Missing CDC alerts? You’re not the only one.
CDC alerts — including Health Alert Network (HAN) messages — aren’t going out as often as they used to, leading to a drop in crucial public health information that clinicians rely on to inform their practice.
“When I ask my subscribers, what more can I do for you…they don’t want more essays. They don’t want more news. They want more data,” said Caitlin Rivers, PhD, an infectious disease epidemiologist and founder of Force of Infection (FOI), a Substack-hosted e-newsletter platform about outbreaks.
Now Rivers and others are taking matters into their own hands — by creating their own public health monitoring services designed especially for clinicians.
A recent report revealed “unexplained pauses” and delays across CDC databases. HAN notifications have dwindled from 18 in 2023 and 16 in 2024 to six in 2025, most issued in the first quarter.
The HAN hasn’t mentioned current outbreaks of measles, pertussis, or infant botulism, Rivers said. Its most recent advisory was for New World screwworm, which “is primarily a disease of livestock,” she said, and there are currently no human cases in the US.
“Not that I’m criticizing HANs,” Rivers said. “It’s just that what’s in and what’s out did not always make a lot of sense.” The last three alerts focused on diseases not even circulating in the US, she said.
That’s why Rivers created FOI Clinical, a Force of Infection spinoff featuring a weekly newsletter plus same-day urgent alerts to help clinicians track outbreaks and disease activity. The service, available by email or smartphone notifications via the Substack app, will launch February 11 and cost $10 per month.
It comes 2 months after NEJM Evidence, in partnership with Center for Infectious Disease Research and Policy (CIDRAP), started publishing its own public health alerts. “Over the past year, we have been hearing from public health officials across the country about the need to have a forum to rapidly share data,” said Chana A. Sacks, MD, MPH, the journal’s editor-in-chief. The alerts are free, peer-reviewed, and published as needed. In December, California health officials reported on the community spread of the clade 1b mpox virus — critical information for “clinicians who may see other people who are affected,” Sacks said. For email notifications, you can sign up for the “NEJM Evidence This Week” newsletter or CIDRAP’s “Daily News Headlines” newsletter.
FOI Clinical: What Is It?
Rivers said the biggest value of FOI Clinical is the perspective she brings as an epidemiologist. She is also the director of Johns Hopkins’ Center for Outbreak Response Innovation and a cofounder of the CDC’s Center for Forecasting and Outbreak Analytics.
“We do the monitoring and the translating into plain language and the provision of context so that clinicians have the information they need before they head into the clinic,” said Rivers.
Surveillance data can be a minefield, Rivers said. Some pathogens are reported reliably, but others — like salmonella and Giardia — are often undercounted because most people recover without seeking care. Her service explains which numbers you can trust and how to interpret the rest. The content can also help guard against misdiagnosis by providing data needed to differentiate between conditions with similar symptoms.
Rivers has already become known among her followers for spotting useful trends. Sarah Nielsen, MD, a pediatrician in Verona, New Jersey, said Rivers’ updates helped her during the COVID pandemic, particularly when lockdown ended.
“It was really important for families to know what [symptoms] to look out for,” Nielsen said. The information helped her decide which respiratory virus was most likely, when to test, and whether a test result was accurate or taken too soon. Nielsen prefers having the information sent to her email, which she’s more likely to check regularly than a website, she said.
One highlight under consideration for FOI Clinical’s first edition is a “huge spike in pertussis” midway through 2025, which Rivers said wasn’t “well-recognized or reported.” Two other pathogens on her radar are tularemia and chikungunya. A puzzling rise in tularemia cases in Oklahoma last November and December has her asking state health officials for details — including whether this looks like an outbreak or a reporting error. Although tularemia is known in Oklahoma, historically the state has only contributed about 10% of cases — meaning clinicians in surrounding states should stay alert in case testing or reporting problems are masking cases or leading to misdiagnoses.
Rivers uses a top-down approach, starting with national trends before drilling down into more localized data. That’s how she discovered that an apparent national spike in chikungunya is actually contained to Florida. The virus looks similar to other insect-borne illnesses, with common symptoms like fever and joint pain, she said. Because of its mosquito vector, she warns that clinicians should be aware chikungunya “is brewing” and could become established in the state.
Rivers said she heavily uses CDC Notifiable Infectious Disease Data, a resource that isn’t casual-user friendly — think 1.5 million rows of data. Still, this database is vulnerable to the same delays and pauses as other CDC sources. During last year’s government shutdown, Rivers continued to provide flu updates by collecting state and local health department data.
“My research assistant and I went to all 50 state websites and collected data week over week until the federal government came back online,” Rivers said. “I think that kind of robustness and trustworthiness, and the ability to have someone outside of the federal government who’s doing some interpretation and sharing, [that] is an asset.”
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