Lots to dig into: Ticks are top of mind and showing up at a higher-than-normal rate this year, while the stomach flu is at its seasonal peak, and measles could be quietly becoming endemic in Utah. Plus: a CDC rabies testing pause that’s less scary than the headlines suggest but points to a major problem underneath the surface, and, as always, some genuinely good news.

Here’s what’s circulating and, most importantly, what you can do about it.

Ticks are having a year

Tick season is off to an unusually bad start. Emergency department visits for tick bites are running at roughly 71 per 100,000 people per week, more than double the typical rate at this time of year (around 30 per 100,000).

Will the trend continue? It’s hard to say because three factors are colliding:

1. Weather. A bad tick season usually follows a mild winter, since ticks can only be killed by sustained temperatures below 10°F for several days. Northeasterners who just endured the region’s harshest winter in a decade may be skeptical, but much of the West and South saw record warmth, which could keep the national average high.

2. Reach. Ticks are expanding into new geographies.

3. Detection. Health systems are getting better at identifying tick-borne diseases.

All of which makes this trend worth watching as the season unfolds.

Tracking tick-borne diseases is hard because no single system captures the full picture. CDC tracks confirmed diagnoses reported by doctors and hospitals, and separately tracks ED visits, but both have limitations.

Field surveillance fills in another piece: one method is the “tick drag"— literally dragging a sheet through tick areas to test them. Shout-out to the Illinois Department of Public Health's vector surveillance team, who brought the public along for a day in the life of tick surveillance.

What this means for you: Keep enjoying the outdoors! But if you’re in a tick-prone area, take that extra minute to do a tick check. The most important thing is removing the tick properly (use fine-tipped tweezers, grab close to the skin, pull upward, no twisting, no Vaseline, no matches). Then watch for symptoms: fever, rash, fatigue, joint aches. If you find an attached tick and are in a high-risk area for Lyme disease, it’s worth calling your doctor if it was attached for more than 36 hours.

I recently stumbled upon the PA Tick Research Lab, where you can submit your tick for testing to identify the species and screen for tick-borne pathogens. Testing is free for Pennsylvania residents; $50 for everyone else.

Norovirus is (hopefully) peaking

Norovirus (think diarrhea, vomiting, and nausea) is currently at its seasonal peak. There are early signs of a decline, but it will likely take another month or two to come down meaningfully.

What this means for you: This is never a fun one for a household to get, because it’s extremely contagious. Wash your hands. Hand sanitizer doesn’t help.

RSV is late—parents of infants should pay attention

RSV typically peaks in winter and is gone by March. This year, it's still elevated across much of the country in April. This matters because RSV is the leading cause of hospitalization in infants.

This late wave is not only unusual but also has real practical implications. The window for infants to receive monoclonal antibodies for proactive RSV protection typically closes in March, at the end of RSV season. Now that we’re in April, many parents and clinicians are left uncertain about whether to act:

1. Should my infant get RSV protection now, or wait until fall? If your baby is around 1 month old, the guidance from the American Academy of Pediatrics is clear: don’t wait. Younger age and first-season administration should always be prioritized. For older infants who missed protection earlier this season, the calculus is harder, but given that RSV is still circulating at elevated levels, the case for acting now rather than waiting until fall is strong.

2. Will insurance cover it this late in the season? It should. Coverage for RSV monoclonal antibodies should remain in place through at least April 30. Private insurers and state Medicaid programs have signaled that they recognize the disease trend has shifted later this year, so barriers to coverage should not be an issue. And for the clinician readers out there, the Vaccines for Children program should also continue to pay for these immunizations, but we, of course, want to hear from you if you’re experiencing otherwise on the ground (comment below).

Measles: one outbreak ends, another grows

The United States tally is currently at 1,748 confirmed measles cases. Two important developments this past week:

1. South Carolina’s outbreak is winding down, coming at a staggering cost.

South Carolina has not reported any new measles cases since March 17, bringing the total to 997 since the outbreak began in October 2025. If no new cases are reported, the state could officially declare the outbreak over by April 26.

The cost was staggering: an estimated $35.5 million in response spending as of early March, plus significant school disruption, missed workdays, and caregiver burden.

2. Utah is now the epicenter of measles in the United States.

Utah’s measles outbreak began in June 2025, with now 597 confirmed cases, and more than half of those have been diagnosed just this year.

What’s most concerning are two things:

• This outbreak has been spreading for more than 10 months.

• Many of the people who are getting sick had no known contact with anyone else who was infected. That means the virus isn’t just jumping from person to person in traceable clusters anymore. It’s circulating quietly through the community.

Both of these point to a disease becoming endemic, meaning it’s no longer an outbreak but a permanent presence.

Utah’s MMR vaccination coverage among kindergartners sits at roughly 88% (well below the 95% threshold for herd immunity), and around 10% of in-person kindergartners have a non-medical exemption or missing documentation. Utah has the second-highest exemption rates in the country.

The CDC paused rabies testing. How worried should the U.S. be?

The headlines have been scarier than the immediate risk, but there is a serious underlying problem.

The testing pause: CDC posted a list of more than two dozen types of testing that have become unavailable, including rabies and mpox. This is a temporary pause for a quality review. This is not the first time the CDC has paused some of its lab testing, but it is pausing more kinds of tests than ever before. Testing should be back up and running in a few weeks.

Human rabies specifically: This pause is not raising major red flags for me. Human rabies is extraordinarily rare (<5 cases per year), and the CDC typically tests only a few dozen people annually. The testing that was paused is confirmatory testing for people who are already sick, and by that point in a rabies infection, there is usually very little that can be done. Critically, post-exposure prophylaxis (PEP), the treatment you get after a potential rabies exposure, is based on epidemiological factors, not on waiting for lab confirmation. So the management of exposures continues as normal.

Where I do have concern: About 1.5 million people seek medical care for animal bites each year, and rabies risk should be considered for most of them. Nearly all of those risk assessments are handled by clinicians or state and local health departments. The cases that reach the CDC are the most complicated ones—a bat found in a room with a sleeping child, a mass exposure at a summer camp—situations that are time-sensitive and require deep expertise.

But due to DOGE and budget cuts, CDC’s rabies and pox virus staff will soon be down to just one person to advise on these complex consultations. That could mean unnecessary treatment for some and missed treatment for others.

The erosion of specialized public health capacity at the federal level makes it harder to respond to rare but serious events when they do occur.

Good news

1. The Artemis II crew splashed down safely, a beautiful reminder of what humanity can accomplish when thousands of people work in precise coordination toward a single extraordinary goal, through decades of scientific investment, expertise, and discipline. At a moment when the world can feel small and fractured, sending humans around the moon is a quiet insistence that we are still capable of choosing something bigger.

2. Menthol restrictions are working. Massachusetts data show that restricting menthol cigarette sales has reduced smoking prevalence by 1.4% since 2020. Although seemingly small, this reduction is estimated to have saved $200 million in health care costs over ten years.

3. Global maternal mortality has fallen by more than 40% since 2000, and deaths among children under five have dropped by over 50%. Maternal conditions that were once life-threatening (elevated blood pressure, cancer, HIV) are increasingly manageable, extending and improving lives worldwide.

4. NIH funding fight resolved: The Trump administration dropped its court fight to cap NIH payments for research overhead costs, effectively ending the 14-month standoff that had threatened universities, hospitals, and academic medical centers. (Read the YLE deep dive on indirect costs here.)

Bottom line

Stay safe out there, do your tick checks, and remember that the public health system, even a strained one, is full of people working hard to keep you well.

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 over 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 below:

Subscribe now

Spring is here, and so is a shift in what’s circulating. Flu season is officially behind us, tick season is just getting started, and a new Covid-19 variant is making the rounds in the news and on social media (but has not yet been felt in hospitals). And with Lyme disease season upon us, the news of a long-awaited vaccine couldn’t be more timely, though there are some real caveats worth understanding.

Here’s what’s going on and, more importantly, what it means for you.

Disease “weather” report: what’s spreading right now?

Good riddance, flu season. We are officially out, as rates have now fallen below the “epidemic threshold.” Some states are still high, like New Mexico, but the trend is the same. The other main fall/winter viruses, including RSV and Covid-19 are all decreasing, too.

Odds are that if you get sick in the next month or two, it will be the common cold (the gray line below). This will continue to increase until May/June.

Enter tick season. Emergency department visits for tick bites are low but climbing, which is normal for this time of year. Expect two waves: one peaking in May and another in mid-October. By year’s end, more than 500,000 people will likely be diagnosed and treated for Lyme disease.

Ticks thrive in warm, lush spring environments and can carry pathogens responsible for over a dozen diseases. Lyme is the most well-known. It can cause flu-like symptoms and, if untreated, serious complications including neurological and cardiac issues.

Not all ticks carry disease. Risk depends on the species, geography, and duration of a tick’s attachment. Currently, tick-borne illnesses are most concentrated in the Northeast, with emergency department (ED) visits at 13 per 100,000 people.

What this means for you: You can take several steps to protect yourself from ticks, including applying DEET or picaridin, treating clothing and gear with products containing 0.5% permethrin, and conducting thorough tick checks after engaging in outdoor activities. Here is a YLE deep dive on tick threats.

A new Covid-19 variant is getting attention. What’s going on?

Covid-19 continues to mutate, and the latest variant attracting attention is BA.3.2 (nicknamed “Cicada”), a descendant of Omicron that has been circulating globally for some time.

BA.3.2 now accounts for 11% of U.S. cases, but it’s too early to tell how quickly it’s growing. What is clear is that it has yet to trigger a surge. Wastewater levels, emergency department visits, and hospitalizations all remain low. Historically, a variant doesn’t drive a significant new wave until it reaches ~50% of cases.

What’s drawing attention is the spike protein, which has 75 mutations compared with the strains included in last fall’s Covid-19 vaccines. The spike protein acts like a key that unlocks our cells, and when that key changes enough, existing antibodies struggle to recognize and block it. Lab studies confirm this is happening, but antibodies are just one layer of defense. The immune system has other tools that protect against serious illness, and current immunity is expected to hold up.

One thing researchers are actively tracking: early signals suggest BA.3.2 may be infecting kids at higher rates than previous variants. It’s hard to know whether this is real or just random chance, but if it is real, it’s likely due to a combination of many factors. For example, younger kids might not have seen as many Covid-19 variants or had as many coronavirus infections as adults, so they might be less immune to it.

Q: Could this cause a spring/summer wave? A: We have very little data on how fast this is growing, so time will tell. My guess is this will cause a spring/summer wave, but not a nothing burger or a tsunami.

Q: Should people over 65 get a spring Covid-19 shot? A: If it’s been at least three months since your last dose, a spring shot is a reasonable call. Timing it around May or June tends to align well with how Covid-19 seasons typically play out.

Q: Is a second shot within a year a booster? Or is it only a booster if the formulation is different? A: The term gets thrown around loosely. Generally, a booster means a repeat dose of the same vaccine, not necessarily a new formulation. The strains for the next updated Covid-19 vaccine haven’t been selected yet, so there’s no new version available right now. If a pharmacist tells you there’s no booster available, they may be thinking specifically of an updated formulation. A repeat dose of the current vaccine is still an option worth asking about.

Q: Could BA.3.2 spark the next pandemic? A: No. In fact, researchers have argued that another coronavirus pandemic is now less likely, not more, precisely because Covid-19 and the vaccines that followed built widespread, robust immunity across the global population.

A Lyme disease vaccine may finally be on the horizon

Ticks spread Lyme disease, one of the most common and debilitating infections in the country, and for the first time in over two decades, a vaccine to prevent it may finally be on the way. The only vaccine we had before, LYMErix, was pulled from the market in 2002. Not because it was unsafe (the FDA found no real problems) but because rumors about arthritis side effects, amplified by bad press and lawsuits, scared people.

Now Pfizer and French vaccine company Valneva have announced their new vaccine candidate worked in more than 70% of cases in a large late-stage trial of 9,400 people aged five and older.

How does the Lyme disease vaccine work?

The vaccine works differently from most other vaccines in a very cool way. Instead of just protecting you, it actually works inside the tick:

1. The vaccine trains your body to make antibodies against a protein (called OspA) found on Lyme-causing bacteria.

2. When a tick bites you, it drinks your blood along with those antibodies.

3. The antibodies neutralize the bacteria in the tick’s gut, stopping it from ever reaching its salivary glands and getting into you.

But there are a few things worth understanding

• The trial hit a statistical snag. The trial had fewer Lyme disease cases than expected, making the results too uncertain to be conclusive. Researchers had planned two ways to measure the vaccine’s effectiveness before the study began: one starting 28 days after the final dose, which fell just short of the required confidence threshold, and one starting the day after the final dose, which cleared it. Pfizer cited both results in deciding to seek regulatory approval.

• The regulatory path is murky. The manufacturer will seek FDA approval, and if granted, the vaccine will go to ACIP for a policy recommendation. The problem: ACIP currently has no members. What happens next is genuinely unclear.

• The bigger question is whether people will actually use it. The vaccine requires four doses over about a year, plus what looks like an annual booster before tick season. That’s a real commitment. Lyme disease is far better known today than it was in 2002, which gives people more reason to seek protection. But wanting a vaccine and completing every dose are two very different things.

Good news

• Big Tech’s Big Tobacco moment. Last week, a Los Angeles court found Meta and YouTube negligent in the design of their platforms, ruling that features like infinite scroll and autoplay deliberately built addiction into the apps, and that executives knew it and failed to protect young users. The decision could set a precedent for more than 1,500 similar pending cases.

• TB rates are falling after years of post-pandemic rise. New CDC data show that last year, 10,260 TB cases were reported, representing a 2% decline in the national rate compared with the year before. Cases fell across 26 states and Washington, D.C.

• Birthday celebration! Remember that infant botulism outbreak? Amy Mazziotti, mother of Hank, who was hospitalized for 12 days for botulism after drinking ByHeart baby formula, just celebrated Hank’s first birthday. She received a letter from the public health response team that helped her. Each year, this public health team mails roughly 200 cards to babies who recovered from botulism. Program assistant Robin Hinks decorates them with drawings, like frogs in party hats and penguins with balloons. A small, loving, above-and-beyond act. Read more about this from Matt over at YLE CA.

Bottom line

The seasonal transition brings real shifts in disease risk, and a little awareness goes a long way. Have a wonderful week!

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 over 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 below:

Subscribe now

This week we’re covering what that means for you, plus why the polio travel headlines were scarier than the actual risk, what breakthrough measles cases reveal about how vaccines work, and two recalls worth checking before you head out. Good news at the end, as always and a reading recommendation if you find yourself stuck in a TSA line.​​​​​​​​​​​​​​​​

Disease “weather” report

Goodbye flu season. Nationwide, the number of people with fever, sore throat, or runny nose (collectively known as “influenza-like illnesses”) is nearly back to below the epidemic threshold. In other words, flu season is behind us. A few states are still seeing high levels, but they too are on their way down.

Was this the “super flu” season many feared? Earlier this year, a notable mutation raised concerns that this could be a particularly bad season. Looking back, cumulative hospitalizations were worse than average, but not record-breaking.

Spring brings another set of bugs

That said, not all runny noses and prolonged coughs will be avoided, as some common colds, as well as the family of RSV viruses, are at their peak.

Norovirus (the stomach bug behind diarrhea and vomiting) also continues to climb. The number of people testing positive is not necessarily abnormal—it’s within levels seen in previous years and, thankfully, lower than last year, when a new strain triggered a notable surge. Norovirus season typically winds down by April, so we should be peaking soon.

What this means for you: Norovirus is extremely contagious. If you have the stomach bug, use a separate bathroom in your house. Hand sanitizer doesn’t kill this bugger, either. Soap and water are your best bet after touching hotel door knobs or elevator buttons, for example.

Measles has historically been tightly coupled with school calendars. Because of spring break travel, we usually see an acceleration of case counts in March and April. But relative to everything else you worry about, in general, this is still very rare. The latest U.S. tally for 2025 is 1,524 measles cases.

• Utah is experiencing the most rampant spread right now. This is in part is due to a large sporting event held in February 2026. South Carolina and Arizona are on the mend.

• In the Americas, all eyes are on Mexico, which has an enormous amount of cases (7,584) just this year. Guatemala is also a new hot zone with 1,718 cases this year.

What this means for you: If you’re traveling to these places, make sure you’re up to date on your MMR vaccine. If you have an infant under 1 year old, you may want to reconsider travel plans or get them vaccinated early.

Coming in April: As we move into spring, the disease weather report will expand to cover ticks, mosquitoes, allergies, and heat-related illnesses. Stay tuned!

Food (and drug) safety alerts

Children’s ibuprofen recall. Nearly 90,000 bottles of Strides Pharma Children’s Ibuprofen Oral Suspension (100 mg/5 mL., berry flavor, 4 oz.) have been recalled. The product was distributed nationwide and may be on shelves at CVS, Target, and similar retailers.

• Why? Complaints of a gel-like mass and black particles in the bottles.

• How bad is this? No cases of serious adverse events have been reported so far; this warning is a precaution. Specifically, FDA classified this as a Class II recall (not its most dangerous). For context, FDA’s recall classification system has three tiers: Class I (reasonable probability of serious harm or death), Class II (possible temporary or reversible harm), and Class III (unlikely to cause harm but still violates regulations).

• How to check your bottle: Look for lot numbers 7261973A or 7261974A with an expiration date of January 31, 2027. These are typically stamped on the bottom or side of the bottle.

• What to do: If your child took it, call their pediatrician. Before tossing it, many retailers accept returns on recalled products. You can also contact Taro Pharmaceuticals directly for reimbursement.

Raw cheddar cheese is linked to E. coli. The FDA has linked Raw Farm brand raw cheddar cheese to seven E. coli infections across California, Florida, and Texas. Four of the seven cases are in children aged 3 or younger. Two people have been hospitalized. If you have this, toss it.

Breakthrough measles cases at Utah hospital

A Utah Health Action Alert recently flagged that vaccinated health care workers who contracted measles and came to work, not realizing infection was possible despite their vaccination status. The story has been circulating on social media and raises some important questions worth unpacking.

The MMR vaccine works extremely well, but no vaccine is perfect. A vaccinated person is 35 times less likely to get measles than someone who is unvaccinated. Breakthrough infections do happen, though: roughly 3 out of every 100 fully vaccinated people can get infected. The vaccine’s primary job is to prevent serious illness, hospitalization, and death. Preventing infection altogether is a bonus.

Expect to hear more breakthrough cases, and don’t read them as a sign of vaccine failure. When a virus circulates at levels the U.S. hasn’t seen in more than 30 years, more people will be exposed, and more breakthrough infections follow. This is inevitable.

Exposure level matters. A health care worker treating an infected patient is essentially walking through a viral cloud. Antibodies can neutralize the virus, but an overwhelming exposure can sometimes outpace them.

Even when breakthrough infections occur, serious illness remains uncommon. Data confirms that vaccination significantly reduces the risk of severe complications, even among people who become infected.

Breakthrough cases can spread the virus, but this also appears to be rare. The first documented case of a fully vaccinated person transmitting measles was during a 2011 New York outbreak. Out of 88 close contacts, only 4 became infected. An older study found no viral shedding among asymptomatic or mildly ill vaccinated patients, though that research needs replication with more sensitive modern tools.

Many people have a lot of really great questions about immunity against measles. Here are the top 10 we’re hearing from YLE.

Good news

1. U.S. smoking rate drops below 10% for the first time (and researchers are stepping up). Cigarette smoking among U.S. adults fell into single digits: 9.9% in 2024. This is massive progress, given that in 1965, the rate was 42.4%. This analysis was published by a researcher. Normally, the government’s Office on Smoking and Health would analyze and publish these results. But after federal cuts removed this office, outside researchers are filling the gap.

2. How you think about aging appears to shape how you actually age. The power of the mind! A new Yale study followed 11,000+ adults aged 65+ over 12 years and found that 45% showed measurable improvement in cognitive function, physical function, or both. People who held more positive beliefs about aging were significantly more likely to improve.

Question grab bag

I’m headed to Iceland soon. Do I need a polio booster? I thought there was a travel warning about this.

The short answer: No.

What you saw in the news was a case of media misinterpretation, not a new travel warning. And Iceland isn’t on the notice list. Here’s what happened:

The CDC has maintained a global polio notice since 2022. This is a notice (not a warning), which is an important distinction. A notice is meant to provide information to promote safe and healthy travel, not to discourage travel to a destination.

The recent media frenzy was triggered by a fairly mundane internal fix: someone at the CDC noticed a discrepancy between the list of countries named in the notice and the countries shaded on the accompanying world map. When they corrected that mismatch, the page got a new date stamp, and the media interpreted that timestamp as a brand-new advisory. It wasn’t.

Some places on the notice list, including the U.K. and Germany, do fall under the “you can get a booster” category. But the actual risk is genuinely very low for most travelers because:

1. The polio vaccine is 99% effective against paralytic disease. Immunity in anything can wane over time, but in general, this vaccine is believed to provide lifelong protection.

2. Detections in places like the U.K. and Germany has largely been through wastewater surveillance, meaning public health agencies are detecting trace evidence of the virus in sewage systems rather than seeing widespread illness.

3. Normal tourist activities face a very low risk. If you’re traveling to an affected country and plan to spend extended time in a close community setting, it could be worth a conversation with your doctor. A booster would top off your protection by triggering a recall response, so you reach very high antibody levels before you encounter the virus in the real world.

Recommended reading for that TSA line

As many of you know, I’ve been partnering with MAHA grassroots over the past year on several projects. But, I will be honest, it’s often felt like a one-way street: Listening but not being heard. That was until last week, when I read something by Aaron Everitt, who is an acquaintance and MAHA star, about his positive experience at a public health conference. It was incredibly refreshing and felt like a big win. This country has a lot of work to do. Read it below.

Besides The Revolution

Why MAHA Needs Public Health

Wednesday morning, I headed down to Denver International Airport to board a plane bound for Washington. We were on the front end of the power outage that turned the nation’s second busiest airport into a scene from a market in Marrakesh, but we made it out just in time. I’m not usually thankful for a flight on Frontier — their terminal is the worst one …

Read more

a month ago · 21 likes · 7 comments · Aaron Everitt

Bottom line

Spring is approaching, the bugs are changing, and as always, knowing what to watch for is half the battle for staying healthy and enjoying spring.

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. Hannah Totte, MPH, is an epidemiologist and YLE Community Manager. 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 below:

Subscribe now

Also, the respiratory season is finally winding down, but spring viruses are already stepping in to fill the void. The flu vaccine process for next season has begun, and it’s already getting complicated. New data reveal just how much harm a single White House briefing caused for pregnant patients in emergency departments last fall.

Here’s what it all means to you and your health.

Disease “weather” report

The winter respiratory season is finally easing. After six weeks stuck at high levels, influenza-like illness is starting to decline. Good riddance.

That said, RSV and common cold viruses are still climbing. Some outlets are dramatically overhyping a rise in one in particular: HMPV (black in the chart below). But… this virus isn’t showing anything unusual. A rise is normal, starting in March and peaking in April and May.

What is HMPV? It’s a virus related to RSV, and causes similar symptoms (cough, fever, congestion, shortness of breath). For healthy kids and adults, HMPV is typically a miserable cold. But for infants, older adults, and the immunocompromised, it can be as serious as RSV. Like many viruses, HMPV has no vaccine or treatment, and care focuses on symptom relief.

What this means for you: Expect more snotty noses and cranky kids, but nothing unusual so far this spring season. Full viral reprieve will come in another month or two.

And, did anyone catch the measles plot on The Pitt? I addressed it on social media.

Cue allergy season

My husband is downstairs sneezing up a storm. And I know it’s not just him: Google Trends shows an enormous spike in googling allergies. If we look at pollen data, the Southern portion of the country has high levels, specifically from trees.

Allergy season is becoming longer—plants are releasing pollen earlier in the year (about 40 days earlier) and stopping pollination later in the year (about 2 weeks later)—due to rising temperatures. There’s also more pollen because of the increased amount of CO2 in the atmosphere.

What this means for you: You’re getting exposed to more “pollen grains,” and your immune system may be irritated by them. Dr. Zach Rubin, an allergy doctor, joined us on our podcast America Dissected last year and gave great tips on managing allergies:

• Rinse your nose regularly with saline water (just like you brush your teeth)

• Go with second-generation antihistamines, like Zyrtec, instead of Benadryl. Benadryl was made in the 1940s as one of the first antihistamine drugs, but it has a lot of side effects. Always chat with your doctor for more information.

Flu vaccine dominoes are starting

The U.S. annual flu vaccine rollout is a six-month process with many moving parts, refined over more than half a century. It feels early (flu is just now receding), but the sequence has to start now so vaccines are ready for you in the fall.

Last year’s process was a mess: pieces missing, timelines wobbling, disrupted by federal disarray and ideological interference.

Will this year be any different? Too soon to say.

Where things stand: Last week, WHO made its official vaccine formula recommendation: a three-strain (trivalent) formula with one newcomer. Subclade K is a subvariant of flu that mutated enough to behave differently from its parent strain. It only emerged last August and has already driven record-breaking hospitalizations in several states.

Although the U.S. formally withdrew from WHO earlier this year, CDC flu experts were granted an exception to attend the meeting virtually. That’s good news because global data sharing is essential regardless of politics. Two of the three recommended strains came from viral samples collected right here in Missouri and Pennsylvania.

The U.S. doesn’t automatically follow WHO’s recommendation. We run our own process through an FDA advisory committee called VRBPAC, which rarely diverges from WHO. But this year it might.

The uncertainty: The data clearly support an updated vaccine. Whether Americans get one is another question, for two reasons:

1. Formula in flux. RFK Jr.’s political leadership signaled a new framework that would require randomized controlled trials (RCTs) for fall vaccine approval. This is a serious problem: flu mutates fast, production must begin months before the season starts, and there’s simply no room for the long timelines RCTs require. This is also not necessary. Flu isn’t a brand new vaccine. Rather, we tweak it like editing a word or two in a Word document—we don’t create a whole new document.

2. Leadership chaos. Vinay Prasad, the official overseeing this process, is stepping down after an extraordinarily turbulent tenure.

What this means for you: You will almost certainly have a flu vaccine this fall. The open question is whether it’ll be an updated formula (matching this season’s strains, like the rest of the world will get) or last year’s formula held over due to impossible approval standards. The latter isn’t catastrophic, but it’s a poor strategy against a fast-mutating virus.

What’s next: VRBPAC meets this week. You can submit a public comment here.

Tylenol prescriptions plummeted after White House brief

On September 22, 2025, President Trump held a White House briefing in which he claimed that acetaminophen, the active ingredient in Tylenol, was linked to a “very increased risk of autism” in children when used during pregnancy. This claim was not backed by new data or new scientific evidence. Read more in our response here. At the same briefing, the White House promoted leucovorin (folinic acid) as a treatment for autism.

New data is showing just how much words matter. Researchers at Brigham and Women’s Hospital and Harvard tracked prescription orders at a hospital before and after the White House announcement. What did they find?

• Orders for acetaminophen for pregnant women at emergency departments dropped 20%. There was no corresponding change in orders for non-pregnant patients. Prescribing rates gradually crept back toward baseline.

• Prescriptions of leucovorin for children ages 5–17 jumped 71%. This translates to roughly 25 additional children per 100,000.

On acetaminophen: This is just devastating. For pregnant patients in pain or with a fever, the ED is often the last resort. These are people who are already suffering. Acetaminophen is one of the very few tools available to treat them safely, and because of a baseless claim made at a press briefing, even that was being withheld. Untreated fever in pregnancy is associated with miscarriage, birth defects, and premature birth.

On leucovorin: A small body of research suggests that leucovorin may help a subset of autistic children, particularly those with cerebral folate deficiency. But the largest supporting study included just 77 children, and it was retracted in January due to data errors. This means in the hospital prescriptions study, given the rarity of this disease, the president’s claim has likely replaced clinical judgment.

What this means for you: Acetaminophen remains the safest available pain and fever reducer during pregnancy. If you are pregnant and have a fever or pain, talk to a clinician and take acetaminophen.

Losing an hour of sleep: the health impact

With the spring forward change, we lose an hour of sleep. Research has consistently linked the springtime change to a temporary increase in heart attacks, strokes, and fatal car crashes in the days following the shift. The disruption to your circadian rhythm—your body’s internal clock—is the driver. Even a small decrease in sleep can spike stress hormones and affect blood pressure, metabolism, and alertness.

What this means for you:

• Prioritize morning light. Get outside in the morning during this first week. Sunlight is the strongest signal to reset your circadian clock.

• Go easy on evening screens. That extra evening light from the time change already delays melatonin. Screens make it worse.

Good news

• Florida’s rollback of school vaccine requirements is stalled. Despite Surgeon General Joseph Ladapo’s dramatic announcement last fall that Florida would eliminate all school vaccine requirements, the Florida Legislature did not take up the proposal. House Speaker Daniel Perez confirmed this week that the House version of the bill was never heard in committee and won’t be brought to the floor.

• Shift in vaccine communications. CDC Acting Director Jay Bhattacharya posted a video last week simply saying the measles vaccine works and that vaccination is the most effective protection against measles. When you’ve been banging your head against a wall, stopping, even briefly, feels worth noting. We’ll take it. (Read our recent piece on Bhattacharya here.)

Poll

Announcement: YLE webinar on March 17

Every week, 230 million people turn to chatbots like ChatGPT with health-related questions. These tools are fast, flexible, and available anytime, but are they actually giving sound advice? How do these models work? How do we get better as end users? How do we talk to our communities about their strengths and limitations?

Join me, Alex Byrnes (Dewey), and Brian Anderson (Coalition for Health AI) for a webinar on March 17 at 3pm PT.

This webinar is exclusively for paid YLE subscribers. There’s a 500-person limit for this one, so get your seats! Here’s how to register…

Read more

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 Marnik 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.

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.

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.)

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!

Vacunas Infantiles: Cambios de RFK

71.8KB ∙ PDF file

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Download

Childhood Vaccines: RFK's Changes

67.2KB ∙ PDF file

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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 per year, and $7.8 cumulatively over the next 5 years. 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 below:

Subscribe now

While many of you are digging out, literally, major federal decisions are reshaping the systems that affect your health. Whether public health and nursing degrees “count” for federal aid, to the rollback of environmental health protections (and the major tensions at play), to an increase in bird flu cases, this week’s Dose spans workforce, air, outbreaks, and, as always, some good news, too.

And there are things you can do.

Let’s dig in.

Action item: Want your degree to count? Submit a comment.

Students in public health, nursing, social work, and physician assistant programs (and many other essential fields) are at risk of losing access to adequate federal student aid under a new rule proposed by the Department of Education. You can help by sharing your story before a public comment deadline on March 2.

What’s happening? Last year, the One Big Beautiful Bill set a new limit on federal student loans for graduate students, capping per-student lending at $100,000—unless you’re a student in a “professional degree program.” Professional students are eligible for up to $200,000 in federal loans.

But what counts as a professional degree? In November, the Department of Education agreed on a draft definition that included just 11 programs: pharmacy, dentistry, veterinary medicine, chiropractic, law, medicine, optometry, osteopathic medicine, podiatry, theology, and clinical psychology.

Several essential fields—public health, nursing, social work, physician assistant programs, engineering, and others—were removed from that list.

What this means for students: If this stands, students in these programs could lose access to federal financial aid. Specifically, lower borrowing limits that won’t cover students’ real costs, fewer scholarship pathways, and limited eligibility for loan-repayment programs.

What this means for public health: It will make it harder to enter these careers at a time when our country needs more of these professionals. The broader consequences are significant: fewer trained professionals, more barriers for students from low-income backgrounds, and added strain on already stretched health and social systems.

What you can do: Submit a public comment supporting an expanded definition of professional programs. Take note: The Department of Education’s 30-day public comment period ends March 2!

Link: https://www.regulations.gov/document/ED-2025-OPE-0944-0001

There are instructions at that link, but here are some more tips:

1. Your personal experience is important—use it!

• Introduce yourself and your connection to the issue. For example, “I am a public health professional who relies on federal loan repayment to serve rural communities.”

• Be specific about impact. Explain how this change would have affected you; how it would affect your patients, clients, or community; or what happens to workforce pipelines if access shrinks.

• Connect it to other shared priorities in your community. This change will likely exacerbate existing health care workforce shortages, rural health gaps, maternal health access challenges, and mental health crises.

• Explain unintended consequences. Students whose loan needs exceed the program cap will rely on higher-cost private loans, and fewer graduates may choose lower-paying service roles that currently qualify them for loan forgiveness programs.

2. Keep it simple and kind.

• Be concise. This doesn’t have to be a heavy lift! A few clear paragraphs are enough. Short and focused comments are more likely to be read and cited (and easier to write).

• Stay professional. Calm, clear, evidence-based comments carry more weight. So avoid attacks, sarcasm, or partisan framing.

3. We’re stronger when we act together.

• Encourage institutional submissions if you’re a part of a university, hospital, or public health department. This carries weight.

• Encourage others to share their story. The number of individual comments, with personal details, plays an important role in shaping final decisions.

Endangerment Finding repeal knocks down public health guardrails

If 2025 was the year of rollbacks on public health infrastructure, 2026 seems to be the year of rollbacks on environmental health protections. Those that were designed to keep our air clean, our water safe, and toxic chemicals out of our homes.

One of the latest changes: the Endangerment Finding (2009) was rescinded. This is the scientific and legal foundation that lets the Environmental Protection Agency (EPA) regulate greenhouse gas emissions. It’s allowed the government to limit emissions, including those from cars and power plants, and is foundational to the Clean Air Act.

But the Trump administration repealed it. To justify this action, the administration put five handpicked researchers who reject scientific consensus on climate change to work. A Republican-appointed federal judge ruled last month that the administration violated the law by convening the group without open meetings, public records, or balanced representation of viewpoints.

The science behind the Endangerment Finding is clear: carbon dioxide, methane, and other pollutants worsen asthma, heart and lung disease, and pregnancy outcomes, and contribute to early death. More exposure means more disease. An environmental nonprofit found that by 2055, the repeal will result in:

• 15,400 to 58,000 premature deaths

• 9 million to 37 million asthma attacks

• 26,000 to 92,000 ED and hospital visits

• 5 million to 15 million lost school and work days

But like most policies, the public tension isn’t just about science. You can see that playing out between the lines:

1. The invisible shield. Clean air policy is one of those public health systems that works quietly in the background. When people experience a heart attack or an asthma exacerbation, they may be told to change lifestyle habits or medications. But it is equally important to recognize the powerful population-level forces shaping health in the background, like air quality protections. When those protections work, people don’t see them.

2. Economics versus health (at least that’s how it feels). The economic impact of policy decisions is immediate and tangible. Families feel gas prices, job losses, industry slowdowns, and everything in between. This is often pitted against health, but this is a false dichotomy. Because in reality, long-term economic strength depends on healthy lungs, healthy hearts, and healthy communities.

3. Distant verses local. In many rural communities, environmental policy has come to symbolize a distant government regulating from afar without fully understanding local realities. In rural Alaska, for example, electric vehicles don’t make sense because towns can be hundreds of miles apart, and the most pressing air quality issue in Fairbanks is wood-burning stove emissions during extreme winters, which is a very different problem from tailpipe pollution. When policy feels mismatched to lived experience, people do not see health protection but rather constraint.

What’s next? Courts are taking this up because it conflicts with a previous Supreme Court decision. A coalition of environmental and health organizations sued the EPA and its administrator Lee Zeldin in the D.C. circuit last week.

What this means for you: More exposure to pollution will mean more health risks. The good news is that many state-level initiatives are continuing to move forward. We can also raise awareness, as clean air and clean water are among the most bipartisan issues in this country, with more than 80% of Americans supporting them.

Good news

There’s always good news worth celebrating:

• Access to evidence-based information. A permanent legal agreement now prevents the government from erasing research for ideological reasons, helping ensure clinicians and patients can rely on complete, evidence-based information. This win was the result of a lawsuit filed when peer-reviewed research linking endometriosis to suicide risk was removed from a federal patient safety website (PSNet) because it mentioned LGBTQ+ patients.

• Promising research for immunocompromised patients. Fred Hutch Cancer Center scientists took a meaningful step toward protecting people from Epstein-Barr virus (EBV), which is a virus linked to cancer, multiple sclerosis, and other serious conditions. By testing human antibody genes in a mouse model, they developed monoclonal antibodies that successfully blocked EBV infection. There’s more work to do: human trials are still down the road. But the research is promising!

Question grab bag

“Can you do one on avian flu? Nobody is reporting on it well. NJ is having a lot of dead birds, and people are blaming road salt and cold weather.”

Bird flu (avian flu or H5N1) is still active!

In the past 30 days, a total of 9.42 million birds nationwide have been affected. (In contrast, 1.4 million birds nationwide were affected by avian flu over the three months of September, October, and November of 2025.)

The high numbers are mainly due to a big outbreak in Pennsylvania. More than seven million birds (mostly commercial poultry and backyard flocks) have tested positive in recent weeks in the South and Central regions of the state. The state is now requiring 214 nearby dairy farms to test bulk milk tanks to make sure the virus isn’t spreading among cows again. Colorado also has a large outbreak, with more than 1 million birds affected at one facility.

In New Jersey, USDA has not detected any commercial flocks impacted by bird flu in the past 30 days. But New Jersey is in the migration path of Pennsylvania, so it could be (and likely is) circulating among wild birds, which may explain the dead birds you’re seeing.

What this means for you: So far, not too much unless you own birds in your backyards. (Here is what you should do with backyard flocks.) Also, egg prices haven’t changed yet, but many are keeping an eye on this.

Bottom line

Stay warm, stay healthy, and stay loud.

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. Hannah Totte, MPH, is an epidemiologist and YLE Community Manager. YLE reaches more than 425,000 people in 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 below:

Subscribe now

Here’s what’s happening and what it means for you.

A slippery slope that could hurt vaccine innovation: Moderna vs. a new FDA

UPDATE: Just an hour after I published this newsletter, we received good news: the FDA has agreed to review the new Moderna flu vaccine. I’m relieved to see that this important innovation work will continue, and I’ll be keeping a close eye on this topic.

Last week, Moderna asked the FDA to review its new mRNA flu vaccine after completing a large clinical trial. Instead of reviewing it, the agency sent something called a “Refuse to File” letter, meaning it would not even begin reviewing their application. This means this vaccine will not go onto the long pathway to licensure (and ultimately, to your arms).

That might sound technical, but it matters. A lot.

Why flu vaccines need innovation

Flu vaccines help, but they’re far from perfect. In most years, they reduce the risk of hospitalization by roughly 40–60%. (To compare, the measles vaccine is 97% effectiveness against severe disease). Flu changes quickly, which means innovative vaccines are needed.

There are two potential advantages of mRNA technology:

1. Speed: mRNA vaccines can be updated much faster than traditional flu vaccines (3 months vs. 6 months), so they could catch up to flu mutations more quickly.

2. Immune response: Early research suggested stronger immune responses, including T cell and memory B cell responses that were comparable to or stronger than those from enhanced flu vaccines used in older adults.

So, Moderna invested an estimated $500–700 million to develop a new mRNA flu vaccine candidate, called mRNA-1010, and tested it in a Phase 3 trial involving more than 40,000 adults age 50 and older. The study compared the mRNA vaccine with a standard licensed flu shot.

Results showed 26% better protection in adults over 50 with the mRNA flu vaccine than with standard flu shots, a meaningful gain. Side effects such as fatigue and chills were more common (as they are with mRNA Covid-19 vaccines).

Where the controversy starts

FDA leadership objected to the main comparison: Moderna compared its vaccine to a standard-dose flu shot rather than a high-dose version often used for older adults (who are at greatest risk for severe flu disease).

At first glance, that sounds reasonable. But Moderna did conduct a smaller trial with about 3,000 participants specifically to address this question. In adults aged 65 and older, Moderna found that the mRNA vaccine elicited stronger antibody responses than the high-dose vaccine. For decades, this has been used as a strong proxy for a robust immune response that would protect patients.

Why this stands out

There are three main reasons:

1. The clinical trial design had already been cleared by the FDA in 2024. Even though political leadership changes between administrations, continuity matters because vaccine and drug development typically takes around 5-10 years. Companies rely on stable expectations when they make long-term investments in innovation. Political appointees changed the expectations in the last mile.

2. Refuse to File decisions are rare (about 4% of applications receive them) and typically happen when major information is missing. That doesn’t appear to be the case here.

3. Other regulators, like those in Europe, Canada, and Australia, have accepted the application for review.

Taken together, this hints at an increasingly partisan shift that could reshape the future of vaccine innovation.

The big question

Without the U.S. market, it’s unclear whether Moderna will move forward commercially. The company has already announced it will pause new Phase 3 trials for other infectious disease vaccines, shelving programs for viruses such as Epstein-Barr, herpes, and shingles.

What we don’t know yet is how other vaccine manufacturers will interpret this moment. If the regulatory environment feels unpredictable, investment could slow, not just in flu vaccines but also in future outbreak preparedness. In other words, this is how vaccine innovation is slowly destroyed.

What this means for you: In the short term, this means there will be no new flu vaccine option for you. The current ones should still be available this fall. In the long term, the concern is broader, and that matters because better vaccines usually arrive through incremental improvements, not overnight breakthroughs.

Colorectal cancer is rising in young people

Another story last week hit close to home. James Van Der Beek died at age 48 after a three-year battle with colorectal cancer. As a millennial, I’ll admit stories like this land hard. The rise in younger colorectal cancer cases feels new and unsettling, and many of us are paying attention for exactly that reason.

The big picture first

Most colorectal cancer cases and deaths still occur in older adults, especially those over age 65. Among younger adults, the disease rates and death remains rare, but the rate is increasing. That trend is why researchers (and, honestly, many of us) are watching closely.

Because of this rise, in 2021, colorectal screening guidelines changed. Getting screened at 45 instead of 50 is now the standard for average-risk adults.

Why is the rise happening?

We don’t fully know yet. But in epidemiology, this is called a “cohort effect,” which typically points to environmental causes rather than genetics. Leading theories include:

• Ultra-processed diets

• Low fiber intake

• Obesity & metabolic health

• Sedentary lifestyles

• Microbiome changes

The rise is likely due to multiple drivers rather than a single cause.

Why not lower the screening age even more?

Screening decisions always balance benefits and harms:

• Colonoscopies are invasive.

• They have risks and costs.

• Screening millions of very low-risk people can cause harm, including false positives, unnecessary follow-up procedures, and stress.

The U.S. already screens earlier than many countries. For example, screening often starts at 50–55 in parts of Europe and Canada, while in Australia it starts at 45, as in the U.S.

Right now, scientists don’t have strong evidence that screening everyone under 45 would save more lives than it might inadvertently harm. That could change as data evolves.

What you can do now

If you are 45 or older, make sure you get screened. You have a few options, including:

• At-home FIT test every year

• At-home stool DNA test, like Cologuard every 3 years

• Colonoscopy every 10 years if normal

Any positive at-home test means you should schedule a colonoscopy.

If you are under 45 years old, it’s important to know your family history and take symptoms seriously at any age (blood in stool, persistent bowel changes, unexplained weight loss). And advocate for yourself if you have these symptoms.

A healthy lifestyle also helps reduce risk:

1. Eat more fiber (only 6% of the U.S. population meets recommendations).

2. Move your body regularly.

3. Eat a nutrient-dense diet and limit alcohol.

These aren’t guarantees, but they do meaningfully lower risk over time.

Disease “weather report.”

Influenza-like illness is annoyingly sticking around. This is mainly due to one strain of flu (called flu B), as well as rising rates of the common cold and RSV. RSV is now the highest it’s been all season, in an uncharacteristically late winter season effect.

Measles. The U.S. has now reached 1,004 cases (huge thanks to the Yale School of Public Health team for keeping nearly daily tabs). Hitting this number in just 1.5 months represents an extraordinary rate of acceleration, one we haven’t seen in a very long time.

• South Carolina outbreak is slowing down, as well as Utah and Arizona.

• Eyes are on an outbreak in Florida, with 78 cases, 57 of which are associated with the outbreak at Ave Maria University.

• Smaller outbreaks in North Carolina, Washington State, and California continue to grow.

In food safety, there’s a dangerous, extensively drug-resistant Salmonella outbreak from Rosabella Moringa powder capsules. Those who got sick had purchased it from Amazon or other online retailers. The outbreak is small thus far (seven people, three hospitalized). But typically Salmonella can be treated with antibiotics, and this is a drug-resistant strain that cannot be treated with first-line antibiotics.

What this means for you: If you have a bottle that expires in 2027, check its lot code on the bottom of the bottle. If it’s one of the 52 affected lot codes, toss it.

Good news

• A federal judge temporarily blocked proposed CDC cuts, protecting about $600 million in public health grants for California, Colorado, Illinois, and Minnesota while a legal challenge moves forward, which is a meaningful early win for public health programs that were at immediate risk. The administration said the cuts were meant to realign CDC spending with new policy priorities, but it is highly unusual (and possibly unprecedented) for federal funding cuts to target specific states, especially ones that do not closely align politically with the administration. For now, the decision keeps critical public health infrastructure, such as surveillance systems, workforce staffing, and prevention programs, running without interruption. While the legal fight isn’t over, this ruling buys valuable time and shows the courts are taking the concerns seriously.

Bottom line

Stay healthy out there. One of these days, we will be out of the winter respiratory season. In the meantime, I will keep you updated on any health changes that affect you.

Love, YLE

Correction: This article was updated to reflect that New Zealand will provide free colorectal screening for those 58 and older as of March 2026, not 45.

Your Local Epidemiologist (YLE) is founded and operated by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, wife, and mom of two little girls. Hannah Totte, MPH, is an epidemiologist and YLE Community Manager. 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 below:

Subscribe now

In the health world, we’re seeing a late-season flu bump, and measles in South Carolina is doing what measles does best: spreading. Also, don’t let the flashy Trump Rx discounts or Super Bowl wellness ads fool you too much.

Here’s what’s happening, and what it means for you.

Disease “weather report”

There are still plenty of sick people out there. After several weeks of decline, we’re seeing a modest uptick in people with coughs, sore throats, and fevers. This bump appears to be driven by late-winter suspects: the common cold, RSV, and flu B.

Flu B often rises after flu A has already peaked, so a late-season increase like this is expected and not unusual.

How big will flu B get? It’s unclear. Some countries, like Japan, are experiencing a sizable second wave of flu, while others are not. Historically, flu B causes smaller waves than flu A, partly because of existing population immunity. We’ll be watching the data closely.

So far, the much-hyped “super flu” hasn’t materialized at the national level. Overall severity, measured by cumulative hospitalizations, has been middle-of-the-road. That said, some states have had very tough seasons (as we covered at YLE New York), while others have fared better (as we covered at YLE California).

Measles. There have now been 803 confirmed cases nationally in 2026. In just five weeks, we’ve hit 35% of the total number of cases in 2025.

• South Carolina keeps on growing. It has now reached an astonishing 920 cases. It looks to be slowing, but time will tell how big this gets.

TrumpRx: Big branding, limited impact

Americans pay outrageously high prices for brand-name drugs, so I’m all for efforts that tackle the root causes. But despite the patriotic branding behind TrumpRx, it lacks real teeth, and most people are unlikely to see any meaningful relief from the new drug website.

Here are the details:

1. TrumpRx only applies to people who pay cash for prescriptions. So, the vast majority of Americans with health insurance will not benefit.

2. If you do pay cash for drugs from the site, it will likely not count towards your deductible. However, this may be changing following a recent FTC settlement involving Cigna/Express Scripts. Also, eight states have passed laws requiring insurers to count certain cash prescription purchases toward deductibles and out-of-pocket limits.

3. Don’t forget generics. One of the more misleading aspects of TrumpRx is that it focuses on brand-name drugs without clearly telling consumers that much cheaper generic drugs already exist. In fact, 18 of 43 of the drugs on TrumpRx already have cheaper options. So, before you use the platform, double-check that there isn’t already a cheaper option here. For example:

   1. Tikosyn (antiarrhythmic): TrumpRx $672 vs. generic version for $36

   2. Pristiq (antidepressant): TrumpRx $200 vs. generic version for $20

   3. Protonix (acid reflux): TrumpRx $361 vs. generic version on Mark Cuban’s Cost Plus Drugs platform is $6.

4. This isn’t a change in the law. TrumpRx is essentially an online drug marketplace; it doesn’t alter legal requirements or hold industry players more accountable. Real cost relief requires stronger levers. That’s what sets it apart from approaches like California’s, which uses legislation to change the system itself by holding middlemen accountable and reshaping incentives across insurers and pharmacies.

5. Sweeping changes are still needed. The most consequential shift we’ve seen so far came with the 2022 Inflation Reduction Act, which finally allowed Medicare to negotiate drug prices, but it is narrow, and more reform is urgently needed.

   • Starting this year, 10 Medicare drugs are now, on average, 22% cheaper than before.

   • Just announced: in 2027, 15 more drugs will be added, with prices about 44% lower on average.

Super Bowl commercials are worth a closer look

Whether you were there for the friends, football, halftime show, or snacks. As always, the ads were entertaining, but my public health head just couldn’t resist looking closer at two wellness ads.

Hidden details in Hims & Hers. A telehealth company, Hims & Hers, promoted a blood-based multi-cancer screening test called Galleri, which looks for cancer-related DNA signals in the bloodstream. The challenge here isn’t whether the test can ever detect cancer (it can), but how often it misses cancers and how often it raises false alarms.

So what does the data actually show? The company tested the blood of nearly 36,000 adults over 50 who were asymptomatic and followed them for a year. (This was not a randomized controlled trial). Results were:

• Of everyone who had cancer, the test caught about 4 out of 10.

• Among the cancers it did catch, more than half were early-stage, and about three-quarters were cancers that currently have no routine screening tests, such as pancreatic cancer.

• Of everyone who tested positive, about 2 out of 3 truly had cancer, while a little more than 1 in 3 people experienced a false alarm.

• Among those who had a negative test, 99% were confirmed to be negative.

These are not strong numbers, and it remains unclear whether the test improves long-term survival. Screening always has tradeoffs, and consumers deserve to understand them, especially before paying around $900 for a test that is not FDA-approved, not covered by insurance, and can trigger significant anxiety if a result turns out to be a false alarm.

Shame doesn’t work. The second ad featured Mike Tyson promoting realfood.gov, a government site where he describes how eating processed foods led him to self-hate. MAHA sponsored the commercial, and that’s what makes it so frustrating. With decades of behavioral science showing that shame backfires and agency-based messaging works better, this could have been a powerful, empowering moment. Instead, they missed an opportunity to make a far more impactful and effective case for healthier eating.

Shame-based framing (“I ate this, so I’m bad”) largely doesn’t work because it shuts people down. Guilt-based framing paired with agency (“This choice wasn’t great and I can change it”) is more likely to make a difference. People rely on ultra-processed foods because of cost, time constraints, and limited access to healthy foods, not simply a lack of willpower. And some ultra-processed foods, like seasoned canned beans or whole wheat bread, can be part of a healthy diet. If the goal is healthier eating, the message should offer honesty, nuance, and realistic choices, rather than moral judgment.

For more on this, check out the YLE deep dive from last year below.

Some good news!

• Congress passed funding for the CDC at roughly the same level as the 2024–2025 budget, restoring programs that had been paused. In this moment, “nothing got worse” qualifies as good news.

• Hospital-acquired infections are declining, meaning fewer patients are being harmed. This trend suggests that strengthened infection-control practices from the pandemic era are paying off.

• A personalized mRNA cancer vaccine sustained a 49% reduction in melanoma recurrence or death at five years. The new follow-up data suggest that mRNA-based cancer therapies may deliver durable, long-term benefits. This is only from a Phase II trial. In other words, there is still a while before it may go to market, but we will take this as a win!

In case you missed it

• Do clinicians make money off vaccines?

• Marisa over at YLE in New York covered the pros and cons of the new NYC Health Commissioner pick.

• Matt over at YLE in California covered the TB outbreak in a school and measles at Disneyland.

Bottom line

Stay healthy and warm out there! And don’t let the performative policy changes and ads fool you.

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. Hannah Totte, MPH, is an epidemiologist and YLE Community Manager. 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 below:

Subscribe now

Meanwhile, the U.S. officially left the WHO, which seems… poorly timed, to say the least. A heartbreaking photo marks the moment and stands in stark contrast to the pride I felt when I worked at WHO ten years ago.

What does this all mean for you? Let’s dig in.

Measles: the first crack in childhood disease protection

We are watching the first building block of childhood disease protection fall in real time: protection against measles. Because this is the most contagious virus on Earth, even small drops in vaccination coverage give it an opening. And boy, are we giving it openings both nationally and globally.

What’s happening globally. On January 23, 2026, the World Health Organization (WHO) announced six European countries lost their measles elimination status: Armenia, Austria, Azerbaijan, Spain, the United Kingdom, and Uzbekistan. Canada lost its elimination status late last year. This means measles is no longer a random event in these countries; it’s endemic and freely flowing.

This is due to several forces colliding:

• Collective amnesia about vaccine-preventable diseases (vaccines are victims of their own success)

• Global instability

• A radically changed online information ecosystem

• Bad actors exploiting spaces

• Deepening mistrust in institutions

WHO will examine the U.S. measles elimination status in April, and all signs point toward us losing it.

What’s happening in the U.S. This year isn’t off to a great start. In January 2026 alone, 662 measles cases were reported. This is an astonishing number for a single month. It’s especially concerning because January is typically a slower month for measles spread.

Public health eyes are on several areas:

• South Carolina, where a large outbreak has surpassed the size of Texas’s outbreak last year, and is spreading through a tightly knit religious community with low vaccination rates. Wastewater is showing some hopeful signs that the outbreak may be slowing down.

• Utah and Arizona, where cases continue to raise concern.

• ICE detention centers in Arizona and Texas are reporting cases. This is concerning because these facilities have close quarters, making them a perfect breeding ground for measles.

What’s most troubling, in all of this, is the silence from national leadership. In the past, federal health leaders publicly encouraged vaccination and ran national prevention campaigns. Right now, that messaging is absent. Awareness, education, and empowerment are not front and center. As a result, measles will likely demand far more public health attention in the years ahead.

What this means for you: If you’re vaccinated, you’re very well protected. About 96% of cases are among unvaccinated people. Check vaccination rates in your county using this map. If you have a child under 12 months old, an early first MMR dose at 6 months may be an option. Talk with your pediatrician.

Nipah virus: scary headlines, low risk

Do you remember the movie Contagion? That fictional outbreak was inspired by Nipah, a serious virus that can cause brain swelling and has a high fatality rate (40-75%). There’s no approved treatment yet, though vaccines are in development, including one in clinical trials at Oxford. Vaccine progress in the U.S. has largely stopped due to vaccine skepticism and regulatory headwinds.

Right now, Nipah is causing a small outbreak in India. Social media and international headlines are lighting up, but we are not on the brink of another pandemic.

Here’s why.

1. The outbreak is small and controlled. This means the immediate risk is limited. Two nurses were infected in West Bengal. Indian health officials rapidly traced 196 contacts. All were quarantined, asymptomatic, and tested negative. This means the outbreak is under control. Some airports have added screening measures, despite no cases outside India, which appears to be an abundance of caution and possibly a reaction to exaggerated reports.

2. Nipah does not spread easily between people. Infected people become very sick very quickly, often dying, which limits opportunities for the virus to move to others. Nipah spreads through direct contact with bodily fluids, like blood, or contaminated food, but not through the air. As a result, one person with Nipah typically infects fewer than one other person. Compare that to measles, which can infect about 18 unvaccinated people from a single case. In short, human-to-human transmission is extremely limited.

3. Nipah primarily lives in animals. Fruit bats are the virus’s natural host, where it thrives. Occasionally, the virus jumps from bats to humans, particularly as deforestation, globalization, and climate change drive ecosystem changes. These spillover events are rare, and the virus does not easily spread from person to person.

Nipah poses a serious but highly localized risk rather than a global pandemic threat. While it could mutate, the risk of a pandemic is very, very small (about 2%).

What this means for you: Epidemiologists are keeping a close eye on this, and India has moved fast on containment. For now, Nipah still makes a great movie, but your risk is essentially zero.

Respiratory viruses: resurging

Reports of fever, cough, and sore throat are rising again, as is typical when schools resume after the holidays.

This increase is mostly driven by flu, especially among children. RSV is also contributing.

Covid-19 levels continue to drop nationally. While they remain highest in the Midwest, there might be increasing activity in the South. We will see where this virus takes us next.

What this means for you: At this point, it probably doesn’t make sense to get a flu vaccine until next season. Covid-19 vaccines for spring should be coming soon for those over 65 years old.

The U.S. officially leaves the WHO

More than ten years ago, I checked into the WHO headquarters in Geneva and took the picture below of all the UN flags—pride oozing from my veins as I worked toward a healthier world with all countries. Last week, I was sent a starkly different image: the U.S. flag being lowered at the WHO as the U.S. officially departed.

WHO has long needed support and reform; there’s no question about that. But reforming is very different from walking away, and it’s worth the effort. While this move may not directly affect all of us in the short term, the consequences are real: reduced financial support for low-income countries facing outbreaks like Nipah, diminished U.S. influence on the global stage, and Americans themselves becoming less informed and less prepared.

I wrote about this when the president first announced the plan to leave WHO, and the implications haven’t changed. Read more here:

Did California join the WHO? Not exactly. States can’t be full members. But after the U.S. withdrawal, the California Department of Public Health began joining WHO weekly calls through the Global Outbreak Alert & Response Network, and other states will likely follow. This keeps states connected to critical information on global outbreaks and their potential impact on Americans, now that the CDC is no longer filling this role.

What this means for you: Health threats don’t respect borders. This will make it much harder for public health to protect you.

Bottom line

Infectious diseases love this time of year, and this week is no exception. I hope you all stay healthy, safe, and warm 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. Hannah Totte, MPH, is an epidemiologist and YLE Community Manager. 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 below:

Subscribe now

What’s happening here is not normal. It’s dark and disorienting, and it’s hard to keep all the balls in the air, including our health. So I’ll continue to pull together a clear snapshot of what’s happening in public health (“translated,” timely, and actionable) to make things a little easier on your end.

This week: infectious diseases are moving, policy shifts are reshaping health protections, and communities are navigating new realities, including how to respond to ICE. But there is also real, meaningful good news. I’m finding myself holding onto that more these days.

Let’s get into it.

Infectious disease “weather” report

Measles. This year is off to a rough start—the worst January in more than 30 years. The U.S. has already reported hundreds of measles cases. That’s especially concerning because January is usually a slower month for measles. School breaks often slow spread, and temperatures help measles peak later, closer to spring.

Most of the cases are coming from a large and fast-growing outbreak in South Carolina:

• 243 cases in just the past 10 days

• 558 total cases since October

• 96% of cases are unvaccinated

• 90% are children

• 531 people are in quarantine, meaning weeks of missed school or work

• Spread has reached other states, including North Carolina, Colorado, and Washington

This outbreak could easily become larger than last year’s Texas outbreak.

Another outbreak in Utah and Arizona has reached 433 cases since late last year, but the pace there seems to be slowing.

Like wildfires igniting in dry tinder, measles ravages areas with low vaccination rates. A new tool from Boston Children’s Hospital, Harvard Medical School, and the Icahn School of Medicine at Mount Sinai highlights high-risk pockets. Zooming in on the South Carolina hot zone shows multiple very high-risk zip codes. Some news outlets reports some schools have less than 30% vaccination rate. (Measles herd immunity requires 95%.)

What this means for you: Check out your zip code here. If you’re fully vaccinated, you are very well protected, even if you live in a “high-risk” area. If there’s an active outbreak and you have a baby under 12 months, talk with your pediatrician about early vaccination at 6 months.

Winter respiratory illnesses

Visits for fever, cough, and sore throat are finally dropping. That’s good news. But respiratory seasons often have two waves. Schools are back in session, and different flu strains—like Flu B—can take over. Flu season often lasts into March, so we’re not done yet.

Covid-19 levels are moderate nationwide but vary by region. The Midwest is seeing very high levels, followed by the Northeast. Overall, things seem to be slowing, which suggests another relatively mild Covid winter.

What does this mean to you? There are still plenty of sick people around. Wash your hands, consider masking in crowded indoor spaces, and stay home when you’re sick.

Toss this supplement out

LiveItUp Super Greens has been recalled due to a Salmonella outbreak that has sickened more than 45 people and hospitalized 12 nationwide. If you have it, toss it:

• Expiration dates August 2026–January 2028

• Sold online, including Amazon

EPA pollution rules no longer count lives

One of the most important ways the U.S. government protects public health is by regulating pollution so that companies’ activities don’t harm people’s health or the environment. The Environmental Protection Agency (EPA) sets and enforces limits on air, water, and soil pollution under laws like the Clean Air Act.

When the EPA evaluates a new regulation, it typically uses cost-benefit analysis to compare:

1. Costs— what companies (and sometimes consumers) will have to spend to comply (e.g., upgrading equipment, changing processes).

2. Benefits — how much better off the public will be if pollution goes down, including fewer illnesses, fewer hospital visits, less lost work time, and lives saved. To do this, economists estimate the value of reduced health risks in dollar terms, including a widely used figure called the value of a statistical life. This is essentially the amount society is willing to pay for reductions in mortality risk and has ranged from $6.8 million under the Bush administration to roughly $9.8 million under Biden.

Last week, the EPA announced a big change. For some major air pollutants, such as fine particles and ozone, cost-benefit analyses will no longer include the dollar value of health benefits. This is a significant shift because health benefits, especially avoided premature deaths, historically accounted for a large share of the quantified benefits in air pollution rules. This tilts the math in favor of corporate interests. Pollution rules now appear far more costly, making it easier for companies to push for weaker protections.

What happens next? Companies now have stronger legal arguments that pollution rules cost “too much.” Expect lawsuits aimed at weakening air quality standards.

Who is most at risk? The effects won’t be immediate, but they will add up over time. Communities near highways, factories, and industrial sites, which are often low-income or historically marginalized communities, are likely to be hit hardest.

What can you do? Track your local air quality. AirNow uses official data and can be found in your phone's weather apps. PurpleAir offers community-level data, though it’s less precise (but getting better). Also, you may want to purchase an indoor air filter (Wirecutter has some good ones).

ICE and public health

The scenes of fear, trauma, and threat to safety in communities, like in Minneapolis, are hard to watch. And many are not just watching, they are living it, like my daughter’s school friend.

This situation has direct and indirect impacts on health, as it changes how families live, work, and, critically, how and when they seek medical care. When people worry about enforcement on the way to a clinic or hospital, many delay or avoid care even for serious conditions, which can worsen illness and increase community health risks.

What this means for you: Communities can still be a source of strength. Educators play a critical role in schools. Clinical care teams, whose primary role is to ensure patient safety, can take actionable steps to support these communities within the clinical setting.

But this is new territory. Marisa, YLE’s correspondent in New York, pulled together resources for you to help support families carrying this burden. She also took a deeper dive into the data and noted the recent rollback of protections for sensitive locations. Check it out here:

Your Local Epidemiologist in New York

The ripple effects of deportations

Immigration, one area experiencing significant policy change, is inextricably linked to public health. News of ICE raids has been all over the media, but what does that mean, and how do they affect New Yorkers…

Read more

a year ago · 76 likes · Marisa Donnelly

Bright spots this week

Exhale. There is good news.

• Funding restored

  • The American Academy of Pediatrics had $12 million in grants reinstated after a court order.

  • $2 billion for mental health, substance use treatment, and overdose prevention was restored to SAMHSA after bipartisan pressure. This was less than a day after cuts affected 2,000+ organizations.

• Overdose deaths are falling. From August 2024 to August 2025, overdose deaths dropped in 45 states. This is in big thanks to naloxone access, service expansions, and improved treatment. There’s still work to do, but this is progress to celebrate.

• Cancer survivorship is at an all-time high. Seventy percent of U.S. cancer patients diagnosed between 2015 and 2021 reached five-year survival. Gains were seen even among some of the deadliest cancers, including liver, lung, and multiple myeloma. Better prevention, screening, and treatments are saving and extending lives.

• New hope for multiple myeloma. A recent trial of a new immunotherapy combination showed that more than 80% of patients remained alive and progression-free for nearly three years (compared to 30% of patients who didn’t receive the therapy).

In case you missed it

• What to know about flu antivirals.

• YLE Reader Survey! Help us understand who you are and what we can do better. Please take a few minutes to take this year’s survey.

  Take the Survey!

Bottom line

Please be healthy and safe out there. And remember, power comes not only from the top down, but also from the bottom up.

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 below:

Subscribe now

Hello YLE readers! I’m Jess Steier, public health scientist and founder of Unbiased Science, stepping in while Katelyn is on a much-deserved vacation. (During brief periods of WiFi connectivity, she’s sending pics that have me very jealous.)

What a week to guest-host: flu season is brutal, the new dietary guidelines are... interesting, the policy landscape is shifting fast, and the annual reader survey needs your feedback. Let’s get into it.

Subscribe now

Infectious disease “weather report”

Flu. Buckle up, folks. We’re in the thick of a very rough flu season. The CDC tracks “influenza-like illness” (ILI)—doctor visits for fever, cough, and sore throat—as a proxy for respiratory virus activity. Most of those cases right now are flu. ILI is the highest it has been since 1997-98 (nearly 30 years), and the highest on record since the CDC started tracking. Last season, infections peaked at the beginning of February, and we’re already seeing similar rates a month earlier this year. And infections will continue to increase, since they haven’t peaked yet.

Emergency department visits are highest among kids ages 5-17, with children under 5 close behind. Seventeen children have died from the flu so far this season. For context, last year set the record for pediatric flu deaths (280). Looking at this horrible season, we might see similar rates this year, unless uptake of the flu shot—which greatly reduces the risk of hospitalization and death—catches up.

Subclade K, the latest offshoot of H3N2 (type A)—basically a slightly updated version of the virus we already know—emerged over the summer and is to blame here. It’s better at evading this season’s flu shot and prior immunity. It has accounted for roughly 80% of flu samples tested so far.

What this means for you: The best thing you can do is get a flu shot, and make sure everyone in your family 6 months and older has received one. It’s not too late.

• The flu shot might not fully prevent an infection, but it can greatly reduce severity and reduce spread in the community.

• Despite changes to the Health and Human Services (HHS) childhood vaccination schedule, the American Academy of Pediatrics still recommends the flu shot for everyone 6 months and up. (HHS taking the flu shot off the list amidst a flu season that could break records for pediatric deaths is cruelly tone deaf.)

• If you do get sick, prescription antivirals like Tamiflu or Xofluza can reduce severity, hospitalization, and even death—especially for high-risk groups. The sooner you start, the better. I’m working on a deep-dive on antivirals for you later this week—stay tuned!

• Even if you’ve already gotten the flu, getting a flu shot (if you haven’t yet) can help you. Since there are multiple strains of flu floating around, and the shot protects against some of them well, it can boost your overall immunity.

• Other protective measures help, too: wear a mask in crowded indoor spaces, improve ventilation when possible, and stay home if you’re sick.

Measles. The U.S. has confirmed over 2,200 cases and 3 deaths this season—the highest annual total since 1992. Two major outbreaks are driving the surge: South Carolina (313 cases, with 125 added last week alone) has now spread to North Carolina and Ohio, and the Utah-Arizona outbreak continues to grow (nearly 400 cases combined). For latest full Yale School of Public Health SITREP report, go here:

YSPH VMOC Special Report Measles The Americas Jan 11 2026

1.45MB ∙ PDF file

Download

Download

The big question is whether the U.S. will lose its measles elimination status, which we’ve held since 2000. Canada lost theirs in November. If ongoing outbreaks are linked to the Texas outbreak that started last January—meaning continuous transmission for 12 months—we could be next. The Pan-American Health Organization — our regional version of WHO—is set to evaluate U.S. data soon.

Some good news: Covid-19 rates remain low nationwide, and common cold viruses (like rhinoviruses and seasonal coronaviruses) are down. RSV cases are lower than this time last year but starting to rise.

New Dietary Guidelines: MyPlate is out, the inverted food pyramid is in

I’ll let Megan, YLE’s registered dietitian nutritionist, take it from here…

Last week, the United States Department of Agriculture (USDA) and HHS released the Dietary Guidelines for Americans (DGA). The DGA are updated every five years to guide nutrition policy, education, and programming for health professionals. While some federally funded programs like school meals must follow them, others use them as best-practice guidance. As an RDN, I reference the DGA often in my work.

Historically, the DGA has aligned with its Scientific Report—a public, multi-year evidence review by an independent advisory committee. This cycle, the DGA diverged from that report (released in 2024), openly criticized it, and introduced a separate Scientific Foundation developed privately by contracted scientists.

Reactions to the new DGA vary widely, including praise for its emphasis on “real” whole foods, confusion over vague or conflicting messaging, and concerns about its propaganda-like language, questionable scientific rigor, and opacity in the review process and author selection.

Notable takeaways include:

• Significant reduction in length (10 pages versus the previous 164) to make it simpler and more accessible, but potentially at the expense of detail, guidance, and nuance that clinicians, schools, and policymakers rely on to translate recommendations into practice.

• Continued emphasis on nutrient-dense food groups—fruits, vegetables, whole grains, protein foods, and dairy—with expanded inclusion of full-fat dairy and red meat, more explicit guidance to limit highly processed foods, and stronger limits on added sugars.

• A heightened focus on protein, increasing recommended intake by 50–100%, with less emphasis on plant-based sources.

• Encouragement of animal fats (e.g., beef, beef tallow, whole milk, butter), while still keeping the saturated fat limits to <10% of calories (~22 grams/day).

  • Note: This level is nearly reached with a glass of whole milk (4.5 grams), 1 tablespoon of butter (7 grams), and a 4-oz serving of ribeye (9 grams).

• Softened alcohol guidance, removing specific daily limits (<1–2 drinks) despite growing evidence that no amount of alcohol is safe, and instead offering only a vague recommendation to consume less for better health.

• Explicit removal of health equity as a consideration in reviewing evidence and shaping guidance, including factors like socioeconomic status, race, culture, research representation, and diverse population needs.

• Replacement of the MyPlate graphic with an inverted food pyramid.

How will these changes affect daily life for most folks? For many adults, not much. Most Americans don’t follow the guidelines anyway. Still, the DGA shapes guidance for federal nutrition programs, such as school meals and nutrition assistance programs, which serve at least 1 in 4 Americans, and informs recommendations from health professionals. That’s why its clarity and scientific integrity remain important for both individuals and public health.

Would a deeper dive into the new guidelines be useful? If so, what questions do you have for us? Let us know in the comments.

With more Medicaid eligibility requirements, more missed cancer screenings

The “Big Beautiful Bill” changed Medicaid eligibility, adding new work and renewal requirements. When they go into effect in January 2027, they will affect care in a myriad of ways, including cancer prevention.

An analysis published in the Journal of the American Medical Association (JAMA) last week predicted that, due to losing Medicaid coverage, millions of people will lose access to cancer screenings.

Their projections? More than one million missed screenings in the next two years, resulting in 155 preventable deaths. This study focused on implications for breast, colorectal, and lung cancers, all of which have shown increased survivorship after widespread screening implementation. This estimate is conservative; for example, it does not include recommended cervical cancer screening.

There will also be significant variation across states: in states that expanded Medicaid (where a larger fraction of the population is covered), more screenings will be missed.

Bottom line: This is just one direct health impact for those who will lose Medicaid coverage next year.

• Will states step in? Probably, but it depends—and probably not to the full extent of the Medicaid coverage net, at least in the short run.

• There may be opportunities to expand screening capacity at other points of care, such as community health centers and primary care visits, but this will require investment in already stretched systems.

HRSA endorsed an at-home HPV self-collection test

I unfortunately have had the experience of a super uncomfortable, borderline painful, hastily accomplished Pap smear. I get it: as an important cervical cancer prevention tool, we’ve needed them. But like many of the other women in my life, I dread them.

Enter the at-home human papillomavirus (HPV) self-collection test. We can collect our own samples using at-home kits, and they are now FDA approved as a cancer screening tool in Health Resources and Services Administration (HRSA) guidelines. The at-home kits are less invasive, involve less equipment, don’t require a trip to the clinic, and are a welcome alternative for people who have experienced sexual trauma.

The U.S. Preventive Services Task Force (USPSTF) first endorsed self-collection swabs for clinical use back in 2024. They were then available through prescription only in May 2025. These updated guidelines reflect additional data that vet how they can be reliably used to test for HPV, the infection that causes the majority of cervical cancers, and expands access without prescriptions.

For context, the HRSA recommends that women aged 30 to 65 at average risk of cervical cancer get screened with HPV testing—now including at-home tests—every five years, and women aged 21 to 29 at average risk get a Pap smear every three years. (The American Cancer Society (ACS) guidelines recommend beginning to test for HPV at 25 years.) This at-home test aims to increase screening rates: an estimated 1 in 4 adults are not up to date with cervical cancer screenings.

This brings us to some nuance:

• First, there’s a risk of people forgoing a clinician’s care, like at an annual physical, to collect samples at home.

• Even though most insurance plans will have to cover them in 2027, they might not be available to everyone—especially people without insurance.

• An HPV test is not a Pap smear. Pap smears also check for precancerous cells on the cervix, which might become cancerous if they are not treated properly.

• Self-collection is not recommended for everyone. People with the following conditions should talk to their clinician before opting for at-home tests:

  • Abnormal tests or precancers in the past

  • Solid organ or stem cell transplant

  • Human immunodeficiency virus (HIV) infection

  • Taking medicines that suppress the immune system

  • Exposure to diethylstilbestrol (DES) before birth

If you want to try this option:

• Find FDA-approved self-collection kits through your doctor’s office, Planned Parenthood, or other clinic.

• Talk to your clinician about whether you’re a good candidate for at-home testing, and how to stay on schedule, follow up in case of a positive result, and stay accountable for other appointments.

• HRSA notes that clinician-collected samples are still preferred, since an abnormal result can immediately be followed up with additional testing at the clinic.

Good news

• Minimum wage increased to $15 an hour in 19 states. An economic change on the surface, with real public health gains down the line. Research shows that increasing income improves self-reported health, improves social interactions, reduces overtime work, increases birthweights, and can make life just a bit more affordable, improving mental health and well-being.

• You can set resolutions that stick. It’s January, and resolutions are on the brain. According to psychology research, the best type of goals are the ones that are specific and manageable:

  • Specific means that you can look back on your day or week and know whether you kept your resolution. Resolutions work best when you choose them for you and your “why”—not because of external pressure.

  • Manageable means it fits into your life. You can connect whatever new habit you’re trying to build to what you already want or need to do, like walking while listening to your favorite podcast. Or think about when you were able to reach your goals in the past to help you recreate those conditions.

In case you missed it

• Take the reader survey! It takes about 5 minutes and makes a big impact!

• 15 health wins in New York, from Dr. Marisa Donnelly in New York

• Health impacts of coastal floods, from Dr. Matt Willis in California

• Last week, we talked about changes to the childhood vaccination schedule. Here’s

  a NEW PDF of changes to vaccination schedule, translated into Spanish:

Vaccination Schedule Changes (Spanish)

68.3KB ∙ PDF file

Download

Download

That’s it for this week!

Love,

Jess

*Correction: In the original version published Jan. 13, Dr. Jess Steier’s credentials were incorrectly listed as PhD. She is DrPH.

Jess Steier, DrPH, is a public health scientist and founder of Unbiased Science. Megan Maisano, MS, RDN, is a registered dietitian nutritionist. During the day, Megan works at National Dairy Council, a non-profit dairy nutrition research and education organization. (She does not write about the dairy industry for YLE.) Hannah Totte, MPH, is an epidemiologist and YLE Community Manager.

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 below:

There’s one big thing we need to talk about: flu. It’s everywhere, as this is shaping up to be a rough season. (Perhaps it’s a bad year to recommend dropping vaccines?!). We also crossed a sobering measles milestone, and several new health policies kicked in at the start of the year, including changes that restrict choice for some SNAP beneficiaries.

Here’s your Dose to start the week (and year) on a public health note.

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Infectious disease “weather report”

There are so many sick people out there.

Influenza-like illness (ILI)—the number of patients clinicians see with cough, fever, and sore throat—is a metric to gauge the state of respiratory health in the U.S. Levels are high and exponentially increasing. In fact, it’s the highest it’s been in the past 6 years.

Rates dramatically vary across states, but 32 jurisdictions have “very high” levels. Eventually, I expect the entire map below to be deep red and purple.

Flu

Flu, though, is having a year. Thus far this season, CDC estimates 11,000,000 illnesses, 120,000 hospitalizations, and 5,000 deaths from the flu. (Here’s why we still trust CDC numbers.)

New York, one of the leading states for the flu season, is breaking records for both acceleration and the total number of flu hospitalizations compared with previous years. We’re seeing similar patterns in Colorado and Massachusetts, among others. If you squint, New York seems to be slowing down, so hopefully the leaders are at the peak soon.

Why is this flu season so intense? Two main reasons:

1. One flu strain—called influenza A (H3N2)—mutated over the summer as it circulated in the Southern Hemisphere, shifting from one form (J subclade) to another slightly different form (K subclade). Mutations are very normal for flu; it’s notorious for throwing curveballs. But this year’s changes were more substantial than usual—not enough to spark a pandemic, but enough to fuel a severe season.

   The timing of this mutation was also terrible, as it occurred after the flu vaccine formula was finalized in February. That means this year’s vaccines likely recognize part—but not all—of the updated virus. This is just bad luck.

2. Vaccination rates, especially among children, continue to decline substantially. Last year was the deadliest non-pandemic flu season for U.S. children on record. It also happened to have one of the lowest flu vaccination rates. This season, the vaccination rate is even lower. Already, nine children have died from the flu, including an influencer’s 5-year-old son as well as a healthy 16-year-old. The “true” number of deaths is higher, as reporting is delayed.

Vaccination still matters. Even a mismatched flu vaccine still provides some protection against severe illness. This is because the vaccines still train the immune system to recognize viral components that haven’t changed. Also, there is more than one flu strain circulating (not just H3N2). Preliminary data from the U.K. show that flu vaccination reduces hospitalization by 70–75% in kids and 30–40% in older adults.

What this means for you: It’s not too late to get the flu vaccine. We still have plenty of flu season left, which usually stretches out into March. Flu tests can still detect this strain, and if you do get sick, early antiviral treatment like Tamiflu can help reduce the number of days you’re sick.

RSV

RSV activity continues to increase among our youngest, but man, this has been a relatively mild year. Parents and hospital systems sure are thankful.

Covid-19

Covid-19 transmission remains low nationally, but is increasing. This is a late wave, as this will be the first winter Covid-19 doesn’t peak in the first week of January.

Norovirus

The stomach bug—diarrhea, cramping, vomiting—is also increasing, though not as high as last year when the virus mutated. Norovirus is extremely contagious, so wash hands frequently, disinfect surfaces (bleach works), and don’t cook while sick. Hand sanitizer does not work.

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New year, new policies: SNAP restrictions

Last year, USDA and HHS encouraged states to request SNAP food restriction waivers to limit purchases of non-nutritious food items as part of the Make America Healthy Again strategy. So far, 18 states have received approval to test these restrictions for two years. In previous years, similar waiver requests were denied due to cost, implementation challenges, and limited evidence of health impact.

I will let Megan, YLE’s registered dietitian nutritionist, take it from here on this topic…

Restricting SNAP beneficiary choice—like banning the ability to purchase of soda— has long been debated because, like most health policies, it sits at the intersection of science, ethics, economics, culture, and politics. It’s also expensive (about $1.6 billion for retailers) and complex to implement. The lack of a clear definition of “non-nutritious” foods makes implementation, enforcement, and evaluation challenging across states.

What does the science say about the effectiveness of restriction on health? The research is limited and mixed. Among the studies on this topic, scientists have found:

• SNAP restrictions can reduce purchases of targeted items (like sugary drinks).

• Restrictions may not increase purchases of healthier items (e.g., fruits/vegetables) or improve overall diet quality.

• Combining incentives (such as financial incentives for fruits and vegetables) with restrictions seems more promising. Some trials show this pairing can reduce calories from unhealthy foods and improve overall diet quality.

• We don’t yet know if the changes will meaningfully improve health outcomes, like obesity or diabetes rates.

There are also ethical concerns regarding autonomy and stigma. SNAP was designed to reduce hunger by supporting household food purchasing power, yet these restrictions can feel punitive—“Here’s the money, but we don’t trust you to use it right.” They also divert attention from other upstream drivers of health, such as improved access to health services, food, and education.

All of this is especially hard to reconcile, given that this administration eliminated funding for SNAP-Ed: the very program designed to educate SNAP recipients about nutrition and promote healthy food purchases.

Bottom line: Efforts to improve nutrition through pilot programs are important and widely welcomed, and could provide valuable insights. But they must be done the right way. SNAP purchase restriction waivers must be evaluated through an evidence-based lens that considers their real-world impacts on families, autonomy, dignity, and health.

Good news

• The chickenpox vaccination is finally being offered in the U.K. The chickenpox vaccine is finally being offered in the U.K., following the U.S. lead. Strong evidence shows it does not increase shingles risk (an early concern); rather, evidence shows the opposite—it helps prevent shingles. In the U.S., the vaccine has prevented 91 million cases of chickenpox, 238,000 hospitalizations, and saved $23.4 billion.

Bad news

• In 2025, the U.S. crossed 2,000 measles cases (2,024 to be exact). Large outbreaks in Utah (142 cases), Arizona (195), and South Carolina (156) continue to grow, with over 90% of cases unvaccinated. This is bad news on every level—not just for the children affected by this preventable disease, but because the U.S. is now likely to lose its WHO measles elimination status. In other words, measles may soon become endemic.

Poll

I’m curious what deep dive would be of interest to you:

Bottom line

Stay healthy out there. Get your flu shot, wash your hands, wear a mask, and stay home if you’re sick. Wellness, from the food we eat to the infections we prevent, is both an individual and a community effort.

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.

Megan Maisano, MS, RDN, is a registered dietitian nutritionist. She holds a BS in psychology from the United States Military Academy at West Point and an MS in nutrition communications and behavior change from the Friedman School of Nutrition at Tufts University. During the day, Megan works at National Dairy Council, a non-profit dairy nutrition research and education organization. (She does not write about the dairy industry for YLE.) Megan is a lifelong learner of all things food, health, and well-being and believes “wellness” is deeply personal and should help us feel nourished and empowered, never restricted or discouraged.

This newsletter is free to everyone, thanks to the generous support of fellow YLE community members. To support the effort, subscribe or upgrade below:

Since it’s a holiday week, this Dose was supposed to be a light one, with a quick infectious disease “weather report” to help you navigate holiday gatherings. But alas, 2025 had one last surprise in store with a last-minute vaccine policy scare from RFK Jr. Thankfully, we dodged the bullet for now, but it’s worth understanding what happened.

So, here’s my attempt to bring you along for the ride. Let’s dig in!

A last-minute vaccine policy scare—and why it matters

Last Thursday, I was in a vaccine policy meeting talking about something that has become increasingly fragile: how to protect access to vaccines for Americans who want them, given increasing uncertainty and destruction from the federal government.

In the middle of the conversation, my phone started buzzing. Text after text said the same thing: tomorrow, RFK Jr. would move the U.S. childhood vaccination schedule to the Danish schedule. A press conference was scheduled for Friday at 4 p.m.

Over the next four hours, I was the most worried I have ever been about access to childhood vaccines in the United States. Introducing a completely different vaccine schedule into our system overnight would not have been a minor tweak; it would have been disastrous.

Then the press conference was canceled.

A few days later, Politico reported why: legal and political concerns. HHS was not confident that changing the childhood vaccine schedule to match Denmark’s would hold up in court, and it would be politically risky. (Duh. More than 80% of Americans support routine childhood vaccinations.)

So, for now, Americans dodged a bullet. But I have no doubt this idea will resurface in a different form, so it’s worth understanding what it was all about.

What is actually different about the U.S. and Danish schedules?

Denmark’s childhood vaccine schedule includes fewer vaccines than ours. They don’t routinely vaccinate children against chickenpox, RSV, rotavirus, hepatitis A or B, meningococcal, flu, or Covid-19.

This can look appealing to some. But what makes this work in Denmark is everything beneath the surface: universal healthcare, 46 weeks of paid parental leave, near-universal prenatal screening, centralized medical records, and reliable follow-up.

Because of this system, disease burden is low. Take the Hepatitis B infant dose. Denmark screens nearly 100% of pregnant women and follows up reliably to help prevent transmission. In the U.S., 12–18% of pregnant women aren’t tested, and only 35% of those who test positive complete follow-up care. Before the U.S. universal birth-dose recommendations, thousands of U.S. babies were infected annually by family members who didn't know they carried the virus.

Our broader recommendations exist precisely because our system has gaps. What is safe and effective in Denmark does not translate to the U.S. context. I’ve written about this before here.

Can RFK Jr. actually do this?

Possibly, but it sits in a legal gray area. An independent CDC advisory committee, the ACIP, has historically set vaccine policy. However, the HHS Secretary can issue a directive that changes the schedule without an ACIP vote. That happened earlier this year with Covid-19 vaccine guidance for kids and pregnancy.

That decision is now being challenged in court by the American Academy of Pediatrics. No injunction was issued, so the changes remained in place while the case progresses. In other words, this path exists, but it’s legally shaky.

Why would this be such a big deal?

The childhood vaccine schedule is not just a list of shots. It determines which vaccines kids need for school, what insurance must cover, and which vaccines families can get for free through Vaccines for Children—a program that pays for vaccines for more than half of U.S. children.

It also affects which vaccines are covered by the Vaccine Injury Compensation Program (VICP). This program was designed to compensate people who experience rare but real vaccine-related injuries, while sparing families from lengthy lawsuits against manufacturers or health care providers and safeguarding vaccine supply and access. If a vaccine is removed from the routine schedule, that safety net can disappear, liability risks increase, and manufacturers may discontinue production because it becomes too costly.

Taken together, changes like these could cause supply chain problems, leave states with massive unexpected bills (~$600 million to $2 billion), increase liability for doctors and hospitals, and create widespread confusion. And confusion alone is enough to lower vaccination rates.

What this means for you

For now, nothing. Thank goodness. All vaccines are still available to you. But it’s clear HHS intends to move dramatically on childhood vaccinations. There is significant mobilization behind the scenes to ensure this doesn’t move forward quietly. I will be sure to bring you up to date if anything changes.

For those of you looking for more, together with the Evidence Collective, we pulled together a short briefing you can find HERE, which includes:

• Background, including comparison of schedules, key context, and comparison of the country’s processes

• What could realistically happen

• Common misconceptions to be ready for

Infectious disease “weather report”

Influenza-like illnesses—coughs, fevers, and sore throats—are on the rise across the country, with particularly high levels in New York, New Jersey, Colorado, and Louisiana. Soon, much of the map will be lit up in red/purple with very high rates.

This increase is mostly driven by the flu, which is already making the rounds. Unfortunately, two more pediatric flu deaths were reported this week.

Covid-19 levels are still relatively low nationwide but are slowly creeping up, especially in the Northeast and Midwest. Based on patterns from the past five years, Covid usually peaks in the first week of January. This year, the wave may arrive a bit later than usual.

RSV is also rising, but the season appears to be milder than in previous years. According to the Center for Forecasting Analytics (CFA), hospitalizations from flu, Covid-19, and RSV combined are expected to be roughly the same as last year. The new flu variant may make this season feel heavier, but the mild RSV season and low Covid levels are good news.

What this means for you: There are a lot of sick people peppered throughout the nation. Travel and indoor gatherings will accelerate the spread of all viruses. So…

• If you’re sick, stay home.

• Consider wearing a mask in crowded indoor spaces, like airports.

• It’s not too late to get your flu or Covid vaccines—protecting yourself now can prevent severe illness later.

Bottom line

We’re heading into a much-needed break (unless RFK Jr. pulls another fast one). For now, vaccine access remains intact, viruses are rising across the U.S., and the basics still matter: protect yourself, stay home if you’re sick, and get vaccinated if you haven’t yet.

Most of all, I hope you’re able to rest, unplug, and find some joy over the holidays.

Love, YLE

P.S. Some of you have been asking if Your Local Epidemiologist can accept donations as part of your year-end giving. Yes, and I am so grateful for you! 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.

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 below:

Subscribe now

Here’s The Dose to start your week.

Mass shootings continue to outnumber days in the U.S.

I tried to put into words last night the evidence-based solutions to mass shootings. I was initially trained as a violence epidemiologist, am married to a police officer, and am a mom, and I know there are things we can do as a society. Then I deleted it. Then I rewrote it. Then I was just mad about the whole situation and stopped.

It’s hard to put into words the toll this takes on our communities. And it makes it even harder when it happens over and over and over again.

This time, tragedy struck Brown University during finals prep, a time meant for focus, hope, and growth. Students, faculty, first responders, and many of my friends—some who were working the emergency department or were on campus with students—are left in shock and grief, trying to make sense of yet another traumatic event.

As of December 14, the U.S. has had 391 mass shootings—more than the number of days in the year—for the seventh consecutive year. Seventy-five of these occurred at schools. The frequency is high enough that epidemiologists can now identify patterns. The timing of the shooting at Brown follows a familiar one: school shootings often cluster around periods of transition to and from school breaks.

Across the world, another mass shooting tragedy hit Australia, where people celebrating the first night of Hanukkah were likely violently targeted for their beliefs. The horror of losing loved ones at a gathering meant for reflection and celebration is unimaginable.

Almost immediately, social media seized on the tragedy to argue that Australia’s strict gun laws don’t work. I’ll stop that right there. This isn’t a debate because the data are crystal clear:

1. Mass shootings are extremely rare in Australia. Since the Port Arthur massacre in 1996, strict firearm regulations (a buyback program and tight licensing) have kept mass shootings to zero or one per year on average in Australia. By contrast, the U.S. experiences roughly 400–650 mass shootings annually, with more than 46,000 deaths from gun violence each year. As the graph below shows, it’s not even close.

   

2. A tragedy does not disprove the effectiveness of these laws. Data show that strict regulations reduce deaths. Beyond Australia, places like the U.K., Japan, and Canada have similarly strict gun laws and extremely low rates of mass shootings. We can also see variability within the United States. States with the most lax gun laws have the highest rates of gun violence.

3. Firearm deaths are the leading cause of death for children in the U.S., whereas in Australia, child deaths from firearms are extremely rare, with suicide and road accidents being the top causes.

While every loss of life is devastating and mourned, the scale of firearm deaths in the U.S. makes clear that the problem is far from isolated. It is systemic and ongoing. It doesn’t have to be this way. Public support for stronger gun laws is high. Polls consistently show that a large majority of Americans back measures such as universal background checks, restrictions on high-capacity magazines, and mandatory waiting periods.

What this means for you: Please donate blood. For those looking for immediate resources for helping children and youth, the National Child Traumatic Stress Network developed the following fantastic resources:

• Talking to Children about the Shooting (En Español)

• Helping Youth After Community Trauma: Tips for Educators (En Español)

Below are previous YLE posts that are as relevant today as they were before. I hope they help you feel empowered. There are solutions and paths forward.

• We can reduce gun violence in the U.S.—we’ve done hard public health things before.

• It’s hard to explain (and fix) evil—but it’s not mental illness. Focusing solely on it largely avoids confronting the real, more complicated causes.

• Firearms: What you can do right now—there’s a lot.

• Epidemiology of mass shootings—you’ll notice these tragedies follow some, but not all, patterns of previous school mass shootings.

Infectious disease “weather” report

It’s officially respiratory season: the percentage of physician visits chalked up to coughs, fevers, and sore throats—also called influenza-like illness (ILI)—has passed 3% and continues to rise quickly.

Right now, rates are uneven across the country: some states remain green, reflecting minimal activity, while others are already lighting up red, signaling high levels. Before long, the entire map will be red and purple.

For flu, specifically, we’re seeing this increase first among younger populations, especially school-aged children. Soon these illnesses will spread to older adults as well. CDC estimates there have already been at least 2.9 million illnesses this year and 30,000 hospitalizations. By the end of the season, we can expect roughly 15% of Americans to get the flu.

Tragically, the first pediatric flu death was reported for the 2025-2026 season. I expect many more, given that flu vaccination rates are the lowest they’ve been in decades. Since 2004, we’ve seen an increase in the number of deaths year over year. Last year was a record year for pediatric deaths. Most children who died were not vaccinated.

Covid-19 remains low nationally, but it doesn’t look like this will continue for long. Cases in the Northeast and Midwest are increasing quickly. The South is inching upwards as well. (See your local wastewater trends here.)

We’ll see where this takes us, but given that we had a mild Covid-19 winter and summer, there are a lot of people out there susceptible to infection. Trends are still hard to predict, given this is a relatively new virus: we could see a large wave or smaller and smaller waves, with Covid-19 becoming the common cold. Time will tell.

What this means for you: All of these trends will only intensify with holiday gatherings, as mixing of households and social networks creates more pathways for viruses to travel. Wearing a mask in crowded indoor spaces helps reduce disruptions in your life. Testing is useful, though for mild illness, it rarely matters which virus you have—except for high-risk individuals, for whom results could guide antiviral treatment. Stay home until symptoms improve to protect others and prevent further spread.

Measles outbreaks continue to march on with 1,926 cases this year. Word on the street is that the U.S. will also lose the WHO measles elimination status early next year.

Two outbreaks continue to grow quickly:

• South Carolina: This outbreak is growing exponentially, with Spartanburg County remaining the epicenter with 126 cases. Fifteen new cases were reported last week, mostly household transmission. Currently, 254 children are in quarantine at 11 schools, missing 21 days of school for an easily preventable disease.

• Utah/Arizona: 291 cases with ongoing transmission spreading through Utah and Mohave County, Arizona.

What this means for you: If you’re near a measles outbreak, follow guidance from your local public health department. Children under 12 months can get MMR as early as 6 months old, and families up to date on vaccinations are protected.

Alright, I need some hope… and help.

Simply making it through this year is an accomplishment. Still, even through the fog, there have been wins and moments of good news, and I truly believe we need to hold onto them to keep hope and joy alive.

Every year, I collect public health victories to mark the close of the year, and I’m not stopping now. I’d love your help. What’s your favorite piece of public health good news or biggest win this year? It can be local, national, or global. Share it in the comments, and I’ll try to include some in the final 2025 accomplishments report.

Bottom line

This week, as respiratory illnesses rise and outbreaks continue, and as our communities are shaken by yet more mass shootings, taking small but meaningful actions—masking in crowds, staying home when sick, staying up to date on vaccines, and advocating for safer environments—can help protect the people we care about.

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 below:

Subscribe now

The administration has a new crush on Denmark’s routine vaccination schedule, flu is taking off, fall vaccination rates are doing a concerning slow crawl, and a gut-punch report covers how deportation fears are hurting kids’ health. Also: make sure to download the pre-RFK routine childhood vaccination schedule below.

Here’s your quick health briefing to start the week informed, prepared, and maybe a little more fired up than you expected.

And yes, YLE is building an AI model (because who isn’t these days) and would love your input. See more at the bottom!

Two things for your ACIP hangover

Three days later, I’m still reeling from that ACIP meeting. (Read our debrief here.) And from the reactions that followed, like the “mission accomplished” tweet from Robert Malone (yes, the anti-vaxxer now sitting on ACIP), and Trump’s call to “fast track” changes to the childhood vaccination schedules to align with other countries. Denmark, in particular, was repeatedly brought up during the meeting.

Two things are now at the top of my mind:

1. Download the pre–RFK Jr. routine childhood vaccination schedule. My sister asked me for this, so I figured you and your family may want it too. Stick to this as best you can; more changes are likely coming. Here is the schedule before RFK started messing with it:

0 18yrs Child Combined Schedule

386KB ∙ PDF file

Download

Download

2. Remember: the U.S. is not Denmark. Our health system, population, and infrastructure differ in ways that matter when people suggest simply “copying” another country’s routine vaccination schedule. Roughly 80% of health outcomes are shaped by socioeconomic, environmental, and behavioral factors—not just medical interventions. And many of these factors are subpar in the U.S. I wrote about this in the context of Covid-19 vaccines a few years ago, and the same logic applies to routine childhood vaccinations.

Infectious disease “weather” report

The percentage of people with coughs, fevers, and sore throats—what epidemiologists call influenza-like illness—is rising sharply. Rates just crossed the epidemic threshold for the season, though a bit later than usual.

This is when I start masking in crowded indoor spaces like airports. Yes, well-fitted masks work. This is a physics question with a clear answer. And I’ll take all the protection I can get—I’d love to not miss upcoming school performances, work travel, and some fun family events.

Right now, the common cold is still driving most of the stuffy noses, though it’s starting to decline. Flu is taking off, although not more than usual. (We still have our eyes on this new flu strain. It’s really impacting the UK right now.) Covid-19 levels are stalled at low levels for now.

RSV is still struggling to take off this year, which is good news for babies and pediatric hospitals. We don’t yet know whether it’s simply delayed, inherently weaker, being crowded out by flu, or reflecting increased protection from pregnancy vaccination and infant monoclonal antibodies. Nonetheless, we’ll celebrate this quiet season.

Covid-19 and flu vaccination rates: It’s not looking good, folks

CDC has finally begun publishing vaccination data for this season. I trust this information because the states manage it, and I know many of the CDC scientists who collate and review it—they would flag any changes made for ideological reasons. Although the data is about two months late, it should now be updated every Wednesday. Here’s what we’re seeing.

Covid-19 vaccination rates are down 21–39% compared to last year. Specifically:

• 5.7% of children are vaccinated compared to 9.3% this time last year

• 14.7% of adults are vaccinated this year compared to 18.6% this time last year

I’m especially worried about older adults. Only 32% of people 65+ have received the new Covid-19 vaccine—a 20% drop from last year. For comparison, the U.K. is at 61% for this age group.

This is our most vulnerable population. As people age, their immune systems don’t “remember” viruses as efficiently. This is due to a combination of factors, including a higher prevalence of chronic conditions and waning immune memory—both antibody levels and T cell responses.

Flu vaccination rates for children continue to slide. Since 2019, pediatric vaccination has fallen in a steady, stepwise pattern, and this year looks particularly concerning, with only 35.8% of children vaccinated—a 23% drop compared to 2019 at the same time.

Adult vaccination rates are largely unchanged from previous years—still below the Healthy People 2030 target of 70%, but not showing additional decline.

These disappointing numbers aren’t surprising. It’s been a rocky year for vaccines given federal disarray, confusing and changing eligibility communications from RFK Jr.’s CDC, a lack of federal vaccination campaigns, waning concern about Covid-19, and lower circulating virus levels, all of which add up to reduced urgency and low uptake.

What this means for you: With low vaccination coverage now, we could be facing a more severe hospitalization season as winter transmission ramps up. Get vaccinated. It’s not too late.

A devastating new report on immigrant family health

A new report from Migrant Clinicians Network and Physicians for Human Rights shows how deportation fears are shaping health behaviors. The findings are heartbreaking and entirely preventable.

This chilling effect is well documented: fear of deportation or legal consequences keeps families from seeking care. But now we are seeing it in real time at a massive scale: 84% of surveyed health care workers report significant or moderate decreases in patient visits since January 2025 executive orders on immigration.

Specifically:

• Families are declining surgeries, ER visits, and specialty care. A California physician reported: “I have had multiple parents decline visits with specialists, including delaying surgery, because of the fear of immigration enforcement in the destination city or on the way there.”

• Kids are afraid to play outside. One physician in Massachusetts described this: “I have pediatric patients that are flagging in the obese range for weight and when we talk about playing in parks and getting other forms of exercise the parents note that they are not leaving their apartments for fear of encountering ICE. Their children suffer the double trauma of fear of family separation and immigration enforcement as well as lacking a safe place to play and exercise and other healthy outlets for children.”

• Children, some as young as six, are showing up to clinics alone, carrying anxiety and trauma. A physician from Illinois noted “children coming to ED by themselves as parents await outside.”

• Families are avoiding insurance or SNAP renewal, viewing it as a “trap.” One community health worker in North Carolina stated: “We are increasingly alarmed that the children of immigrants may soon lose access to vital programs like SNAP and Medicaid, not because they are ineligible, but because their parents are being targeted and surveilled when attempting to complete these applications on their behalf.”

What this means for you: There’s a lot that we can all do, including educators and clinicians, to support the needs of these children. See a helpful list here.

In case you missed it

• There have been changes to the Hep B vaccine recommendations, and not for the better. Read more here:

  • YLE pre-bunk.

  • The Evidence Collective (TEC) fact check.

  • Katelyn’s takeaways.

• Marisa over at YLE New York covered a lot, but the most exciting news: New York City just beat its own life expectancy goal, 5 years early! Read about it here.

• Matt over at YLE California covered how San Francisco is taking on the nation’s first lawsuit against major food manufacturers over ultra-processed foods (UPFs). Read about it here.

Develop a better health chatbot with YLE

YLE has partnered with Dewey, an organization that creates search and Q&A tools from searchable libraries of information. Together, we’re training a chatbot on all YLE content so your questions can be answered faster and more reliably.

We need your help! We want the YLE community to test, shape, and refine the chatbot. Curious? Please fill out this short survey to get involved and help make the chatbot as useful and accurate as possible.

Bottom line

A lot is shifting fast—from vaccines to virus trends to families avoiding care—but staying informed, getting vaccinated, and showing up for one another is how we keep our communities safer this winter.

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 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.

Subscribe now

Here are a few things that might help you survive the holiday: viral updates, food safety tips (yes, bird flu is hitting turkeys), navigating tricky conversations, and a poll for the most important debate of the season: store-bought or homemade cranberry sauce.

We also touch on the opioid settlement, which sends $7 billion to communities, the Department of Education removing public health degrees from “professional” status, and, as always, some great scientific news.

Infectious disease “weather report”

Colds, fevers, and coughs (also known as influenza-like illnesses, or ILI) are just getting started and haven’t reached the epidemic threshold. That’s great news heading into Thanksgiving, as there’s simply less circulating illness than in previous years, which means a lower chance of getting sick and fewer last-minute cancellations at your table.

Covid-19 levels remain very low nationally. I expect activity to pick up soon and peak around January.

RSV is rising rapidly, so for infants, it’s best not to pass them from person to person during the holiday. If the mom got the RSV vaccine during pregnancy or the infant received the monoclonal antibody, they are incredibly well protected, and I wouldn’t think twice about it.

Norovirus—the nasty, highly contagious stomach bug that causes vomiting and diarrhea—is rising across all U.S. regions, with the South hit hardest. On average, one infected person can spread it to 2–7 others. It’s a common foodborne illness. So, if you have symptoms (or recently recovered, since you can still spread it for days after they fade), avoid preparing food or drinks for others. Wash your hands thoroughly (30 seconds with soap and water) and clean bathrooms frequently with bleach-based products. Hand sanitizer won’t work against this one.

More Thanksgiving survival tips: Health + family edition

We often say “public health is everything”—and yes, that includes what happens around the Thanksgiving table. Here are a few public health tips.

Hard topics. You may not see eye to eye with relatives on what’s happening in the world (and there’s… a lot happening). Thinking Is Power shared eight tips for approaching conversations:

1. Never mock or judge. Defensiveness shuts things down.

2. Don’t make it personal. Address the belief, not the believer.

3. Find common ground. Shared values build connection.

4. Work together. Explore the idea collaboratively.

5. Ask, don’t tell. Curiosity opens dialogue.

6. Lead by example. Model the tone you want.

7. Focus on why, not what. How people form beliefs matters.

8. Know when to walk away.

If vaccines come up, keep these in your back pocket:

• The vast majority of people (80-90%) support routine vaccinations.

• Hesitancy is a spectrum. Only a tiny fraction are true deniers (e.g., those who believe vaccines contain 5G chips). Don’t assume the extreme if they have doubts or questions.

• Separate Covid vaccine conversations from routine childhood vaccination conversations. There are a lot of feelings around Covid-19 vaccines that we don’t want bleeding into other vaccines.

• Avoid the words “misinformation” or “mandate”—both trigger strong reactions for ~50% of the country. Try “falsehoods,” “rumors,” or “school requirements.”

• Remember, you will not change someone’s mind in one conversation. The goal is to set new foundations of trust so they keep coming back with curiosity and being met with empathy.

Our friends at Unbiased Science put together a crash course on how to handle some of this year’s controversial topics (think seed oils, vaccines and autism, conspiracy theories.) Check it out here.

Food availability and safety. Bird flu (H5N1) has taken out nearly 2 million turkeys since September 1. While this happens every year—bird flu spreads two times faster in turkeys than in chickens—it has started earlier than expected. This shouldn’t impact supply.

Can you get bird flu from eating turkey? There have been no reported human cases of bird flu in the U.S. linked to handling raw food from the grocery store. Regardless, remember to cook turkey to an internal temperature of 165°F to kill bacteria and inactivate viruses.

Opioid settlement: $7B for communities in need

Last week, a judge ruled that $7 billion from the Sackler family fortune will flow to communities across the nation to help fund solutions to the opioid crisis. The Sacklers, who owned Purdue Pharma, had aggressively marketed prescription opioids while denying their addictive properties to maximize profits. This decision represents justice that hits home for a lot of people who lost loved ones to this epidemic.

One of those families was in Marin County, CA, where Matt Willis—YLE correspondent—served as public health officer. Matt, take it from here:

During my first week as public health officer in Marin County in 2013, I met a father whose son died from an overdose of a prescription painkiller. The young man was at a party in his first year of college, took two pills, and never woke up. That conversation helped open my eyes to the local toll of this crisis. Working with other impacted families, we formed OD Free Marin, a county-wide initiative to tackle the opioid crisis.

Eight years later, I was invited to Washington, D.C. to share our local experience with federal judges deciding how opioid settlement dollars should be spent. I shared two perspectives: as a physician, I’d been trained to treat pain as “the fifth vital sign” and address it in every visit. With the whole medical community, I was misled by manufacturers like Purdue Pharma, that opioids were effective and non-addictive, if used as directed.

As a health officer, I saw how our community was fighting the opioid battle on multiple fronts—mental health and rehabilitation services, law enforcement, health care, schools—without enough resources to address the crisis these companies created. Communities like ours were sharing approaches, proving what was possible, but needed support to scale services to match overwhelming demand.

Purdue is one of many companies being held responsible for fueling this epidemic. So far, around $50 billion has been invested back into American communities through lawsuits against familiar names like CVS, Walgreens, and Johnson & Johnson—companies that manufactured, distributed, or dispensed these medications while the crisis escalated.

The judges decided that most funds should be allocated to state and local governments for evidence-based strategies: treatment for opioid use disorder, Narcan distribution, education campaigns, youth outreach, and rehabilitation services. Ensuring these funds end up supporting opioid mitigation, and not going to fill potholes or other government priorities, is another challenge. You can track spending here.

The money flowing from this decision will ideally help fund the kind of work we began in the wake of that young man’s death: preventing more losses, supporting those at risk, and building local infrastructure to fight this crisis on all fronts. It won’t bring him back—or the more than 1 million Americans who have died from overdose since 2000—but it’s placing accountability on an industry that knowingly put profits ahead of health.

Good news

Three pieces of great news this past week:

• 86 million girls vaccinated. Vaccine alliance Gavi announced that 86 million girls in high-risk countries have received the HPV vaccine, preventing an estimated 1.4 million deaths from cervical cancer.

• Another mRNA win: better flu vaccines. Clinical trial data shows mRNA flu vaccine was 34.5% more effective than a licensed seasonal flu vaccine. Side effects were more common (e.g., fever: 5.6% vs 1.7%), but overall, this a major step forward toward better flu vaccines. The bigger question is whether people will accept mRNA platforms amid ongoing rumors and falsehoods.

• Short workouts = big benefits. New research shows short bursts of vigorous exercise are incredibly efficient for heart health—6× more effective for preventing cardiovascular disease and 9× more effective for preventing diabetes than moderate activity. If vigorous activity isn’t your thing, moderate exercise is still great. The bottom line: move your body.

Question grab bag

The government no longer considers MPH and DrPH (master of public health and doctor of public health) professional degrees. What does this mean for students and public health as a whole?

Last week, the Department of Education agreed on a draft definition of what counts as a “professional degree program” under the One Big Beautiful Bill. Several essential fields—public health, nursing, social work, physician assistant programs, and others—were removed from that list.

If this stands, students in these programs could lose access to federal financial aid. Specifically, lower borrowing limits, fewer scholarship pathways, and limited eligibility for loan-repayment programs. It will make it harder to enter these careers at the exact moment our country needs more of these professionals. The broader consequences are significant: fewer trained professionals, more barriers for students from low-income backgrounds, and added strain on already stretched health and social systems.

The Department of Education will release a formal proposal in the next few weeks, launching a 30-day public comment period. When that opens, I’ll make sure you know, because responses will matter.

Bottom line

That’s it for the week. YLE is closed until next week for the holiday and some much-needed unplugging. Grateful for all of YOU!

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 is a public health newsletter that reaches over 400,000 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.

Subscribe now

The bad news? We could be heading into a brutal flu season. The infant botulism outbreak linked to formula is climbing, and the U.S. may soon face a review of its measles elimination status, following Canada’s loss of theirs last week.

And with the gears turning again in Washington, health policy questions are back in play. One we got recently: was the Affordable Care Act ultimately helpful or hurtful? (See our answer below.) As always, we’ll end with some good news.

Infectious disease “weather report”

Every Friday, the CDC updates their “influenza-like illness” (ILI) data. This is a database where providers tally patients who presented with ILI—a fever, a cough, and/or sore throat—at their offices. So these numbers are a general indication of the climate of respiratory health in the United States.

ILI is starting to creep up (particularly in Louisiana and Southern states) but is still below the “epidemic” level threshold. (This threshold is usually when I put on my mask when I’m at airports or crowded indoor places, because I don’t have time to get sick.) In other words, things aren’t bad yet.

Flu

That said, buckle up for a potentially rough flu season. While the U.S. season is just ramping up, the U.K., Japan, and Canada are already seeing steep increases.

Why? One strain of flu—influenza A (H3N2)—mutated over the summer as it spread through the southern hemisphere. Specifically, it shifted from a J subclade to a K subclade.

Mutations are normal for the flu. In fact, the flu is infamous for quick, unpredictable curveballs. But this particular change raises concern for two significant—but not catastrophic—reasons:

1. How much it changed. Flu can change in two ways:

   1. Shift—a major overhaul that happens when two different flu viruses infect the same cell and swap genetic material, creating a new virus. This is the type of exchange that can spark pandemics because our immune systems have never seen that version of the virus before.

   2. Drift—the smaller, incremental changes that happen as the virus spreads because it can’t copy itself perfectly. This was drift—but more drift than usual. Enough to matter but not enough to trigger panic.

2. The timing. The mutation happened right before our flu season. This means our current vaccines—which were finalized back in February—will likely recognize some, but not all, of this updated virus. It’s simply bad luck that H3N2 evolved so much in the months after the vaccine formula was set.

Together, these factors mean the virus will be better at slipping past both vaccines and prior immunity. That likely translates to more cases and more severe disease among those at highest risk.

Flu doesn’t behave uniformly around the globe. One strain may dominate in one region while a different strain circulates elsewhere. So what happens abroad doesn’t always predict what happens here. However, updated CDC data shows flu activity is low but growing—and 12% of U.S. samples are this newly mutated H3N2 subclade K. In other words, the same strain behind surges in the U.K., Japan, and Canada is already taking off here, too.

But we’re far from powerless. Vaccination still matters—a lot. U.K. data shows it reduces hospitalization by 70-75% in kids and 30-40% in older adults, and it protects against other circulating flu strains. (This year’s vaccine is important enough that the U.K.’s National Health Service launched a nationwide “flu jab SOS” campaign.) We use slightly different vaccines in the U.S., so the numbers may not be quite this high, but still it will provide some protection.

What this means for you: This is the perfect time to get the flu vaccine. Also, flu tests will still be able to pick up this strain, and and if you do get sick, early antiviral treatment like Tamiflu can help reduce the number of days you’re sick.

RSV

RSV activity continues to increase among our youngest.

We’ve heard from some of you that the RSV vaccine isn’t stocked everywhere. After checking with Vaccines for Children, there are no national shortages—meaning some pediatric practices are simply under-ordering due to underestimating demand.

Covid-19

We’re in a Covid lull, which is great. Historically, Covid cases start ticking up by the end of November due to changing weather, holiday travel, and indoor gatherings.

One big question right now: are vaccine rates lower this year because of the federal disarray under RFK Jr.? Normally, we’d have clear national data by now. But the CDC website hasn’t been updated yet—I’m hoping that’s due to the government shutdown, not anything more concerning (like malice).

These numbers matter. Without them, we can’t accurately anticipate what’s coming: hospital strain, missed work, and the broader burden of a potential wave. State data give us a glimpse, though, and it’s not reassuring. New York, for example, is reporting vaccine uptake about 30% lower than this time last year.

Measles

Canada lost its WHO measles elimination status last week after the same strain circulated there for more than a year, resulting in more than 5,200 cases and 2 deaths (89% of cases are unvaccinated). This is their worst year since 1991. Losing this status means that measles is now considered “endemic;” in other words, it’s constantly spreading across the country and not due to travel. This is a concern for people who are unvaccinated, including parents of children under 12 months old, who are too young to get the vaccine.

What does this mean for the U.S.? The Pan American Health Organization—the World Health Organization’s regional office for the Americas—will review the U.S. status in January. We’ve also seen the most annual cases (1,600+) since 1990. But elimination status isn’t determined by total case count—it depends on whether a single strain spreads continuously for 12 months. In other words, it requires sustained transmission of one outbreak, not multiple separate outbreaks seeded by travel. We don’t yet know whether the U.S. meets that threshold, and I’m looking forward to seeing the PAHO’s assessment.

One interesting feature of measles is its natural pattern: it tends to surge every five years, even before vaccines existed. Are the Americas just having a bad year? Possibly, but it’s likely a mix of both a bad year and a broader problem: declining immunization rates.

A severe human case of bird flu

After nearly nine months without a human case—and with very little activity in birds—bird flu is picking up again. A person in Washington State, right along a major migratory bird pathway, has developed a severe infection. Details are still sparse, but the leading hypothesis is exposure to backyard poultry that had contact with wild birds. This is the first human case ever reported with the H5N5 strain—a different strain from H5N1, which has caused roughly 70 human cases since the beginning of last year.

If you have backyard flocks, you are at increased risk for bird flu infection, and it can be severe. Take appropriate measures, especially now that bird flu is starting to ramp up again and we really don’t want to give this virus an opportunity to jump, mutate, and create another pandemic.

Botulism outbreak update: 23 reported infant cases

More infant botulism cases linked to ByHeart formula were reported last week, bringing the national total to 23. While the company ultimately recalled all of its products, its initial response—pushing back on regulators and downplaying the evidence—badly misfired.

And the evidence was unusually clear:

• Of 85 infant botulism cases reported since August nationwide, 37 had consumed formula at some point. And 20 out of those 37 were fed ByHeart products (54%). (Since these numbers were released, 3 more cases were added to the count.) The company’s formula products account for about 1% of U.S. baby formula sales.

• A tested sample of ByHeart formula fed to one sick infant contained the botulism-causing bacteria. When rats were tested with the formula, they died several hours later.

This is the first time this bacteria has ever been detected in infant formula. Typically, infant botulism comes from environmental exposure or honey. And because symptoms can take up to 30 days to appear, epidemiologists expect the case count for this outbreak to grow. Two families have already filed lawsuits.

What this means for you:

• Stop using any ByHeart products.

• If a baby consumed a recalled product, close it, label it DO NOT USE, and keep it for 30 days. If the baby remains symptom-free, discard it.

• If the product was never opened or used, it’s safe to discard now.

• There is now an Infant Botulism Outbreak Hotline if you have questions. Call 1-833-398-2022

The communication lesson: ByHeart’s early messaging—insisting the recall was simply “out of an abundance of caution,” hinting at consumer error, and minimizing the link—created confusion, frustration, and mistrust among parents. It’s a textbook example of what not to do, and I hope it’s taught in classrooms in years to come: When the facts are pointing in one direction, denying them only deepens public concern and hurts the trust of a brand. As New York YLE Marisa wrote in her moving piece last week, infant botulism is traumatic for families. Shame and blame have no place here.

Shutdown is over, but SNAP impacts remain

The government shutdown ended with a commitment to fully fund the Supplemental Nutrition Assistance Program (SNAP) through September of 2026. That’s a welcome relief. But the disruption left wide-ranging effects that can’t be fixed with a check alone.

A clinician and YLE reader shared stories from the field highlighting how deeply SNAP supports long-term health—and how quickly progress can unravel when those benefits are interrupted.

• A 14 year-old patient had made great strides in reducing body mass index (BMI) through lifestyle changes. When SNAP benefits were cut, her family could no longer afford the healthy foods that supported those changes. The food pantry offered pastries—not what she needed—and her weight increased over the past three months.

• Others reported receiving mostly candy and processed foods during the disruption, offering calories but not nutritional value.

Bottom line: People’s trust in the safety net is ruptured, with potential long-term effects to health and disruptions to treatment plans. To be clear, food banks stepped UP during the shutdown. But sometimes, food banks and pantries can’t fully replace the choice, consistency, and nutritional quality that SNAP provides.

Good news: politics, make room for epi

Public health has often viewed politics as the third rail: Don’t touch it lest you get burned. The problem with this is that it ignores the fact that the third rail provides power to the train. I’m cheering on my fellow epidemiologists who are running for political offices, as reported in The Atlantic.

Question grab bag

I loved yours and Hayden’s piece on the “5 ways the health care system is utterly insane.” But I have a simple question: Was Obamacare helpful or hurtful?

Short answer: Both.

When Obamacare (or the Affordable Care Act), became law, it changed American health care in ways that were both dramatic but also imperfect. Millions of people gained insurance through Medicaid expansion or subsidized marketplace plans, and protections like coverage for pre-existing conditions, no lifetime limits, and free preventive care became reality for many families. Suddenly, going broke from a hospital visit was less common, and young adults could stay on their parents’ plans longer.

But the story isn’t all victory. Costs remain high for all. People in states that didn’t expand Medicaid were left behind, and navigating the system—marketplace rules, subsidies, enrollment windows—is a maze. This also didn’t touch consolidation or the underlying drivers of cost.

In short, Obamacare helped a lot, giving millions their first real protection and peace of mind, but it didn’t solve the underlying chaos of U.S. health care.

Bottom line

Enjoy the viral lull, as more will come soon!

Love,

YLE

Editor’s Note: A previous version of this article misstated the share of cases attributed to the H3N2 flu subclade K in the U.S.. It is 12%.

Your Local Epidemiologist (YLE) is founded and operated by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, wife, and mom of two little girls. YLE is a public health newsletter that reaches over 400,000 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.

In the meantime, RSV and flu are picking up speed, and a concerning infant formula recall has been linked to a rare botulism cluster, thanks to a small but mighty team in California. The FDA is expected to remove the black box warning from hormone replacement therapy—a move that’s scientifically sound but bound to spark drama from HHS. We also have new blood pressure guidelines that could make prevention a lot more personal. And amidst it all, a few more pieces of genuinely good news to end on a high note.

Let’s dive in!

Disease “weather” report: RSV and flu gaining momentum

It will take some time for the CDC data systems to ramp up again after being offline for over 40 days. For now, we’ll continue to rely on the alternative sources, such as Dr. Caitlin Rivers’ updates and the PopHive dashboards.

RSV continues to climb slowly but steadily, especially among children under five. National growth is still linear—not yet exponential—but that acceleration could occur at any time.

The flu remains relatively low but is beginning to increase, particularly among young children. As Dr. Rivers notes, “Hawaii has moved to moderate activity, Arizona has surpassed its seasonal baseline, and New York cases jumped 49% in the past week.”

U.S. childhood flu vaccination rates have dropped from 62% to 49% over the past five years. Last year saw one of the deadliest seasons on record, with 280 pediatric deaths—the highest since tracking began in 2004. About 90% of those children weren’t fully vaccinated. Our deadliest flu season came at a time of historically low vaccination rates, which can’t be a coincidence. We don’t yet know this season’s coverage, but if it falls further, we could be facing another tragic record.

Covid-19 remains in a lull, though we typically see a winter rise starting in mid-to-late November.

I’m really hoping these three viruses don’t peak simultaneously. Hospitals strain under just a bad flu season; I couldn’t imagine the “big three” all at the same time. Historically, their peaks have staggered, but given how little we truly understand about these overlapping patterns, that may have been more a matter of luck than a rule. Time will tell.

What this means for you: This is the best time to get vaccinated. It’s certainly not too late.

Infant formula outbreak and Listeria in pasta

Over the weekend, a troubling cluster of infant botulism cases was linked to ByHeart Whole Nutrition Infant Formula. Even during a government shutdown and an increasingly challenging environment, outbreak teams have been working around the clock to protect our most vulnerable.

What this is: Infant botulism is extremely rare but serious. It occurs when Clostridium botulinum spores—commonly found in soil, dust, and some foods—germinate in a baby’s intestines and release toxins that can paralyze muscles, interfere with breathing, and require intensive care. In a typical year, the U.S. sees 160–180 cases, often linked to environmental exposure or foods like honey. Even a small cluster of cases is a clear red flag.

What we know: Clostridium botulinum spores have been detected in ByHeart infant formula, resulting in the hospitalization of 13 infants across 10 states. The California Department of Public Health (CDPH) played a key role in identifying this cluster. CDPH is the only source in the world for BabyBIG—the lifesaving antitoxin—and manages all clinician calls and treatment distribution. Their team noticed a spike in requests and discovered that the affected infants all consumed the same formula brand, prompting an alert to CDC. Importantly, ByHeart produces just 1% of U.S. infant formula, so this alone is unlikely to cause a national shortage. (Be sure to sign up for YLE CA for a deeper dive this Thursday.)

What we don’t know: Epidemiologists are investigating whether contamination is truly confined to ByHeart or reflects a broader issue in the manufacturing or ingredient sourcing process.

What to do: Stop using ByHeart Whole Nutrition Infant Formula immediately. Retailers should pull it from shelves, including Amazon, Kroger, Walmart, Whole Foods, Target, and Sam’s Club.

There is also the ongoing Listeria outbreak associated with frozen pasta dishes, including some sold at Trader Joe’s and other grocery chains. We’ve covered this before, but according to the agency’s ongoing investigation, two more brands of food are linked to the outbreak. There’s a long list of recalled products you can find here. Throw out immediately.

In total, there have been 27 illnesses reported, 25 hospitalizations, and six deaths in 18 states since late September.

HRT ‘black box’ warning may be gone soon

Word is that the FDA will remove the black box warning from hormone replacement therapy (HRT) this week. (It may now be pushed back with the government reopening.) If this announcement reflects the HRT review conducted at HHS last month, it will likely be messy and riddled with inaccuracies. However, if you look at the science without the drama, removing the black label is not unreasonable.

The black box warning—the strictest warning label, meant for drugs with potentially life-threatening risks—was enacted after a 2002 Women’s Health Initiative study found increased risks of stroke and breast cancer. Since then, research has revealed crucial nuance: risks depend on timing, dose, and delivery. Starting HRT earlier, using low-dose or localized estrogen, and tailoring therapy to each woman can be both effective and safe.

What this story is really about: Menopause is universal, yet too often misunderstood. While the science continues to evolve, the major problem is that clinical practice and training have lagged far behind. Women deserve evidence-based care, informed clinicians, and the freedom to make choices rooted in both science and compassion. We are still far from what is needed for women.

New blood pressure guidelines

Major new blood pressure guidelines dropped for the first time in years.

At the center of the update is an enhanced assessment tool called the PREVENT calculator, developed by the American Heart Association. It’s designed to estimate a person’s 10-year risk of cardiovascular disease using factors like blood pressure, cholesterol, smoking, and diabetes. The model was built using data from 6.5 million U.S. adults aged 30 to 79, making it one of the most representative tools available.

Here’s what stands out:

• A new threshold for medication. The key number to watch is 7.5%. If your 10-year risk of heart disease is at or above that level, physicians are now encouraged to consider medication even if your blood pressure hovers around 130/80 mmHg. If your risk is below that, lifestyle changes, like healthy eating, exercising, and better stress management, remain the first step.

• A focus on home monitoring. The guidelines also emphasize checking blood pressure at home. Growing evidence shows that home readings may actually be more accurate predictors of long-term risk than in-office measurements. So spending $45 on an arm monitor if you have hypertension might be a great (even lifesaving!) idea.

What this means for you: This makes heart health more personalized than ever. You can calculate your own 10-year risk using the PREVENT calculator (although you will need some pretty specific numbers from your last blood panel). Regardless, aim for blood pressure readings below 130/80, and use these new tools to guide smarter—and earlier—prevention.

Good news!

Here are some of the great things worth highlighting:

• The American Academy of Pediatrics (AAP) is standing up for science. The organization filed an updated lawsuit last week against HHS Secretary Robert F. Kennedy, Jr., asking a court to disband a panel (ACIP) appointed by RFK Jr. and to overturn recent decisions made by that panel. Then, to proceed under court supervision. The legal move is a direct push to restore expert-led vaccine policymaking.

• The Vaccine Integrity Project (VIP) is stepping up on Hep B. With the next ACIP meeting coming up in early December, where the agenda will likely include the Hepatitis B vaccine for infants, the childhood vaccination schedule, and HPV—VIP, an independent group of scientists formed in response to waning trust in RFK Jr.’s ACIP, is conducting an evidence review ahead of what could be a contentious meeting. Their work helps ensure the science remains front and center.

• Vaping among youth has seen a decline; but we still have a long way to go. A new study has found that the number of U.S. teens vaping has decreased overall. That’s progress. But among those who still do it, vaping is becoming more frequent and harder to quit—signs that use is shifting from experimentation toward dependence for some. If you have a teen who vapes, check out the EX Program, which is a free, anonymous text-messaging program designed specifically for young people who vape. There’s also SmokefreeTXT for Teens.

Question grab bag: You ask, we answer!

How long does the Covid-19 vaccine last? I got mine in September, do I need to get another?

A study published last week confirmed what we’ve consistently seen: protection against Covid-19 wanes over time. A study of more than 1.8 million Americans from the previous season showed protection against infection and severe disease declined after 4-5 months. The findings underscore the benefit of getting a Covid-19 vaccine every six months, especially for adults over 65, who accounted for nearly 80% of hospitalizations in the study.

In case you missed it

• Help shape our AI + Health conversation. Thanks to everyone who responded to our survey last week! We’re running the AI and health survey to hear your thoughts on using tools like ChatGPT, Claude, Copilot, and PerplexityAI to get health information. If you missed it, take the survey here.

• New York YLE’s Marisa discussed the state reaching a historic low in youth tobacco use.

• California YLE Matt discussed the impact of ICE raids on access to healthcare.

Have a wonderful week!

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 is a public health newsletter that reaches over 400,000 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. To support the effort, subscribe or upgrade below:

Subscribe now

This week, we’re talking about falling back (literally and figuratively). From SNAP beneficiaries missing payments on November 1, to falling back on our broken health care system as open enrollment begins, to the time change messing with our health, a lot is shifting. We’re also flying a bit blind when it comes to respiratory disease data, but I’ve pieced together the best snapshot I can from different sources. There’s also always some good news to share! And, finally, we need your help: take a quick survey to help us learn how you’re using AI tools for health information.

Here we go!

From a health perspective, we’d be better off without daylight saving

Where are all my tired moms at? “Spring forward, fall back”—and children are waking up an hour earlier, of course. Over the weekend, clocks changed. This practice—a polarizing one—has been observed for over a century in an attempt to reduce energy use. In the U.S., most states follow this rule, except Arizona, Hawaii, and some territories. (Hello, Puerto Rico!)

This isn’t just annoying; there are health impacts:

• In the spring, when we lose an hour of sleep and wake up in the dark, our circadian rhythms are disrupted, making it harder to get up and function. Fatal car accidents rise by about 6%, heart attacks spike by 24%, and rates of abnormal heart rhythms and inflammation increase.

• In the fall, shorter days and reduced light exposure (sunsets are earlier) are linked to higher rates of depressive episodes.

Research shows that keeping one time year-round—either standard or daylight saving—would be healthier. Modeling studies that account for light, circadian effects, and health outcomes suggest that adopting a permanent system could prevent hundreds of thousands of strokes and lower obesity rates. While more evidence is needed, these findings give policymakers a clearer picture of what’s at stake.

Last week, a bill aiming to make daylight saving time permanent (the Sunshine Protection Act), authored by Florida U.S. Sen. Rick Scott, and backed by President Donald Trump, was blocked by Arkansas Sen. Tom Cotton. That means that, unfortunately, without Congressional approval, the 19 states that have passed laws for permanent daylight saving time cannot act.

What this means for you: The biggest health impact comes when we “spring forward.” But as you adjust to “fall back,” make time for daylight exposure during the day—it helps recalibrate your sleep and mood. (We noted how you can improve sleep by adjusting light exposure, for example, in an earlier Dose.)

What else “fell back” this weekend?

1. SNAP fell back. For the first time in history, SNAP benefits didn’t go out as scheduled. Two federal judges have since ordered the USDA to release the funds, but it’s taking time, and that uncertainty is straining families. Calls to 211 are up 97% compared to the rest of the year, according to researchers at WashU. Not all 42 million recipients receive benefits on November 1—states stagger benefits by Social Security number or first letter of the last name—so the longer the delay, the more severe the overall public health impact.

2. Falling back on broken health care. The weekend kicked off open enrollment for Obamacare (ACA), during which more than 20 million families will shop for health insurance coverage. Unfortunately, this will come with sticker shock: a ~30% price hike. The price calculations are assuming that lawmakers won’t extend tax credits. (If there is a deal from the shutdown, prices will go down, but will be higher than last year regardless.)

3. My vaccine uptake anxiety fell back. Normally, we’d have national data on flu and Covid-19 vaccination rates by now. But with the data shutdown, we’re in the dark. When I got my shots last weekend, I asked my pharmacist whether he’d seen any changes in demand. His answer: “No —actually, more people seem to be getting vaccinated this year.”

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Infectious disease “weather report:” quiet for now

I’ll be honest, we’re flying a bit blind at the national level right now when it comes to what’s spreading and how. CDC data hasn’t been updated since the shutdown, so we’re missing our usual backbone of information. In the meantime, I’ve been relying on PopHIVE, which pulls data from multiple sources—but it hasn’t been updated since last week (although I’ve heard new data is coming soon).

Here’s what we can piece together: RSV is still low but continues to increase, while flu is just getting started among kiddos.

Here’s how I got there:

• Scraping state and local health department websites. Shoutout to epidemiologist Dr. Caitlin Rivers for doing that heavy lifting; she mentioned a few places where flu cases are starting to increase.

• In Google, we’re seeing an uptick in RSV-related searches, especially in Florida, Montana, Idaho, and South Dakota. That aligns with the early signs of an RSV wave we started to see last week. Still, activity remains low overall.

• Anecdotal data. When I went to get my flu and Covid-19 shots last week, a few people in line were picking up Tamiflu—so it seems flu season might just be getting started too.

• Private data. One diagnostic tool I found is reporting their data, and it seems like the common cold is really taking the cake. However, it’s unclear to me who is being tested and whether the results are representative of the U.S. population.

• Europe. They are usually a few weeks ahead of us, and their flu season is starting to increase. They are also having a tranquil RSV season.

Overall, it’s an unusually quiet season. By now, RSV among infants is usually peaking and flu is picking up steam. Why the lull? Viral patterns depend on a complex mix of weather, humidity, human behavior, viral evolution, and unknown unknowns. In other words, we don’t really know.

What this means for you: Enjoy the lull!

Bird flu

Detections are rising across the country, and migratory birds are to blame as well as weather shifts. As the human flu starts to spread, so does flu for animals. Washington and Wisconsin have reported more than 3.5 million and nearly 2 million avian flu detections, respectively, in the past month. The most commercial flocks (12) have been affected in Minnesota.

This is expected, but the the greater the spread, the more chances there are for the virus to mutate. We haven’t seen human-to-human spread yet, but other variants like H5N2 and continued mutations in H5N1 might eventually make that possible. Unfortunately, all human reporting is currently down due to the shutdown, making it difficult to determine if there is human-to-human spread.

Good news

People STEPPING UP to fill in SNAP gaps. There isn’t anything good about nonpayment to beneficiaries, but it has been refreshing to see communities step up. Social media is filled with donation campaigns. Schools are sending announcements for food drives. More people are volunteering. As Fred Rogers said, “Look for the helpers. You will always find people who are helping.”

Obesity rates are on a steady decline. Recent results from a Gallup poll, which combined three nationally representative surveys, show that U.S. adult obesity rates continue to decline. The exploding popularity of GLP-1 drugs is part of the explanation here, but these drugs are still not available to everyone because of their relatively high price tag. Epidemiologists are still investigating the reasons behind this decline, but for now, it remains a dramatic phenomenon.

Announcement: survey on AI for health information

YLE has been thinking a lot about how AI tools are being used for health. We’re hearing from you that you’re turning to these tools with health questions, and we’ve also started exploring how AI could make it easier for you to find helpful advice on topics we cover. What we’ve learned so far is that there are some really cool things happening—and some really important questions that we want to explore together.

Our next webinar—and some upcoming posts—will dig into your questions, and ours, about how artificial intelligence is transforming the way we discover and understand health information. Think ChatGPT, Claude, Co-Pilot, PerplexityAI, Open Evidence, and more. How do these tools work on the backend? What questions should (and shouldn’t) we ask them? And most importantly, when (if ever) can we trust the answers they give?

We want to make sure this conversation is helpful to you. Please take a minute (literally) to complete this quick poll. Stay tuned for the registration link, which will be available soon (early to mid-November).

In case you missed it

• New York YLE Marisa explained what NY is doing while SNAP is in limbo.

• California YLE Matt broke down reports of recent Clade 1 mpox cases in his state.

And that’s it! You’re all caught up for the week.

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 is a public health newsletter that reaches over 400,000 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. To support the effort, subscribe or upgrade below:

Subscribe now

While diseases have been quiet (and oddly, any RFK Jr. drama, but let’s not jinx it), signs point to a ramp up. RSV is on the rise, and SNAP benefits are set to expire November 1, putting millions of families at risk. You may also see headlines about monkeypox, but your risk remains extremely low. And yes, there’s plenty of good news, too.

Here’s what you need to know to stay ahead.

RSV season is here, while other respiratory viruses remain low.

After an unusually quiet October for respiratory viruses, an RSV wave is starting to take hold. Flu remains remarkably low, and Covid-19 transmission is at one of the lowest points we’ve seen in months.

Although CDC data remain paused because of the federal government shutdown, emergency department records compiled by PopHIVE show RSV activity is starting to climb, especially among children under four. This follows a familiar pattern: the virus first hits the youngest children (particularly those under one year) before spreading to adults, often about a month later.

• Data pro tip: Don’t rely on wastewater yet to gauge RSV spread—infants wear diapers, so RSV trends appear much later in wastewater data.

RSV places a massive burden on families and health systems every year. The youngest children are hit hardest—about five in every 1,000 kids under five are hospitalized each year, a rate much higher than for flu or Covid-19. The younger the child, the greater the risk, as tiny airways struggle to move air when inflamed.

RSV burden tends to be less severe for adults, but it can still cause serious illness for those with weakened immune systems or underlying heart or lung conditions.

Each year in the U.S., RSV is responsible for an estimated:

• 3.6-6.5 million outpatient visits

• 190,000-350,000 hospitalizations

• 10,000-23,000 deaths

The great news: we have several effective options for protection, something scientists have been working toward since the 1960s. It’s not too late to get vaccinated. Monoclonal antibodies (for infants) work essentially immediately, and the vaccines take about two weeks to take hold.

Quick RSV FAQ:

• How contagious is RSV? Each infected person spreads RSV to about three others (R₀ ≈ 3). So it’s less contagious than Covid-19, but more than flu.

• How is it spread? Mainly through the air via the nose, so masking could help you, but unfortunately, it’s pretty inevitable for infants.

• When are people contagious? Usually for about a week. People can be contagious a day or two before they start showing signs.

• Is there an RSV test? Yes. There’s also one at-home test that distinguishes between flu, RSV, and Covid-19, though it requires mailing a sample to a lab. The recommendations are generally the same for most respiratory viruses, though: Rest, hydrate, and reach out to your healthcare provider for guidance.

• Is there treatment? There’s no specific antiviral medication for RSV. Care focuses on symptom relief, like oxygen therapy in severe cases.

• How long is someone protected after infection? Not long. RSV is adept at evading immunity, so reinfections are common, even within a single season. One long-term study found children didn’t experience milder cases until their third RSV infection. In adults, repeat infections tend to be milder until older age.

• Should I worry about Guillain-Barré Syndrome from the older adult vaccine? There is a small but real safety signal for Guillain-Barré Syndrome (GBS)—about 10 additional cases per 1 million doses of Pfizer and GSK vaccines. This risk has not been observed with Moderna’s RSV vaccine (mRESVIA). For most, the benefits of vaccination far outweigh the risks, but it’s always worth discussing with your doctor.

Measles continues to do what it does best: find unvaccinated pockets of people. The national counts exceeded 1,600 last week, the highest count in more than 30 years. There are three active outbreaks: Utah/Arizona, South Carolina, and Minnesota. All are among communities with low vaccination levels.

Mpox (or monkeypox). Two years after the U.S. declared the emergency over, you may start seeing headlines again. That’s because three unrelated, severe cases of a different strain—called Clade 1—recently appeared in California. Epidemiologists are paying close attention, as these cases suggest community spread (not linked to travel to Africa), something the U.S. has never seen before. This strain has generally been rare and quiet in Africa, but it’s begun spreading more rapidly. In the U.S., the details of the three cases are surprisingly sparse, but they were adults and are recovering. Your risk remains extremely low.

SNAP benefits expire November 1. How can we help our neighbors?

A major deadline looms this week: Supplemental Nutrition Assistance Program (SNAP) benefits are set to expire on November 1. A default on SNAP has never happened before. The $8 billion needed to keep the program running in November has yet to be secured, and the federal government has already notified states that next month’s benefits cannot be issued.

If the government doesn’t act, the fallout will be a significant public health challenge. More than 40 million low-income Americans (1 in 8 households) would lose funds they rely on to buy food, an average of $190 per person per month. Grocery stores would feel it too, facing both lost sales and frustrated customers.

The impact will go far beyond food, too. A 2015 study found that SNAP benefits create ripple effects across the economy, allowing families to pay rent, keep their cars, and cover other essentials—often the very things people sacrifice when food runs short. SNAP helps people move out of poverty.

Here are some ways to help your community, as outlined by Dr. Liz Marnik:

• Donate money to your local food pantry. Every bit adds up.

• Organize a food drive at your work, school, or other community location. Be sure to connect to your local pantry to find out what food items they actually need and can accept.

• Make a meal and deliver it to a family you know is in need.

• Ask your child’s school if you can drop off extra snacks (if they don’t already provide free breakfasts and lunches).

• Volunteer to cook for/at a local community meal.

• Call your representatives and urge them to act on health care and food access. Here’s our guide to building relationships with your representatives.

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Good news

• Peanut allergies are on the decline! For years, pediatric guidance advised delaying exposure to common allergens like peanuts until a landmark 2015 study showed that introducing peanut products to babies could reduce their risk of developing an allergy by 80%. By 2017, this approach became official guidance, and it worked! Now, a new study finds food allergy rates have dropped by 36%, primarily driven by a 43% decrease in peanut allergies. Cheers to more kids enjoying PB&Js safely!

• Filling in federal holes. A new publication, NEJM Evidence, will start sharing notes from the public health front lines. For decades, CDC’s Morbidity and Mortality Weekly Report (MMWR) has been the nation’s go-to source for data-driven updates on outbreaks and other public health issues. But after recent layoffs (and some rehiring) amid political turmoil, its capacity is uncertain, and trust in the administration is shaky. NEJM Evidence is welcome news for local and state health departments, ensuring critical, uncensored information continues to be shared even as the federal system struggles. Unfortunately, CDC scientists still face restrictions on publishing there; they need administrative clearance.

• Scientists discovered how mRNA vaccines help take down tumors. Researchers from multiple academic medical centers have identified a mysterious, potentially life-saving mechanism in cancer treatment: Covid-19 mRNA vaccines. Patients who got one within 100 days of starting cancer immunotherapy survived much longer than those who didn’t (37.3 months with recent vaccine vs. 20.6 months without vaccine). This was even true for those with very advanced cancers with poor prognoses, and after correcting for a bunch of other factors (39!) that could explain the effect. If this holds, we could vastly increase access and reduce the cost of treatment using something that’s been shown to be safe in billions of people.

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In case you missed it

• YLE New York covered city-owned grocery stores last week and what it means for the NYC election.

• YLE California was off last week, but Matt will catch you up this Thursday on a lot happening in the Golden State.

• Over the weekend, Joe Rogan claimed that measles was something “everyone got” as kids—you’d feel sick for a few days, then have lifelong immunity—and that people are exaggerating its dangers. I think he’s mixing it up with chicken pox, but either way, here’s a YLE deep dive into the history of measles.

Have a wonderful fall week! I hope it’s filled with a lot of cute ghosts and witches.

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 is a public health newsletter that reaches over 390,000 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. To support the effort, subscribe or upgrade below:

Subscribe now