Back to School: What You Need to Know

Chris Dall: Hello and welcome to the Osterholm update, a podcast about infectious diseases and public health featuring Dr. Michael Osterholm. Dr. Osterholm is an internationally recognized medical detective and director of the Center for Infectious Disease Research and Policy, or CIDRAP, at the University of Minnesota. In this podcast, Dr. Osterholm draws on over 50 years of experience in infectious disease epidemiology to provide straight talk on the latest infectious disease outbreaks, counter misinformation and disinformation about vaccines, and distill the complex and ever evolving public health threats facing our world. I'm Chris Dall, reporter for CIDRAP news, and I'm your host for these conversations. Welcome back everyone to another episode of the Osterholm update podcast. As summer comes to a close, another chapter begins. Back to school. Kids are sharpening their pencils, packing their lunch boxes, and heading back to the classroom. But with that comes a lot of different public health challenges and a lot of muddled guidance for parents. Among the many questions parents of school aged children might have in 2026 are how do we deal with measles in schools? When's the best time for my kids to get their flu shot? And do I need to be worried about the blueberries in my child's lunchbox? We'll try to answer some of these questions in this August 27th episode of the Osterholm Update episode number 216. We'll also touch on COVID-19 different foodborne illnesses like Cyclospora, Salmonella, and E coli. Two recent measles deaths, the latest on the Ebola outbreak in the Democratic Republic of Congo. And we'll bring you the latest installment of This Week in Public health history. But first, as always, we will begin with Dr. Osterholm's opening comments and dedication.

Dr. Michael Osterholm: Thanks, Chris, and welcome back to the podcast family. It's wonderful to be with you again. It's hard to believe that these podcast hours keep happening and happening, and what a wonderful gift it is for us to be able to share this information with you. And it's wonderful to hear from you about what we're doing and what it means to you, and how we can improve on that. So thank you very much. For someone who may be joining for the first time, I hope we're able to provide you with what you're looking for. If you're not, let us know we didn't and tell us why. And we surely will consider that very much in our future episodes. Chris, as you mentioned, Back to school season is starting a grandfather, a professor. I know that that's really happening. So this week I wanted to dedicate the episode to everyone heading back to school, whether it's kindergarten or college, whether you're going back to school yourself or just reminiscing when you see all the new school supplies out on your grocery run, it's an exciting time of the year. I know there are many of you who have returned to school after or during a period of full time work. Maybe you're pursuing a graduate program, working on your PhD, or completing a technical certificate. Whatever program you're following, I hope you're proud for taking a moment to further your education.

Dr. Michael Osterholm: School can be a big commitment, but choosing an education is so important. They can take a lot of things away from you, but they can never take away your education. I also want to shout out to anyone who works at a school educators, paraprofessionals, librarians, custodians, cafeteria staff, administrators, and anyone in between. Your jobs can be so selfless, but they are absolutely impactful. Thank you for all the incredible work you do day after day. And lastly, I'm also thinking of parents managing pickups, drop offs, lunches, new school supplies is no easy task, especially when you're balancing everything else in your life. And if you're a single parent, it's even more significant in terms of trying to find the time and the ability to carve into your life the needs for a school child, and for those parents sending their kids off to school for the first time. We're sending you a big hug. This is a huge milestone. And trust me, it will get easier. And finally, I also want to acknowledge some grandpas and grandmas, because I do know that there are a number of school children today that are fortunate to have a grandpa or a grandma who can be there in the morning when they leave to go to school, or in the afternoon when they come home. You two have a very important role.

Dr. Michael Osterholm: So if you know a parent with a child in school, a student of any age, or somebody who works in education, please make sure to show them the real gratitude that they deserve as this school year kicks off. Normally, I would move into that next section called sunlight, which I know so many of you really love. Others not, but I'm going to take a departure today. I want to acknowledge someone who has had such an impact on so many people over the course of her life, as I'm sure all of you are aware by now. Earlier this week, Dolly Parton died. Dolly was a real supporter of COVID research, having donated substantial amounts of money to COVID vaccine research and even looking at improving on treatments for those with serious illness due to COVID. She was always there to support whatever COVID efforts were needed. Everyone who ever knew Dolly Parton would tell you, besides her kindness, was her generosity. And over the course of her lifetime, having been raised in poverty, she never forgot where she came from. And so today, I just want to make certain that all of you know that we lost a real champion in the COVID fight and one that forever will be remembered as a very special individual. Now I'll move into that sunlight issue. Kind of some interesting information for you. Well, first of all, today, August 27th, in Minneapolis/St. Paul, the sunrise is at 6:29 am in the morning, sunset at 7:58 pm. That still is 13 hours, 29 minutes and 31 seconds of sunlight. But we are losing sunlight at about two minutes and 57 seconds a day. In addition, the loss of that sunlight is accelerating each and every day. And very soon, on September 18th, we will hit the maximum loss of sunlight in any given day at three minutes and six seconds of loss. And that's an important number because that's where we bottom out. You might say, in that actual loss, we will see the same amount of sunlight loss from September 18th to October 2nd, and then the actual rate of sunlight loss Decrease it until we get to December 21st. But over the next month, expect to see a bit more darkness. And for those of you in Auckland, New Zealand, at the Occidental Belgian Beer House on Vulcan Lane, your sunrise today is at 6:49 am. Your sun sets at 5:56 pm. 11 hours, six minutes and 49 seconds of sunlight. You're still a bit behind us, but you're gaining at two minutes and nine seconds a day. And as we get to that September 21st date, we will basically both pass each other with you having more sunlight in Auckland than us. But we're looking forward to you sharing that sunlight with us.

Chris Dall: Mike. Sticking with the back to school theme, there is a lot for parents to be thinking about this upcoming school year, and while some of the issues are familiar for parents, many reflect our current reality. In 2026. In the US, for example, we're seeing measles outbreaks, and that includes two measles deaths that were reported in Pennsylvania this week. Parents are also being confronted by foodborne illnesses that might affect the foods their children eat, and confusing information about childhood vaccination. What advice do you have for parents this upcoming school year?

Dr. Michael Osterholm: Well, let me just start out by first acknowledging that after 50 years of actually dealing with this very issue of myself as first a parent and a grandparent, I understand it can be challenging. And when you talk about infectious diseases, there are very few buttons that you can push in a parent's life that is more concerning than a potentially serious infectious disease. So even as someone whose job it is to stay on top of these things, it is a challenge even for me. And quite literally, it takes an entire team. So anyone out there who's feeling lost or overwhelmed, and especially parents of children heading back to school, know that you're not alone. In fact, I'd say if you're feeling that weight right now, it's because you clearly care about doing what's best for your kids, and that's nothing to apologize for ever. So with that, let me try to offer some perspective that I hope is helpful and maybe cuts through some of the noise. Measles. Oh my. Measles. It's here. It's going to get worse. We learned earlier this week of two residents of Lancaster County, Pennsylvania, have died of measles. It's unclear yet what their ages are as that has not been released. But nonetheless, we know that there is a substantial outbreak occurring right now in the Amish population in that county. If we take a step back and look at what's happening nationally, according to CDC's latest update posted last Friday, August 21st, we're up to a total of 2777 cases nationally in 2026.

Dr. Michael Osterholm: And throughout the past several weeks, we've actually seen weekly case counts climb up a bit, which is not the direction we'd like to see heading into the new school year. Now, with that being said, a lot of the activity is happening. Just a handful of states, primarily Ohio and Pennsylvania. In Pennsylvania, as I just noted where the deaths occurred, nearly half of the cases reported in the state this year have occurred in that single county. Why does that matter? Well, it's because measles is not spreading evenly across the entire country. And so we're really dealing with situations where it's finding those pockets of susceptibility and takes off from there. So it's basically been a whole series of rolling outbreaks or flare ups in different places, which really makes the state and local response important when it comes to containment. Now, when you look at who is actually getting infected, it's worth pointing out that, yes, 94% of measles cases reported in the US this year were not vaccinated or had unknown vaccination status. So this isn't random, and we're not going to see measles spread indiscriminately in classrooms across the country. At the same time, given how contagious the virus is.

Dr. Michael Osterholm: We can surely expect to see more situations where it finds its way into populations lacking protection. This brings me to my second point, which has to do with vaccine coverage. Recent data from CDC showed that for the past school year, 4.2% of U.S. kindergartners had an exemption from at least one of the vaccines required to attend school, up from 3.6% the previous year. Notably, this increase isn't being driven by medical exemptions, which remain flat at about 0.2%. Instead, it's a byproduct of growing non-medical exemptions, which have basically doubled over the past decade. Now, if you look at overall coverage for MMR vaccine among U.S. kindergartners, there is a slight decrease from 92.5% to 92.4%, which doesn't necessarily feel all that dramatic. But let's step back and understand what this means. What we're talking about today are clusters of vulnerability. What do I mean? Well, you can have a state with an overall average of 92% of the students vaccinated and yet have a number of schools where the maximum vaccination rates are in the 40% level. And these are children born to parents who often associate with certain religious identities or other social groups that are opposing vaccines. So this is where it becomes very difficult to have outbreaks among these clusters. And when that happens, some of these clusters can amount to 100 to 200 cases because of the lack of vaccination across that age population.

Dr. Michael Osterholm: So when we think about these outbreaks, please don't take comfort in whether it's 94 or 95%. Tell me what's happening in your school. When you tell me that only 40% of the young children coming into that school are vaccinated for mumps, measles and rubella? I'm telling you, that's a time bomb waiting to go off. And it will. So again, don't take the national average as being some kind of measure of success for overall protection. It's not about whether we lose one more or two more percents of protection. It's when we see these clusters. And let me give you some examples of exactly what I'm talking about with MMR vaccination coverage among kindergartners, the CDC data showed it ranged from 98.9% in West Virginia, down to just 75.2% in Idaho. It's really important to point out that also, a state like West Virginia does not allow non-medical exemptions for vaccines. And while coverage went up in some states, it declined in more than half of all the states. The trend is in the wrong way. It's also notable this past week that the Catholic bishops in Florida actually wrote the Florida attorney general a letter saying there is no theological reason for school vaccine exemptions. This had often been relied upon by certain elected officials to support the idea that mandated vaccine programs violate a religious tenet.

Dr. Michael Osterholm: The Catholic bishops, loud and clear, said, no, that's not the case. And so we also need to begin to look at that, where people are using that as a refuge for declaring their anti-vaccine status for their children. It's not a threat to religious liberty, according to the bishop. As I just noted, within a state, there can be a lot of variation in levels of vaccination. If you're a parent trying to make sense of your own situation, it's worth getting granular. In other words, what does vaccine coverage look like in your county? Many state and local health departments publish that information. In some states, like my own Minnesota, you can even find district and school level data that can tell you far more about your family's risk than the national numbers can. And in some cases, can actually be a bit frightening when you see the actual levels of vaccination in some of these schools. Another thing that can be worth understanding ahead of time is what would actually happen in the event of an outbreak at the school. There are state and local policies and they can vary quite a bit, but they might help answer some questions such as who gets notified and when. Under what circumstances would children be kept home and for how long? And what happens if I have a child who has some chronic health condition that might predispose him to an increased risk of serious illness with measles? What will I know? When will I know it? Otherwise, what is my advice heading into the school year? Well, I know when things are chaotic and confusing.

Dr. Michael Osterholm: There's sometimes a temptation just to tune out everything. But I strongly encourage you to stay the course, remain informed, and when you hear about a claim, ask where it came from and what it's actually based on. Look at what's happening locally, not just nationally. And when it comes to your children's health, talk to your pediatrician, your family practitioner or nurse practitioner and ask them to help you understand what's happening locally. Again, I understand why people are feeling confused right now. There's a lot of noise out there, including the recent executive order on vaccines coming out of the White House, and even this past week, when the president seemed to go on an uncharted discussion of vaccines for which he had no factual data. All of this can be so challenging when that's the message the community is hearing. But I can tell you that our team here at CIDRAP are committed to following the actual data and calling balls and strikes. We will do everything we can to keep you informed as to the status of what is happening.

Chris Dall: So, Mike, I just want to follow up on these two measles deaths in Pennsylvania. They are the first two US measles deaths reported this year after three were reported last year. And it has to be noted that this is happening amid repeated questioning of the MMR vaccine by the president of the United States and his Health Secretary. For those parents out there, Mike, who are just confused about all that they're hearing, what would you tell them?

Dr. Michael Osterholm: Well, Chris, I think as you know, and hopefully many of you in the audience here, I've always wandered into that world of prediction and have tried to help understand what is ahead of us, what's the storms that we will encounter in our journey? Let me just give you some kind of a picture of where I see us going right now, and how these two deaths this week and future deaths will play into this. When you actually think about measles as a disease that has historically been transmitted over the decades and decades of this past century, before vaccines arrived, we had a very classic pattern, much like influenza, in the sense that it was often very seasonal, such as late winter, early spring. Most of the transmission often occurred between the months of March and May. So we're not even in those months yet that likely could see major enhanced transmission. And let me just give you a potential vision for the future. If you think about what happened in Canada in the last year, it's very instructive. Many of the challenges that we have in this country in terms of the pockets of unvaccinated individuals, those pockets of vulnerability I talked about just a moment ago. And that was the big risk factor for so much transmission in Canada last year.

Dr. Michael Osterholm: Think of this in 2025. Last year, Canada reported 5,462 cases. Now remember the Canadian population is only 41.2 million. The United States population is over 392 million. We're 8.3 times larger than Canada. So if, in fact, we were to play out this next year like Canada did last year, we could be expecting to see over 45,000 cases of measles in this country with enhanced transmission in March to May of this next spring could really add to the rapid growth of those cases. Now think about this. We're talking now about 2,700 cases and it is a disaster. How would we respond to a potential annual number of cases almost reaching 50,000? That is not some kind of just scary scenario. That is actual data based on what just happened in Canada. So I think, Chris, to put the context of what we're seeing right now with these two deaths and the measles activity we're seeing, this could easily just be the warm up that scares me. And I don't say that very often that an infectious disease scares me. So we have to understand how important it is to get these kids vaccinated. We also have to understand, for all of you who for the last 20 years have escaped vaccination and or illness with measles, you are still very vulnerable.

Dr. Michael Osterholm: You do not want to be a pregnant person today and not having had measles vaccination or previously been infected and then get infected during your pregnancy because of the potential for that virus to actually spread to your unborn child and cause a condition known as congenital measles. This would be a horrible outcome. And so this is also another reason why you want to be mindful of will your child bring home measles from school? And if they do, only because they themselves were not vaccinated, you're not vaccinated. That really is a terribly unfortunate situation. So as much as you're hearing from the president and other members of the administration about why measles vaccine is dangerous or unnecessary, these are the numbers. This is what we're up against. This is why you, as a parent, can play a key role also in helping to share with your neighbors, with the parents of the school children who are attending school with your children. Why it's important to talk about these vaccines. Why it's important to emphasize what they can do to save the life of your child. Unfortunately, our future right now, if left unchanged, is going to be a rather sad measles future.

Chris Dall: Let's turn now to COVID. We've had a lot of listeners who are concerned about the late summer uptick in COVID cases that we've discussed in recent episodes, and how their children might be affected by that as they head back to school. For today's ID query, several of our listeners want to know, is COVID still a thing? How do we best protect ourselves and what do we do if we get sick?

Dr. Michael Osterholm: Chris, let me give you the punchline right now. Yes, it's still a thing, but let me put it into context. Let me share with you what that means. I'm not seeing signs of any kind of a significant summer surge, despite the fact some people are suggesting that's the case. We surely have a potential wave, meaning that we see seasonality where a particular infection may go up a level higher than it was several months ago. But I can't call that a peak or a wave or an outbreak. The national wastewater concentration is still very low across the country, but I acknowledge it is increasing. Levels are very low and stable in the Midwest and Northeast. While it is true levels in the South are increasing and getting closer to the threshold of being considered low. But remember, that threshold is still low. The West has crossed that threshold and is continuing to increase, but it's not yet into what I would call upper atmosphere conditions. It's not a big peak yet. Emergency room visits resulting in a COVID-19 diagnosis have increased in every age group except the 50 to 64 year old and the 65 and older age groups. These are important data because the individuals we would most be concerned about for serious illness, hospitalizations and deaths are those in those older age groups, and hospitalizations have only increased in the less than one year old age group and have remained relatively steady or decreased even among other age groups.

Dr. Michael Osterholm: While these increases are minor, especially when considering the levels we have seen in years past, they go to show that the virus is still here. COVID is definitely still a thing, but it is not causing the number of severe cases we were seeing in the early days of the pandemic or overwhelming our medical systems, but rather, it's now something we're living with and that is constantly changing. So when I look at the issue of how we're going to talk about COVID, what does the wave mean to some people, it means it's increasing, some others it means it's like what we see with flu season. We really hit a big peak. I'm sure of the mind that we could see a substantial increase in COVID over the next 6 to 12 months. And why is that? Well, it's all about waning immunity at this point. Virtually everyone in our population has either been infected with COVID or infected and vaccinated or vaccinated are one of those three categories of immunity. And we know that immunity with COVID viruses wanes over time. And when it hits a certain level, we're more likely to start to see cases occur. The good news is typically, if you have some of that protection remaining from a previous infection or a previous vaccination, it's very likely your illness will be much milder.

Dr. Michael Osterholm: So we're not seeing the same kind of hospitalizations that we would have seen early in the pandemic, when individuals were, in fact, for the first time, encountering the virus. Jess Steier of Unbiased Science wrote a great piece on her Substack addressing these exact questions, and we'll link it to the episode bio for you to read through. She touches on the seasonality of it. The bottom line is that the virus does not stop circulating throughout the year, and there is very distinct separation between how we think about seasonality of COVID in comparison to flu and RSV. Now, to the listeners questions about what do we do if you're sick and how to best protect yourself? Let's start with what do you do if you feel sick? Things really haven't changed here. Stay home. Take a test. The FDA currently maintains a website which actually shows all the expiration dates for test kits that were available over the last several years, and in many instances, those test kits have been upgraded in terms of how long they still are effective, some of which expired more than a year ago but have been approved for current use as testing shows that they still are effective. We have a link in our show notes that will direct you to that website. So should you get sick and you still have COVID tests at home and they appear to have expired in terms of use.

Dr. Michael Osterholm: Go take a look at that website to see you very well. May still have a test kit that is effective. Guidelines say that if you test positive, stay home until at least 24 hours symptoms free. Part of why people are wondering if COVID is still a thing is because you don't hear about people testing positive, but people can't test positive, they don't test at all. But now, how can you protect yourself? The best tool we have to protect ourselves from severe disease and death is clearly vaccination. We don't want you to have to get infected to achieve an improved immune status after you have recovered. The updated vaccines are not available yet, but we're hoping they will soon be, and as soon as they are, I would encourage anyone and everyone to receive one. I certainly plan to have mine. It'll be about eight months since I had my last dose. Aside from And vaccination. A well fitted respirator, like an N95, would be a layer of defense to prevent infection. The answers to what to do really boil down to the fact that, yes, COVID 19 is still a thing. If you feel sick, test and stay home. And most of all, please stay up to date on your vaccination. That is the key to assuring that you will not experience a serious illness, be hospitalized or even die.

Chris Dall: Continuing with COVID here, Mike, you've frequently stated that COVID is seasonal in that it can occur in every season with Omicron being dominant the last few years. It does appear like we've fallen into a larger winter and then smaller summer wave each year. So what did the data say about predicting the seasonality of SARS-CoV-2 these days?

Dr. Michael Osterholm: Chris, let me elaborate a bit more on what I just discussed in the last question. I'm glad we're revisiting this topic, especially as we start approaching flu and RSV season SARS-CoV-2 isn't an exact parallel to these other viruses, but more research is helping us better understand when and why cases can ebb and flow throughout the calendar year. For some background, CDC's surveillance team published a rigorous analysis in emerging infectious diseases that assessed four years worth of lab data looking for some sort of predictable rhythm of cases of COVID 19. They typically observed a larger wave of cases in the winter, and then a slightly smaller wave in spring or summer. That's a baseline pattern people have been pointing out for the last several years. But a piece I want to spend a bit more time on comes from a group of researchers in the epidemiology department at Harvard, whom I know well and have great respect for their work. They took three years worth of COVID data at the county level and modeled how the pattern changed over time and geography. They also found an approximately twice a year pattern, but it was a bit more complicated than just the month of the year. There were two overlapping cycles occurring, one that lasted approximately one year, which is our relatively reliable winter wave, and a shorter one that cycled every 4 to 6 months.

Dr. Michael Osterholm: The magnitude of these waves was influenced by climate. Warmer states in the South got two comparable sized waves each year, while the colder northern states got a more dominant winter wave and another, more moderate bump in the spring or summer. A really interesting part of the analysis was when these researchers looked into human behavior. They wanted to test whether things like holiday travel and indoor gatherings may explain the shorter cycle. However, those factors and others like age and income, didn't have an effect on the timing of the second wave. What did seem to have the strongest effect on the timing of these waves was more biological. In other words, immunity fading relatively sharply within months of infection or vaccination. Now, variants are also an important part of the patterns for COVID cases. And the researchers looked at this as well. The initial introduction of Omicron, one of the biggest examples of immune escape in the pandemic, did not change the underlying frequency or timing of the waves, but it did make it much bigger. In contrast, earlier in the pandemic, when we had a more immune naive population and an alphabet soup of new variants, seasonal timing was genuinely unpredictable. Now, in this age of Omicron, most of us carry layered immunity from past infection and multiple doses of vaccine.

Dr. Michael Osterholm: New subvariants seem to be sliding into that underlying rhythm rather than resetting it completely. So my honest and cautious answer here is that SARS-CoV-2 may be falling into a loose, biannual pattern that is closely tied to our own fate and immune protection. It's very important to note that this is only based on a few studies and a handful of years of data, so we still have a lot to learn about the layered immune protection and the impact of future variants. It does provide some reason to suggest that two doses of vaccine per year may be an appropriate strategy, especially for those who are higher risk of severe outcomes for COVID 19. But all of this is said with a great deal of caution. SARS-CoV-2 has thrown plenty of curveballs at us in the past, and I am sure it can do that again in the future. In my opinion, our best defense would be to develop a durable, broadly protective coronavirus vaccine that doesn't require us to guess the exact timing of each new wave. There's a global effort underway to build this, and we have an entire roadmap towards reaching that goal on our website. If we can get that right, this whole conversation about predicting COVID's next wave becomes an issue of the past.

Chris Dall: Mike while recovering respiratory illnesses. Are there any updates on flu and RSV activity?

Dr. Michael Osterholm: Of course, we couldn't leave them out. Fortunately, there is nothing noteworthy in the flu or RSV world. Levels are very low across the board for both viruses. What a great piece of information to be able to share with you. In a typical respiratory season, we expect to see activity start to creep up starting around mid-September and the true flu season to begin around mid-October to early November. And we also tend to see a little uptick as kids return to school. As of right now, we are not seeing any signals suggesting that we should expect anything unusual this season. But if that changes, we'll be sure to get that information to you as soon as possible. I've had a number of questions from podcast listeners. When will the flu vaccine become available? Well, as you probably know, it's available now in many of the big box stores around the country. Encourage you to come into their pharmacy and get vaccinated. The Moderna vaccine, which is an mRNA based platform, it has been approved but has not yet been made available. We expect that to change soon, and when it does, we'll let you know. One of the points I want to make here, however, and I make this year after year after year to with only limited success, you do not want to get your flu vaccine right now. Not because I don't want you to get your flu vaccine. I definitely do eventually. But we know that from the time that you get vaccinated for flu over each month, you lose about 6 to 10% of the protection that you had at the time, shortly after vaccination.

Dr. Michael Osterholm: So if you get your vaccine in August, September and the flu season doesn't really hit hard until January, you've lost potentially up to half of the power of that vaccine by just the waning protection. That was as a result of the vaccine. And so at this point, again, we'll keep you informed of when we begin to see flu activity that we believe warns now getting the vaccine. And I'm telling you right now, you want to get that flu vaccine, but you don't want to get it too early. A note with regard to who should get flu vaccine this year. I strongly urge that all of us consider getting it, and particularly for those 50 and older, where the risk is truly increased for severe illness, hospitalizations and deaths. And also for children. Here we are talking about going back to school, and we know that schools have played a key role in the mixing and matching of the virus, with children getting infected at school and bringing it home. And also, people often don't appreciate just how much impact flu can have on children. For example, in the 2020 425 flu season, 297 children died from flu in this country. That's 297. That, to me would be all the reason why, as a parent, I would also want to get my children vaccinated.

Chris Dall: Let's turn now to foodborne illnesses which have dominated the headlines this summer. Whether it's been Cyclospora linked to lettuce from Taylor's farms, a salmonella outbreak in jalapenos, or E coli found in blueberries. Mike, walk us through these different outbreaks. Is there any reason why we're seeing so many outbreaks in the news this year? And do you have any practical advice for listeners to help navigate these different outbreaks?

Dr. Michael Osterholm: Chris, let me just sum it up in one sentence as to what's happened this summer. It's produce, produce and produce. Every one of these outbreaks were a produce item that was basically grown somewhere in the environment, whether it's in a field or a greenhouse. Those fields differed substantially by where they were geographically and the conditions around those fields in terms of protection of the product. This summer has seen overlapping and ongoing foodborne illness crises one after another. Most recently, the FDA and the CDC announced that they were investigating an outbreak of Shiga toxin producing E coli, or STEC, and salmonella, tied to alfalfa sprouts. Now, let's just be honest about it, really. It was Minnesota and the state of Wisconsin that actually solved this outbreak long before CDC had any contribution whatsoever. About three quarters of the 34 people interviewed said that they ate alfalfa sprouts in that outbreak. Most of them were infected with STEC, which, as you know, can be serious or deadly for young kids, older people and other people with weakened immune systems. And two had E coli and salmonella. As a result, the Minneapolis based company everything. Sprouts has recalled the produce sprouts are notorious for causing outbreaks of foodborne illness for several reasons. First, contamination often occurs when the bacteria lodges into the nooks and crannies of sprouts seed coats.

Dr. Michael Osterholm: This is where sanitizers cannot reach them. Second, the warm, humid, and nutrient rich conditions needed to grow them are a breeding ground for bacteria. And last, because sprouts are typically eaten raw, they aren't subjected to the heat required to kill the bacteria. Last Friday, a jalapeno linked salmonella outbreak you mentioned topped 430 cases, including 57 hospitalizations and in 32 states. And let me emphasize again, a point I make in every one of these discussions. These case numbers represent a small, small, small part of the entire iceberg, just the very tip of it that the vast majority of infections never get reported, and only with some selected investigations where efforts were made to capture everyone who might have consumed the food. Do we often see that wow, we missed a lot of cases. The jalapeno peppers that I just referred to were grown in Mexico and distributed in Texas and Louisiana by citrus distributors from early July to early August. The producer in that case, nature's best precut and produce voluntarily recalled products containing the tainted jalapeno. Of the 224 people interviewed, 91% reported eating in a Mexican style restaurant before the illness, namely Chipotle and Qdoba. The Cyclospora outbreaks. And notice I used the word outbreak because I'm convinced that was. What happened is multiple outbreaks overlaid on top of each other set a record for Cyclosporiasis in the U.S.

Dr. Michael Osterholm: these outbreaks have now been linked to iceberg lettuce grown in central Mexico and sold by Taylor Farms and possibly other entities, some of which was served at Taco Bell restaurants in five states. The Taco Bell related outbreak is clearly now over. Any new cases are from different sources. Taylor Farms recalled the lettuce on July 17th, so it's no longer being sold. And quite honestly, I don't believe it was even available even as of July 17th. That's one of the issues about a perishable food item. Like a leafy green, it spoils how many people can remember what a bag of lettuce has been in your refrigerator for two weeks looks like. And therefore, this is a product that goes through the system very quickly. The latest data from CDC shows more than 10,900 confirmed infections, including 454 hospitalizations and two deaths, all occurring in 17 different states. Again, let me emphasize these numbers represent just a small sampling of the number of individuals that actually got sick. In our last podcast, I discussed the testing snags that delayed the identification and response to these outbreaks and the federal response to and communication of these outbreaks. It's not the first time Taylor Farms has been linked to foodborne illness outbreaks, including a 2013 Cyclospora outbreak tied to salad mix that infected 631 people in 25 states.

Dr. Michael Osterholm: And a 2024 E coli outbreak linked to contaminated onions sold to McDonald's. The second 104 people in 14 states last a small recall outbreak linked to frozen organic blueberries in May and June in Florida and Georgia. 12 people were infected and four were hospitalized. The producer, based in Chile, recalled the fruit in early July. In addition to the toll of these outbreaks take on people directly. They also shake the trust of the public in their food supply. People need to know whether the produce they rely on to stay healthy, is safe to eat, and how they can protect themselves and their families from these potential deadly threats. These crises also hurt the food industry with declining sales. I truly believe if another round of outbreaks linked to leafy greens occur again next spring, which seems to be the seasonality of this particular pathogen, it could tank producers for the long term, and this would be unfortunate. When you think about the number of cases that occurred in this outbreak, it's huge when you realize that just prior to this outbreak, 150 million servings of leafy greens occurred every day in this country, which if you think of a week's time, that's over a billion. So even with this very large outbreak, it still represented a very small percentage overall of the individuals potentially exposed to this parasite actually got sick.

Dr. Michael Osterholm: Now, what food item have we tried to impress upon? Society is healthy for you, your vegetable, your leafy greens. And so we have a conundrum here because on one hand, this isn't something like an alternative food source, that whether you have it or not, is not all that important. We want people to eat more produce. So we have a lot of work to do. And at this point, that work is understanding how these outbreaks occur so that somebody can put into place the kind of stopgap measures that will keep them from happening. I can tell you that Taylor Farms has had a very active food safety program in place. I have served as a consultant to the Fresh Express Company, another leafy green producer who put incredible numbers of steps in to protect the safety of this product. But we've got to do a lot more. So in the meantime, you know, you can protect yourself from foodborne illness through practices such as hand hygiene, surface sanitation, safely thawing food, cooking food, thoroughly, keeping raw meat away from other foods, refrigerating perishable items, keeping hot foods hot and cold foods cold, and you should also avoid unpasteurized milk and cheese.

Chris Dall: Before we get to our final segment, let's check in on the Ebola outbreak in the Democratic Republic of Congo, which is now the country's largest on record. The DRC has reported over 5,000 cases and more than 2,500 deaths, and the outbreak is rapidly expanding, with one African health official warning this week that it's getting out of hand. What's the latest, Mike? And are there any signs of hope in this outbreak?

Dr. Michael Osterholm: Well, Chris, by the very nature of your question, you answered a lot of this already because it can be summarized in very simple words. It's a disaster. As of August 24th, there have been over 5,200 confirmed cases of Ebola and 2516 deaths since the outbreak was declared on May 15th. It is now the fastest spreading Ebola outbreak on record, and transmission seems to be outpacing control efforts in DRC by a lot. While the Ituri province remains the epicenter of the outbreak, Ebola has now spread to a sixth province within the country. Notably, community deaths or those occurring outside of the dedicated Ebola treatment centers accounted for 60% of fatalities recorded over the past six weeks, according to the WHO. This indicates that the majority of Ebola cases are not reaching treatment facilities, so patients are not getting the care they need, nor are they being isolated to prevent spread of the virus to family, friends and members of the community, outbreak response efforts have increased over the past few months. Laboratory capacity to test for Ebola has expanded from a single testing site now to 19 laboratories, which is really good news considering that they can now process more than 3000 samples a day. Treatment capacity has increased from less than ten beds to more than 1300 beds. However, both of these responses rely on Ebola patients seeking care, and given the high proportion of community deaths, we know that just isn't happening. The current outbreak is as much a social political challenge as it is a scientific one.

Dr. Michael Osterholm: The outbreak response is hindered by recurrent armed conflicts in DRC, population displacement, attacks on healthcare facilities and community reluctance to abide by containment measures. A community centered approach will be critical for the next phase of outbreak response. Dr. Tedros, the WHO Director General, recently said, and I quote, "We can bring the Ebola outbreak under control, but only through scaled up action in affected communities that is led by national, provincial, local leaders and the affected communities, sustained by needed resources and backed by committed collaboration by all partners in DRC and beyond." While the current situation is pretty grim, there is one piece of good news to share the International Coordinating Group on Vaccine Provision at WHO approved the immediate release of 7000 doses of the stockpile of Ebola vaccine. The first batch of vaccine doses has already arrived in DRC, 50,000 doses to be given to frontline and health care workers, and the other 20,000 doses will be used in a phase three clinical trial to understand the effectiveness of the vaccine on the Bundibugyo virus. This is necessary because the vaccine was designed to prevent disease from a different strain of Ebola, previously known as Zaire Ebola. However, as mentioned in the last episode, there are some promising data from animal models indicating that the vaccine may have some protective effect against the current outbreak strain. I'm cautiously optimistic that the Ervebo will be a turning point for the current outbreak, and we will, of course, keep our listeners updated as data become available.

Chris Dall: Now it's time for this week in public health history. Mike, what are we talking about this week?

Dr. Michael Osterholm: Today I want to talk about our 32nd president of the United States, Franklin Delano Roosevelt. When we think of FDR, we might think of his New Deal, which created different welfare programs following the Great Depression, including Social Security and food stamps. Or the fact that he was the first and only president to serve more than two terms. Fdr was also the first American president with a significant physical disability. On August 25th, 1921, over 100 years ago, FDR was diagnosed with polio. He was 39 years old, and he received his diagnosis, which was about a decade before he was elected president. At the time, polio was one of the most feared diseases in the country, also known as infantile paralysis. The disease paralyzed hundreds of thousands of children every year. Fdr diagnosis came after a sailing incident in which he fell overboard and felt paralyzed by the icy water. At first he just had lower back pain, but as the days progressed, his legs became weaker and weaker until he could no longer support his own weight. After a few misdiagnoses, a doctor finally concluded FDR had polio. It was unusual for a middle aged person to be diagnosed with the disease. Shortly after his diagnosis, FDR decided to distance himself from politics to prioritize his health.

Dr. Michael Osterholm: He started to swim on a routine basis, which slowly helped him regain strength in his arms. By winter, FDR was fitted with leg braces. When spring came, he was able to stand with some assistance, which was considerable progress from his condition. Nine months prior, in 1924, FDR returned to politics. He was concerned how people might treat him because of his disability back in the 1920s. Disabled people were often discriminated against and isolated from the rest of society, whether it was at work, school or even by people's own family. However, FDR disability was never brought up as an issue. People were sympathetic rather than embarrassed. In 1938, FDR created the National Foundation for Infantile Paralysis, which would later become the March of Dimes. This foundation would go on to help fund Doctor Jonas Salk's research, who created the first polio vaccine in 1955. About ten years after FDR passed. Although FDR didn't live to see the successful creation of polio vaccine, he is remembered for his tenacity, perseverance and commitment to helping those with polio. I can only hope that our history lesson has taught us such a valuable lesson, that we do not have to replay the polio scenario that, unfortunately, people like FDR had to go through.

Chris Dall: So, Mike, what are your take home messages for this Back to school themed episode of the Osterholm Update?

Dr. Michael Osterholm: Without any question. Number one for me is all about measles and all that it represents in terms of our vaccine enterprise in this country. We are going to see measles cases increase dramatically in this country over the days and months ahead. It's a challenge that should be met by a unified federal government response, where we very strongly support childhood vaccines in our community. Instead, what we're getting is the information that says how dangerous these vaccines are, why they don't work, and the fact that you do not want to expose your child to something so dangerous. That's a huge challenge, just a huge challenge. I don't know what we can do that will actually turn the tide at the federal level as long as this administration is present. The second thing is this has been a bad year for foodborne disease and the whole area of perishable food items. And I think it's so important that we understand these are one of the food items that we want to encourage our population to eat part of a heart healthy diet, but it can't be seen as that when you're dealing with outbreaks of the magnitude and the impact that this last summer's outbreaks have demonstrated. So at this point, all I can say is that the industry has to understand one more season of outbreaks with Cyclospora in produce, and I think we're going to have a huge challenge rebuilding any trust back in the produce industry.

Dr. Michael Osterholm: And third, but yet very important, is our seasonal viral respiratory pathogens that we need to keep in mind, protect ourselves, urge you to get your flu vaccine, probably sometime in October. We'll keep you posted. By that time, I'm convinced the new Moderna vaccine will be available for some of us that want that. We also want to get vaccinated for COVID as soon as possible. Don't confuse the two. You don't need to get vaccinated for flu and COVID at the same time. When the new version of the COVID vaccine is out, which should be very shortly, it would be time to get it. This is one where I would get as soon as possible. So that gives you a sense of my top three today. I think I could have actually had six different take home messages today. There's a lot going on out there, but stay tuned. We'll keep you posted. And remember, we covered a number of items that are going to be highlighted in the show notes. So at the end of this podcast, do go look at those notes. They will take you to sources of some very important information.

Chris Dall: And they understand are closing this week is about another end of summer tradition, this one that is particular to our great state of Minnesota.

Dr. Michael Osterholm: Chris, this is a real joy to talk about. This one I want to cover a piece of important information for those of us from Minnesota. We happen to be very proud of our State Fair. And why is that? Because it is such a unique and special event. Every year for 12 days, we get together here in the Twin Cities at the State Fairgrounds. A very special place. And again, this year, in fact, beginning today, Thursday, August 27th, the State Fair runs for the next 12 days to September 7th. Over 2 million individuals will come visit the State Fair. This is often seen as the end of summer. It's marked as when schools will begin, and it is a, in a sense, almost like a rite of passage for that year. So for this reason, and tying into our dedication, I'm very happy to share with you a poem from Leslie Ball, our own Twin Cities singer, producer and writer who's performed on theater stages and music clubs around the region and the entire country. As someone who is recovering herself, Leslie spent more than a decade in the public schools teaching young people struggling with addiction to drugs and alcohol. Colleagues described her as the heart and soul of their school community, and parents continue to testify to her healing impact in their children's lives.

Dr. Michael Osterholm: Leslie was awarded the Hawkinson Peace and Justice Award for her work as an artist and educator, so she surely fits in very, very well with our dedication today. And I am so happy to be able to share with you a poem that Leslie wrote that is all about the Minnesota State Fair. This poem was actually written back in 2006, but it seems to have an eternal life to it, because anybody who reads it today will recognize that's exactly what we're going to experience the next 12 days here in Minnesota. "The Fair is a Living Thing" by Leslie Ball. Just past 6:00 am, light starting to leak into the sky. They predicted rain. We don't care. Today is day one of our beloved State Fair. People already streaming onto the ground. Three teenage boys cross in front of us, each wearing a feed cap. Each leading a newly shorn lamb. We hiked past the old machinery hill to our favorite breakfast counter. We talk about what we need to do first cattle barn, space tower or spin art. We talk about why we love the fair. The fair is a living thing for those few days. We stop being isolated from each other. We stop being frantic little gerbils on our own.

Dr. Michael Osterholm: Daily wheels, car, cubicle. Car, computer. The fair is a living thing. Feet of flesh, hooves, claws, fins, feathers, bristles and fur. Tap dancers and fiddlers. Hank Williams and Joey Ramone. The fair is a living thing Anything that breathes and grows and squeals. Waiting all year long for us to return. Waiting to take us in. To feed our bellies and our souls. To welcome us home. "The Fair is a Living Thing" by Leslie Ball. Thank you again for being with us. I hope that this information was helpful. Uh, we surely could cover a lot more, but we'll do what we can to keep you updated. And at this crazy time of our country's history. Again, I just want to remind all of us. As difficult as it can be sometimes kindness can rule the day if we make that our priority. As challenging as it might be right now, we need to never forget that. Be kind. And it's something that you can do easily if you just make it a priority. So thanks again for being with us. I look forward to being back with you in two weeks. Keep those emails and letters coming in. We surely appreciate the feedback we get and all I can say is be safe. Be kind. Support our kids in school.

Chris Dall: Thanks for listening to the latest episode of the Osterholm update. If you enjoyed the podcast, please subscribe, rate and review wherever you get your podcasts. And be sure to keep up with the latest infectious disease news by visiting our website, CIDRAP.umn.edu. This podcast is supported in part by you, our listeners. The Osterholm Update is produced by Sydney Redepenning, Elise Holmes and Ruby Guthrie. Our researchers are Cory Anderson, Meredith Arpey, Leah Moat, Emily Smith, Clare Stoddart, Angela Ulrich and Mary VanBeusekom.