This week I'm very challenged to limit the number of topics to discuss; much of interest, though nothing earth-shattering. I'll focus on 2 non-COVID items while slipping in a couple more ideas.
Speaking of COVID-19, it's mostly a good news situation for the moment. I continue to watch developments in the UK and it does seem like their uptick in cases is tailing off without having seen a big increase in hospitalizations. I hope we'll see that trend continue in the US. At the same time, I'm keeping a watch on South Africa. Gauteng province, the first alert to omicron problems originally, now is experiencing an increase in cases and hospitalizations likely driven by BA.4 and BA.5 omicron subvariants. It is also spilling over to other provinces. Time will tell if this is the next new surge there and worldwide.
Also, a good news/bad news package from the FDA. Counterfeit at-home COVID-19 diagnostic tests have appeared, but there are ways to identify them. Also, we saw a tentative schedule for FDA-VRBPAC meetings to discuss vaccines for the youngest children. Data submission from Moderna and Prizer is not yet complete, but I certainly hope one or both of the products will fulfill criteria for authorization.
Be Careful Counting Your Chickens
We now have the first detection of human influenza A H5N1 infection, a "bird flu," in the United States. Not a huge deal from a public health perspective in terms of numbers of people at risk. However, I'm glad it got a little news coverage because clinicians need to be aware of this. Birds have been affected in 30 states so far and include both poultry farms and backyard flocks.
The take-home message for front-line healthcare providers is to remember to inquire about history of close exposure to birds, not just chickens but wild birds as well, in anyone with influenza-like illness. CDC has guidance for what to do.
Fulminant Hepatitis Update
We've had some updates this week, but still more questions than answers. UK scientists have provided us with more information about their cluster investigation, as has the CDC for the cluster in Alabama. The association between adenovirus 41 (a gastrointestinal, not respiratory, adenovirus type) is still just that. The focus so far is on younger, previously healthy children. Whether the adenovirus is causal, a cofactor with another environmental or infectious agent, or just an epiphenomenon remains to be seen. In the meantime, probably a good idea for pediatric healthcare providers to discuss potential hepatitis cases with a subspecialist.
One final iron to mention: summer travel. Travel is opening up worldwide, increasing chance for spread of many infections. I take this opportunity to remind practitioners about measles, now increasing in several places around the world. It is still the most highly contagious respiratory infection known, though I'm waiting for one of the SARS-CoV-2 variants to exceed that. This high transmission rate combined with its rather prolonged incubation period and infectivity prior to clinical symptoms make it easy to take off in a community. Currently with general immunization rates relatively low due to the pandemic, many US communities are at very high risk if measles is introduced. Stay vigilant.