5N1 bird flu could begin spreading from human to human and spark a widespread outbreak or even a pandemic. However, it can’t be overlooked that a plethora of other respiratory viruses are around—and SARS-CoV-2 transmission was relatively high in Missouri at the time—it’s impossible to draw any conclusions at this point about whether the illnesses were bird flu infections.
But, the illnesses do clearly raise concern about the health investigation, which is being conducted by Missouri officials. “The slow trickle of info is the most concerning part,” infectious disease expert Krutika Kuppalli wrote on social media Friday. The CDC can get involved at the request of a state, but such a request has not been made. For now, the CDC is only providing technical assistance from Atlanta.
In its update today, the CDC emphasized that “to date, only one case of influenza A(H5N1) has been detected in Missouri. No contacts of that case have tested positive for influenza A(H5N1).” The agency added that blood testing results for H5 antibodies are pending.
Enlarge/ An entomologist for the Louisville Metro Department of Public Health and Wellness in a swampland area on August 25, 2021 in Louisville, Kentucky collecting various mosquito species, and testing the samples for mosquito-borne diseases, such as EEE.
New York is facing an unusual boom in mosquitoes toting the deadly eastern equine encephalitis (EEE) virus, which has already led to one rare death in the state and a declaration of an “imminent threat” by officials.
While the state’s surveillance system typically picks up EEE-positive mosquitoes in two or three counties each year, this year there have been 15 affected counties, which are scattered all across New York, State Health Commissioner James McDonald said this week.
“Eastern equine encephalitis is different this year,” McDonald said, noting the deadly nature of the infection, which has a mortality rate of between 30 and 50 percent. “Mosquitoes, once a nuisance, are now a threat,” McDonald added. “I urge all New Yorkers to prevent mosquito bites by using insect repellents, wearing long-sleeved clothing, and removing free-standing water near their homes. Fall is officially here, but mosquitoes will be around until we see multiple nights of below-freezing temperatures.”
On Monday, McDonald issued a Declaration of an Imminent Threat to Public Health for EEE, and Governor Kathy Hochul announced statewide actions to prevent infections. At the same time as the declaration, the officials reported the death of a New Yorker who developed EEE. The case, which was confirmed in Ulster County on September 20, is the state’s first EEE case since 2015.
The disease is very rare in New York. Between 1971 and 2024, there were only 12 cases of EEE reported in the state; seven cases were fatal.
Rare but deadly
EEE is generally rare in the US, with an average of only 11 cases reported per year, according to the Centers for Disease Control and Prevention. The virus lurks in wild birds and spreads to people and other animals via mosquitoes. The virus is particularly deadly in horses—as its name suggests—with mortality rates up to 90 percent. In people, most bites from a mosquito carrying the EEE virus do not lead to EEE. In fact, the CDC estimates that only about 4–5 percent of infected people develop the disease; most remain asymptomatic.
Fo those who develop EEE, the virus travels from the mosquito bite into the lymph system and spreads from there to cause a systemic infection. Initial symptoms are unspecific, including fever, headache, malaise, chills, joint pain, nausea, and vomiting. This can progress to inflammation of the brain and neurological symptoms, including altered mental state and seizures. Children under the age of 15 and adults over the age of 50 are most at risk.
The CDC estimates that about 30 percent of people who develop severe EEE die of the disease. But, with small numbers of cases over time, the reported mortality rates can vary. In Massachusetts, for instance, about 50 percent of the cases have been fatal. Among those who survive neuro-invasive disease, many are left severely disabled, and some die within a few years due to complications. There is no vaccine for EEE and no specific treatments.
Overall numbers
While New York seems to be experiencing an unusual surge of EEE-positive mosquitoes, the country as a whole is not necessarily seeing an uptick in cases. Only 10 cases from six states have been reported to the CDC this year. That count does not include the New York case, which would bring the total to 11, around the country’s average number of cases per year.
In addition to New York, the states that have reported cases are Massachusetts, Vermont, New Jersey, Rhode Island, Wisconsin, and New Hampshire. Most cases have been in the Northeast, where cases are typically reported between mid-June and early October before freezing temperatures kill off mosquito populations.
EEE gained attention last month when a small town in Massachusetts urged residents to follow an evening curfew to avoid mosquito bites. The move came after the state announced its first EEE case this year (the state’s case count is now at four) and declared a “critical risk level” in four communities.
Between 2003 and 2023, the highest tally of cases in a year was in 2019, when states reported 38 EEE cases.
