Welcome to another week of chaos in the world of infectious diseases in the US. The stress finally got to me, as evidenced by the fact that I willingly listened to the CBS News interview of RFK, Jr., this past week. Some news reports after the event aired seemed to give him credit for damning measles vaccination with faint praise, and I felt I needed to hear everything myself. Even with using special protective accommodations (running at the fastest speed with closed captioning so I could get through the 33 minutes as quickly as possible but not miss anything), I came out with my sensibilities bloodied. He started talking about measles at about the 3:50 mark and soon claimed that, because the rate of increase in cases had decreased, the outbreaks were substantially under control. Simply looking at the numbers would call those claims into question. He later stated that, "We're always going to have measles no matter what happens." In fact, because there is no animal reservoir for rubeola virus, it could theoretically be eliminated. Don't hold your breath, though especially now. He also stated that immunity from measles vaccine "wanes very quickly." I have no idea where that came from, maybe he was confused about maternally-derived antibody waning in newborns a few months after birth.
He saved the biggest whopper for his explanation of why the Novavax covid vaccine was not officially approved by FDA recently as originally planned. He has decided that "for respiratory illnesses the single antigen vaccines have never worked." Again, I don't know where that came from, and it contradicts a boatload of recent evidence from covid and RSV vaccine studies.
At any rate, I won't make the mistake of listening to him again. He's dangerous.
Measles
CDC has been fairly quiet in the midst of a serious outbreak, normally we would be hearing updates and valuable advice from them in all the media. At least we still have the raw numbers.
That slight dip in the most recent week wasn't available at the time of RFK's interview, plus it generally just reflects the delay in confirmation of the most recent cases. We are up to 712 confirmed cases in 25 jurisdictions. Watch out for things boiling over in Kansas, Ohio, or Indiana in the coming weeks.
Here's the latest from Texas. Maybe RFK didn't read the fine print in the shaded area.
Invasive Group A Strep
In a follow-up from our discussion last week CDC and others reported on invasive group A streptococcal illness over the years 2013 through 2022 in 10 sentinel states and showed an increased incidence from 3.6/100,000 persons to 8.2/100,000, fairly substantial. Invasive GAS was defined as isolation of GAS from a normally sterile site or from a wound in a patient with either necrotizing fasciitis or streptococcal toxic shock syndrome. The greatest increase was in the 18-64-year-old age groups. Risk for higher incidence was seen in American Indians or Alaska Natives, people experiencing homelessness, those injecting drugs, and residents of long-term care facilities. The study wasn't designed to address other factors such as genetic characteristics of the GAS strains involved which are likely important in increasing invasiveness.
WHO Report on Impact of Defunding Support
I had mentioned several weeks ago that the US withdrawal from WHO wouldn't have an impact until next year when the next payments are due, but all of the other plug-pulling (USAID et al) is already having deleterious effects across the world, as detailed in a new report. Here's a representative snapshot of part of the report:
Speaking in terms of service areas, the most severely affected are malaria, NTDs (they didn't define, but I think this is neural tube defects), vaccination, TB, maternal and child health, sexually transmitted infections, family planning, and outbreak detection and reporting. This is a dangerous situation, not only in these countries but for the entire world.
Next Week with the ACIP
Yes, it's finally time for the postponed ACIP meeting to occur, now on April 14 and 15 instead of last February. I had reported recently on the changed agenda, and last week the "final" agenda was posted and is essentially the same as the previous two. I'm most interested to see if there is any apparent stifling of opinions from CDC and whether the non-CDC committee members will have sufficient time for discussion. I plan to view as much of the meeting as my schedule permits.
Not All Painful
Don't let my whining make you think you should pity me. I had a great end to the week with visits from our NYC clan, including granddaughter. It doesn't get much better than that!