COVID-19 vaccine – Page 2 – Pediatric Infection Connection

Tirade Time

Bud WiedermannSeptember 8, 2024September 8, 2024Leave a comment

It's unusually cool today in the Washington, DC, area, prompting my landscape designer wife to don her poison ivy hunting apparel and venture into the nether regions of our back yard to keep it safe for us.

We've had a lighter week in infectious diseases events. I'll take advantage of that to share a rare criticism of one of my favorite ID feeds. But first .....

Leptospirosis

This is a tough diagnosis most of the time; it's a relatively uncommon infection in the US, and the early stages don't have particularly novel signs and symptoms; it's just a nonspecific febrile illness. About 10% of cases can progress to a second and more severe stage, often called Weil's disease. It's important to remember that it can be a water-borne pathogen, as illustrated by these 2 recent reports.

First, this week's MMWR provides us with documentation of the leptospirosis outbreak in Puerto Rico following Hurricane Fiona in 2022. Leptospirosis is endemic in parts of Puerto Rico, and a disruption like flooding due to a hurricane increases its reach and can result in disease spikes. Look at these graphs of weekly rainfall and leptospirosis cases - it certainly fixes in my mind the tie between water and leptospirosis.

The MMWR article has a link to a nice clinician fact sheet.

Similarly, there's a new spike in leptospirosis infections in Thailand, so far just in news reports (you'll need Google translate again).

I first took a deep dive into leptospirosis as a medical student when I came upon a landmark article of detective work surrounding an outbreak in St. Louis. Two of the authors were mentors of mine, and they loved to regale me with (probably augmented) tales of tracking rats through the sewers of St. Louis. I'm sure this contributed to my choice of pediatric infectious diseases as a career, though not to the extent that I've chased sewer rats.

Mixed Messages About Vaccine Protection From Long Covid

A new article reached a different conclusion from several other reports showing that covid vaccination is somewhat protective against long covid, now better termed PASC (Post-Acute Sequelae of COVID-19). The new study is a retrospective cohort study mining an administrative database from a single (large) healthcare system. The bottom line is (of course!) towards the bottom of the table: no real differences in PASC rates based on vaccine status. Also note this was primarily a study of adults.

Is this a flawed study? Are the authors' conclusions wrong? Well, no to both. We will have differences in conclusions from such studies primarily when we are seeing retrospective studies that rely on administrative databases. The authors did a heroic job of attempting to adjust for various errors in how such data is recorded, but it's impossible to account for everything. Thus, we can have errors in diagnosis, diagnostic code assignment, and missing data, among other issues. Couple that with different definitions of PASC and the likely heterogenous pathogenesis of different forms of PASC, and it's a recipe for conflicting study results. I think we likely will have a clearer picture of PASC, including whether covid vaccination can offer some protection, but it will take prospective longitudinal studies which require more time for data collection and analysis. A longer discussion of the science of PASC is reviewed in Nature Medicine. In the meantime, studies like this one help us fine tune future studies.

Shame on CIDRAP

CIDRAP (Center for Infectious Disease and Research Policy at the University of Minnesota) is one of my favorite daily feeds. I think they blew it in mentioning FDA clearance of a new Lyme test; not only is it not newsworthy, but it could lead some individuals to chase harmful Lyme disease testing. I could be guilty of the same by even mentioning it here.

First of all, FDA clearance of diagnostic tests is a relatively low bar to clear. Although I couldn't find any FDA commentary on the test in question (I guess that would require a Freedom of Information Act request), I did link to the criteria that I think likely were used in this setting, because the particular methodology this test utilizes is nothing new. So, I believe the manufacturer would only need to show "substantial equivalence" to existing tests. This is not the same as showing the new test improved diagnostic accuracy or improved healthcare outcomes. Here's the summary of applicable FDA guidance:

"Studies to Demonstrate Substantial Equivalence

The types of studies typically used to demonstrate substantial equivalence may include the following:

In the majority of cases, analytical studies using clinical samples (sometimes supplemented by carefully selected artificial samples) are sufficient.
For some IVDs, the link between analytical performance and clinical performance is not well defined. In these circumstances, clinical information may be warranted.
FDA rarely requires prospective clinical studies for IVDs, but regularly requests clinical samples with sufficient laboratory and/or clinical characterization to allow an assessment of the clinical validity of a new device. This is usually expressed in terms of clinical sensitivity and clinical specificity or agreement."

This new Lyme test is simply an immunoblot, a very common type of test utilized in multiple settings but with the drawback that interpretation is somewhat subjective - a human needs to decide if a band is prominent enough to be considered present.

When I dug deeper to find supporting studies for this particular test, I became more alarmed. While there are some preliminary studies that I think might have used this new immunoblot method, they don't answer any clinical performance questions. More worrisome is that the test will be sold by a California lab called IGeneX, a company that offers many Lyme tests that, in my opinion, have falsely diagnosed many of my patients with Lyme disease. They often rely on their own interpretations of what constitutes a positive test and provide no reliable scientific evidence to suggest their methodology is valid. In fact, the press release for this new test stated that "Results interpretation is based upon new criteria and not CDC criteria."

Even now on their website they steer providers and patients away from the standardized two-tier testing preferred by CDC. Here's a quote from the IGeneX website: "Lyme disease is typically diagnosed by a two-tiered testing (TTT) approach involving an enzyme-linked immunosorbent assay (ELISA) followed by a Western blot test. However, the sensitivity of these commercially available tests is poor, meaning they can miss active infections. Experts advise against this testing technique due to the ambiguity of its results." It's easy to find a so-called expert to say anything. Again, in my opinion, this lab is to be avoided, and you'll notice I didn't provide a link to them. I'm disappointed CIDRAP gave them free publicity.

Lyme disease testing is far from ideal, and it's certainly possible this new test is an improvement, though I doubt it. CDC explains diagnostic testing for Lyme disease, including the recommended two-tiered testing options. I suspect IGeneX might try to claim that their new immunoblot can fulfill CDC recommendations, but I'm concerned that they will use unsubstantiated rules for interpretation of a positive immunoblot result, as they have for similar tests in their lab.

COVID Crystal Ball

Last week my wife and I got our new covid vaccines, more based on upcoming travel plans rather than any immediate concerns about getting covid. In fact, things seem to be winding down. According to the latest CDC clairvoyance, "we estimate that COVID-19 infections are growing or likely growing in 7 states, declining or likely declining in 16 states, and are stable or uncertain in 25 states." (Not a totally reassuring conviction if half the states could be uncertain!)

I couldn't find a separate precise definition of cutoffs for their categories, but from viewing the data it appears that the Stable or Uncertain category is defined as a probability that the epidemic is growing in those states as between 0.5 and 0.75. By comparison, all the Growing states had probabilities of 0.93 and above.

Curmudgeon-in-Residence

I think I've paid my dues long enough to be entitled to curmudgeon status. The new Lyme test thing reminded me of my dismay that some of the children I've seen in my practice over the years were harmed by use of misleading diagnostic tests resulting in prolonged and unnecessary antibiotic use. I wear my Statler and Waldorf credentials proudly. I think I bear more of a resemblance to Statler.

Now, to cool off a bit, I'll take a quick stroll in my (safer) back yard.

Seeing You in September

Bud WiedermannSeptember 1, 2024September 2, 2024Leave a comment

This month always bring me back to The Happenings version of "See You in September;" I remember it fondly from my junior high school era. The Harvest Month often is a transition period from summer to fall/winter infections.

The Respiratory Infection Front

Right on schedule, the ACIP published its official flu vaccine recommendations. Nothing new in there, but it's a good one-stop shopping place for seasonal flu information. Things remain calm on the overall respiratory illness view, and covid may have reached its peak.

However, I'm still waiting for covid wastewater trends to start heading down in most areas of the country (same link as above). We may not be out of the woods yet.

Also note that the covid vaccine from Novavax was authorized by FDA this week. I'll be interested to see how effectiveness compares to that of the mRNA vaccines; Novavax targets a slightly earlier variant (JN.1) than the Pfizer and Moderna products which used KP.2. KP.2 is decreasing in prevalence in the US but still is more closely related to the current variants KP.3.1.1, KP.2.3, KP.3, and LB.1.

We have more longterm follow-up information about myocarditis and covid, looking at both vaccine- and natural infection-associated complications compared to other ("conventional") etiologies. It looked specifically at individuals 12-49 years of age hospitalized with myocarditis. Without going into great detail, it was clear that vaccine-associated complications were less common than with myocarditis associated with conventional or SARS-CoV-2 infection; however, confidence intervals were wide for several of the outcomes due to low numbers of events.

I was excited to see a new update from the HIVE (Household Influenza Vaccine Evaluation) program that has been monitoring households in Michigan since 2010 and was expanded to cover other respiratory infections in later years. The new update covers the years 2015-2022. (The watermark in the figures below signifies this is an accepted manuscript that hasn't yet appeared in the print journal.) Even though it's limited to southeast Michigan, it is valuable data because it is an ongoing active surveillance program in these volunteer households and gives us a glimpse of how the pandemic affected other virus epidemiology.

Far Away Challenges

Mpox continues to rage in the DRC and other areas of Africa, with exported cases appearing in far-flung countries. In addition to vaccine, these countries need better front line diagnostic tests. WHO has requested test manufacturers to apply for emergency approval.

On the polio front in Gaza, we've all heard the good news that there will be a pause in fighting to allow for vaccine administration, but it remains to be seen if this will really happen. Regardless, this will be an extremely difficult undertaking, targeting over 600,000 unprotected children in the region.

Bugs Transmitting Bugs

Healthcare providers and the general public are understandably reeling from all the information about various outbreaks of vector-borne infections. It's important to keep in mind 2 main points: 1) Nothing is happening this year that hasn't happened before in the US. This is the season for vector-borne viral infections. 2) Global warming has increased both the range of these vectors, introducing these infections to areas that haven't seen them in past years, and also increased the season length that these infections circulate. We could see increases in all these infections in coming years.

Here's a breakdown of some of the viruses being hyped in the news.

West Nile Virus

Approximately 70-80% of infections are asymptomatic. The most feared complication, neuroinvasive disease, occurs in <1% of all infections but has a 10% mortality and higher rates of permanent neurologic sequelae such as paralysis. So far in 2024, we have had 289 cases from 33 states in the US, with 195 being neuroinvasive (reflecting the fact that only the worst cases get tested for WNV, not any change in asymptomatic rates). Here are some maps for prior years in the US:

As of now, nothing out of the ordinary for West Nile disease in the US. But, it's pretty common if you recognize that we're only identifying maybe 1% of infections.

Dengue

Here the risk is very high in Puerto Rico, but otherwise mostly restricted to travelers from the current epidemic/endemic areas. Some border states, especially Florida, are more likely to see autochthonous (locally acquired) cases. The asymptomatic infection rate is about 75%; 5% of the symptomatic infections progress to severe dengue with capillary leak syndrome and/or hemorrhagic complications. IMPORTANT CLINICAL PEARL: severe dengue usually appears when things otherwise look good - start of afebrile phase after 2-7 days of the febrile phase. This is the time to be very vigilant if dengue is suspected. The slide below (#42 in the pdf) is taken from a wonderful IDSA/CDC Clinician Call webinar this past week, available at https://www.idsociety.org/globalassets/idsa/multimedia/clinician-call-slides--qa/8-28-2024-clinician-call.pdf and https://www.idsociety.org/multimedia/clinician-calls/cdcidsa-clinician-call-update-on-dengue--other-vector-borne-diseases/.

Here are some numbers from the main CDC website above.

For 2024, the only locally acquired cases in the US have been in Puerto Rico (2676 cases), US Virgin Islands (85), and Florida (21), though those numbers are certain to rise since the season isn't over and reporting in general is delayed. If you add in the travel-associated cases, we've seen a little over 4000 in the US.

Oropouche Virus

This is a relatively mild illness for the most part. The asymptomatic infection rate is around 40%, but 4% of those with symptoms will develop neuroinvasive disease. Now there is concern for vertical transmission in pregnant people, still not completely clear. Management guidelines for infants with possible intrauterine infection are updated and available.

Although I was aware of Oropouche virus previously, this is the first year I've ever heard of the term "sloth fever" which only applies if you acquire the infection in the jungle. This is a slide from that same IDSA/CDC webinar, slide 69 in the pdf.

Oropouche may be over with in South America now, and the main risk area remaining is Cuba. CDC reported 21 US cases in travelers returning from Cuba.

Eastern Equine Encephalitis

Saving the worst for last. It's very uncommon, but you definitely don't want EEE. The encephalitis picture occurs in <5% of those infected with EEE virus, but of those with encephalitis the mortality rate is 30%, and 50% of survivors have permanent sequelae.

We've had 4 cases in 2024 so far. Here's data from prior years:

This is a horrible disease. Certainly precautions such as mosquito spraying and personal protection from bites should be implemented in areas where the virus has been identified.

Earworms

Not wanting to end on a depressing note from the rare but severe EEE disease, I thought of earworms. I'm not referring to the real earworm infecting corn ears, nor RFK Jr.'s brain worm, but rather the more contemporary use of the term. Last week I went down the rabbit hole for the Maurice Williams song "Stay," and this entire past week I've been unable to get it out of my head. Maybe I'll replace it with "See You in September."

“There never was a good war or a bad peace.” 2

Bud WiedermannAugust 18, 2024August 18, 20242 Comments

This quote from a Benjamin Franklin letter written 241 years ago still rings true. It's not hard to list bad traits of war, but I find that sometimes we overlook war's contribution to infectious disease outbreaks. Now we're seeing yet another example of this that could expand if not controlled.

Last week revealed a bundle of things to mention, I've tried to trim the list as best I could.

Oropouche HAN

Now the CDC has jumped on the Oropouche virus bandwagon with a new alert via the Health Alert Network. Most useful to front line healthcare providers is an approach for when to consider Oropouche infection more likely:

Consider Oropouche virus infection in a patient who has been in an area with documented or suspected Oropouche virus circulation within 2 weeks of initial symptom onset (as patients may experience recurrent symptoms), and the following:
- Abrupt onset of reported fever, headache, and one or more of the following: myalgia, arthralgia, photophobia, retroorbital/eye pain, or signs and symptoms of neuroinvasive disease (e.g., stiff neck, altered mental status, seizures, limb weakness, or cerebrospinal fluid pleocytosis); AND
- No respiratory symptoms (e.g., cough, rhinorrhea, shortness of breath); AND
- Tested negative for other possible diseases, in particular dengue. If strong suspicion of Oropouche virus disease exists based on the patient’s clinical features and history of travel to an area with virus circulation, do not wait for negative testing for other infections before contacting your state, tribal, local, or territorial health department.

As I've said previously, it's a clinical syndrome similar to dengue or chikungunya; note the absence of prominent respiratory symptoms. Cuba and Brazil travel has been associated with imported Oropouche in other countries; the disease is also experiencing a rise in Colombia, Peru, and Bolivia.

Mpox

Similarly, we now have mpox reported from Sweden in a traveler returning from an area of Africa where clade I disease has been active. Details are scant, but it was certainly only a matter of time before this happened. Clade I seems to have a higher mortality rate than the more common clade II variant, but it's hard to get precise numbers, much less whether anything is different about the clade Ib variant now being seen. Transmission epidemiology seems to be slightly different than the clade II epidemic of a couple years ago which stemmed primarily from men who have sex with men. In this year's clade I iteration, infections also are being spread by heterosexual encounters, usually via sex workers, and also within households. Young children and pregnant women are at highest risk for complications including fatal outcomes. Like most sexually transmitted infections, public health measures are hindered by infected people not being willing to disclose their sexual contacts. In the Democratic Republic of Congo, the epicenter of the clade I outbreak, homosexuality is not officially illegal but societal norms in the DRC are not favorable to LGBT individuals.

Effective mpox vaccines exist for preventive measures, but a recent press release from the NIH had discouraging news about antiviral therapy. Tecovirimat, aka TPOXX, had been useful in clade II disease. Now, in a placebo-controlled randomized trial of almost 600 mpox-infected subjects in the DRC, tecovirimat outcomes for mortality and for time to improvement were the same as with placebo recipients. I'd like to see the actual study results, but I tend to trust NIH press releases more than most others. CDC has a nice update and map.

Parvovirus B19 Alert

Parvo B19 infection isn't a notifiable disease in the US, so if concern has arisen it usually means something dramatic is going on. This week CDC issued a HAN notice about this infection. The disease is well known to pediatric healthcare providers and to many parents as erythema infectiosum or fifth disease. It's a minor illness unless a pregnant person is infected, with subsequent risk of miscarriage or severe fetal anemia and non-immune hydrops fetalis. Individuals with chronic hemolytic conditions are at risk for aplastic crisis and severe anemia, and immunocompromised people have higher risk of complications. Read more if you need a refresher.

Is It Time for Universal Screening for Congenital CMV?

Last week's MMWR reported on the first 12 months' experience with Minnesota's universal newborn screening program for cCMV; it began in February 2023. 184 of 60,115 (0.31%) newborns screened on a dried blood spot had positive CMV results. Note that screening dried blood spots is less sensitive than other methods; 3 infants with cCMV with negative blood spot results and were picked up by other means. Buried in the report was the interesting finding that of 11 infants with permanent hearing loss, 4 passed their hearing screening test as newborns. Clearly we need more than universal hearing screening to identify at-risk infants. I look forward to further outcome data on Minnesota's program.

Dinner at the Sick Restaurant (apologies to Anne Tyler)

I like to think of myself as an adventuresome diner, but probably I would have drawn the line at these 2 delicacies I found at ProMED, the listserv I've used for decades.

Chicken liver sashimi is a new one on me, but now linked to an outbreak of campylobacteriosis in Japan. (You'll need Google translate for this one.) Perhaps slightly less disgusting is the idea of smoked non-eviscerated fish. Recent testing found a commercial product potentially contaminated with botulinum spores; thankfully no clinical cases have been reported. I've eaten sardines from a can. They also are non-eviscerated, but apparently the fish reported this week were capelin and exceeded the length allowable for packaging non-eviscerated fish. The product was produced and distributed by a company in Florida.

Covid

Meanwhile, let's not forget about our old friend. National wastewater levels are still up.

Levels might be tapering off in some parts of the country.

Meanwhile, clinical indicators suggest we're going to be seeing increasing cases the next few weeks at least. Here's an example with percent test positivity from the same link as above. It's a little higher than it was a year ago, though it's difficult to compare time periods since different factors now drive test-seeking behavior.

Meanwhile, if we can believe news reports (the FDA can't disclose approvals ahead of time), the new KP.2 variant-based mRNA covid vaccines should be available later this week. The Novavax vaccine presumably will be ready a little later. Timing for when to get the new vaccine should be based on individual considerations, including immunocompromised state, travel plans, and other factors. However, trying to predict the amount of covid activity over the coming months is only slightly better informed than a roll of the dice. Here's the current forecast from CDC.

Polio in Gaza

Not that it's unexpected, but a case of polio has been reported in a 10-month-old child in Gaza. This child would have been born just near the start of the new war and presumably was never immunized. Breakdowns in the health system as well as with clean water and sanitation are ideal for a reappearance of polio; it hasn't been seen in Gaza in 25 years. The UN has called for a "polio pause" to allow vaccine distribution. I try to avoid political statements in this blog, and I won't change that now, but I think my old friend Ben Franklin had it right about war.

Batesian Mimicry

To end on a lighter note, when I first saw this term I immediately thought of Norman Bates and "Psycho," perhaps Hitchcock's most famous movie. But no, it's not (spoiler alert) Norman mimicking his mother. This refers to Henry Lewis Bates' 1862 publication on butterflies in the Amazon. For an easier read, try this Wikipedia page. It explains my astonished update in last week's post that the mysterious black butterfly in our garden was in fact a dark variant of the easily recognized tiger swallowtail. Apparently it is an example of Batesian mimicry whereby a vulnerable butterfly species develops the ability to mimic a less desirable (to predators) butterfly. In this case, the tiger swallowtail mimics the unpalatable and toxic pipevine swallowtail. I mentioned last week that I had probably forgotten a lot about what I learned about butterflies in my childhood. I certainly don't remember anything about Batesian mimicry or dark tiger swallowtails. Needless to say, I've been down a rabbit hole all week about this. When I went back to my 3 texts on butterflies, all mentioned the black variant in the tiger swallowtail section but not in the sections on black-colored swallowtails where I was looking. As you can see below taken from "Mimicry and the Swallowtails," they are very different but in fact have subtle similarities that escaped me.

Summer Surge is Coming

Bud WiedermannJuly 21, 2024July 21, 2024Leave a comment

If past experience with wastewater monitoring is worth anything, we will see a surge in covid illnesses starting in the next few weeks. And, that may not be the only summer surge in the works.

Wastewater

CDC wastewater data for SARS-CoV-2 is very reminiscent of the last 2 summers when we saw subsequent upticks in covid illness.

Of course this can vary across the country and is less informative due to absence of wastewater tracking in large swatches of the country. Still, you can see that higher levels of activity (the darker the blue the more the virus concentrations, with gray denoting insufficient data) are common all over. (Data as of July 18, 2024.)

Contrast this with the latest map of influenza-like illness that should pick up covid cases - nothing much doing here.

Wastewater tracking methodology is the least changed post-pandemic, so it is the most useful information to use to compare with past years. Monitoring of infections, illnesses, hospitalizations, and deaths have all changed dramatically, due both to changes in individual behaviors in testing use and changes in reporting mandates for communities and medical institutions, with resulting under-reporting of clinical events due to covid. Keep an eye on what happens on the west coast, probably the first region to ring in the clinical surge.

Take-away point: it might be time for high-risk individuals to go back to masking and avoidance of high-density indoor crowds for a while. New covid vaccines may be available as early as next month.

Speaking of Influenza

Not surprisingly, more human cases of influenza A H5N1 have cropped up in Colorado, this time in poultry workers involved in culling infected chickens. Clinical illness is mild. CDC has sent an outbreak investigation team to these sites and, coupled with a serologic survey getting going in Michigan, should help define modes of transmission and range of clinical illness.

PEP Didn't Work for Covid

A new article in NEJM failed to show any benefit of nirmatrelvir-ritonavir (Paxlovid) compared to placebo in postexposure prophylaxis for household contacts of persons with covid infection.

It's a well-constructed study and should end talk about using this agent for post-exposure prophylaxis in most circumstances.

Fear of Flying

No, not the Erica Jong book. I came across a systematic review published recently suggesting that masking was beneficial on long airline flights. It covered studies performed in the early pandemic period so it may not be entirely reflective of current events, but it was interesting.

It's not overwhelming evidence, but wearing a mask on long airline flights might be a choice, both for high-risk individuals as well as for those who just don't want their expensive vacations spoiled.

Enterovirus Surge?

July through October usually is peak enterovirus season in the US, with much variability depending on climate and who knows what else. You may not be aware, but CDC has a National Enterovirus Surveillance System (NESS) set up to monitor enteroviral activity. It is a laboratory based system, and reporting is passive and voluntary, so it tends to have relatively little data and a significant lag in reporting spikes in enterovirus illness. 2023 data, as of April 2024, reported on 193 specimens tested at CDC for that entire year. It is mostly useful for identifying strains responsible for more severe illnesses such as acute flaccid myelitis.

Anecdotally though, it seems as if we're having one of those bumper years for enteroviral disease. In my telemedicine practice at a few regional hospitals surrounding Washington, DC, I've had a handful of newborns with mostly mild illness test positive. Similarly, I'm hearing a lot about hand, foot, and mouth disease from primary care doctors consulting me as part of some nationwide volunteer curbside consults I perform.

If this is true, primary care offices, urgent care settings, and emergency departments could get a little busy with covid and enterovirus illnesses soon.

I Ain’t Worried*

Bud WiedermannJuly 7, 2024July 7, 2024Leave a comment

H5N1 Human Victim #4

Now we can add a fourth case this year of avian flu in a human residing in the US, again a mild case with conjunctivitis in an individual in close contact with infected dairy cows. No surprise there, but I'm waiting to see what happens with all the summer state fairs that provide more opportunities for human exposure to infected poultry and mammals.

Summer Covid Watching

The bottom line in the US is that covid infections are likely still pretty low, and we don't really know if we'll see a significant surge in the next few months. Any prediction is harder these days because our monitoring systems are probably the worst they've been in the past 4 years. On a national public health level, post-pandemic reporting and tracking have been relaxed and made voluntary, which for many healthcare institutions and jurisdictions can mean no reporting at all. On an individual level, people are less likely to seek testing or treatment, probably due to a combination of numbness from years of being on the edge plus relatively lower disease severity.

I'm focusing on a few data sites.

First is the CDC's Respiratory Virus Weekly Snapshot. The percentage of positive tests sheds some light in disease activity, still cloaked in individual behaviors in seeking testing in the first place and lack of reporting from most home testing. The recent covid percentage is trending up, though not at the level of fall 2022.

Covid wastewater trending is helpful and perhaps the least altered by changes in practice over time. Unfortunately, vast areas of the country have no reporting. Activity levels are rising particularly in the western US, but still well below prior surges. I noted that wastewater updating took a holiday last week, so we're missing the most recent numbers.

Second, I'm keeping a watch on relative predominance of different variants, with an eye to how effective our next vaccines will be. The top 4 variants currently are KP.3, KP.2, LB.1, and KP.1.1. Any late summer or fall surge likely would include one or more of these. I'm waiting for more data on how well serum from recipients of the new vaccines will neutralize these variants in vitro.

Should I Change My Annual NJ Beach Trip?

A flurry of beach closings due to poor water quality last week. I couldn't find any national consortium on this, so you'll need to look at specific states to find out what's going on at your beach rental house this summer. In my browsing I particularly liked the Massachusetts interactive water quality dashboard; Massachusetts seems to be one of the harder-hit states.

Meanwhile, a bit farther south:

Only 1 site in NJ is closed currently, I'm OK!

*

The song I Ain't Worried was written for the beach football scene in the movie Top Gun: Maverick. It was conceived early in the pandemic (when we were worried!) and was an upbeat breather contrasting with the intensity in the rest of the movie. Not a bad antidote for your summer worries, whatever they may be.

Tag: COVID-19 vaccine