This is the first of my "hiatus" posts as I try to upgrade the appearance of the website. During this time my posts will be brief and not necessarily weekly.
Second Round of IDSA Streptococcal Pharyngitis Guidelines
I discussed the first iteration in my commentary last October 19 and mentioned that the Infectious Diseases Society of America said they would publish part 2 soon, which they did this week. Part 2 is all about using scoring systems to distinguish streptococcal pharyngitis from the many other (mostly viral) causes. Most studies have found these scoring systems aren't useful in children.
The new guidelines, while acknowledging low sensitivity and specificity of all scoring systems, do recommend using a scoring system for both children and adults, primarily to identify those with very low risk of streptococcal pharyngitis and thus avoid unnecessary testing and antibiotic therapy. The recommendation is classified as being conditional and with very low certainty of evidence. You can look back at my October 19 post to see the specifics; this newly published guideline just goes into further detail about methods used to make this recommendation. We really need better studies, especially in the new era where streptococcal PCR testing becomes the dominant diagnostic tool.
MMWR Unshackled
I was shocked, shocked to find that CDC scientists were allowed to publish anything favoring covid vaccination, especially for children. During the time period from August 29, 2024 to September 2, 2025, vaccine effectiveness in preventing emergency department and urgent care visits for children ages 9 months to 4 years was 76% (95% CI 58-97%) and for children 5 - 17 years of age was 56% (35-70%). They also reported a number of sensitivity analyses and discussed methods in detail.
As I've stated ad nauseum, covid vaccination provides real value to healthy children; it is more expensive to prevent these emergency department and urgent care visits because these events are much less common than in high risk individuals, but for children the vaccine benefits still outweigh risks even in the current covid era.
I'm Worried About South Carolina Measles
We continue our steady rise in measles cases, now officially 1912 cases this year nationally. The situation in upstate South Carolina continues to advance, now with 126 outbreak cases (out of 129 total this year in the state) originating from 11 different schools. Currently 303 people are in quarantine and 13 are in isolation as a result of potential exposures. Maybe the winter school break will bring some relief, but these outbreaks show no sign of slowing down.
No Association Between Vaccines and Autism, Again
For what it's worth (the anti-vaccine movement will care less), the World Health Organization has performed a new analysis and found no association between vaccines and autism.
WRIS
Winter respiratory infection season is still at low rates (very low for covid specifically) nationally. Influenza-like illness is clearly on the rise but spotty across the country.
More specifically, lab-confirmed influenza hospitalizations are increasing (red line below).
All evidence still points to a more severe flu season this year because influenza A H3N2 predominates and tends to cause more severe illness than does H1N1. Get vaccinated!
RSV hospitalizations are picking up, though at lower levels than this time last year. Below are the rates for children 0 - 4 years of age this year compared to last.
Let It Snow
With a nod to the seasonal song, this morning we had our second small snowfall in Silver Spring this month, a bit unusual this time of year. It was mostly a good excuse for us to have breakfast in front of the fire in our newly updated fireplace.
Speaking of updates, I mention again you are all welcome to suggest anything I can do to improve this website - just use the comments tab on the home page.