Those pandemic doldrums may be lifting, but it's difficult to determine in today's post-pandemic era of reduced reporting. First, a look at a couple other things from a slow week in the world of infections.
ProMED Still Going Strong
I mentioned last week that my most cherished web site, ProMED, had some internal turmoil that threatened its existence. I don't know if the disagreements have been solved, but their postings have continued. Here's an example from last night's email of topics:
ProMED Digest, Vol 107, Issue 221
1. PRO/AH/EDR> Anthrax - Indonesia (07): (JT) cattle
2. PRO/AH/EDR> Crimean-Congo hem. fever - Asia (22): Afghanistan
3. PRO/EDR> Pertussis update (21): USA (NY)
4. PRO/AH/EDR> Canine influenza - North America (08): USA (OK) RFI
5. PRO/AH/EDR> Listeriosis - Americas (05): (USA) kosher ice cream, recall
6. PRO/EDR> Leishmaniasis, Americas (10): Brazil (MG)
7. PRO/AH/EDR> Leptospirosis - Italy: (VN) swimming, river
8. PRO/EDR> Measles update (36): Sweden, cruise ship
9. PRO/EDR> Meningitis, meningococcal - Norway: (VF) fatal, ex Greece
10. PRO/AH/EDR> Newcastle disease - Poland (02): (PD) poultry, spread
11. PRO/AH/EDR> Anthrax - USA (07): (ND) cattle
12. PRO/AH/EDR> Lumpy skin disease - Asia (11): Indonesia ex Australia, cattle, disputed, RFI
13. PRO/EDR> Measles update (37): South Sudan (WH) fatal, children
14. PRO/AH/EDR> Avian influenza (129): Americas (Argentina) sea lion, HPAI H5
15. PRO/AH/EDR> Echarate virus - Peru: (JU) new variant
16. PRO/AH/EDR> Eastern equine encephalitis - North America (05): USA (NC)
17. PRO/AH/EDR> Brucellosis - Paraguay (01): (AS) veterinary school, RFI
18. PRO/AH/EDR> Crimean-Congo hem. fever - Asia (23): Iraq
19. PRO/AH/EDR> West Nile virus (12): USA (NM, DE)
20. PRO/EDR> Pertussis update (22): Canada (SK)
It's a longer list than most of their posts. I couldn't remember what the Echarate virus (ECHV)was, so I looked deeper at that one. Turns out ECHV is a Phlebovirus, a genus of viruses that can cause nonspecific febrile illnesses in humans. It is transmitted primarily by sandflies, mosquitoes, and ticks. Echarate is the capital city of the Echarate District in Peru. One of the many reasons to use insect repellant.
Vaccination of Pregnant Persons
The timing worked out well for me, so I tuned in to a CDC COCA call on vaccination during pregnancy. The event recording and slides are available at their website. Virtually none of my patients have been pregnant people, but as with most pediatric healthcare providers it's been very common for parents of my patients to be pregnant at the time of their child's visit with me. So, pediatric providers have a role in encouraging vaccination for pregnant people.
No surprise, but uptake of the 3 vaccines with specific benefits during pregnancy (Tdap, influenza, covid) has been pretty poor lately:
The benefits of influenza and covid vaccines accrue to both the pregnant people, since those diseases are more severe during pregnancy, as well as to providing antibody to their newborns. Tdap vaccination is recommended for every pregnancy, regardless of prior immunization status, because pertussis protection wanes quickly over the year following vaccination and therefore is unlikely to provide newborn protection for a subsequent pregnancy. Tdap immunization specifically for pregnant people was first recommended in 2011 but excluded those who had prior Tdap vaccination; that was amended in 2012 to include all pregnant people regardless of prior vaccination.
Multiple studies have shown the effectiveness of this approach, seen above in the reduced rates in the less than 1 year-old group. Of course, the further sharp decline in recent years is related to pandemic isolation when rates dropped for multiple infectious diseases. We likely will see increases back to pre-pandemic levels or higher as we return to more normal societal interactions, so vaccination for all 3 conditions will become even more important.
At the time of this writing, we're still waiting on the FDA to make some sort of determination on RSV vaccination for pregnant people to protect their newborns, although the need for this intervention is attenuated by the recent approval and recommendations for nirsevimab, the long-acting anti-RSV monoclonal antibody for newborns.
Recommendations for how to guide pregnant people in their vaccine choices begins on slide 38 of the presentation, found at the link mentioned above.
'Demic Doldrums
At least one indicator suggests a significant change that could mean the summer calm of low covid rates is lifting. Still it's difficult to determine since almost all reporting has reduced. Even hospital reporting has changed post-pandemic, so case rates for hospitalizations and ED visits are less reliable. You can still see the upward trends, though still very low rates overall.
More significant, however, are new wastewater reports particularly in the upper Midwest. I've detailed previously that wastewater monitoring in the US is voluntary and very sketchy, but trends in this one region now approach last winter's numbers.
Again, time will tell whether this summer breeze ends our covid doldrums.
I think we've seen a bit too much hype about covid variants lately, specifically with the EG.5 (a descendent of XBB.1.9.2) that has appeared in both lay press and medical updates. Remember that overall this is based on relatively few viral samples tested and is very hard to predict for the future. Also, no hint yet that it produces more severe disease, it just has a growth advantage and effective immune escape properties compared to prior prominent variants.
Most important is that virtually everything going on now is in the XBB lineage which is included in the planned autumn covid vaccine dose. It should provide good protection against all of these.
A Tune Stuck in My Head
Speaking of summer breeze, given my age I immediately thought of the Seals and Crofts song of the same name listed as #20 in Rolling Stone's best summer songs. I hadn't realized it was also a hit for the Isley Brothers a couple years later.