Feeling under the weather? Local health officials are tracking a variety of viruses making rounds in the community right now.
Here's what to know about outbreaks of norovirus, bird flu, COVID, and other current illnesses:
Norovirus
Nearly 150 people in shelters due the Camp Fire in California became sick with symptoms of norovirus, an easily spread gastrointestinal illness.
A common stomach bug is surging, according to new data from the US Centers for Disease Control and Prevention.
In the week of December 5, there were 91 outbreaks of norovirus reported, up from 69 the previous week. In the same period in recent years, there generally were 65 or less outbreaks per week. (It might not seem like a lot, but many more cases probably go unreported.)
To help with these questions, I spoke with CNN wellness expert Dr. Leana Wen. Wen is an emergency physician and clinical associate professor at George Washington University. She previously was Baltimore’s health commissioner, with responsibilities that included overseeing infectious diseases as well as food safety.
What exactly is norovirus?
Dr. Leana Wen: Norovirus is the leading cause of foodborne illness in the US. According to the CDC, it is responsible for 19 million to 21 million illnesses every year. It results in over 2.2 million outpatient medical visits, 465,000 emergency department visits and 109,000 hospitalizations.
Also sometimes called the Norwalk virus or winter vomiting bug, norovirus is an extremely contagious virus. It is a common cause of illness outbreaks on cruise ships, where more than 90% of diarrheal illnesses are attributed to this virus. It also causes outbreaks in schools, day care centers, jails and other settings where individuals come into proximity with others.
Norovirus can be spread through direct contact with an infected person or through contaminated surfaces. If you share food or drink or utensils with an infected person, you could pick up the virus. You could also contract it by touching a surface that an infected person touched and then touching your mouth. In addition, the virus could be transmitted through tiny drops of vomit or fecal material that splatter onto surfaces.
Symptoms of norovirus include nausea, vomiting, diarrhea and stomach cramps. Some people may also experience fatigue, low-grade fever, chills, headaches and muscle aches.
It’s common for people to go from feeling well to suddenly having gastrointestinal symptoms. These symptoms can be unnerving and unpleasant.
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The good news is that most people improve within one to two days and recover completely, with no long-term health effects. There are, though, some people who become severely ill from norovirus, usually because they are unable to keep down fluids and become very dehydrated.
What should people do if they think they may have it?
Wen: There is no specific treatment for norovirus. As this is a virus, antibiotics that target bacteria won’t work. There is no directed antiviral against the norovirus, nor is there an approved vaccine to prevent it.
Most people will recover without medical intervention. The key is to try to keep down fluids to prevent dehydration, which can be a common side effect. Adults should drink water and most other fluids, including juice and sports drinks. Children can benefit from Pedialyte and other similar electrolyte solutions that are specifically formulated for kids with vomiting and diarrhea. Nursing moms should continue breastfeeding, even if they or their kids are experiencing gastrointestinal symptoms.
At what point should people go to the doctor?
Wen: People should contact their doctor if they have specific concerning symptoms, if they cannot keep up hydration, and if they are especially vulnerable to severe illness.
Those with typical norovirus symptoms can generally let the illness run its course. However, if they have blood in the stool, high fevers, shortness of breath or other unusual symptoms, they should consider consulting a medical professional — since what they have may not be norovirus. Those with norovirus should start feeling better in a couple of days after symptoms begin. If symptoms don’t improve, that’s another reason to visit the doctor.
In addition, it’s crucial to keep up hydration. If someone is vomiting so much that they are unable to keep down fluids, they should also see a health care professional. Families with babies who are no longer making the same number of wet diapers should also call their clinician.
Those who are especially vulnerable should have a lower threshold for contacting their health care provider. This includes babies and young children, older individuals and people with serious underlying medical conditions such as having kidney or heart disease and being immunocompromised. They may need a clinician to keep an extra close watch on them during their illness.
What food safety tips can reduce the risk of spreading norovirus?
Wen: People who have symptoms of vomiting, diarrhea and stomach cramping should not be preparing food. They shouldn’t handle food or plates or utensils for others until at least two days after their symptoms subside.
It’s also a good idea to wash your hands before eating. You may have touched a doorknob, elevator button, serving spoon or some other surface that an infected person touched.
If someone in the household has norovirus, be aware that the virus can spread easily through the family. Everyone should regularly wash their hands well with soap and water, especially before eating and after using the bathroom. Infected surfaces can be cleaned with solutions containing bleach to kill the virus.
In addition, be aware that there are other foodborne illnesses, too, such as E. coli, salmonella and listeria. There are additional precautions that can prevent the spread of these illnesses, too.
Don’t drink raw milk or eat raw or undercooked meat. Use an internal thermometer and make sure that what you are cooking reaches the recommended temperature.
Don’t eat perishable food that has been left out for more than two hours. Be sure to wash vegetables and fruits well and keep them separated from raw meat.
Everyone preparing or serving food should wash their hands well. Do not prepare food or share meals with people while having gastrointestinal symptoms. If everyone practices good hand hygiene with frequent handwashing — and using hand sanitizer when running water isn’t easily accessible — we could reduce the chance of contracting and spreading norovirus and other gastrointestinal illnesses.
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COVID-19
After a relatively slow start to the respiratory virus season, Covid-19 levels in the United States began ramping up just ahead of the winter holidays.
In previous years, Covid-19 levels have typically started to rise in early November and reach their seasonal peak by the end of December. But this year, levels were nearly the lowest they’ve ever been through October and all of November, according to wastewater surveillance data from the US Centers for Disease Control and Prevention.
Trends started to shift in early December, though, with levels rising from low to high by the middle of the month. In the week ending December 21, there was nearly three times as much Covid-19 circulating in the US than there was during the week ending December 7, CDC data shows.
This surge happened in all regions of the country, but there has been a particularly sharp uptick in the Midwest, where Covid-19 levels are nearly twice as high as they are in other parts of the country.
Some experts worry that the rapid rise after an unusually long lull could have left many people vulnerable to disease spread at the height of the holiday season.
In a social media post in mid-December, Dr. Michael Hoerger, a researcher at the Tulane University School of Medicine, called the latest wave of Covid-19 transmission a “’silent surge,’ coming on late out of nowhere.”
Hoerger runs a Covid-19 forecasting model that pulls heavily from the CDC wastewater surveillance data, and his estimates suggest that without any testing or isolation policies in place, there was a 1 in 8 chance of Covid-19 exposure at a gathering of 10 people on Christmas Day. On a plane of more than 100 people, there was a 3 in 4 chance of exposure.
The rapid rise in cases corresponds with a newly dominant coronavirus variant called XEC.
XEC is a hybrid of two JN.1 variants, which was the Omicron subvariant that accounted for most cases during last winter’s surge, according to the CDC. Agency data shows that the XEC variant has been circulating in the US for months but overtook one of the so-called FLiRT variants – KP.3.1.1 – between the end of November and the first week of December. From December 8 to 21, XEC accounted for 45% of new cases, up from 15% of cases two months earlier.
Variants are expected as “gradual changes to the virus, known as mutations, result in new viruses that look different to your immune system,” the CDC says. But this novelty is what makes it easier for variants to escape your immunity and make you sick.
The currently circulating variants are similar enough to each other that the latest Covid-19 vaccines are still expected to be effective against severe illness or death, but vaccination rates are lagging. Only about 21% of adults and 10% of children have gotten their Covid-19 vaccine this season, according to CDC estimates.
And despite Covid-19’s slow start, the latest forecasts from the CDC’s official models predict that there could be as many hospitalizations for respiratory viruses as there were last year.
Overall, respiratory virus activity in the US is high. Flu levels had been high and rising for a few weeks before Covid-19 levels started to rise, and RSV levels are increasing, too. There were about 6 respiratory virus hospitalizations for every 100,000 people in the US during the third week of December, according to CDC data, twice as many as a month earlier.
And outbreaks of some other contagious diseases – including whooping cough and norovirus – are worse than they’ve been in more than a decade.
Norovirus is a common and very contagious virus that causes gastrointestinal symptoms. There have been nearly 500 outbreaks reported since August, according to CDC surveillance systems, a third more than this time last year.
Whooping cough, also known as pertussis, is a very contagious respiratory illness. For many, the bacterial infection starts with symptoms similar to the common cold — a runny nose, sneezing, a low-grade fever and a tickly cough — but a painful, full-body cough can develop after a week or two. These coughing fits can be so severe that they cause patients to vomit or break ribs, and they’re often accompanied by a whooping sound as the person tries to catch their breath.
Although whooping cough can be serious for all ages, children younger than 1 are particularly sensitive because their immune systems are still developing. This is especially true for infants and young children who haven’t had all their recommended vaccines.
There have been more than 32,000 cases reported this year, according to preliminary data from mid-December – about six times more than there were at this time last year and more than there have been since 2014.
Children now have the highest rate of emergency department visits for flu and RSV, according to the latest CDC data. Visits for Covid-19 are most common among seniors, followed closely by children younger than 5.
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Bird flu
Most human cases of bird flu in North America have been mild, a fact that’s underscored by a new study of the first 46 confirmed human H5N1 infections in the United States this year. But the case of an ill Canadian teen stands out because of its severity and because the source of exposure remains a mystery.
With the number of cases continuing to grow, leaders from the National Institutes of Health are calling for more action to tackle the bird flu outbreak.
The teenager, who was hospitalized with H5N1 infection in November, became critically ill and spent almost two weeks hooked up to machines that took over for her failing heart, lungs and kidneys, according to a report published Tuesday in the New England Journal of Medicine.
The 13-year-old had asthma and obesity but was otherwise in good health before catching H5N1. She recovered after aggressive treatment with a combination of three antiviral drugs, according to the report.
“She had multiorgan failure and was horribly ill,” said Dr. Megan Ranney, an emergency medicine physician and dean of the Yale School of Public Health, who was not involved with the girl’s care.
The teen was treated with extracorporeal membrane oxygenation, or ECMO, in which machines take over the work of the heart and lungs to give the body a chance to recover. She also had continuous dialysis to help remove toxins from her blood because her kidneys weren’t working, as well as plasma exchange, in which machines separate the clear part of the blood from blood cells so harmful substances can be removed.
“Were those extraordinary treatment modalities not available, she likely would not have lived,” Ranney said.
Health officials in British Columbia closed their investigation into the case late last month after being unable to find the virus in any of the household pets, nearby animals, or soil or water samples. Close monitoring of people who were around the teen determined that no one else caught the virus from her. At the time, it wasn’t clear whether she had recovered.
The new report on the teen’s case “clearly shows that a child who was otherwise generally healthy became sick and then got very, very ill in a matter of days. This is a very worrisome outcome that we should be much more concerned about happening with other infections,” said Dr. Jennifer Nuzzo, who directs the Pandemic Center at Brown University. She was not involved in the case.
The teen was infected with a newer variant of the H5N1 virus, D1.1, which is carried by wild birds. This variant has played a role in some infections of poultry workers in Washington, which were mild, and a recent human infection in Louisiana, which was severe.
In both severe infections – the teen’s and the case in Louisiana – the virus has shown changes that mean it might be adapting to humans, a finding that has put infectious disease experts on high alert since it increases the possibility of human-to-human spread.
“For this reason, we should be much more aggressive in conducting environmental surveillance for H5N1 to track the virus and to prevent people from becoming infected,” Nuzzo said.
The report of the first 46 human cases, also published Tuesday in the New England Journal of Medicine by researchers at the US Centers for Disease Control and Prevention, shows that most were exposed to infected animals or to raw milk.
Eye redness, or conjunctivitis, was the most common symptom in these farmworker infections, showing up in 42 of 46 cases (93%). Almost half of the workers had fevers, and more than a third reported respiratory symptoms. The average duration of illness was about four days.
The article also acknowledges that the official number of cases is an undercount. Although the CDC says there have been 66 confirmed cases in the US this year, recent testing on dairy farms found that 7% of workers had evidence of recent H5N1 infection in their blood.
In a commentary that accompanied the two studies, Dr. Jeanne Marrazzo, who directs the National Institute of Allergy and Infectious Diseases, says the mutations found in the virus isolated from the Canadian teen highlight an “urgent need for vigilant surveillance and assessment of the threat of human-to-human transmission.”
Surveillance has been hampered because of incomplete reporting of animal infections, she wrote. The US Department of Agriculture hasn’t been submitting critical details like the exact dates when animals have gotten sick or precise locations that help scientists track the evolution of a virus over time.
Taken together, she writes, the new reports of human cases show that the pace of human H5N1 infections has been accelerating. There have also been an increasing number of people with respiratory symptoms, like breathing problems or coughing, linked to their infections.
Although the overall number of human infections related to H5N1 has been low, the continued drip, drip, drip of human and animal detections is not a good sign.
“This kind of repetitive, persistent opportunity for passage from one species to another, from one anatomic space to another, that’s what that’s what influenza thrives on to mutate,” Marrazzo told CNN. “This virus doesn’t miss a beat.”
She and co-author Dr. Michael Ison, who is chief of the Respiratory Diseases Branch at NIAID, call for better cooperation between human and animal disease investigators, complete reporting of data from animal infections so scientists can better track how the virus is spreading, development of countermeasures like vaccines and antiviral medication, and more precautions to prevent infection, such as increased use of recommended personal protective equipment and education about the risks of being around sick animals.
“The risk is really going to come when this gets better at obviously infecting humans, and then we are faced with potential for human-to-human transmission,” Marrazzo said.
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Valley Fever
Valley Fever cases are at their highest number in Arizona in more than a decade.
The last time the number of cases was this high was in 2011, according to the Arizona Department of Health Services.
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Whooping cough
Whooping cough has been surging in the United States for months and the latest data from the US Centers for Disease Control and Prevention suggests there are no signs of slowing.
There have been more than 32,000 cases reported so far this year, according to preliminary data from mid-December — about six times more than there were at this time last year and more than there have been since 2014.
Whooping cough, also known as pertussis, is a very contagious respiratory illness. For many, the bacterial infection starts with symptoms similar to the common cold — a runny nose, sneezing, a low-grade fever and a tickly cough — but a painful, full-body cough can develop after a week or two. These coughing fits can be so severe that they cause patients to vomit or break ribs, and they’re often accompanied by a whooping sound as the person tries to catch their breath.
This coughing can last for weeks or months, and people can spread the infectious bacteria for weeks after the cough develops. However, infections can be mild enough for some that they spread the illness without even knowing they have it.
