Well, not exactly, and directionally it's more like my front yard. On February 1 the Maryland Department of Health issued a press release of a measles case in a recent international traveler who resides in my Maryland county, listing an apartment complex with my same home zip code as a site of potential exposure. Details are lacking, and I do note the DOH still hasn't sent a notice to Maryland licensed physicians. Keeping my fingers crossed there are no secondary cases.
Last Summer's Vibrio vulnificus Flurry
CDC reported on last summer's burst of V. vulnificus infections across 3 states, a total of 11 severe cases occurring during heat waves in residents of Connecticut, New York, and North Carolina. Median age was 70, and 5 people died. Of the 10 with available information, all had at least 1 underlying risk factor for severe Vibrio infection, including diabetes (3), cancer (3), heart disease (3), history of alcoholism (3), and hematologic disease (2). While the clusters can't be blamed definitely on the heat, Vibrio growth is augmented in warm water; we may see an increase in Vibrio infections associated with climate change.
An impaired reticuloendothelial system (including liver disease from any cause) is a big risk factor; high risk individuals should be warned about avoiding contact with brackish water, salt water, and raw seafood (2 cases last summer had raw oysters as only known exposure).
Late Treatment for Congenital CMV
A new report from the Collaborative Antiviral Study Group reported on a phase 2 randomized, double-blind, placebo-controlled trial of 6 weeks of oral valganciclovir for infants 1 month to 3 years of age with congenital CMV infection and sensorineural hearing loss. Although the treatment group had much lower urine and salivary viral loads during treatment, there was no difference in hearing outcomes compared to the placebo group. Back to the drawing board.
Diphtheria in Africa
It looks like diphtheria is going to be a big problem for some time to come. WHO lists major diphtheria outbreaks in Nigeria (the most cases), Guinea, Niger, Mauritania, and South Africa. The cumulative total of suspected cases is 27,991 with 828 deaths. For those of you needing a little help with African geography, here's what it looks like:
So, this is not just clusters related geographically, but rather scattered throughout the continent. Cases were more prominent in the pediatric ages, and about a quarter of the cases were fully immunized. The numbers could be much higher given the difficulties in diagnosing diphtheria in resource-poor settings.
Bad E. coli in China
Although I'm never happy to hear about new virulent and resistant organisms, I was particularly unhappy about this news for a few reasons. First, it is a hypervirulent strain, apparently more likely to cause severe invasive infections. Second, it carries carbapenem resistance, often our last relatively safe resource in the antibiotic armamentarium for multiply resistant Gram negative bacteria. Worse is that 13% of these carbapenem-resistant organisms did not express a known carbapenem resistance gene, suggesting other perhaps new resistance mechanisms might be present. Lastly, these organisms caused a prolonged outbreak in a children's hospital.
You can see this outbreak occurred a few years ago, but I don't think we've heard the last of this.
WRIS
I'm looking forward to the week when I can retire a regular update on Winter Respiratory Infection Season. For now we have some encouragement but still too early to tell which way we're headed, especially with covid since our data sources are less reliable/predictive.
We seem to be over the hump with RSV season, still plenty out there but we tend not to see late rebounds with RSV.
Flu is a mixed bag depending on locale, but seems to be headed downward overall.
The covid wastewater report doesn't look too bad, either.
JN.1 is the predominant variant in most places now. I include a graph from the UK just because it's pretty.
We also have some other good news on the covid front: the fall vaccine seems to have high effectiveness (54%; 95% CI 46-60%) against development of symptomatic infection in immunocompetent adults. The study covered the time period September 2023 - January 2024 so is very recent and includes the time of JN.1 variant predominance.
Squirrel Wars 2.0
Speaking of my front yard, it is the new site of my war to keep squirrels away from my bird feeder, first mentioned in these pages on January 14. You recall that the capsaicin-laced safflower seeds, advertised as obnoxious to squirrels, turned out to be a delightful snack for those obnoxious rodents here. I tried to access research proven methods for preventing squirrels from eating all the bird food, but sadly there doesn't appear to be a trove of studies to guide me; in other words, no such thing as evidence-based squirrel medicine.
However, many sites mentioned trying to choose a site for a feeder that is beyond the reach of a typical squirrel's jumping prowess of 5 feet upward from the ground, 7 feet across, and 9 feet downward. After much thought, we selected a site in a large front yard tree. Armed with my long-suffering wife's long tree branch cutters and her assistance, 2 rickety ladders, slippery wire, packaging tape, and an autographed baseball from my youngest son's youth baseball team (circa 1990's, I was the official scorekeeper since I was too uncoordinated to be a coach), I succeeded in placing it in the perfect place with only minimal self-injury. Passersby seemed alternately amused and alarmed. If this works, I should get a MacArthur genius grant.
