Or haze, or just blackness. It's a beautiful sunny day in Maryland, but cancellation of the FDA's VRBAC meeting to discuss next fall's flu vaccine composition makes things a lot hazier. More on that later.
Covid Vaccination Protective Against Post-Covid Conditions in Children
This is a report from a multicenter study of children 5-17 years of age, originally enrolled July 2021-September 2022 and then followed longitudinally. The cohort was surveyed from December 2022 through May 2023, with questions about a variety of symptoms lumped under Post-Covid Conditions (PCC) detailed in the footnotes below.
The lower odds ratios of PCC in vaccinated children is impressive. The study's strengths are its prospective design, but the fact that they are relying on survey results, as opposed to specific follow-up encounters to determine signs and symptoms, is a bit of a weakness. Other longitudinal studies are ongoing with longitudinal in-person evaluations, so we'll eventually have better data. Also, this study doesn't tell us anything about benefits of ongoing covid immunizations in children. I've previously mentioned other studies suggesting benefit to children from ongoing immunizations.
Measles
The outbreak in Texas with probable spillover to New Mexico continues. Here's the latest from CDC in their February 28 report. Be aware there is a time lag from when cases are reported by states to when they are included in CDC numbers.
I was hoping the West Texas outbreak wouldn't result in large numbers of cases given the relatively rural and smallish population involved; we aren't yet approaching the 2019 New York outbreak that occurred in a densely populated community.
The Texas authorities' update from Friday tallies 146 cases, and New Mexico shows 9 cases. Five of the NM cases were 18+ years of age and 4 children 5-17 years old. Texas HHS also reports a large exposure area for a measles case in San Antonio and surrounding area. I think it's interesting to look at the sites and consider the immense resources needed to track down and protect exposed people.
WHO Soldiers On
The polio vaccination program in Gaza sounds like it was very successful: 603,000 children under 10 years of age were immunized over a 5-day period, aided by the cease-fire that I hope will continue.
New World Screwworm
Apologies, I think I've mentioned this topic once before but can't find it in a search of my posts. This disease is a form of myiasis, and the recent news is that it's getting closer to the US with new data at the end of last year showing the fly (Cochliomyia hominivorax) appeared in Mexico. The previous "barrier" to creeping closer to the US was the Darrien Pass in Panama, which you may recall from various immigration discussions in the lay press.
Now new efforts are underway to release sterile flies in Mexico, an established method to control the population. The USDA has a helpful document explaining the history. In endemic countries this is mostly a concern for livestock and other animals, but we humans also can be affected; it is very painful, beyond unpleasant, and gross, requiring manual extraction of the fly larvae from soft tissue. Here's the history in the US, at least as of late 2016 following the finding of the flies in Florida, resulting in a sterilized fly release for control.
Avian Flu
A lot of back and forth in the lay press about influenza A H5N1. My take on the bottom line is that there is nothing substantive that is new. I'm still watching closely for more concerning trends including extensive infection in pigs (where conversion to a strain with greater ability to infect humans is more of a risk) and any evidence of human-to-human transmission.
USDA monitoring is ongoing, with of course many infections in wild and domestic birds, cattle, and other mammals including a flurry of domestic cat infections recently. The map below is current as of February 26.
Our new agriculture secretary has released a plan for avian flu control. It is advertised as a means to lower egg prices which is fine, but we won't see any impact on that soon. I'm just glad we're seeing some movement to get a handle on this. The more H5N1 circulates in any animal, the more likely we'll see a new strain with greater potential to sicken humans.
In the meantime, I might try to steal my wife's oatmeal stash a few mornings a week.
Hooray for MMWR!
Not only does this week's edition look like the old days, it even included a sensitive topic for the current political administration: HPV vaccine.
HPV was strikingly effective in lowering the rate of cervical precancers in young women (the solid blue lines below) as well as in women in their late twenties. The fact that the current administration allowed them to publish these results is encouraging; HPV vaccine has been a target as well as a source of income (from lawsuits) for RFK Jr. in the past.
Last year's flu vaccine early estimates of effectiveness looked like a glass-half-empty versus -full in the lay press. The half-empty folks point to somewhat low effectiveness against all infections, but that's not the point. As with other respiratory virus vaccines, the main point of vaccination is preventing healthcare visits and serious outcomes. Here's the bottom line we should pay attention to: "Interim 2024–2025 seasonal influenza VE estimates were derived from four U.S. VE networks. Among children and adolescents, VE was 32%, 59%, and 60% in outpatient settings (three networks) and 63% and 78% against influenza-associated hospitalization (two networks). Among adults, VE was 36% and 54% in outpatient settings (two networks) and 41% and 55% against influenza-associated hospitalization (two networks)."
I'm in the half-full camp.
WRIS
I think we might really be headed down for winter respiratory infection season, largely due to a sustained decrease in influenza with no significant upswings in covid. RSV is almost out the door. Here's the latest from FluView.
That's not to say it's gone, however. We're definitely still in flu season in many areas of the country.
FDA Advisory Committees
I'm perplexed about why the FDA VRBPAC's scheduled meeting was cancelled. Supposedly the selection of next fall's flu vaccine composition will be done internally by the FDA, but one of the key advantages of the VRBPAC meetings was the chance for anyone, including the general public, to view the discussions in real time and get a better understanding of issues and risks/benefits.
I have a bit of personal experience to illuminate this. I've participated as a panel member on several FDA Advisory Committee meetings, though never anything to do with vaccines. Here are some key points that I can relate from first-hand experience.
- I filled out an incredible number of forms about my potential conflicts of interest for every session. It was the equivalent of a paper strip search.
- I spent many hours/days reviewing documents with a lot of raw data, both from FDA experts as well as from any pharmaceutical companies and device manufacturers. It was a very granular level of detail.
- Every session included presentations by mostly lay public individuals given time to speak at the meeting. It was a broad representation: patients and relatives of patients who might benefit (or be harmed) by the product, other industry and association representatives, and yes, some pseudo-science/misinformation folks.
- The discussion was very helpful; sometimes my mind changed as I learned from others.
- All committee members explained their votes. The votes were not binding to the FDA, but I can't remember a situation where they didn't follow the vote for any of the committees I served on.
- My exact recollection has faded, but I think at first I was reimbursed for lunch but later I wasn't. Everyone was reimbursed for travel and lodging when the meetings were held in person in the DC area. Of course, since I'm local that really didn't amount to much even if I submitted my gas mileage! In short, people serve on these committees for civic duty, not for any remuneration.
Now that meetings are virtual, there is not much reason to cancel them. The cost is born by the committee members; FDA and industry participants still need to do the same amount of work. I hope transparency in healthcare administration will return soon.
Paint It Black
This Stones' song came on my Pandora station just as I was wrapping up my first draft of this post. The sun isn't quite "blotted out from the sky" from the FDA VRBPAC and CDC ACIP postponements and cancellations, but it's enough to cast a shadow on my sunny day. Here's to brighter times.