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.
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.
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.
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.
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.
When I saw the latest CDC online shenanigans I laughed, briefly. It's preposterous but also real.
The asterisked heading is contradicted by everything else on the page.
The remainder of the page is a useless compilation of "facts" ignoring the issue that it is impossible to prove, in an individual case, whether an exposure to something caused a particular outcome. One commentator has compared this to calling for studies investigating the role of ingestion of a popular soft drink on causing autism. Not only does this stance by the new CDC increase confusion and vaccine hesitancy, it risks diverting limited resources to studies that will not answer any useful question.
Diphtheria in Africa
WHO provided a situation update on diphtheria in the African region. It's discouraging.
Outbreaks are ongoing in 8 countries: Algeria, Chad, Guinea, Mali, Mauritania, Niger, Nigeria, and South Africa. As of November 2, the total number of suspected cases in Africa was 20,412 including 1252 deaths (case fatality rate 6.1%). Mali, Mauritania, and Niger seem to be the "hottest" spots for new infections recently.
Management of the outbreaks is complicated by limited laboratory resources and insufficient supply of antitoxin.
Vaccine coverage rates are somewhat variable among the affected countries.
Although the organism, Corynebacterium diphtheriae, is widely distributed in the environment worldwide, including the US, most infections occur following exposure to respiratory secretions or skin lesions of individuals with active disease. Transmission also can occur from asymptomatic carriers of the organism. The risk of this spreading to the US population is relatively low but could rise if population vaccination rates continue to fall. This includes adults who don't update their Tdap every 10 years.
MMWR is Back
MMWR may not be able to hold on to the W(eekly) in its title if this year's trends continue, but we did see a new issue appear on November 20; the previous issue was from October 2. The number of topics seems to be diminishing on average this year, only 2 this week, but both were excellent studies and dealt with RSV.
The first report looked at implementation of nirsevimab administration to newborns at birthing hospitals in the US. The Vaccines for Children program will pay for administration of this long-acting monoclonal antibody. The product is recommended to be administered within the first week of life during RSV season for infants born to mothers who did not receive RSV vaccine. However, this payment requires hospitals to enroll with the VFC. If the hospital isn't enrolled, those newborns won't receive nirsevimab during their stay, and we know that many may not be seen for outpatient follow-up by 7 days of age.
Hospital VFC enrollment has increased, but it is still a glass half-full situation. "A CDC effort with professional organizations and health departments to enroll birthing hospitals in VFC was associated with an increase in enrolled birthing hospitals from 763 (27.1% of 2,817 facilities) at the beginning of the 2023–24 RSV season to 1,021 (36.2%) by the end of the 2024–25 RSV season. The number of nirsevimab doses ordered approximately doubled." Rates for individual states varied widely. I was ashamed to see that my home state, Maryland, had only 6 of 33 hospitals enrolled by March 31, 2025.
The second report looked at effectiveness of nirsevimab in preventing ICU admissions in infants. It was a case-control study of 27 hospitals in 24 states in the Overcoming RSV Network which is an extension of the Overcoming COVID Network.
The study included 457 children admitted to ICU with a positive RSV test compared to 302 RSV-negative children. Nirsevimab was 80% effective (95% CI 70-86%) in preventing RSV-associated (positive test and admitted for respiratory symptoms) ICU admission and 83% (74-90%) against respiratory failure. These numbers are for children who received nirsevimab for a median of 52 days and 50 days, respectively, prior to onset of the endpoint. More evidence that nirsevimab is a game-changer for RSV disease.
Current Epidemiology
Winter respiratory infections still appear to be lowish nationally with covid, flu, and RSV all officially very low according to CDC. The map as of data through November 15 shows a little variability, typical for this time of year.
Again, look for RSV and influenza to take off soon.
If we've learned nothing else this past year, it seems that local pockets of mostly unimmunized individuals are feeding ongoing measles transmission, with overall falling immunization rates contributing to higher risk of spreading outside these communities. Here are the hotspots for the past 2 weeks according to the Johns Hopkins site.
I'm Thankful for ....
As we enter Thanksgiving week, I remain thankful for many things, chief among them my family who somehow continues to put up with me. It would take a few hours to compose a semi-comprehensive list of everything I'm thankful for, but I'll mention a few.
Friends - any friends I have are mostly because of my association with my LSW; they tolerate me so that they can talk with her. I'm the equivalent of the odd green jello salad that accompanies the beautifully-cooked turkey for Thanksgiving dinner. You take a few bites of the jello out of politeness, but what you really came for is the turkey, dressing, gravy, and other accompaniments.
My health - of course not perfect, but I've been a remarkably fortunate septuagenarian so far.
Asterisks
In these pages, I've mostly used the asterisk to follow "LSW" when referring to my Long Suffering Wife.
They are very useful as a wild card for searching in PubMed and other search engines.
I was surprised to learn that the asterisk dates back to the Ice Age.
Our HHS Secretary presumably used the asterisk to taunt a certain Louisiana senator:
"* The header "Vaccines do not cause autism" has not been removed due to an agreement with the chair of the U.S. Senate Health, Education, Labor, and Pensions Committee that it would remain on the CDC website."
But sort of a bust for the pediatric infectious diseases universe. It was the opposite of the previous week, when I had so many intriguing original articles appearing I had to streamline my presentations of each. This week? Exactly zero new articles caught my eye. So, in lieu of that track of discussion, I'll be able to spend a little more time on the goings on in the vaccine regulatory world (or country) and have a quick update on current epidemiology.
CDC, Vaccines, and RIFs
Early in the week we learned the acting director of the CDC finally signed off on ACIP recommendations, facilitating planning for vaccine administration. We now have a fully-approved CDC vaccination schedule that pretty much allows anything as long as discussion with a health provider takes place. I found a summary of "shared clinical decision making" that has some useful examples and links.
This sign-off means that the VFC program and most insurance programs should cover almost every instance where a provider discusses options with parents and patients. It's not like this wasn't happening previously, but it does place another barrier particularly for those who don't have ready access to a healthcare provider. Also, rules will vary by state, which is really confusing. I'm hoping once the dust settles that someone will produce a clearinghouse website where all the state rules can be viewed, In the meantime, providers should look for updates from their own state health departments and medical societies. I've been receiving updated guidance from all 3 jurisdictions where I have an active medical license.
In the likely event you don't want to do either of those options, I'm happy to summarize for you. It was all about ISO.
You don't need to be embarrassed, but I certainly was because when I heard that acronym it meant nothing to me. It stands for the Immunization Safety Office at the CDC. I've heard many reports from this group over the years but hadn't latched on to the entity itself. The NASEM report aims to change that. NASEM's review, conducted at CDC's request (I couldn't tell whether this request occurred before or after the change in administration last January), consisted of reviewing of CDC historical web sites and other documents beginning with the start of the pandemic and continuing to the present. They concluded their review with a list of action items. I came away with 2 main points. First, ISO did a wonderful job of systematically tracking and reporting vaccine risks, but did so in a confusing fashion especially in the early phases of the pandemic. The confusion arose from lack of clarity as to target audiences, causing intermingling of information for healthcare professionals and the lay public. Even though the findings were of high quality, too much technical language was used in most of the documents.
Second, the NASEM panel believed the ISO's messages were not separated from the CDC's mission for promotion of vaccines generally. (Now CDC's mission seems to the exact opposite, creating confusion and raising questions based on faulty data that cause the public to have more concern about all vaccinations.) NASEM believes, and convinced me, that ISO's deliberations and messages should be more independent of CDC's vaccine promotion mission. That isn't to say they should separate from or not collaborate with CDC, but rather after such collaboration their reports should focus only on explanation of vaccine risks. CDC, FDA, medical societies, and others then can use this information to develop their own recommendations.
All of this would require reorganization and significant new funding, so I doubt anything will happen with these recommendations in the next few years at least. Even if something were developed now, I can see the current administration stacking ISO with anti-vaccination zealots such that we end up with less reliable information on vaccine risks.
A couple of other crazy happenings last week. The acting CDC director called for development of separate measles, mumps, and rubella vaccines. Not only would this be extraordinarily expensive requiring years of new clinical trials, it makes no sense. There is no scientific reason to separate them, plus it would only encourage delayed vaccinations and cause more pain to infants with repeated injections. I hope this idea will crawl under a rock and die.
A second dose of craziness is that the October 22-23 ACIP meeting is now postponed to an unspecified date. This again will cause confusion, but I would predict that when it does finally happen we'll see attacks on other vaccines as well as the entire immunization schedule.
WRIS
It's about the time of year that I start my regular Winter Respiratory Infection Season reporting. This year it's different given that CDC's resources are significantly depleted - I can't even keep up with the whole firing/rehiring thing - and I'll be turning to other resources to supplement CDC. Here's a look at a couple.
First is the Johns Hopkins measles (not winter-specific, but I'll include here) site that I mentioned a few weeks ago. Recent county-level areas to watch are in Mohave, Arizona (11 locally-acquired cases from 9/28 through 10/10/25) and Southwest Health District, Utah, with 10 cases. Also note an interesting cluster of 10 imported cases in the Twin Cities Metro Area, Minnesota. That's the kind of thing that could turn into a bigger locally-acquired outbreak of conditions are right.
The current total measles cases for this calendar year is 1569.
The second non-CDC resource I'm monitoring is called POPHIVE, Population Health Information and Visualization Exchange, from the Yale School of Public Health. It reports a variety of important public health trends, including for respiratory diseases. Here are totals for COVID-19 ED visits by age, though note that it's difficult to compare numbers over this long a time period because of differences in testing rates and healthcare seeking behavior now compared to a few years ago.
Other respiratory diseases being tracked at this site include RSV, flu, and pneumococcus.
The Great Week
I mentioned this was a big week for me. My second grandchild, a boy, was born. Both baby and mother are doing great, and I am in seventh heaven.
But, I was somehow reminded of one of my favorite books to browse, Ambrose Bierce's The Devil's Dictionary. I remembered he had a witty definition of a baby:
"A misshapen creature of no particular age, sex, or condition, chiefly remarkable for the violence of the sympathies and antipathies it excites in others, itself without sentiment or emotion."
March 11 marks the 5th anniversary of the World Health Organization declaring COVID-19 a pandemic. WHO had declared it a Public Health Emergency of International Concern (PHEIC) on January 30, 2020. I can't say I'll be celebrating this anniversary, but it did lead me to discover a new site: the CDC Museum COVID-19 Timeline. It's yet another rabbit hole for me to get lost in.
Wasteful Lab Tests
Two publications last week highlighted the developing science of diagnostic stewardship - increasing effective use of diagnostic tests and minimizing test ordering that does not help, or worse, harms, patients. First, a retrospective database study showed that respiratory pathogen panel (RPP) orders, already on the rise in pediatric hospitals, increased sharply during the pandemic but continue to be ordered at high levels even as the pandemic ended. The larger multiplex RPPs test for a number of pathogens for which there is no treatment and thus really no benefit to detecting those viruses for the vast majority of children. Also, most practitioners don't recognize that many respiratory pathogens (e.g. enteroviruses, adenoviruses, and Mycoplasma) can persist positive on these panels for weeks or months. largely because the pathogens themselves remain in our systems for a prolonged period though don't cause harm. Thus, positive tests can sometimes reflect something that happened 2 months ago and not have anything to do with the current illness being evaluated.
The authors found that respiratory testing overall seems to have remained quite high, at least through 2023, for both hospitalized children as well as for children seen in the ED but not hospitalized.
Not shown in a nice graph but included in the text of the article, they found that testing for SARS-CoV-2 alone decreased during the post-pandemic period, but this was not accompanied by a decrease in use of the larger RPPs. They also estimated the costs of such testing: about $20 million in 2016, a high of $111 million in 2022, and $83 million in 2023. Remember, this is just for children's hospitals included in a national consortium. The true excess costs likely are much higher.
Another report focused on a new guideline for management of pneumonia in neurologically-impaired hospitalized children, based on expert panel opinions of different scenarios. It's a useful guidance document, but what I found most interesting was in the diagnostic stewardship realm. They recommended against routine use of procalcitonin, ESR, CRP and large panel respiratory viral testing. (Sorry, you'll need to access the article to see all the explanatory footnotes, just too large to include here.)
The World
There's a lot going on in the world of infectious diseases outside of the US, and of course sometimes those issues come home to us via international travel - it's inevitable.
Sudan Virus in Uganda
In the latest WHO outbreak news from March 8, Sudan virus hemorrhagic fever continues to be a problem in Uganda with 12 confirmed and 2 probable cases total since the outbreak started in late January. That doesn't sound like much, but underreporting is always a particular problem in resource-poor regions. The most recent case had symptom onset in mid-February. We have no proven vaccines or therapeutic agents for Sudan virus disease, but WHO began a vaccine trial using a ring vaccination model: vaccinating primary and secondary contacts of index patients to see if this presents spread to the larger community. A therapeutic agent trial also is being planned.
Poliovirus in European Wastewater
Last week's MMWR (yes, it's back in mostly fine form!) announced findings of a vaccine-derived strain of poliovirus type 2 surging in wastewater in some European countries; this is the strain that has produced paralytic disease in other countries. The particular strain originated in Nigeria and has spread to 21 other African countries. There are no known cases of clinical infection, but remember that paralytic polio occurs in only around 1% of those infected with the virus and it's very difficult to identify the asymptomatic and mildly symptomatic infected people without very costly tools.
This isn't a time for alarm or for closing borders, though I'm sure some will use this as an excuse to do so, but it bears watching as well as ensuring adequate immunization against polio. Of course the killed polio vaccine, used in the US and other countries where polio has been eradicated, does not carry the risk of spread of vaccine-derived virus known to occur with the live virus polio vaccines.
Unknown Agent(s) Causing Deaths in Democratic Republic of the Congo
WHO officials have been monitoring this situation in the DRC, still very unclear whether it is a single agent or just a cluster of multiple known agents causing deaths. I haven't mentioned this previously because it is still unexplained and most often will not result in any new information concerning for spread outside of a limited region. I'll swing back with an update when the situation is pinpointed.
Measles
I'm saddened that measles likely will be a regular feature in my posts for the next few weeks at least. On Friday, CDC issued an advisory through its Health Alert Network about the increasing numbers of measles cases in Texas and New Mexico. These areas are definitely not on my travel list, even though I know my measles antibody titers are high. The advisory has a lot of useful information and links for healthcare providers and the general public.
I was also pleased to see that Texas has accepted help from the CDC, although I learned this only through lay press announcements that CDC had posted the news on X, absolutely the last place I'd normally go for any useful information.
I didn't bother to read any of the 491 replies, not a good use of my time.
Here's the latest from CDC; note that the recent decrease in numbers isn't necessarily real, there is a lag time for reporting and verification of cases:
The official CDC total for 2025 is up to 222 cases. One death of an adult in New Mexico who tested positive for measles is still under investigation to see if measles was actually the cause of death or just coincidental. Apparently this person did not seek medical attention before death.
As bad as the outbreak numbers are, I think I was most dismayed by the rumors in the lay press that CDC has announced a new study of a linkage between autism spectrum disorder and the MMR vaccine. This is perhaps the best-studied association known to modern science, with reports of cumulative numbers of several million children across the globe showing no connection between MMR and ASD. Yet another study seems like wasteful spending and use of government workers' time!
I won't bother to go into depth with the studies, you can look at the CDC site for an excellent discussion and some key references (click on the tab for references 3,4,5,6). However, I did want to make a couple points about issues that anti-vaccination proponents misinterpret or deliberately ignore. First, these studies look a large numbers of children who received and did not receive MMR vaccine and present results for the group as a whole. It is impossible to prove that MMR vaccine could not have caused a particular child's ASD. You can think of it as analogous to a situation where one tries to see if a particular medication had caused a rare side effect in a child where that side effect was not previously known to cause the adverse event. About the only way to prove it caused the problem for that child is to wait for the side effect to go away and then re-challenge the child with the same medication and see if the adverse event recurs. There's no way to do that with a vaccine and ASD. Second, anti-vaxxers often misinterpret how various tracking systems for vaccine adverse events are collected and what the limitations of these databases can be. From my observations of past RFK's interpretations of vaccine safety reports, I expect that any new study that doesn't align with his views that MMR causes ASD will just be disregarded or twisted to change the results. I pity the CDC scientists forced to work on the new study.
And, speaking of a waste of time, we now have a new CDC page listing all the conflicts of interest reports from ACIP members. I say this because the details have all been part of the public record and available at every ACIP meeting in the past, plus archived on the ACIP web site. I suspect this will be used as an excuse to remove members from the ACIP and replace them with less knowledgeable individuals who have never been involved with a vaccine trial.
All of this measles news caused me to unearth what's left of my old measles folder containing some very yellowed pages at this point. This coming week I'll go through some key articles on effect of vaccination rates on measles transmission, the reproductive numbers for measles, what we know about measles transmission in office settings (spoiler alert, it's not as much as you think), what vitamin A does and does not do for measles, and maybe some others. Stay tuned for my next post.
WRIS
At least we can end with some good news. The winter respiratory infection season continues to wind down, and without a big jump in covid so far. Both covid and RSV are low and decreasing; flu is still high but also continues to decrease.
That COVID Timeline Museum
Taking a stroll through the CDC's site wasn't that picturesque for me; in fact, there are no pictures or graphs beyond the same worn-out cartoon of the virus itself at the top. It did have a lot of words on a timeline, however, and I found myself trying to remember what was going through my mind at various times as the pandemic evolved. I wish I had kept a written journal, but I well recall that 5 years ago this month, among other concerns like grocery shopping, I was trying to research how to safely re-use N-95 masks in my clinical practice. We definitely had a shortage of those masks that prevented any single use options, and it was very time consuming to use other methods such as our hospital's limited supply of PAPRs (powered air-purifying respirators). US cases were still low in early March, 2020; here's a screenshot from the Museum:
Readers of past postings know I try to avoid politics in this blog. Today's post represents a complete failure to achieve that goal. I have followed RFK Jr.'s statements and writings about vaccines and public health for many years. His brand of pseudo-science is incomprehensible to me and anyone who understands biology and scientific methodology. His confirmation as HHS Secretary last week marks a sea change in the American health system; although he spouts some worthwhile targets to improve public health, in his new position he poses a grave public health threat for infectious diseases in particular. Regardless of any specific vaccine or other policies he might introduce, his mere confirmation as HHS Secretary may serve to further normalize anti-vax sentiment and likely will increase rates of vaccine refusal. Welcome to the new Dark Ages, though I doubt it will last several centuries like the last one. More on this later.
The Global Watch
A number of things to be aware of globally, though none immediately troublesome for the US.
Marburg Outbreak in Tanzania
This outbreak of a viral hemorrhagic fever disease (similar to Ebola) was declared about a month ago. Ten cases (2 confirmed, 8 suspected) have been identified, all fatal. Now, the 281 contacts of those 10 cases have passed the 21-day incubation period and remain well, very reassuring. However, WHO still rates the risk at the national level as high, given that the locale, Kangera, is a major regional transportation hub to other countries. Risk for global spread is still low.
Ebola (Sudan virus) Outbreak in Uganda
AfricaCDC reports that the vaccine trial is underway now in 7 of the 8 planned sites. Disease activity seems relatively stable, though the weekly reports tend to lag with last update posted from February 10.
PPE for VHF
With every viral hemorrhagic fever outbreak, healthcare providers comprise a prominent number of infected individuals. This occurred even in the US when 2 American nurse providers were infected during the 2014 importation from travelers. It's a good time to remember precautions to prevent VHF spread in healthcare settings, also a bit confusing since different guidelines apply according to whether the suspected patient is clinically stable or unstable. Front line providers need to contact their friendly local ID or infection control practitioner for help as soon as a suspected VHF case is encountered. Remember to obtain a good travel history.
mpox
In WHO's February 13 situation report, clade Ib mpox remains primarily in the DRC, Rwanda, and Uganda. MMWR just reported confirmation of a case of Ib infection in California from November 2024, in a traveler returning from east Africa. More on MMWR later.
Measles Again!
No surprise, but we have new outbreaks in the US, presumptively heavily related to cases in unvaccinated persons who were old enough to have received 2 doses of MMR vaccine.
A February 14 update from the Texas Department of State Health Services lists a total of 48 cases in the South Plains region, with age distribution of 13 cases in 0-4 year-olds, 29 in school-aged children (5-17 yo), 5 18 and older, and 1 with age unknown. Digging through the data from their spreadsheet links, MMR coverage in 2023-24 in the Seminole ISD (apparently the epicenter of the outbreak) is an appallingly low 82%. In Gaines County, home of 42 of the outbreak cases, the rate of "Conscientious Exemptions" for vaccine administration for children rose from 7.45% in 2013-14 to 17.62% in 2023-24. Even the earlier rate is super-high. Gaines County is the red box below.
The CDC measles page is updated only monthly, perhaps not frequently enough given the current situation. And, speaking of the CDC ...
Interesting Week Ahead for the CDC
I'll be watching closely this week. MMWR seems to be back, but with fewer topics per issue. I looked at the 2024 content, and only about 10% of the weekly publications had less than 4 topics. Both issues following the "publication pause" had only 2 articles each.
More telling, the Advisory Council on Immunization Practices is scheduled to meet on February 26-28. The draft agenda was released on January 19, and I'll be interested to see if the topics change. Currently on the schedule are votes on meningococcal, chikungunya, and influenza vaccines plus further discussion on maternal and pediatric RSV vaccines on Wednesday. These are not particularly high profile targets for the anti-vaccination lobby or for anti-DEI issues. However, part of the discussion process for vaccines at ACIP meetings has been an "Evidence to Recommendations" portion that normally includes a section on equity. I wonder whether this will change. Thursday's draft agenda includes perhaps more controversial subjects of HPV and mpox vaccines, due the relationship of these infections to spread via sexual contact in different high risk groups. Thursday's discussion also touches on pneumococcal and adult RSV vaccines, plus a 5-minute blurb on Lyme disease vaccination that I'm wondering about. The meeting wraps up Friday morning with discussions on covid (!) and CMV vaccines. I hope to attend much of the meetings and I'll report back next week.
This week's New England Journal of Medicine included a Perspective written by 3 former editors-in-chief of MMWR plus a former director for one of CDC's Centers. It was entitled "The Consequences of Silencing the 'Voice of CDC.'" Clearly the authors carry some implicit bias in favor of the CDC, but the article was enlightening. They repeated the reports I heard that the February 6 issue suppressed a discussion on H5N1 influenza (may have related to spread between cats and humans), which is concerning. I was interested to learn a bit of history: MMWR first appeared in 1961, during my lifetime but in a period when my interests fell more along the lines of Tinkertoys and butterflies. Currently I am one of 147,000 electronic subscribers to MMWR. CDC shares titles and brief summaries of reports with the Office of the Assistant Secretary for Public Affairs at HHS to alert them of content, but the authors were not aware of any time the reports had been altered or censored by the executive branch.
The authors went on to mention how rapid publication in MMWR helped public health management, citing the initial descriptions of what was eventually AIDS, outbreaks of foodborne illness related to hamburger contaminated with E. coli O157:H7, and anthrax related to intentional distribution of anthrax spores. I was a practicing pediatric ID physician during all of these outbreaks and still remember reading MMWR and changing my practice to account for new disease situations.
In addition to the evolving VHF situation in Africa mentioned previously, we need ongoing high-level surveillance for avian flu and for the large outbreak of tuberculosis in Kansas. With regard to the former, we did hear some information in MMWR this week: new serologic evidence of H5N1 infection in veterinarians providing care for cattle but with no known link to infected herds, suggesting more widespread cow infection than has been detected so far.
As an aside, since I do most of the grocery shopping in my household, I discovered the USDA has egg market reports. If you need some distraction from hand-wringing, you can track how many 30-dozen egg cases are moving around in your region each weekday!
WRIS
I'm thinking I don't need to tell any front line healthcare provider that influenza season is in full swing and is the one prominent player in our winter respiratory infection season at the moment.
More concerning is that illness severity is quite high.
Virtually all circulating strains are influenza A, and avian flu is not contributing to this with still just a handful of human cases detected in the US. Not too late to vaccinate.
My Test Grade Was 3
Please pardon my error last week in inviting readers to take the "How Ignorant Am I?" online quiz, not realizing it required subscription access. The quiz itself is based on a 1950 publication by statistician and weather forecaster Glenn W. Brier, updated in the Nature article you probably can't access. Briefly, the new quiz consists of 5 questions covering percentage of water in human body parts, timing of publication of genetic theories, planet size, number of atoms in common molecules, and melting points of precious metals; in short, scientifically based but nothing recently discovered. The kicker to the quiz is that it's not just whether you provide the correct answer, but that you quantify your confidence in the answer you provided. The scoring system is weighted such that failure (getting the wrong answer but thinking you are correct) is punished more severely than rewarding success (just getting the right answer). Here's the scoring interpretation: "If you ended up with a negative total, you did worse than a complete ignoramus who just answered 5 to every question" [5 indicates you had no idea which answer was correct, resulting in a score of zero if you answered 5 for all questions]. "People who actually know a lot, or are extremely lucky, get higher scores." (The highest possible score, getting all answers correct and being absolute certain of your answers, is 125.). So, my score of 3 isn't great, with a consolation prize that "Those with an awareness of their own doubts ... might end up with a small positive score." The main point of the quiz was " ... to train forecasters to be less over-confident, and have insight into their own thought processes." Applies to weather forecasters and possibly to healthcare providers as well!
