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Published on Leave a comment on Please Don’t Take My Sunshine Away*

I continue to improve following my unscheduled illness a couple weeks ago. One thing I learned is that my mother's go-to remedy from my childhood, warm Dr. Pepper with lemon, didn't appear to help very much.

A Plea to CDC Staff Amid the Chaos

The recordings for the recent ACIP meeting appeared on their website this past week. I would have been better off never looking at them. The ACIP members, along with some new members of working groups, not only are unqualified and ill-prepared to assess vaccination policy but also are following an agenda of pseudoscience and disinformation designed to lessen vaccine uptake in the US. Presentations were extremely biased, and members repeatedly spouted ridiculous claims and even shouted at representatives of vaccine manufacturers.

I'll mention just a few things related to the covid vaccine discussions the second day. I didn't have the stamina to listen to all the presentations, just too painful.

There was a very unusual presentation about case reports of various cancers in covid vaccine recipients, buttressed by mention of several studies about persistence of mRNA vaccine products and rat immunologic data that stretch the limits of believability. The fact that such a presentation was even given a spotlight was sad, but I was interested to see if any of the attendees of the meeting spoke up about the fact that no control group or case definition was given. Are these cancer rates higher than what is seen in the unimmunized population? If it appeared in publication somewhere, anywhere, it must be true, according to the presenters. I tried to listen to the Q&A period after the presentations; surely someone would point out how ridiculous this was, but I only heard general thanks to the presenters. This was a complete sham.

The shouting match arose mainly with an ACIP member and Pfizer representatives. It appeared that the ACIP member was trying to trap the Pfizer folks into admitting some sort of variance in data presented to the FDA related to what actual products were submitted for testing. The Pfizer representatives seemed to be deliberately evasive in their answers, suggesting to me that they feared legal ramifications. A couple of slides would have resolved the issue, but I noted that neither Pfizer nor Moderna representatives were allowed to show slides.

On a slightly upbeat note, presentations by rank and file CDC staff contained the usual rigor, clarity, and transparency they have been known for. Missing was the standardization of the presentations, which usually would include a summary of GRADE criteria (Grading of Recommendations Assessment, Development, and Evaluation) that explains level of certainty in various data elements, as well as the Evidence to Recommendations framework that clearly weighs risks and benefits of different recommendations and also the degree of variability in Work Group member opinions. Lack of a predetermined, structured process on which to base recommendations and help ACIP members ask clarifying questions is perhaps the biggest problem with the "new" ACIP.

I was also grateful that some liaison representatives to the ACIP, instead of completely boycotting the meeting, did speak up against some of the wacky comments.

If you do want to see one voice of reason, look over the presentation 11 from September 19 by Perlman/Bernstein/Miglis, members of the covid Work Group who appear to be in the minority. It accurately summarizes (and refutes) much that was mentioned in the previous several hours of covid vaccine misinformation that day.

My heart goes out to the dedicated CDC staff. I don't know how they can hang in there in the face of such blatant destruction of the scientific method in service to political and ideological ends. I can only thank them and hope that they hang in there long enough to outlast this assault on vaccination and then try to put us back together again.

Lots to Watch in Africa

I don't know that we are at risk of any immediate spillovers from current infectious disease outbreaks in Africa, but I'm starting to wonder if a US map might start to resemble this recent one from the Africa CDC.

I've mentioned all of these entities previously, but keep in mind what's going on with dengue, Ebola, measles, mpox, and now especially cholera. WHO just published their final cholera report for 2024, but numbers for 2025 already exceed last years totals.

The most recent cholera surge in Africa is in Chad, with the original outbreak traced to a refugee camp. Cholera is both treatable and preventable, the latter predominantly by assuring adequate water safety but also by vaccination. Unfortunately, cholera vaccine stockpiles in Africa are below recommended levels, with foreign aid very much in doubt. A large vaccination campaign has just started in Sudan.

Mostly Good News About STIs

CDC released some preliminary numbers for sexually transmitted infections in 2024, showing slight decreases in some diseases. I'm desperate for good news these days.

Primary and secondary syphilis, gonorrhea, and chlamydia all showed modestly lower numbers.

Sadly, congenital syphilis did not show a decrease, still around 4000 cases last year.

Warm Dr. Pepper With Lemon Causes Fatigue and Back Pain

If I so desired, I could write and get published (at least in a paper mill journal) a case report with the title above, and it could then be used as evidence in a campaign to instill fear of Dr. Pepper and have it removed from the market. This is analogous to the evidence presented to ACIP about mRNA vaccines causing cancer. I haven't yet heard what the HHS Secretary will declare from the ACIP votes for MMRV, hepatitis B, and covid vaccines, but it's very clear we all need to keep working on and refining alternatives for appraising and guiding vaccination use in the US. The Vaccine Integrity Project will continue to provide regular literature reviews and make them available to organizations such as the American Academy of Pediatrics and others to develop immunization recommendations and schedules. Let's hope everyone, in every state, is able to access vaccines in keeping with sound guidance.

Note that I consumed diet Dr. Pepper during my illness, so perhaps I can add all kinds of other maladies to future case reports and blame lack of corn syrup or cane sugar. Stay tuned. In the meantime, don't anyone dare try to take away my Liquid Sunshine!

*Did you know that "You Are My Sunshine" is one of the state songs of Louisiana? It is an old song, writers disputed, but it was first recorded in 1939 by Jimmie Davis who later was elected governor of Louisiana. Take a listen.

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Published on 2 Comments on Ripple

I've had an ear worm all week after I heard the Grateful Dead's Ripple play on the radio. Little did I know it was a spooky foreshadowing for my weekend.

Meanwhile, measles is dominating the infectious diseases news, with only a few notable exceptions.

New Dengue Alert

CDC issued a new alert about dengue risk in the US. Not only are Puerto Rico and U.S. Virgin Islands hot spots for dengue acquisition, we continue to have significant spillover into the continental US, including in persons who haven't traveled to endemic areas. These autochthonous infections arise when enough of the local mosquito population becomes infected from travelers returning from endemic regions. Here's the map of total US dengue cases for 2025 so far:

Drilling down on the same website to look at just the autochthonous (locally acquired) cases:

Clearly just a handful of autochthonous cases, but spring has just started and summer is ahead, a good time for a reminder to practice good mosquito bite prevention measures. In 2024 we had a little over 10,000 dengue cases in the US, about 6500 of which were autochthonous, led by Puerto Rico. Florida, California, and Texas were the higher-risk states for locally acquired dengue in 2024.

For people having trouble choosing among various mosquito repellants, scroll down to the Insect Repellent Bot on that same prevention page for an interactive discussion.

Cholera

WHO has raised the alarm about global cholera outbreaks. Cholera is tough to track, so the case counts probably represent significant undercounting. So far in 2025 WHO has tallied 70,488 cases and 808 deaths from cholera and acute watery diarrhea.

We have both effective vaccines and treatments, but still a very tough problem to control.

Measles Marches On

We are in for a long year of measles. The Texas/New Mexico/Oklahoma (I think I'll call it TeNMO) outbreak isn't slowing down, and control measures are hindered by likely underreporting with infected individuals not seeking medical attention. I was hoping the rural nature of the epicenter in Texas would limit spread, but travel and low vaccination rates are conspiring against us. Going forward I will focus mainly on CDC numbers as a whole, unless unique aspects about local infections warrant discussion. Remember that Texas and New Mexico are reporting case counts and other information regularly.

Here are current CDC data:

Measles Deep Dive #2

Last week I probably confused everyone about the measles reproductive number in Deep Dive #1. This week's dive addresses the measles risks for children under 12 months of age, before routine measles vaccination is recommended.

An offshoot of the Texas outbreak was an exposure of newborns in a hospital in Lubbock, Texas, to a mother admitted in labor who was found to have active measles. If the mothers of exposed infants had immunity through vaccination or natural infection, these other newborns likely are protected though I'm sure they underwent evaluation and immunoglobulin treatment. I've never seen a case of neonatal measles, probably because I've always practiced in an area where the vast majority of women of childbearing age have immunity. I was interested in an oldie-but-goodie article from Japan describing 7 children < 30 days of age who acquired measles from their mothers. Three developed pneumonia but thankfully all did well. The interesting part of the report was that the rash was atypical in 6 infants, appearing on the same day as the fever started (i.e. no 2-4 days of cough, coryza, conjunctivitis prodrome) and before the fever in 2. All had Koplik spots.

Travel season is upon us, and recommendations for vaccination for children as young as 6 months who plan international travel hasn't changed.

"Persons aged 6 months and older who will be traveling internationally to any country outside the United States who do not have presumptive evidence of immunity should be vaccinated with measles-containing vaccine if they are not already protected against measles, mumps, and rubella. Before any international travel—

  • Infants 6 through 11 months of age should receive 1 dose of MMR vaccine. Infants who get one dose of MMR vaccine before their first birthday should get 2 more doses according to the routinely recommended schedule.
    • The first dose should be given at 12 through 15 months of age and the second dose at 4 through 6 years of age.
    • The second dose can be administered earlier as long as at least 28 days have elapsed since the first dose.
  • People 12 months of age and older who will be traveling internationally should receive 2 doses of measles-containing vaccine;A unless they have other presumptive evidence of immunity against measles. The second dose should be administered no earlier than 28 days after the first dose."

Local health departments may recommend this early vaccine dose for infants 6-11 months of age who are deemed to be at risk from individual outbreaks as well, certainly pertinent to some areas of Texas and New Mexico at least.

As most primary care providers know, this early measles dose doesn't count as part of the routine 2-dose MMR vaccination; the early dose is sometimes called "dose 0" so that it won't be counted. Response to measles vaccine at 6 months of age isn't robust and can be inhibited further if maternal antibody is still present in the infant. However, data from around the world suggest that virtually no 6-month-olds will have detectable measles antibody. Here's a study from Belgium as an example:

This seems to be the case in resource-poor communities as well.

WRIS

I'm hoping this will be my last regular posting for this year's winter respiratory infection season. National levels of respiratory illness are low, as are most states.

Influenza-like illness continues to fall, though still above baseline. We still have some "red states."

I won't have a WRIS update until/unless something changes.

New Water Wonderland

Mid-week I had a plumber in the house to fix a problem with my shower water temperature and, while he was at it, fix a minor drainage problem in the basement. By Saturday I had a new wading pool in my basement, complete with ripples when I run water from anywhere in the house. I'm a very unhappy camper and hoping this gets fixed soon. The joys of home-owning.

Published on Leave a comment on Fall Back

Once again I find myself, an ostensibly tech-savvy individual,* faced with manually resetting the time on 11 clocks and appliances in my house. Only my phone, laptops, and tablet appear to have joined the 21st century by self-correcting to eastern standard time. Of course, if our country had truly joined the 21st century, we wouldn't be making this twice yearly switch in the first place.

My election anxiety is somewhat mollified by focusing on infectious diseases, so you can categorize the following as therapeutic in nature.

WRIS

Still not much going on, though I was intrigued that my state of residence is 1 of only 2 to show up with moderate respiratory illness activity last week.

I'm pretty impressed by how quiet the SARS-CoV-2 front is. However, it's still around, and we can expect to see a resurgence sometime.

The fact that influenza has not yet appeared might indicate we are returning to a more "normal" flu season. The graph below shows how different the prior 3 flu seasons were from pre-pandemic experiences, where last year had a very early peak and 2020-21 and 2021-22 had very low and atypical peaks. (Apologies for CDC's labelling here, but if you stare at it long enough you can pick out which line goes with which year.)

New Development in Bird Flu

The so-called highly pathogenic avian flu H5N1 cropping up in dairy and poultry farms and in wild bird populations has been in the news for many months now. It still seems to be a mild illness in humans, most of whom have direct exposure to these farms. Only 41 humans have confirmed infections in 2024 so far. What's a bit noteworthy this week is that the virus may now have shown up in pigs. USDA officials reported probable swine cases at a backyard farm in Oregon where poultry, cows, and pigs all mingle. The farm itself has no role in commercial production of any foods, so it isn't a risk to others. What is of slight concern is the fact that pigs are involved. Pigs have a special place in influenza science because they have both human and avian flu receptors in their respiratory tracts, making the chance for a recombination event to occur if they happen to be infected with human and avian viruses at the same time. Most of the time this doesn't cause creation of a new pandemic strain, and I wouldn't hit the panic button at all now. Actually I'm surprised it took this long for swine infection to be found. The affected animals were all euthanized and multiple studies are ongoing, so I'm sure we'll hear more about this.

Polio

The news isn't great as both wild and vaccine-variant polio cases continue to be reported. This Global Polio Eradication Initiative map is a good summary.

No new cases have been reported in Gaza, with just the 1 case confirmed so far. The interrupted vaccination campaign in northern Gaza restarted this week.

Dengue Still Going Strong

I was browsing the CDC dengue page this week; infections are still plentiful.

Puerto Rico has the greatest number by far, but note that we have had autochthonous (locally acquired without travel to endemic areas) dengue in the mainland US (California with 11 cases, Florida with 49).

*

Can I really claim to be tech-savvy? I think so. I have an advanced degree in educational technology with classes that included instruction in networks and the various hardware involved; the fact that my schooling ended in 2008 shouldn't disqualify me. Also, this past week I restored to full health our K-cup brewing machine that became confused and wouldn't deliver the appropriate coffee volumes or allow the correct menu choices in its buttons. I guess in the interest of full disclosure, when I couldn't find a satisfactory replacement brewer online, my astute intervention was reading the instruction manual, realizing that I hadn't ever de-scaled the device in the approximately 90 years I've owned it, and made it new again using only a low-tech tool (vinegar).

In spite of my skills with technology and vinegar, I'll be performing my semiannual time resets for the foreseeable future; I could never part with my grandfather's clock.

Published on Leave a comment on Invasive Species

Last week I outsmarted myself. The closing photo in the September 8 blog I was sure would result in at least 1 person calling me out; I was then going to follow up in this week's post to explain about invasive species. I guess I forgot to factor in the politeness of my audience in not wanting to berate me for mistakes. (This is a more preferable explanation than the alternative that no one even read that post!)

Still not much going on with our summer respiratory season. The percentage of ED visits due to covid continues to fall nationally.

However, covid wastewater levels in the western US plateaued or even increased a little.

Measles Still Here

It looks like we have settled into a persistent trickle of cases in the US. I'm still holding my breath hoping we can avoid another major outbreak this year. The official tally for 2024 now is 251 cases from 30 states and DC.

Not included in the totals above is a new case occurring in an unvaccinated student at Western Kentucky University, probably acquired during international travel. It looks like that person attended several public events over a few days in late August; with an incubation period of around 2 weeks, we should be hearing soon if secondary cases resulted from this person.

Meanwhile, the UK has reported a measles death in a "young person who was known to have other medical conditions." With 2465 confirmed measles cases so far this year, the UK is much worse off than we are in the US. Still, it's unsettling to hear about measles deaths in high income countries. The UK has had 1-5 deaths per year since 2019 but hasn't had double-digit death figures since 1988. Best estimates are that, even with the best medical care, 1-3/1000 children with measles will die.

A Couple Vaccine Updates

Nothing really new here, but it's easy to overlook important guidance with the flood of emails and other reminders we receive. First is the official statement from ACIP about Hib vaccination for American Indian and Alaskan Native infants. It is the follow up from an ACIP meeting last June. For both socioeconomic and biologic reasons, it's been clear for decades that this population has a very high rate of Hib disease and also a less robust response to most Hib vaccines compared to the general US population. The best Hib vaccine for this group is a conjugate using the Hib polysaccharide PRP joined to an outer membrane protein from Neisseria meningitidis. The OMP is a carrier protein that helps infants form antibody to PRP, the real protective antibody here. This is the basis for all conjugate vaccines; it fools the infant immune system into thinking it is seeing a protein antigen rather than a polysaccharide antigen; PRP and other polysaccharide antigens are not well recognized by infant immune systems - normal infants even fail to form antibody to PRP with natural Hib disease. Conjugate vaccines fool infant immune systems.

At any rate, for a long while we've only had 1 Hib vaccine with the PRP-OMP combo: PedvaxHIB. This summer we saw FDA approval of Vaxelis, a hexavalent vaccine with DTaP, IPV, HepB, and Hib, the latter using the PRP-OMP product. Vaxelis is now officially recommended as an option for the AI/AN infant population, as well as for other infants. The recommendation for the AI/AN group was made on the basis of a phase IV randomized study of Vaxelis versus PedvaxHIB showing good antibody formation in both groups. No effectiveness study was performed because this population didn't have enough Hib disease present at a background rate to determine any significant differences with a new vaccine - PedvaxHIB has worked very well for these children in the past, another vaccine success and cause for celebration.

A second vaccine update is just the recommendation, again from CDC, for the next round of covid vaccines recommended for everyone 6 months of age and older. Again, nothing new, but it's a good resource to have all that information in one document. The tables serve as a quick reference for many different situations.

Mosquito Invasion

Any ID physician worth their salt will obtain an extensive travel history when seeing patients. We are mostly looking for clues to diseases seen mostly in international travelers, such as typhoid fever and the vector-borne infections that include dengue, chikungunya, malaria, and others. However, sometimes the travel history is negative but the patient ends up having one of those exotic diseases, acquired locally in the US (aka autochthonous infection). Such is the case recently with autochthonous dengue fever cases in Los Angeles County, CA. These cases appear when there is an existing reservoir of infected people plus a reservoir of the vector. For dengue virus, the vector is the Aedes mosquito, specifically A. albopictus and A. aegypti, plentiful in much of California.

The range of these mosquitoes have been increasing the past few decades at least, mostly due to warming of our climate. The last extensive study of Aedes presence in the US was in 2017, summarized by CDC.

As one of those people who seem to be particularly tasty for mosquitoes, I find it interesting (and depressing) that we have about 200 different species of mosquitoes in the US. I'm not terribly comforted by the fact that only about a dozen of these can transmit those infections we worry about. Besides the Aedes genus, we also need to worry about Anopheles and Culex mosquitoes.

Of these, it is Aedes that is the most versatile in transmitting disease to humans, implicated in Cache Valley virus disease, chikungunya, dengue, eastern equine encephalitis, La Crosse encephalitis, and zika infections. Anopholes can spread Cache Valley virus, and Culex are implicated in eastern equine encephalitis, St. Louis encephalitis, and Oropouche virus, though midges more commonly spread the Oropouche. Other viruses such as Jamestown Canyon virus can be spread by many different species of mosquitoes and vary with time of year and location.

As our global temperatures have warmed, the mosquito season has lengthened; in many locations mosquitoes are out and about throughout the year. Also, the idea that high altitudes are safer from mosquito-borne infections is becoming invalid in many parts of the world, including the US. It wasn't the altitude per se that mosquitoes didn't like, it was the cool weather which now is warming.

I realize that for many of you this is already too much mosquito information, but if you want more visit Arbonet.

More Invasion

Getting back to last week's post, I had mentioned that my wife was outside working hard to clear our back yard of poison ivy while I was indoors typing leisurely. It turned out she didn't find any poison ivy. The photo I placed at the end of the post wasn't poison ivy but rather a portion of the massive porcelain-berry plant she removed instead. While poison ivy is a native plant, not invasive but still hated, porcelain-berry is a horribly invasive vine deliberately introduced into the US for its attractiveness but quickly discovered to spread indiscriminately, eliminating native vegetation in its path. It is the plant world equivalent of pod people.

Published on Leave a comment on Seeing You in September

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."

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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