Measles record (and hot questions), foodborne illness summer, Covid-19 summer wave, and more
The Dose (July 28)
Well, folks, it sure feels like we’ve entered a new phase of health status in the U.S.
It’s hard to keep track of what food is safe to eat and where. (It’s also expensive to eat, and 4 million Americans are losing access to food.) We also just hit a measles record, which means more medical bills are piling up and more kids are missing school. The milestone is prompting a whole lot of great questions on Twitter, from whether this is caused by illegal immigrants to what would have happened if Kamala Harris was president.
But there is good news: There are things we can do. From individual actions, like the first people volunteering for an Ebola vaccine clinical trial just because they care, to the effort of many public health workers to slow down the explosive diarrhea outbreak.
Here’s your “disease weather report” and what it means for you.
Foodborne illness summer may be slowing
Cyclosporiasis cases keep adding up, with states tallying over 14,000 suspected cases. This is an insane number of cases compared to previous years, when we would see 3,000-4,000 cases annually. (But still lower risk compared to other bugs that give you diarrhea, like norovirus).
FDA is investigating six outbreaks. They haven’t said why they know all these outbreaks are separate, but my hunch is genetic testing. Through DNA, you can tell if parasites are related or not. This is what we know:
By far, the biggest outbreak is tied to iceberg lettuce. This has confirmed cases across 9 states, but the recall covers 28 states after checking shipments.
The other Cyclospora outbreaks are much murkier. FDA is doing traceback analyses (looking at receipts, etc.) to figure out what food is causing it and where. We don’t know anything other than one outbreak has at least 72 confirmed cases. I would expect more recalls.
North Carolina has racked up 561 cyclosporiasis cases. State officials say parsley and cilantro (and lettuce) keep showing up in patient interviews, but haven’t recalled anything yet.
I believe we are going to see a national downtrend soon. The largest outbreak is being caused by lettuce. And there’s only so long that lettuce is good for. It’s hard to see where we are in the outbreak, though, because data are imperfect. Case data are very sensitive to who is testing and how. For example, there are so many cases in Michigan that some hospital systems have run out of testing supplies. This has created a backlog, so several hospitals are now only testing the most high-risk patients who are hospitalized or have weak immune systems so they can get treatment.
But, lab test positivity rates are falling even though testing is still focused on high-risk people—which should be positivity keeping rates high—so the real decline may be even bigger than the numbers suggest. This is still preliminary data, but a hopeful sign we are turning a corner.
What this means for you: We aren’t out of the woods yet. If you’re in the 27 states (see map below because it’s almost impossible to keep track), continue to avoid iceberg lettuce. There may be more recalls soon as answers hopefully come with the other outbreaks.
There’s also a Salmonella outbreak tied to more than 19 million white and brown cage-free eggs. Nearly 100 people are sick, and 26 hospitalized. Midwest Poultry Services recalled more than a million cartons sold at Kroger, Brookshire’s, and smaller grocery stores in Texas, Louisiana, Oklahoma, Arkansas, Mississippi, and New Mexico.
What this means for you: If you are in one of these states, check your fridge. Toss any carton with plant code P-1950 or 0840962 and a Julian date between 157 and 184 (best-by dates July 20 through Aug. 17).
Covid-19 cases are very low, but rising
We are slipping into a summer Covid-19 wave. Levels are still very low in absolute terms, but they’re climbing across all metrics. The West is the leader, but emergency department rates are climbing almost everywhere.
For the last two summers, the summer Covid-19 wave has outpaced the winter one. Given how small this past winter’s bump was, that bar won’t be hard to clear again. Whether Covid is becoming a summer virus is a fascinating, still-unanswered question.
In the spring, an external FDA committee recommended a new 2026-2027 vaccine formulation for the Covid-19 vaccine. It’s supposed to be available as early as mid-August. News around this has been surprisingly quiet.
What this means for you: If you’re over 65 and never got your spring Covid-19 vaccine, the time is now. I wouldn’t wait for the updated fall vaccine. You can get this before the winter wave, which is usually in November.
Measles hits a 35-year record
The U.S. reached 2,318 cases this year, which is a 35-year record, with five months still left to go in the year. This total has been driven by 35 separate outbreaks (defined as 3 or more cases), but most cases come from a spillover outbreak from last year in South Carolina as well as ongoing spread in Utah this year.
Sure, compared to other countries, this case count isn’t that bad. Canada and Mexico’s tallies are much higher. And, thankfully, no one has died this year in the U.S. (which is lucky, as we would have expected 2-3 deaths by now). But health isn’t just about life and death.
Those 2,318 cases mean:
151 hospitalizations
~44,300 school days missed1
Many losing immunity to other viruses
~2 kids with permanent hearing loss
~1 kid will die in 10 years from brain disease
$204 million in costs
All of this is preventable. This signal measles is sending us is big: the U.S. is moving backward in health, not forward.
What this means for you: If you’re up to date on vaccines, you are very well protected. Ninety-three percent of cases are among the unvaccinated.
Spotlight: Measles questions
I posted about measles on Twitter yesterday, and got so many hot questions. Some are hostile, some are genuinely curious, and some (I think most) are a mix. Here are the top three questions answered, because you’re likely seeing them (or curious about them) too:
Wouldn’t we have the same number of measles cases right now if Kamala Harris was president? Yes, I think so. The unvaccinated people getting infected right now made their decisions to not vaccinate years ago, not because RFK is the Health Secretary. But in the next couple of years, it will matter.
Isn’t this due to illegal immigrants? This is a common perception, but data show us that 3 in 4 index measles cases are U.S. citizens who travel abroad and bring it back to their community, and then it spreads like wildfire. Those pockets are getting bigger. Here’s a previous YLE deep dive on that.
If you really cared about this, you’d be trying to understand why measles is rising around the world, not just in the U.S. I actually spend a lot of time thinking about this. I think it’s due to the combination of general amnesia (vaccines are a victim of their own success), low trust in institutions and governments, the information landscape, increasing income disparities, and many other factors.
Question grab bag: Wildfire smoke
“Did the wildfire smoke (which got up to the hazardous category) harm the greens in our garden? Are they still edible? Sure would like your advice!”
Wildfire smoke is mostly particulates; the gases don’t linger. So the real concern is deposition onto garden greens, which washes off fairly easily. Since Canada’s wildfire was pure wildfire smoke, it didn’t stick around.
Urban wildfires are a different story, though, like the one in Los Angeles last year. Those burn buildings, cars, and other materials, so the smoke carries heavy metals. Studies after the L.A. fires actually found the soil enriched with metals, which can then be taken up by plants.
Good news
First person gets new experimental vaccine for Ebola. A group of 50 healthy volunteers is testing the new Ebola vaccine being developed in the U.K. The strain causing the outbreak in the D.R.C. is resistant to previously developed vaccines and treatments, so new versions are quickly being created to try to stop the outbreak.
The first person to participate in this trial told BBC what motivated him: “I had wanted to volunteer for the Covid vaccine trial but was unable to because of work commitments. After seeing news from DR Congo I thought I’d like to do my bit.” Which just makes me smile.
El Salvador eliminates trachoma as a public health problem. Trachoma is the most common cause of infectious blindness, and it is heavily associated with poverty and lack of access to basic health services. El Salvador is the first country in Central America and the second country in the Americas to eliminate it. (WHO)
Bottom line
We may be entering a new phase for health in the U.S., which is extremely disappointing, but there are things each of us can do to keep ourselves, our family, and our community healthy.
Love, YLE
Your Local Epidemiologist (YLE) comprises a team of experts, ranging from physicians to immunologists to epidemiologists to nutritionists, working together with one goal: to “translate” ever-evolving public health science so that people are well-equipped to make evidence-based decisions. The YLE suite of newsletters reaches over 475,000 people across more than 132 countries. This newsletter is free to everyone, thanks to the generous support of fellow YLE community members. To support the effort, subscribe or upgrade below:
I estimated school days missed by combining two groups: the ~1,136 school-age cases (49% of 2,318) each missing roughly 6 school days of illness/isolation per CDC exclusion guidance, plus an estimated 3 unvaccinated, non-immune classroom contacts quarantined per case (per CDC/state guidance requiring 21-day exclusion for exposed contacts without evidence of immunity) missing roughly 11 school days each — totaling roughly 44,300 school days.
With all the vague statements from FDA/CDC/etc. and almost zero mention of ongoing testing and the results being the norm, how will the average consumer know when it will be safe to eat leafy greens from major retailers or have a sandwich with lettuce?
Right now YLE is teh only organization I actually trust to provide the truth
I am so sorry that people have been hostile toward you. You provide so much valuable information and are an incredible example of what is needed in this country.🥳