BANGKOK — Nearly all of the world’s 35,000 online pharmacies are being run illegally and consumers who use them risk getting ineffective or dangerous drugs, according to the U.S. Trade Representative’s annual report on “notorious markets.” The report also singled out 19 countries over concerns about counterfeit or pirated products.

The report also named about three dozen online retailers, many of them in China or elsewhere in Asia that it said are allegedly engaged in selling counterfeit products or other illegal activities.

The report says 96% of online pharmacies were found to be violating the law, many operating without a license and selling medicines without prescriptions and safety warnings.

Their websites often look like legitimate e-commerce platforms, often with false claims that they are approved by the Food and Drug Administration, said the report, released Wednesday. The FDA and U.S. Drug Enforcement Administration have both issued warnings about risks of buying prescription medicines from such sources.

It cited a survey by the Alliance for Safe Online Pharmacies’ Global Foundation that found nearly one in four Americans who have used online pharmacies reported having encountered substandard, fake or harmful medicines.

Last year, federal prosecutors reported that a network of illegal drug sellers based in the U.S., the Dominican Republic and India had packaged potentially deadly synthetic opioids into pills disguised as common prescription drugs and sold millions of them through fake online drugstores, federal prosecutors said Monday. At least nine people died of narcotics poisoning between August 2023 and June 2024 after consuming the counterfeit pills, the indictment said.

Apart from the risks of using drugs that may contain inert ingredients or those that could cause allergies, the medicines are sometimes made in unsanitary conditions, said the report, which did not give annual statistics for those who may have died or otherwise been harmed.

Progress in fighting counterfeit and pirated goods

The USTR’s annual report cited examples from inside the United States, but and also mentioned risks of imported ingredients including fentanyl from China. Many of the illicit online pharmacies are based outside the U.S.

The “Notorious Markets List” did laud progress in fighting counterfeit and pirated goods.

In one case, U.S. authorities, industry groups and the police collaborated in shutting down a Hanoi, Vietnam-based piracy ring, Fmovies, and other related piracy sites, in July and August.

The report said the world’s then-largest pirated movies site had drawn more than 6.7 billion visits from January 2023 to June 2024.

In another Vietnam-linked case, two people operating pirate television platform BestBuyIPTV were convicted and ordered to pay fines and forfeit property.

The report also cited crackdowns on online piracy in Brazil and the United Kingdom and busts of sellers of counterfeit purses, clothing and shoes in Kuwait.

But problems remain with cyberlockers that thwart efforts to restrict piracy of movies and other content and of so-called “bulletproof” internet service providers, or ISPs, that promise people using them leeway for using pirate sites, it said.

One such ISP is Avito, a Russian-based ad platform that allegedly lets sellers advertise counterfeit products.

Baidu Wangpan, a cloud storage service of China’s largest search engine provider, Baidu, was named for allegedly failing to enforce or being slow to act on copyright protection.

The report also pointed to social-commerce site Pinduoduo and to Douyin Mall, a Chinese online platform owned by Tiktok owner ByteDance. It said the shopping platforms have sought to build up protections but that they still host many counterfeit goods.

It also named Shopee, a Singapore-based online and mobile e-commerce site, saying some country-focused platforms serving Southeast Asia and South American had better track records in fighting piracy than others.

IndiaMART, an big business-to-business marketplace in India, still offers a slew of counterfeit products, it said.

While a large share of theft of intellectual property has moved online, the report also highlighted real world locations notorious for selling counterfeit products, including markets in Turkey, bazaars in the United Arab Emirates and Saigon Square Shopping Mall in Vietnam’s Ho Chi Minh City.

The report said Bangkok’s MBK Center, a huge mall of about 2,000 stores, had actively cracked down on counterfeiting, though such products still can be found there. 
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NEW YORK — The 13-year-old boy came to the clinic with a rapidly ballooning neck. Doctors were puzzled.

Testing ruled out their first suspicion. But further tests pinpointed what they — and the boy — had been missing: iodine.

A century ago, iodine deficiency affected kids across large swaths of the country. It essentially disappeared after some food makers started adding it to table salt, bread and some other foods, in one of the great public health success stories of the 20th century.

But today, people are getting less iodine because of changes in diet and food manufacturing.

Although most people are still getting enough, researchers have increasingly been reporting low levels of iodine in pregnant women and other people, raising concerns about an impact on their newborns. And there is also a very small, but growing, number of reports of iodine deficiency in kids.

“This needs to be on people’s radar,” said Dr. Monica Serrano-Gonzalez, a Brown University doctor who treated the boy in 2021 in Providence, Rhode Island.

What is iodine?

Iodine is a trace element found in seawater and in some soils — mostly in coastal areas. A French chemist accidentally discovered it in 1811 when an experiment with seaweed ash created a purple puff of vapor. The name iodine comes from a Greek word meaning violet-colored.

Later that century, scientists began to understand that people need certain amounts of iodine to regulate their metabolism and stay healthy, and that it’s crucial in the development of brain function in children.

One sign of insufficient iodine is a swelling of the neck, known as a goiter. The thyroid gland in the neck uses iodine to produce hormones that regulate the heart rate and other body functions. When there’s not enough iodine, the thyroid gland enlarges as it goes into overdrive to make up for the lack of iodine.

At the beginning of the 20th century, goiter was very common in children in certain inland parts of the United States, especially in a “goiter belt” that stretched from Appalachia and the Great Lakes to the northwest United States. Some of the kids were unusually short, deaf, intellectually stunted and had other symptoms of a syndrome once known as “cretinism.”

Adding iodine to salt

Public health experts realized they couldn’t solve the problem by feeding everyone seaweed and seafood, but they learned that iodine can essentially be sprayed on table salt. Iodized salt first became available in 1924. By the 1950s, more than 70% of U.S. households used iodized table salt. Bread and some other foods also were fortified with iodine, and iodine deficiency became rare.

But diets changed. Processed foods now make up a large part of the American diet, and though they contain a lot of salt, it’s not iodized. Leading bread brands no longer add iodine. In the case of the 13-year-old boy, he has mild autism and was a fussy eater, mostly only eating specific brands of bread and peanut butter.

And for people who do salt their food, the fashion now is to use kosher salt, Himalayan rock salt or other noniodized products.

“People have forgotten why there’s iodine in salt,” said Dr. Elizabeth Pearce of Boston Medical Center. She is a leader in the Iodine Global Network, a nongovernmental agency working to eliminate iodine deficiency disorders.

She noted a reported 50% drop in U.S. iodine levels in surveyed Americans between the 1970s and the 1990s.

How much iodine is enough?

Though iodine consumption is falling overall, most Americans are still getting enough through their diet, experts say. But doctors worry that’s not the case for women and children, who are most vulnerable to iodine deficiency.

The American Academy of Pediatrics and other medical societies recommend that all pregnant and breastfeeding women get 150 micrograms of iodine each day. You can get that from one-half to three-quarters of a teaspoon of iodized table salt.

In the last 15 years or so, U.S. researchers have increasingly reported seeing mild iodine deficiency in pregnant women. A Michigan State University study of about 460 pregnant women in the city of Lansing found about a quarter of them were not getting enough.

Many prenatal vitamins don’t contain iodine, noted Jean Kerver, the study’s lead author. That’s why doctors recommend that pregnant or breastfeeding women check labels to ensure they are taking multivitamins or prenatal supplements with iodine.

Some studies have linked even mild iodine deficiency to lower IQs and language delay in children, although there is debate about at exactly what levels problems start, Pearce said.

Experts say there hasn’t been enough research to establish what impact that iodine deficiency has actually been having on the U.S. population in recent years.

Serrano-Gonzalez said she and her colleagues have seen four other cases in children in their clinic in Providence.

“We’re concerned this may be increasing, especially in patients with restricted diets,” she said. 
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Human Metapneumovirus (HMPV) has recently spread widely across China, overwhelming hospitals and evoking memories of the COVID-19 outbreak. HMPV is not a new virus; it has been known for years and typically has a low mortality rate. Nevertheless, epidemiologists are calling for greater transparency about the spread of the virus to help contain infections. While the health care system is under strain, experts stress that there is no need for panic. They recommend the public follow basic protective measures, particularly during the Spring Festival travel period, to help curb further spread of the virus.

Click here to read the full story in Mandarin.
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GENEVA — The World Meteorlogical Organization says that preventive action cannot avert natural disasters such as the wildfires raging across Los Angeles, but that it can help save lives and mitigate loss of property.

“Land management and prevention, regular clearing of underbrush play a key role in fire management, and evacuation plans are important in saving lives,” the WMO said Friday. “These are all part of effective early warning systems.”

In a briefing to journalists in Geneva, Claire Nullis, a WMO spokesperson, stressed the importance of preparing adequate evacuation plans and early warning systems to prevent some of the worst impacts from a natural disaster.

While acknowledging the staggering losses from the devastating wildfires sweeping across parts of Los Angeles in the United States this week, she said “The early warnings have, in this instance, been very, very good.

“You know, people have been evacuated. It has been impossible to save houses, and the loss of life is still too high, but it has been kept to a relative minimum,” she said.

Media reports say at least 10 people have been killed in this week’s Southern California wildfires, although more bodies are expected to be found once the fires have been contained and searchers can go through the debris.

More than 10,000 structures reportedly have burned, and 180,000 people are under evacuation orders.

While California is no stranger to wildfires, the WMO calls this catastrophic event “extraordinary” in that it is affecting one of the largest cities in the United States.

The WMO said that last year’s rainy season for the Los Angeles area as a whole was slightly above normal, but so far, this year it has been dry.

“The big compounding factor in this context is the winds. … They cause temperatures to rise, and they cause very low humidity, drying out the ground and vegetation,” Nullis said.

The WMO said destructive wildfires have been made worse by climate change.

“Climate change, including increased heat, extended drought and a thirsty atmosphere, has been a key driver in increasing the risk and extent of wildfires in the western United States during the last decades,” it said, citing data from the U.S. National Oceanic and Atmospheric Administration.

The WMO said wildfires require the alignment of a number of factors, including temperature, humidity and the lack of moisture in fuels such as trees, shrubs, grasses and forest debris.

“All these factors have strong direct or indirect ties to climate variability and climate change,” it said.

“Obviously, not every single weather-related disaster is due to climate change,” WMO spokesperson Nullis said. “Nobody would say that. But we get quite clear signals that climate change is exacerbating some of these disasters.”

In addition to the loss of life and destruction of homes and other infrastructure that could total billions of dollars in insured losses, the World Health Organization warns that wildfires can have a significant impact on human morbidity and mortality.

“Wildfire smoke, which is a mixture of air pollutants, of which particulate matter is of major concern as it can be full of PM 2.5. This is a very small particulate matter that gets right down into the lungs, and there certainly is a lot of it.” said Dr. Margaret Harris, a WHO spokesperson.

“A lot of it is associated with premature death in the general population,” she said. “It can cause and exacerbate diseases of lung, heart, brain, the nervous system” and other illnesses.

“It has been shown to lead to cognitive impairment and actually damage your intellectual capacity and lead to memory loss,” she said, adding that firefighters and emergency response workers “are most at risk from exposure to smoke.”

The WHO estimates 4.2 million deaths globally are linked to ambient or outdoor air pollution, with 99% of the global population exposed to air pollution levels that exceed the WHO guideline level for fine particulate matter (PM 2.5).

Harris said more research is needed to understand the long-term health effects of wildfire exposure on vulnerable populations, particularly children, older people, pregnant women and the chronically ill.

“We expect that we will see this over and over again if we do not get what we are doing to the planet under control,” she said.

Meanwhile, the World Meteorological Organization has officially confirmed that 2024 was the hottest year on record, “with a global mean temperature of more than 1.5 degrees above the 1850-1900 average.”

“We have just endured the hottest decade on record, with 2024 topping the list,” U.N. Secretary-General Antonio Guterres said, noting that “blazing temperatures in 2024 require trailblazing climate action in 2025.”

“There is still time to avoid the worst of climate catastrophe. But leaders must act now,” he said.
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For the first time, a person in the United States has died after being infected with the bird flu. Louisiana health officials reported the death on Monday. The World Health Organization says the risk of infection for the general population remains low, but as VOA’s Dora Mekouar reports, some medical experts are still sounding the alarm.
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WASHINGTON — Nearly a quarter of animals living in rivers, lakes and other freshwater sources are threatened with extinction, according to new research published Wednesday.

“Huge rivers like the Amazon can appear mighty, but at the same time freshwater environments are very fragile,” said study co-author Patricia Charvet, a biologist at Brazil’s Federal University of Ceará.

Freshwater habitats – including rivers, lakes, ponds, streams, bogs and wetlands – cover less than 1% of the planet’s surface, but support 10% of its animal species, said Catherine Sayer, a zoologist at the International Union for Conservation of Nature in England.

The researchers examined around 23,500 species of dragonflies, fish, crabs and other animals that depend exclusively on freshwater ecosystems. They found that 24% were at risk of extinction – classified as vulnerable, endangered or critically endangered – due to compounding threats from pollution, dams, water extraction, agriculture, invasive species, climate change and other disruptions.

“Most species don’t have just one threat putting them at risk of extinction, but many threats acting together,” said Sayer, a study-co-author.

The tally, published in the journal Nature, is the first time that researchers have analyzed the global risk to freshwater species. Previous studies have focused on land animals including mammals, birds and reptiles.

Duke University ecologist Stuart Pimm, who was not involved in the study, called it “a long-awaited and hugely important paper.”

“Almost every big river in North America and Europe is massively modified” through damming, putting freshwater species at risk, he said.

In South America, the vast Amazon River ecosystem also faces threats from deforestation, wildfires and illegal gold mining, said Charvet.

Illegal fires to clear forest result in waves of ash polluting the river, and unlicensed gold miners dump mercury into the water, she said.

Rivers and wetlands “concentrate everything that happens around them,” she said. “If something goes really wrong, like an acid or oil spill, you can threaten an entire species. There’s nowhere else for these animals to go.”
…

India TV’s claims that HMPV is a mysterious virus, or speculation that a new virus may have arisen out of China, are false.
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WASHINGTON — The Louisiana Department of Health said Monday that a U.S. patient hospitalized with H5N1 bird flu had died, the country’s first death from an outbreak of the virus that has sickened dozens of people and millions of poultry and cattle. 

Nearly 70 people in the U.S. have contracted bird flu since April, according to the U.S. Centers for Disease Control and Prevention, most of them livestock workers exposed to sick chickens or dairy cattle. 

The patient in Louisiana, the first person in the country to be hospitalized with the virus, contracted bird flu after exposure to a combination of backyard chickens and wild birds, said Louisiana health officials. The patient was hospitalized on Dec. 18, state health officials said. 

The patient was over 65 and had underlying medical conditions, the officials said. 

“While the current public health risk for the general public remains low, people who work with birds, poultry or cows, or have recreational exposure to them, are at higher risk,” the department said in a statement.  

The CDC did not immediately respond to a request for comment.
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CAPE CANAVERAL, FLORIDA — The new year will bring a pair of lunar eclipses, but don’t expect any sun-disappearing acts like the one that mesmerized North America last spring.

While the world will have to wait until 2026 for the next total solar eclipse, the cosmos promises plenty of other wow moments in 2025. It’s kicking off the year with a six-planet parade in January that will be visible for weeks. Little Mercury will join the crowd for a seven-planet lineup in February.

Five planets already are scattered across the sky — all but Mars and Mercury — though binoculars or telescopes are needed to spot some of them just after sunset.

“People should go out and see them sometime during the next many weeks. I certainly will,” said the Planetary Society’s chief scientist Bruce Betts.

Here’s a sneak peek of what’s ahead:

Eclipses

The moon will vanish for more than an hour over North and South America on March 14, followed two weeks later by a partial solar eclipse visible from Maine, eastern Canada, Greenland, Europe, Siberia and northwestern Africa.

The cosmic double-header will repeat in September with an even longer total lunar eclipse over Europe, Asia, Africa and Australia, and a partial solar eclipse two weeks later near the bottom of the world.

Supermoons

Three supermoons are on tap this year in October, November and December.

The full moon will look particularly big and bright those three months as it orbits closer to Earth than usual.

November’s supermoon will come closest, passing within 356,980 kilometers. Last year featured four supermoons, wrapping up in November.

Planet parade

Six of our seven neighboring planets will line up in the sky to form a long arc around mid-January. All but Neptune and Uranus should be visible with the naked eye just after sunset, weather permitting.

The parade will continue for weeks, with some of the planets occasionally snuggling up. Mercury will make a cameo appearance by the end of February. The planets will gradually exit, one by one, through spring.

Northern and southern lights

The sun burped big time last year, painting the sky with gorgeous auroras in unexpected places.

Space weather forecasters anticipate more geomagnetic storms that could yield even more northern and southern lights.

That’s because the sun has reached its solar maximum during its current 11-year cycle that could continue through this year. The National Oceanic and Atmospheric Administration’s Shawn Dahl urges everyone to stay on top of space weather news, so as not to miss any pop-up, razzle-dazzle shows.

Meteor showers

The Perseids and Geminids are perennial crowd-pleasers, peaking in August and December, respectively. But don’t count out the smaller, less dramatic meteor showers like the Lyrids in April, the Orionids in October and the Leonids in November.

The darker the locale and dimmer the moon, the better it will be for viewing. Meteor showers are generally named for the constellation in which they appear to originate. They occur whenever Earth plows through streams of debris left behind by comets and sometimes asteroids. 
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TOKYO — Tomiko Itooka, a Japanese woman who was the world’s oldest person according to Guinness World Records, has died, an Ashiya city official said Saturday. She was 116.

Yoshitsugu Nagata, an official in charge of elderly policies, said Itooka died on Dec. 29 at a care home in Ashiya, Hyogo Prefecture, central Japan.

Itooka, who loved bananas and a yogurt-flavored Japanese drink called Calpis, was born on May 23, 1908. She became the oldest person last year following the death of 117-year-old Maria Branyas, according to the Gerontology Research Group.

When she was told she was at the top of the World Supercentenarian Rankings List, she simply replied, “Thank you.”

When Itooka celebrated her birthday last year, she received flowers, a cake and a card from the mayor.

Born in Osaka, Itooka was a volleyball player in high school, and long had a reputation for a sprightly spirit, Nagata said. She climbed the 3,067-meter (10,062-foot) Mount Ontake twice.

She married at 20, and had two daughters and two sons, according to Guinness.

Itooka managed the office of her husband’s textile factory during World War II. She lived alone in Nara after her husband died in 1979.

She is survived by one son, one daughter and five grandchildren. A funeral service was held with family and friends, according to Nagata.

According to the Gerontology Research Group, the world’s oldest person is now 116-year-old Brazilian nun Inah Canabarro Lucas, who was born 16 days after Itooka.
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WASHINGTON — The highly decorated Special Forces soldier who died by suicide in a Cybertruck explosion on New Year’s Day confided to a former girlfriend who had served as an Army nurse that he faced significant pain and exhaustion that she says were key symptoms of traumatic brain injury.

Green Beret Matthew Livelsberger, 37, was a five-time recipient of the Bronze Star, including one with a V device for valor under fire. He had an exemplary military record that spanned the globe and a baby born last year. But he struggled with the mental and physical toll of his service, which required him to kill and caused him to witness the deaths of fellow soldiers.

Livelsberger mostly bore that burden in private but recently sought treatment for depression from the Army, according to a U.S. official who spoke on condition of anonymity to provide details that have not been made public.

He also found a confidant in the former nurse, who he began dating in 2018.

Alicia Arritt, 39, and Livelsberger met through a dating app while both were in Colorado Springs. Arritt had served at Landstul Regional Medical Center in Germany, the largest U.S. military medical facility in Europe, where many of the worst combat injuries from Iraq and Afghanistan were initially treated before being flown to the United States.

There she saw and treated traumatic brain injuries, or TBIs, which troops suffered from incoming fire and roadside bombs. Serious but hard to diagnose, such injuries can have lingering effects that might take years to surface.

“I saw a lot of bad injuries. But the personality changes can happen later,” Arritt said.

In texts and images he shared with Arritt, Livelsberger raised the curtain a bit on what he was facing.

“Just some concussions,” he said in a text about a deployment to Helmand Province in Afghanistan. He sent her a photo of a graphic tattoo he got on his arm of two skulls pierced by bullets to mark lives he took in Afghanistan. He talked about exhaustion and pain, not being able to sleep and reliving the violence of his deployment.

“My life has been a personal hell for the last year,” he told Arritt during the early days of their dating, according to text messages she provided to The Associated Press. “It’s refreshing to have such a nice person come along.”

On Friday, Las Vegas law enforcement officers released excerpts of messages Livelsberger left behind showing the way Livelsberger killed himself was intentional, meant both as a “wakeup call” but also to “cleanse the demons” he was facing from losing fellow soldiers and taking lives.

Livelsberger’s death in front of the Trump Hotel using a truck produced by Elon Musk’s Tesla company has raised questions as to whether this was an act of political violence.

Officials said Friday that Livelsberger apparently harbored no ill will toward President-elect Donald Trump, and Arritt said she and Livelsberger were Tesla fans.

“I had a Tesla, too, that I rescued from a junkyard in 2019, and we used to work on it together, bond over it,” Arritt said.

The pair stopped talking regularly after they broke up in 2021, and she had not heard from him in more than two years when he texted out of the blue on Dec. 28, and again on Dec. 31. The upbeat messages included a video of him driving the Cybertruck and another one of its dancing headlights; the vehicle can sync up its lighting and music.

But she also said Livelsberger felt things “very deeply, and I could see him using symbolism” of both the truck and the hotel.

“He wasn’t impulsive,” Arritt said. “I don’t see him doing this impulsively, so my suspicion would be that he was probably thinking it out.”

Arritt served on active duty from 2003 to 2007 and then was in the Army Reserve until 2011. With Livelsberger, she saw symptoms of TBI as early as 2018.

“He would go through periods of withdrawal, and he struggled with depression and memory loss,” Arritt said. “I don’t know what drove him to do this, but I think the military didn’t get him help when he needed it.”

But Livelsberger was also sweet and kind, she recalled: “He had a really deep well of inner strength and character, and he just had a lot of integrity.”

Pentagon Deputy Press Secretary Sabrina Singh told reporters Friday that it has turned over all Livelsberger’s medical records to local law enforcement and encouraged troops facing mental health challenges to seek care through one of the military’s support networks.

“If you need help, if you feel that you need to seek any type of mental health treatment, or just to talk to someone — to seek the services that are available, either on base or off,” Singh said.

When Livelsberger struggled during the time they were dating, Arritt prodded him to get help. But he would not, saying it could cost him his ability to deploy if he was found medically unfit.

“There was a lot of stigma in his unit; they were, you know, big, strong, Special Forces guys there. There was no weakness allowed, and mental health is weakness is what they saw,” she said.

Livelsberger seeking treatment for depression was first reported by CNN.
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WASHINGTON — U.S. President Joe Biden’s outgoing administration announced Friday that it will allocate $306 million to bolster the nation’s bird flu response before President-elect Donald Trump takes office.

The new funding will support national, state and local preparedness and monitoring programs, as well as research into potential medical countermeasures against the H5N1 virus.

“While the risk to humans remains low, we are always preparing for any possible scenario that could arise,” Health Secretary Xavier Becerra said in a statement.

“Preparedness is the key to keeping Americans healthy and our country safe.”

The United States has reported 66 human cases of bird flu since the start of 2024, though experts believe the true number could be higher, with cases potentially going undetected among cattle and poultry workers.

While the virus has not been found to spread from person to person, the amount of bird flu circulating among animals and humans has alarmed scientists, because it might combine with seasonal influenza and mutate into a more transmissible form — potentially triggering a deadly pandemic.

The funding announcement comes amid concern over how the incoming Trump administration will handle the threat.

The president-elect told Time magazine recently he would abolish the Office of Pandemic Preparedness and Response Policy established under Biden — though it is not clear if he has the authority to do so, since it was created by Congress.

His pick for health secretary, Robert F. Kennedy Jr., is a vocal vaccine skeptic who has pledged to shake up the nation’s health agencies and promotes raw milk, thought to be a vector for bird flu.

Biden’s administration has also faced criticism for what some consider a subpar bird flu response.

The Center for Strategic and International Studies, a Washington-based think tank, published a report last month citing an array of problems including “lagging data, incomplete surveillance, sluggish coordination, considerable mistrust, and insufficient planning and stockpiling of vaccines and therapies.”

Given these shortcomings, infectious disease epidemiologist Meg Schaeffer of the SAS Institute told AFP: “In my opinion, avian influenza is going to become either a pandemic or a virus…  that will become a very widespread and significant health issue for us in the next one to two years.”

She urged raw milk consumers in particular to “take a pause on that consumption.”

Adding to concerns, a virus sample from a critically ill patient in Louisiana has shown signs of mutating to better adapt to human airways, although there is no evidence it has spread beyond that individual, health authorities said last week.

Researchers are also closely monitoring the growing number of bird flu infections in cats, which could expose humans through close contact. 
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The holidays came with a side of flu for many Americans, with 40 states reporting high or very high levels of illness last week, according to the latest government health data. 

“A lot of flu out there,” said Carrie Reed of the Centers for Disease Control and Prevention. 

Of course, there are a number of bugs that cause fever, cough, sore throat and other flulike symptoms. One is COVID-19. Another is RSV, or respiratory syncytial virus, which is a common cause of coldlike symptoms but can be dangerous for infants and the elderly. 

Reed said that the most recent CDC hospitalization data and other indicators show that the flu virus is trending higher than the other germs. Several seasonal flu strains are driving cases, with no dominant one, she added. 

Pediatric hospitals have been busy since November with RSV, but “influenza has now joined the party,” said Dr. Jason Newland, an infectious-diseases specialist at Nationwide Children’s Hospital in Columbus, Ohio. 

“Now we’re really starting to roll,” he added. “Our hospitals are busy.” 

Where flu illnesses are the highest 

One indicator of flu activity is the percentage of doctor’s office visits driven by flulike symptoms. That level last week was about equal to the peak of last winter’s respiratory virus season — which occurred at the same time of year. Reed noted that most people avoid medical appointments over the holidays if they can help it, so the data in late December might be skewed by people who came down with sudden illnesses. 

Last week’s flu activity was particularly intense in the South, Southwest and West. The states reporting lesser amounts of suffering were mostly in the northern Great Plains and in New England. 

So far this season, the CDC estimates, there have been at least 5.3 million flu illnesses, 63,000 hospitalizations and 2,700 deaths, including at least 11 children. 

It’s not clear if this winter respiratory virus season will be any worse than others. So far it seems relatively typical, at least for kids, Newland said. 

How to protect yourself 

U.S. health officials recommend that everyone 6 months and older get an annual flu vaccination, and they say it’s not too late to get a shot. 

You should also avoid touching your eyes, nose and mouth because germs can spread that way, health officials say. You should also wash your hands with soap and water, clean frequently touched surfaces and avoid close contact with people who are sick.

The CDC also has been keeping its eye on a rise of illnesses from norovirus, a nasty stomach bug, with 91 outbreaks reported early in December. 

Investigators also have been closely watching another kind of influenza virus, the Type A H5N1 version of bird flu. The CDC says 66 human U.S. cases of that were reported last year, but none of them in the last week. 

The cases are “fairly sporadic,” and the overall risk to the public remains low, Reed said. Almost all have been traced to direct contact with infected animals, with no proof of spread between people. 
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WASHINGTON/LONDON — Alcoholic drinks should carry a warning about cancer risks on their label, the U.S. surgeon general said Friday in a move that could signal a shift toward more aggressive tobacco-style regulation for the sector. 

U.S. Surgeon General Vivek Murthy said alcohol consumption increases the risk of at least seven types of cancer, including breast, colon and liver cancer, but most U.S. consumers remain unaware of this. 

Murthy also called for the guidelines on alcohol consumption limits to be reassessed so that people can weigh the cancer risk when deciding whether or how much to drink. U.S. dietary guidelines currently recommend two or fewer drinks per day for men and one drink or less per day for women. 

“Alcohol consumption is the third leading preventable cause of cancer in the United States, after tobacco and obesity,” Murthy’s office said in a statement accompanying the new report, adding the type of alcohol consumed does not matter. 

His advisory sent shares in alcohol companies including Diageo, Pernod Ricard, Anheuser-Busch and Heineken down, in some cases over 3%. 

Alcohol producers and industry associations did not immediately share comments. 

It is unclear when or if the surgeon general’s suggestions will be adopted. U.S. President Joe Biden’s administration is entering its final two weeks. Murthy could be succeeded by Janette Nesheiwat, a director of a New York chain of urgent care clinics and President-elect Donald Trump’s pick for the role. 

Trump, whose brother died from alcoholism and who does not drink himself, has long warned about the risks of drinking. Robert F. Kennedy Jr., Trump’s nominee for Secretary of Health and Human Services, has been open about his past struggles with heroin and alcohol, and says that he attends Alcoholics Anonymous meetings. 

The decision to update the label will ultimately be made by Congress. 

Small print 

Murthy’s advisory harks back to early U.S. surgeon general action on tobacco, starting with a 1964 report that concluded smoking could cause cancer. The report kicked off decades of increasingly strict regulations, starting with U.S. laws on warning labels one year later and still ongoing today. 

Alcoholic drinks in the U.S. already carry warnings on their packaging, including that drinking alcohol while pregnant can cause birth defects and that it can impair judgment when operating machinery. These appear in small print on the back of the packaging. This label has not changed since its inception in 1988. 

Murthy’s recommendations call for an update to these existing labels, rather than new cigarette-style warnings that are today displayed prominently on the front of every packet. 

Analysts, however, pointed out that cigarette warning labels did little to curb smoking and ingrained habits are hard to change. 

“Warning labels won’t be an immediate deathblow to alcohol makers, but it will compound the long-term threats to the industry,” said Blake Droesch, analyst with eMarketer. 

In the U.S., among the largest markets for many western producers, companies face growing competition from alternatives like cannabis and the threat of lower volumes as some consumers, especially younger ones, drink less than previous generations. 

Beer makers especially have, however, enjoyed benefits from a shift toward healthier lifestyles, with low- or no-alcohol products enjoying rapid growth. Heineken’s 0.0 version, for example, grew double digits in 16 markets last year. 

The advisory said alcohol is responsible for 100,000 U.S. cancer cases and 20,000 cancer deaths each year, more than the 13,500 alcohol-associated traffic crash deaths. 

The new report recommends health care providers should encourage alcohol screening and treatment referrals as needed, and efforts to increase general awareness should be expanded.
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Juba, South Sudan   — More than 1.1 million doses of an oral cholera vaccine have arrived in South Sudan, as the government launched a program to inoculate more than 80 percent of the population. But the mass vaccination exercise faces numerous challenges, including a lack of access to the areas dealing with the worst cholera outbreaks.

Medics in South Sudan will attempt to vaccinate at least 9 million people against cholera, an exercise that targets mostly children and mothers.

More than 1.1 million doses of oral cholera vaccine arrived in the capital, Juba, and will be dispatched next week to hot spots areas like the town of Bentiu.

The country’s Ministry of Health reported last week that 199 people have died of cholera, with 13,000 more diagnosed so far with the bacteria.

Dr. Gabriel Boum Tap is an immunization officer at UNICEF in South Sudan.

“Of course, we had also received some vaccines before; only that they were not enough, because, you know, it’s not like the cholera vaccine is manufactured and is put in one place already,” he said.

At least one cholera case has been recorded in 29 of the 79 counties in South Sudan, with Bentiu, Renk and Juba most affected.

The first case was reported on September 23 in Renk, northeast of the capital.

But as the country prepares to roll out a mass vaccination exercise, the process faces some serious headwinds.

Thinjin Khoat is one of the victims of the cholera outbreak. He says he has seen people die of the disease, with many more trooping to local health centers seeking urgent medical attention.

“I was at one of the health facilities, and there was a suspected case of cholera. The patient was a 5-year-old. The patient was vomiting, and in the process, the health workers couldn’t get the vein. The patient is not able to get the oral fluid. … In that process, the patient died of dehydration,” he said.

Cholera is an acute diarrhea infection caused by consuming contaminated food or water. If not treated, it can be fatal within hours.

Khoat says accessibility to health care remains a major hindrance to the fight against the disease.

“Some of the community members, they don’t have access, because, you know, in Bentiu here, there is flooding. There are some areas that health workers cannot access because of the flood and also security issues,” he said.

According to Doctors Without Borders, or MSF, poor living conditions in South Sudan have created the perfect breeding ground for cholera.

Stephanie Ngai is MSF’s project coordinator for cholera response in Bentiu, located in Rubkona County, an area with a large refugee population.

“Here in Rubkona, the explosion on the outbreak very quickly overwhelmed the local systems that are responsible for coordinating the response and scaling up the interventions,” she said. ‘Other partners don’t have adequate funding to properly scale up the level needed, which is massive. And the overall response coordination has not been strong enough to manage the response and ensure that the needs are adequately met.”

The government says the vaccination exercise is expected to roll out next Monday with support from international partners such as MSF and the World Health Organization.

Buok Danhier, the immunization program manager for the Unity State Ministry of Health, says the various entities will split up duties in Rubkona.

“Rubkona has many payams [local districts]. Most of the payams are affected by flooding, and these are the ones that will be taken by WHO — the hard-to-reach areas. WHO and other partners are pledging to cover all those areas that are hard to reach and also very far from town. Bentiu IDP, Rukona and Bentiu town — these areas will be covered by MSF, and the recruitment process is ongoing,” said Danhier.

The vaccination exercise will target children 1 year and above.

WHO says up to 143,000 people worldwide die from cholera each year out of an estimated 4 million annual cases.
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