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Tag: adenovirus

Published on Leave a comment on A Lot of Irons in the Fire

This week I'm very challenged to limit the number of topics to discuss; much of interest, though nothing earth-shattering. I'll focus on 2 non-COVID items while slipping in a couple more ideas.

Speaking of COVID-19, it's mostly a good news situation for the moment. I continue to watch developments in the UK and it does seem like their uptick in cases is tailing off without having seen a big increase in hospitalizations. I hope we'll see that trend continue in the US. At the same time, I'm keeping a watch on South Africa. Gauteng province, the first alert to omicron problems originally, now is experiencing an increase in cases and hospitalizations likely driven by BA.4 and BA.5 omicron subvariants. It is also spilling over to other provinces. Time will tell if this is the next new surge there and worldwide.

Also, a good news/bad news package from the FDA. Counterfeit at-home COVID-19 diagnostic tests have appeared, but there are ways to identify them. Also, we saw a tentative schedule for FDA-VRBPAC meetings to discuss vaccines for the youngest children. Data submission from Moderna and Prizer is not yet complete, but I certainly hope one or both of the products will fulfill criteria for authorization.

Be Careful Counting Your Chickens

We now have the first detection of human influenza A H5N1 infection, a "bird flu," in the United States. Not a huge deal from a public health perspective in terms of numbers of people at risk. However, I'm glad it got a little news coverage because clinicians need to be aware of this. Birds have been affected in 30 states so far and include both poultry farms and backyard flocks.

The take-home message for front-line healthcare providers is to remember to inquire about history of close exposure to birds, not just chickens but wild birds as well, in anyone with influenza-like illness. CDC has guidance for what to do.

Fulminant Hepatitis Update

We've had some updates this week, but still more questions than answers. UK scientists have provided us with more information about their cluster investigation, as has the CDC for the cluster in Alabama. The association between adenovirus 41 (a gastrointestinal, not respiratory, adenovirus type) is still just that. The focus so far is on younger, previously healthy children. Whether the adenovirus is causal, a cofactor with another environmental or infectious agent, or just an epiphenomenon remains to be seen. In the meantime, probably a good idea for pediatric healthcare providers to discuss potential hepatitis cases with a subspecialist.

One final iron to mention: summer travel. Travel is opening up worldwide, increasing chance for spread of many infections. I take this opportunity to remind practitioners about measles, now increasing in several places around the world. It is still the most highly contagious respiratory infection known, though I'm waiting for one of the SARS-CoV-2 variants to exceed that. This high transmission rate combined with its rather prolonged incubation period and infectivity prior to clinical symptoms make it easy to take off in a community. Currently with general immunization rates relatively low due to the pandemic, many US communities are at very high risk if measles is introduced. Stay vigilant.

Published on Leave a comment on Something Besides COVID

I haven't been keeping up with the lay press this past week, but from my standpoint not much earth-shattering happened with the pandemic. Yes, Pfizer announced they will ask for booster authorization for 5-11 year old children, based on results from 140 children. As usual, I would recommend waiting to see the full data and the FDA appraisal before getting your hopes up. Also, ACIP has a meeting planned for April 20 to discuss and vote on booster dose recommendations. No agenda released yet, but I'm hoping they will provide a more rational and specific approach to replace the current vague 4th dose "get it if you want to" advice for the 50+ year-old crowd.

In the meantime, it's still difficult to know whether the upticks in cases across the country represent just the expected numbers when restrictions are lifted or the beginning of a true BA.2 surge. With pandemic fatigue on both the public and governmental levels, we just don't have accurate case numbers to guide us. We'll need to wait and see whether hospitalization rates start to increase which would be an indication that we're in for another rough stretch.

Depressing News About STDs

CDC reported data from 2020, a time when we were mostly in lockdown everywhere, and it's pretty depressing. Gonorrhea and syphilis increased significantly, chlamydia was about the same. Here is a look at syphilis in newborns and women of childbearing age the past few years:

Certainly my own clinical practice bears this out. Although I don't generally see adolescents for STD issues, my colleagues and I have seen plenty of referrals for congenital syphilis recently. A sad commentary on our public health system, reflecting poor infrastructure in many states dating back generations.

New Fulminant Hepatitis?

Although we don't have much information to go on yet, small clusters of what appears to be acute fulminant hepatitis in young children have been reported in the UK, Spain, and the US (Alabama). A prime suspect is adenovirus 41, usually a run of the mill infection. Investigations are still ongoing, but the clusters do not appear to be associated with the more usual viral causes (hepatitis A through E) nor with any identifiable toxin exposure. The best information comes from Scotland where officials published comprehensive but still inconclusive data on 13 children.

Adenoviruses are well known to be excreted in the nose and/or stool weeks to months following infection, so a positive PCR from these sites may not indicate causation of a current illness.

I suspect this will be figured out soon. In the meantime, frontline pediatric healthcare providers should be aware of this possibility, both to identify cases early as well as to ward off panic from parents if their child with a cold happens to have a multiplex respiratory pathogen panel positive for adenovirus, a very common occurrence. Of course the best way to ward this off is to not order this test in the first place - it isn't necessary for routine illness!

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