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Published on Leave a comment on The Olympics You Haven’t Heard About

Yes, you can spend thousands to travel to Italy and maybe get a ticket to a major event, but why not just come to my yard in Maryland? The snowcrete from the snow and ice storm of 2 weeks ago has now become a combination ice rink and slippery downhill ski slope. Wouldn't it be just as much fun to watch me gracefully pirouette on my early morning trek to gather my (now depleted) daily Washington Post print paper, or witness me careening down the slope to fill the bird feeder? And, admission is free.

NMIAI

Check my new acronyms tab if you've forgotten last week's intro to this new acronym.

Nipah virus is again in the news. You recall last week I mentioned the outbreak in India, and now WHO reports a new case in Bangladesh. The patient apparently had no connection to the Indian outbreak and likely was infected from repeated consumption of raw date palm sap. Fruit bats are the natural hosts of Nipah virus, and humans often are infected by consuming food contaminated by infected bat poop, urine, or saliva. Cases of Nipah virus infection are reported fairly regularly in small numbers in Bangladesh, so this one new case is not out of line with past epidemiology.

On the good news side of the globe, the cholera vaccine stockpile is now replenished enough to allow resumption of preventive vaccination campaigns in Mozambique and subsequently in the Democratic Republic of the Congo and Bangladesh, following a WHO allocation framework developed in 2024.

Vaccination Happenings

I don't usually report on preclinical research studies because they are so far removed from clinical applications that most never make it to approval for human use. I'm making an exception for a study that appears to have established a plausible mechanism for how mRNA covid vaccines cause mild myocarditis in some individuals. Unfortunately the publication does not have open access, but the bottom line is that the problem may lie in activation of an interferon-gamma signaling pathway that facilitates myocardial cell injury. Understanding the mechanism can of course lead to effective interventions, but again we are far away from seeing this applied to human health.

CIDRAP collaborated with a group called Unbiased Science to put together a wonderful overview of The State of US Vaccine Policy. The most frightening part of the report was the summary of steps taken by the HHS Secretary that could eventually destabilize the Vaccine Injury Compensation Program and drive vaccine manufacturers out of business. I highly recommend all healthcare providers who administer or discuss vaccines with patients to read this CIDRAP/Unbiased Science report.

CIDRAP and other investigators released a new report on safety, effectiveness, and public health benefits of the birth dose of hepatitis B vaccine. It strongly refutes the move by ACIP and HHS to recommend against a universal birth dose which is still recommended by AAP and all major medical societies.

Measles March

CDC numbers as of February 5 put us at 733 cases in 2026 and 2276 for calendar year 2025. I'm keeping my fingers crossed that we might be seeing a true slowdown recently.

Rewer cases nationally the past 3 weeks in CDC's graph

So far, our neighbors in Canada have logged 94 cases in 2026. See PAHO's Februrary 3 alert for more Western Hemisphere details, including the 740 cases in Mexico for 2026.

WRIS

Winter Respiratory Infection Season finally caught up to LSW and me; we're going through facial tissues at record rates. Influenza activity seems to be decreasing nationally, and I note some evidence of an increase in influenza B detections (the green bars below) which often occurs at the end of flu season. Percent test positivity has leveled off.

CDC graph showing slight rise in influenza B as a percentage of positive tests in clinical labs

RSV and COVID hospitalization rates are static or decreasing. (Remember I'm looking at hospitalizations as probably the least-biased metric of disease activity.)

Chili and Chilly

I'll be parked in front of the TV this evening, trying to watch the big game as well as the million-dollar commercials while feasting on a recently remembered old chili recipe and trying to stay warm indoors. Silver Spring is due for highs in the 40's later this week, none too soon for me.

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Published on 2 Comments on Reading by the Fire

I managed to avoid any severe musculoskeletal or cardiac injury while tackling the "icecrete" in my driveway and walkways this week. It was a time better suited for reading by the fireplace.

NMIAI

No man is an island. I learned about this John Donne quotation several decades ago when I read Hemingway's For Whom the Bell Tolls. It took me probably a few decades more to read Donne's original Meditation 17 from which it came. This work inspires many take-home messages, but the (perhaps) unique message I take away applies to global health. As the US is attempting to complete its severance from the World Health Organization, and California has joined WHO's GOARN (Global Outbreak Alert and Response Network) independently, I am reminded of the importance of keeping abreast of infectious diseases worldwide. Even disregarding any empathy for citizens of far-away countries, we must be engaged with the global community to anticipate, and help prevent, global spread of infectious diseases, including to the US.

So, I'm invoking this nonsensical, unpronounceable acronym as a title to highlight recent global health happenings.

Two global outbreak events are notable this week. WHO updated the Nipah virus outbreak in India. I mentioned this relatively rare virus in my March 3, 2024 post regarding an outbreak in Bangladesh. The current outbreak in the West Bengal State in India is causing concern, though more for local and regional spread than for international spread at this point. You can look through that 2024 post for more information about the disease; I was also interested to see that post because it had a long section about an ACIP meeting, before that group was hijacked.

The second outbreak report is good news: the Marburg virus disease outbreak in Ethiopia has officially ended now that 2 consecutive incubation periods have passed since the last opportunity for transmission occurred. This hemorrhagic fever outbreak had started last November and totaled 19 cases with 14 deaths. This was a very effective public health response.

US Happenings

This week the American Academy of Pediatrics published its updated vaccination schedule for 2026; no momentous changes, basically just incorporating some tweaks that were adopted as AAP policy in the past year. This is the schedule of choice, I strongly advise avoiding the ACIP/CDC recommendations as they now stand. Virtually every professional medical organization and many states have endorsed the AAP vaccination schedule.

CDC's National Center for Health Statistics updated maternal syphilis rates for 2022-2024. It's disheartening but not surprising.

2024 rates rose to 357.9 per 100,000 births

Speaking of CDC surveillance activities, investigators from multiple institutions reported this week that 38 of 84 CDC surveillance databases have been paused, presumably driven by budget cuts and political priorities. No surprise the #1 paused database category was vaccination.

The largest topic in the paused group was vaccination

A nice summary for patients is available, also worthwhile reading for healthcare providers.

Measles

I'm running out of things to say. Measles is out of control in the US. CDC's total case count for 2026 is 588 as of January 30. Totals for calendar year 2025 are now at 2267. The Johns Hopkins map for the past 2 weeks shows South Carolina still leading the way with many other hot spots of local transmission.

377 cases Jan 16-30

WRIS

The most interesting development is a slight uptick in influenza-like illness this past week after some downward trending. Hospitalization rates are still downtrending however. I'm keeping a watch for whether we really see a second flu peak this season.

Meanwhile, RSV hospitalization rates might be leveling off, and Covid hospitalizations are downtrending in most places.

Playboy, Cleric, and Poet/Writer

No, I'm not referring to myself. I'm describing John Donne, a pretty interesting guy. I took the opportunity to reread the modern English version of Meditation 17 and want to share the most famous excerpt with you.

"No man is an island, entire of itself; every man is a piece of the continent, a part of the main. If a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friend's or of thine own were: any man's death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bell tolls; it tolls for thee."

I'm also thinking about rereading For Whom the Bell Tolls; some of its themes also offer commentary on today's headlines.

Look for NMIAI features in future posts.

Published on Leave a comment on Hippocrates’ Aphorisms

I hope everyone is surviving this weekend's storm. I really knew this weather event was a little different when my Sunday morning paper was delivered Saturday at 10 PM. I've adopted the Washington Post's move by trying to get this post published earlier this morning, before the snow/ice severs my electrical and wifi access.

A couple of friends, maybe the only 2 readers of this blog beyond my immediate family, told me independently they didn't see anything different about last week's website. Obviously, I needed to point that out more clearly.

The main difference is the presence of multiple tabs. Here's what it looks like on the LSW's (Long Suffering Wife's) PC:

Screenshot showing page tabs

The area of interest is just above the culture plate photo. Two of the tabs represent new content: Bud's "Laws" and Epidemiology Links. Please click on the tabs to explore what's new.

Not visible to most of you are the changes I've made in the site to optimize search engine spying and to set up accommodations for readers who may have visual impairment. The latter requires me to take a little bit of extra time to include verbal descriptions of any photos, graphs, etc., that will be visible to those who activate disability tools on their devices.

Updates From the RECOVER Studies

I'm usually annoyed by complicated titles invented just to make a catchy acronym, but I'll put my feelings aside because the Researching COVID to Enhance Recovery group is very important to our understanding of long-term consequences of SARS-CoV-2 infection. Two new reports in the Journal of Pediatrics appeared online last week.

The first report concerns the RECOVER pregnancy cohort, comparing 18-month neurodevelopmental outcomes of infants exposed and unexposed to intrauterine SARS-CoV-2 infection. Adults were enrolled in 23 US sites between January 2020 and December 2023, and their infants were evaluated at 12 and 18 months of age with 2 neurodevelopmental tools. They ended up with 1179 participants, 1008 of whom were infected during pregnancy. Eighty percent of the enrollees were infected during the omicron period. Most of the infections occurred during the 2nd or 3rd trimesters. The bottom line news was very good - no differences between exposed and unexposed infants in their neurodevelopmental testing scores.

Here's what some of the 12-month evaluation scores looked like:

Extensive table showing no differences in multiple developmental domains

The second report looked at post-acute dyslipidemia and abnormal BMI in children and adolescents in a retrospective cohort study using electronic medical record data from 25 US children's hospitals covering the time period September 2020 to March 2023. It was a large group, with over 384,000 COVID-positive subjects for lipid studies and over 285,000 for BMI analysis. The covid-negative group numbered over a million and over 800,000, respectively. Infection was defined in multiple ways. The infected group showed higher rates of new-onset dyslipidemia and abnormal BMI

Forest plot of outcomes

Figure 2. Adjusted relative risks of post-acute dyslipidemia and abnormal BMI outcomes in COVID-19-positive versus COVID-19-negative cohorts. Forest plot displaying adjusted relative risks (aRRs) and 95% confidence intervals for incident post-acute
dyslipidemia outcomes and abnormal BMI. Estimates were obtained using modified Poisson regression models adjusted for demographic and clinical covariates. †Definitions and abbreviations: Abnormal HDL Cholesterol: high-density lipoprotein (HDL) cholesterol: < 40 mg/dL; Abnormal LDL Cholesterol: lowdensity lipoprotein (LDL) cholesterol: ≥ 130 mg/dL; Abnormal Non-HDL Cholesterol: non-HDL cholesterol: ≥ 145 mg/dL; Abnormal TC: total cholesterol (TC): ≥ 200 mg/dL; Abnormal TG: triglycerides (TG) ≥ 100 mg/dL for ages 0-9 years, ≥ 130 mg/dL for ages 10-19 years, ≥ 150 mg/dL for ages 20-21 years. Any abnormal lipid lab results: the first occurrence of any of the above thresholds during the study period; Abnormal BMI: BMI z-score≥ 95th percentile for ages 2-18 years, BMI ≥ 30 kg/m2 for ages 19-21 years; aRR: adjust Relative Risk.

Measles

South Carolina looks primed to top the West Texas case numbers from 2025, now at 700 cases compared to 762 from the Texas outbreak that ended last August. CDC numbers for 2026 are at 416 cases country-wide, not even a full month into the year. The updated count for 2025 is 2255 cases. Here's the Johns Hopkins map for the last 2 weeks, remember that the numbers are slightly different from CDC's because they use state and other jurisdiction reports that aren't yet confirmed by CDC.

467 cases country-wide, largest group in northern South Carolina

WRIS

RSV hospitalization rates for children under 5 might have bumped up a little (see black dotted line), hard to know if that suggests any new trend.

Very slight increase, now 11.8/100,000 in this age group.

Influenza hospitalizations are still trending downward (red line), though I'm holding my breath in anticipation of a rebound.

Significant drop continues this past week

Covid hospitalizations also are dropping, seen in the black dotted line.

Hospitalization rates are well below last year's winter peak, last week below 1 per 100,000

On Aphorisms

A special shout-out to Dr. Jim Stockman, whose Question of the Week for the American Board of Pediatrics last week included his usual rabbit-hole dive into medical history and trivia; this time I learned that Hippocrates created a list of 54 medical aphorisms. You readers will only know why I'm mentioning this if you explored the new Bud's Laws tab on the website. I thought I was relatively unique in using aphorisms in medical education, but Hippocrates had me beat by a long shot. He had more, 54 versus 10, and most of his are self-explanatory whereas mine are very cryptic. His aphorisms don't appear too helpful in today's world, ranging from the obvious to the silly to the just plain incomprehensible. For example, #10: "Bodies not properly cleansed, the more you nourish the more you injure."

I wonder how my aphorisms will fare over the next 2400 years.

Photo of early snowfall in Silver Spring, MD
Snowy Silver Spring

I'm reminded of Robert Frost's short, simple, and stately poem, especially these lines.

"The only other sound’s the sweep   

Of easy wind and downy flake."   

Published on Leave a comment on A Different Look

Presumably you've noticed that this site now has a few different tabs. If they aren't visible to you, it's back to the drawing board for me. I'm not terribly happy with how it looked on my cell phone - you'll need to tap the Menu button at the top to see the choices.

Measles!!!

I didn't think it could get much worse, but it has. CDC says just in the first 2 weeks of 2026 (through January 13) we have 171 confirmed new cases. Virtually all are continuations of 2025 outbreaks. The 2025 confirmed case total is now up to 2242 cases, above the number from 1992 which was when the second MMR dose was coming into more complete implementation. Expect the 2025 number to continue to rise slowly as more reporting comes in from last year.

Most startling to me was the recent large bolus of cases, almost all coming from South Carolina.

CDC measles case counts 2023-2026; highest numbers in past 2 weeks

I wasn't sure how this could be happening so far into the SC outbreak; I'm worried that quarantine and other measures weren't working well there. I tried to get some idea from the SC Department of Public Health, but I couldn't really find an explanation for why the outbreak wasn't under better control. The new cases are still coming from Spartanburg County. Here's the recent US measles case map from Johns Hopkins.

Recent US measles cases map showing large outbreak in South Carolina

And speaking of better measles control, last week's MMWR issue had 2 reports on how wastewater monitoring provided early warning of new measles cases in Colorado and Oregon. Here's a quick look at the timeline from Colorado.

Wastewater measles detection provided a few day's warning prior to the first measles case in Colorado in August

Sadly, this may all be a moot point. State wastewater monitoring and reporting is already voluntary, and new federal budget cuts may severely hamper states' ability to maintain this service.

WRIS

Winter respiratory infections are with us. This is an interesting time point in our flu season; we've had a downtrend in cases, but in some past years second (and even third) spikes have occurred.

Perhaps the most accurate reflection of influenza activity is the lab-confirmed flu hospitalization rate. We're seeing a persistent downward trend in this year's (red) line.

CDC data show 2 consecutive weeks of downtrend in flu hospitalizations

I really enjoy an online journal called Eurosurveillance, published weekly by the European Centre for Disease Prevention and Control, part of the European Union. This past week they published 2 reports about influenza vaccine effectiveness in the current season. However, one of the studies, from China, was followed within a few days by an "expression of concern" sent by the main author that there may have been data errors in their calculations, so I won't mention that study. The other was from France.

Remember we are seeing an influenza A H3N2 strain variant (subclade K) which has drifted slightly from the H3N2 strains used for this year's flu vaccines, so it's especially important to see how effective the vaccine is this season.

VE depends on what outcome you view - effectiveness against preventing all infection, against medically-attended illness, against hospitalization, or against death, for example. The French study just looked at outpatient infection rates, i.e. people seeking medical attention as an outpatient. The time period was October 2025 through the first week of January 2026; clearly this is an interim analysis.

VE was decent (about 57%) for the pediatric age group but dropped off in the older populations. The numbers are in the ballpark for other flu seasons and certainly lends support to getting a flu vaccine this year.

Forest plot for VE against outpatient flu infections in France

RSV hospitalizations may be decreasing, and the rates are much lower than last year.

Graph of RSV hospitalization rates suggest numbers may have peaked this year

COVID has yet to take off this year, but early indicators are rising.

Test positivity 5% and ED visits due to COVID 0.9%, both slightly higher than the week before but below last summer's peak

Feedback?

Please let me know through the Comments section if you have any feedback about the website changes, as well as any suggestions for new topics.

Have a nice MLK Day tomorrow! It's a great time for reflection.

Photo of MLK Jr. Memorial in Washington, DC

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Published on 2 Comments on A Hot Winter

A few warm days in Maryland recently. I continue to spin my wheels trying to update the website. The only tangible changes are in implementing improvements for those who are visually impaired, but most of you won't notice these changes. Thankfully I'm meeting with tech experts next week who I hope will demystify the reconstruction of this site.

Between HHS edicts and winter viruses, things have been pretty hot this past week, regardless of the weather in your area.

News Nubbins

The biggest news this past week was of course the release of the HHS edict changing the childhood vaccine schedule to cover only 11 diseases, compared to 17 in the prior schedule. Apparently, even with an ACIP stacked with vaccine skeptics and amateur infectious diseases and immunology experts, HHS has decided to bypass all semblance of transparency.

All healthcare providers should continue to ignore CDC's recommended immunization schedule. But what to do about parents and patients who have questions? I've (painfully) done my due diligence in exploring the HHS rationale for the new recommendations. It appears the primary claimed rationale was to restore public trust in vaccines, interesting to me in that a big part of the recent loss of public trust was amplified by a small number of anti-vaxxers and conspiracy theorists. I would think that a lack of openness about the scientific data leading to any vaccine schedule changes would have lead to even less public trust in HHS. Most of the remainder of the document is the typical cherry-picking of data and absence of any assessment of risks and benefits of the various changes - all of this previously had been part of the ACIP/CDC analyses. Even younger pediatric healthcare providers have witnessed the tremendous benefits of rotavirus vaccination, now delisted in the CDC schedule.

I did note that HHS reversed themselves and did continue recommending varicella vaccine after originally calling for its removal. I wonder if it's related to a reversal by the UK which has now decided to add routine varicella vaccination to its schedule. It appears this was based on a cost analysis. The vaccine more than pays for itself in reductions in healthcare costs. Just ignoring for the moment the health benefits to individuals, it's incredibly cost-saving when one considers the costs of treating complications of primary varicella and of managing zoster in adults. (There was concern originally that varicella vaccine would result in increased cases of zoster, but this was shown long ago to be incorrect; the vaccine actually decreases zoster incidence in recipients.)

Our current situation with HHS is shameful, more so for the fact that it's important to review and revise vaccine recommendations regularly, using pre-determined, structured procedures that are open for discussion with all stakeholders.

For example, there is a legitimate reason to revisit HPV vaccine dosing, with some evidence that 1 dose might be non-inferior to a 2-dose schedule. Fortunately, the Vaccine Integrity Project plans to review the data; they will publish the results, but no timeline was provided.

CIDRAP, the parent organization of the Vaccine Integrity Project, had a very nice discussion on how the HHS's shift of focus to shared clinical decision is in fact an effective covert method to undermine vaccine confidence. It's worth reading.

Maternal vaccinations weren't specifically mentioned in last week's edict, but a new cohort study from Italy added to the list of studies documenting effectiveness of maternal pertussis and influenza vaccination in protecting infants. Influenza vaccine currently is not recommended by HHS for pregnant people, ignoring benefits for both mothers and infants. Also, we have further evidence of lack of harm to infants from maternal RSV vaccination in an interim report from a large US cohort.

Lastly on the vaccine line, I'll mention a new report of a pertussis vaccine study - it is pertinent to the comment posted by Dr. Schwartz after my blog last week in that it documents efficacy of a new form of pertussis vaccine, this one a live attenuated nasal vaccine. It is a phase 2b study in adults - I don't usually report on non-phase 3 trials since they aren't immediately applicable to clinical practice and results might change with larger trials. The study was carried out in England and was a randomized, double-blind, placebo-controlled trial. After administration of the vaccine or placebo, subjects were then challenged with live pertussis organisms 2-4 months later. Most vaccine recipients had a strong mucosal antibody response (mucosal antibody may be more effective in preventing disease) that isn't seen with parenteral pertussis vaccination, and lower rates of colonization with the test strain compared to the placebo group. These results are certainly encouraging but require a large phase 3 study to better understanding effectiveness in preventing disease. Of course it would be unethical to perform this exact study in children since it involves deliberate exposure to pertussis. A large efficacy trial in children would need to be carried out in a community with very high pertussis circulation, even higher than seen in most high-income countries.

WRIS and Measles

Everyone knows we're in the midst of a busy respiratory infection season. As one measure, percent of respiratory tests that are positive are generally up.

Graph showing flu test positivity >30% with perhaps recent decrease. Flu and covid rising.

It's not clear yet whether we should be encouraged by that recent downtrend in flu positivity. The US map of outpatient influenza-like illness remains ugly.

Most states have high to very high activity.

Meanwhile, measles is growing, especially in South Carolina. The official, preliminary number for calendar year 2025 is 2144 cases, with 3 so far in 2026. The 2025 number will continue to be revised as new data come in.

I learned something new, however, though it makes complete sense. It involves how WHO (and PAHO which oversees the Western hemishphere) removes its label of measles transmission elimination. It's not just that there is sustained endemic transmission of measles for a year, but that it is likely the same strain undergoing that transmission. So, apparently US health authorities are trying to gather evidence that the strain that caused the large outbreak in west Texas and spread elsewhere is not the same strain wreaking havoc later in the year. We should know in a month or so if they were successful, but it would still be small consolation for what is truly a bad year for measles in the US.

Next Week

With any luck, next week's post will be part of a visually-enhanced and expanded site. If not, it won't be for lack of trying.

Unless otherwise indicated, the content and opinions expressed on this web site are those of the author(s). They are not endorsed by and do not necessarily reflect the views of the George Washington University.
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