Not only did the summer solstice arrive June 20 as expected, the temperatures outside confirm that summer is here. I noted 100 F in the shade on my patio Saturday afternoon.
Summer usually means a switch in circulating pathogens and pediatric infections. Outdoor activities mean more scrapes and scratches which then means more cases of cellulitis, abscess, and osteomyelitis. Also in the mix are the vector-borne infections including Zika, Powassan, and West Nile viruses, babesiosis, Lyme disease, Rocky Mountain spotted fever, and yes, even in the US, malaria and dengue. International travel lengthens the list considerably.
Respiratory viruses usually take time off in the summer, other than enteroviruses - the name misleads many to conclude these are primarily GI pathogens, but in fact they are more likely to cause mild respiratory illnesses. They do replicate in enterocytes and the viruses are found in stool, hence the name. Peak enteroviral season usually is August and September, though they are present year-round.
That said, let's look at a few out-of-the-ordinary pathogens to watch for this summer.
Summer Covid?
Yes, I know I'm repeating myself, but it's again worth noting that our ability to monitor SARS-CoV-2 is in a new era. With the pandemic ended and little to no availability of free testing, plus local, state, and federal jurisdictions relaxing reporting requirements, we're mostly down to crystal ball guidance to know when to expect the next surge. The closest to an accurate predictor is waste water monitoring, though it too is limited. Here's the latest:
You can see the start of an upward blip maybe - looks a lot like last year when we had a mini-surge that peaked in September and seemed to correlate with clinical disease. Levels are low now. Test positivity is up a little out west.
CDC's Advisory Council on Immunization Practices meets this week, June 26-28, with covid vaccines discussed Thursday morning and voted on Thursday afternoon.
Summer Bird Flu?
Still not a major worry for us, other than folks who have contact with live poultry (included backyard coops), other livestock, and unpasteurized dairy products. Still, it's good to have a plan for when and how to evaluate potential cases if they show up on your doorstep.
If you are seeing a child with a cold this summer (remember, so far the 3 cases of AH5N1 in the US have been mild and include conjunctivitis), please add in a few questions: any exposure to livestock, or to others with this exposure - this includes those state fairs with petting opportunities; also ask about unpasteurized dairy ingestion. If the answer is affirmative, this is someone worth testing for influenza, and if positive for influenza A in the summer in the US should launch more investigation that will involve your local health department.
Fortunately, CDC has lots of helpful advice at the Bird Flu web site. Scroll down to the Recommendations for Clinicians. The weekly update doesn't contain significant new actionable information. Other pages are in the process of being updated, but again your local friendly ID doctor or local health department are good partners to help you.
Summer Reading?
Not a summer pathogen, but will be occupying some of my time the next few months. Many of you probably would surmise that Dr. Fauci's new book is high on my list, but in fact it's not. I lived through all of this, plus I'm much more interested in the science than the politics. I'm sure it will be a bestseller, and I'm appalled at the ongoing vilification and threats he's experienced.
My biggest summer reading project is Emily Wilson's new translation of The Iliad, but it's not really a beach book in spite of the seas and beaches mentioned in the epic. For my annual beach trip I'll instead be buried in noir mysteries and other enjoyable light reading.
Romare Bearden's Odysseus Enters at the Door Disguised as an Old Man, c. 1977, from https://www.nga.gov/learn/teachers/teaching-packets/bearden.html.