June 5, 2025



Global COVID Activity Increases; U.S. Vaccine Policy Shift Fuels Concern, Confusion

Global COVID-19 activity continues to rise, primarily in parts of Asia and the Middle East, with the new NB.1.8.1 subvariant increasingly being detected in the UK and the U.S. NB.1.8.1 accounts for nearly 11% of globally sequenced cases as of mid-May, according to WHO. While the Omicron derivative appears more infectious than the currently predominant LP.8.1, symptoms are similar to previous SARS-CoV-2 strains, and vaccines and antivirals are still expected to offer protection. Despite an uptick in hospitalizations in some countries, NB.1.8.1 is still considered a low overall risk to public health.

Typical process upended

In the U.S., questions and confusion remain over HHS’s unprecedented decision to rescind federal recommendations for routine COVID-19 vaccination in healthy children and pregnant women. Neither the CDC, which typically sets policy for who should receive vaccines, nor the Advisory Committee on Immunization Practices (ACIP), which advises the agency on those decisions, was consulted on or alerted to the decision.

CDC urges shared decision making

Last week, CDC issued updated advice that appears to counter the new HHS policy, stating that children “may receive” COVID-19 shots through shared decision-making between parents and doctors. COVID-19 vaccines during pregnancy—a well-documented risk factor for more severe COVID-19 complications—are now listed as "No Guidance/Not Applicable," where they were previously recommended for all pregnant adults. These changes, which bypassed the usual advisory process and provided no new data underlying the rationale, have led to widespread confusion among healthcare providers and families and may make access to COVID vaccines more difficult due to uncertain insurance coverage or fewer providers who stock doses.

Experts disagree with new guidance

Many public health and infectious disease experts dispute the new recommendations, emphasizing that pregnancy remains a significant risk factor for severe COVID-19 complications. Additionally, the lack of clear federal guidance could further undermine public trust, they argue. A top COVID vaccine adviser to CDC stepped down this week, citing concerns she could no longer support the most vulnerable populations under the new recommendations. At least one state health department has issued a statement continuing to recommend COVID vaccination for children and during pregnancy.

Opinion pieces address COVID vaccine decisions

CIDRAP: Viewpoint: Eroding trust by making COVID vaccine decisions with no transparency (opinion)

STAT: HHS Secretary Kennedy told us not to listen to him. We agree (opinion)

STAT: RFK Jr.’s stance on Covid vaccines for pregnant women is profoundly unethical (opinion)

U.S. Measles Cases Continue Rise, Driven by Falling Vaccinations, Travel-Associated Infections

This year is on track to be the worst U.S. measles year in more than 30 years, fueled by declining vaccination and ongoing outbreaks worldwide, including in neighboring Canada and Mexico. Around 1,160 measles cases in 33 states have been reported in the U.S. this year, with the largest outbreak centered in West Texas. Most infections are among individuals who are unvaccinated or whose vaccination status is unknown.

Vaccination rates decline

Since the COVID-19 pandemic, childhood vaccination rates against measles, mumps, and rubella (MMR) have declined in nearly 80% of the more than 2,000 U.S. counties in 33 states with available data, according to Johns Hopkins University research. The county-level mean MMR vaccination rate in these counties now sits at 91.26%, well below the 95% threshold needed for measles herd immunity.

Travel-associated cases

CDC this week updated its warning about the risk of contracting measles while traveling, recommending all travelers be fully vaccinated against measles before international trips. So far this year, the agency has recorded at least 62 reports of travelers who were contagious with measles while flying into or within the U.S. Recent cases in Colorado, New Mexico, and Minnesota were linked to domestic airports and flights, prompting public health alerts for exposed passengers.

Wastewater surveillance program

For the first time, measles is being tracked in U.S. wastewater. The WastewaterSCAN network developed the first national wastewater monitoring program for measles, with the new tool available for use in nearly 150 wastewater treatment facilities across 40 states. So far, the virus has been detected in three sites in Maryland, California, and Connecticut.

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Editor: Alyson Browett, MPH