US COVID indicators show no sign of slowing down, with most areas of the country seeing consistent rises, the Centers for Disease Control and Prevention (CDC) said today in its latest data updates.

Emergency department encounters for COVID make up 2.3% of all visits, up 4.1% from the previous week. Levels are highest—in the moderate range—across the South and Southeast. 

Wastewater levels jump to 'very high' level

Wastewater detections continue to rise steadily and are now at the very high level. Levels continue to trend upward in all US regions and are highest in the West, followed by the South and Midwest. Test positivity for COVID is still rising and is at 17.6% nationally, up 1.2% compared to the previous week. Test positivity is highest in the region that includes Texas and surrounding states. 

Hospitalization rates are still elevated and are highest in people ages 65 and older. Deaths from the virus continue to trend upward, with a 7.1% rise from the previous week. COVID deaths still make up a small proportion of US fatalities, just 1.5%. 

Among US children born in the past 30 years, childhood vaccines have prevented an estimated 508 million cases of illness, 32 million hospitalizations, and 1.1 million deaths, resulting in direct savings of $540 billion and societal savings of $2.7 trillion, according to a study yesterday in Morbidity and Mortality Weekly Report.

Researchers from the Centers for Disease Control and Prevention (CDC) analyzed data since 1994, when the US Vaccines for Children (VFC) program was launched to cover the cost of vaccines for children whose families might not be able to afford them. They assessed the impact of routine childhood immunizations among both VFC-eligible and non–VFC-eligible children born from 1994 to 2023 for nine vaccines: diphtheria and tetanus toxoids and acellular pertussis vaccine; Haemophilus influenzae type b conjugate vaccine; poliovirus vaccines; measles, mumps, and rubella vaccine; hepatitis B vaccine; varicella vaccine; pneumococcal conjugate vaccine; hepatitis A vaccine; and rotavirus vaccine.

"Although influenza and COVID-19 vaccines are recommended for routine immunization," the authors wrote, "they were not included in this analysis, because the methods for assessing their costs and effects differ from those for other vaccines." They also did not include recently approved respiratory syncytial virus (RSV) vaccines.

More than 1 million deaths, 32 million hospital cases averted

The researchers calculated averted illnesses and deaths and associated costs over the lifetimes of 30 annual cohorts of children born during the study period using established economic models. They also estimated net savings for the healthcare system and for society as a whole.

Routine childhood immunizations remain a highly cost-effective public health intervention.

The investigators found that, among about 117 million children, routine childhood vaccinations prevented approximately 508 million lifetime cases of illness, 32 million hospitalizations, and 1,129,000 deaths, at a net savings of $540 billion in direct costs and $2.7 trillion in societal costs.

They conclude, "Routine childhood immunizations remain a highly cost-effective public health intervention ... Based on the 2022 CDC Market Share Report, VFC made a substantial contribution to these reductions by purchasing approximately one half of childhood vaccines at discounted prices."

As a large mpox outbreak in Africa has set off alarm bells in the global health community, Americans' knowledge of the virus and risk factors surrounding transmission has dropped compared to just 2 years ago, according to new survey from researchers at the Annenberg Public Policy Center of the University of Pennsylvania.

The survey of 1,496 US adults conducted last month shows only 5% of Americans are worried about contracting mpox in the next 3 months, compared to 21% in August 2022, when a global outbreak primarily among men who have sex with men was infecting thousands of Americans and Europeans. Only 9% of those polled last month are worried that they or their family members will contract mpox.

The 2022 outbreak was fueled by infections caused by clade 2 of the virus, which is significantly less deadly than the clade 1 strain currently fueling the outbreak in the Democratic Republic of the Congo (DRC) and surrounding countries. 

Awareness of vaccine also decreased 

Though no clade 1 cases have been described in the United States, the Centers for Disease Control and Prevention earlier this week said US clinicians should be on alert for any symptoms of mpox in patients who had recently been to the DRC or bordering countries. 

"The speed with which the public learned needed information about mpox in the summer of 2022 was a tribute to effective communication by the public health community," said Kathleen Hall Jamieson, PhD, director of the Annenberg Public Policy Center and director of the survey, in a press release. "That same expertise should now be deployed to ensure that those at risk remember mpox's symptoms, modes of transmission, and the protective power of vaccination."

The speed with which the public learned needed information about mpox in the summer of 2022 was a tribute to effective communication by the public health community.

Only 45% of those polled said they knew a vaccine for mpox exists, down from 61% in August 2022.

Six countries reported more polio cases this week, including Afghanistan and Pakistan with more wild poliovirus type 1 (WPV1) cases, according to the latest weekly update from the Global Polio Eradication Initiative (GPEI).

Afghanistan reported 2 new WPV1 cases, 1 in Kandahar and the other in Hilmand, putting its total at 11 for the year. Pakistan reported 3 more cases, 2 in Balochistan and 1 in Punjab, boosting its number to 12 for 2024. Both countries have already doubled the number of cases they reported in 2023.

Elsewhere, four African countries reported cases involving circulating vaccine-derived poliovirus type 2 (cVDPV2). The Democratic Republic of the Congo (DRC) reported 2 cases, both in Maindombe. Ethiopia reported a case in Gambella, boosting its total to 12 for the year. Nigeria also reported 1 more case, in Jigawa, lifting its total to 38. South Sudan reported 1 case in Upper Nile, making 7 infections for 2024. 

WHO preparing polio vaccine campaign for Gaza

At a World Health Organization (WHO) briefing this week, Director-General Tedros Adhanom Ghebreyesus, PhD, said that, following the detection of polio in wastewater samples from Gaza, the WHO is preparing polio vaccination campaigns and is sending more than 1 million doses to be administer in the weeks ahead.

He said the group is mourning the sudden death of Aidan O'Leary, who was director of the WHO's Polio Eradication Program. Tedros said that, before O'Leary died while on vacation with his family, he was working on a plan for two rounds of polio vaccination in Gaza targeting 600,000 children younger than 8 years old.

"We need absolute freedom of movement for health workers and medical equipment to carry out these complex operations safely and effectively," Tedros said. "A ceasefire, or at least 'days of tranquility' during preparation and delivery of the vaccination campaigns are required to protect children in Gaza from polio."

• Bavarian Nordic announced yesterday that it has received a new contract worth $156.8 million from the Biomedical Advanced Research and Development Authority (BARDA) to replenish the US supply of bulk product to make the Jynneos vaccine against mpox and smallpox. BARDA is part of the US Department of Health and Human Services. The bulk product will be made in 2024 and will partly be used to restock inventory that was used to make vaccine for the 2022 mpox outbreak. Replenishing bulk inventory is also needed to fulfil the company's existing contract to make next-generation freeze-dried vaccine for smallpox preparedness in the United States. The contract amount also covers storage of the vaccine from 2025 to 2027.
• In a threat assessment today, the European Centre for Disease Prevention and Control (ECDC) alerted travelers and clinicians about the risk of Oropouche virus infection in certain parts of the Americas, following 19 imported cases reported in June and July, the first for the European region. The ECDC said the risk is moderate for people traveling to or living in epidemic areas in South America, Central America, and the Caribbean. It noted, however, that the risk is higher for those visiting heavily affected areas, including Brazil's northern states and the Amazon region, and for those who don't take adequate protective measures. The agency said the disease is mainly spread by a midge species not found in Europe, though several types of mosquitoes are potential vectors. The virus typically causes an acute febrile illness, but recent data from the Americas suggest that infections in pregnant women can lead to severe fetal outcomes, including death and microcephaly (small brain and head size).
• The Oregon Health Authority recently sent an alert to health providers to be on the lookout for measles cases amid ongoing community transmission. In its latest update, the OHA said 26 cases have been confirmed, all involving unvaccinated people. Two patients were hospitalized, and no deaths have been reported. Ten cases are in kids younger than 10 years old, and 11 involve young people ages 10 to 19 years old. Seventeen cases have been reported in Marion County, with eight in Clackamas and one in Multnomah. In the United States this year, measles activity is at its highest level since 2019, which was a record-setting year. So far this year, the US Centers for Disease Control and Prevention has reported 211 cases.