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Tag: melioidosis

Published on Leave a comment on Is the FDA Reading This Blog?

Well, I'm pretty sure they aren't. Nonetheless I was pleased that they authorized the mix and match strategy for COVID-19 boosters a few days after I described their process as antediluvian for not doing so. This allows much more flexibility to take into account individual patient preferences and circumstances plus streamlining boosters in nursing homes and other settings where not everyone has received the same primary series.

Vaccines for 5-11 Year-Olds?

The FDA posted briefing documents from Pfizer (81 pages) and FDA scientists (39 pages) on October 22. Needless to say I have poured over both of them, and it seems highly likely that the vaccine will be authorized at their October 26 advisory group meeting. Note that if this happens, the actual shots in arms must wait until after the CDC/ACIP meets to provide recommendations, originally scheduled for November 3, but the meeting date has been removed from their website at the time of this writing. In the meantime, pediatric practices would be wise to plan for rollout.

One of our readers, Dr. Michael Schwartz in Pennsylvania, wrote with some very important logistical concerns: how to do this without wasting doses but still accounting for those unscheduled drop-ins wanting vaccine. Thankfully the storage and handling requirements for the Pfizer vaccine have been eased somewhat. For the pediatric doses, which will be supplied in entirely new containers, the initial frozen storage is still at -90 C to -60 C, well below regular freezer temperatures. However, after thawing the vials can be stored at regular refrigerator temperatures (2 C to 8 C) unopened for up to 10 weeks. After an individual vial is entered and diluted it must be used within 12 hours. Each practice will need to figure out if this works within their system, but I suspect most that have utilized mass flu vaccine clinics in the past can use the same strategy here.

Mystery Solved?

In the August 15, 2021, posting in this blog I mentioned the mysterious finding of melioidosis cases in 4 individuals in the US. None had a history of travel to high-risk areas or connection to one another. This past week the mystery might have been solved as researchers discovered contamination of a particular brand of aromatherapy: Better Homes and Gardens-branded Essential Oil Infused Aromatherapy Room Spray with Gemstones "Lavender & Chamomile." Whole genome sequencing testing is pending, but PCR testing of the product did reveal Burkholderia pseudomallei. The product was sold at Walmart but as of October 21 has been removed from their online and brick-and-mortar stores. CDC issued a Health Alert Network message with advice for consumers and clinicians, worth reading.

Published on Leave a comment on A 3rd Vaccine Dose, Plus a Non-COVID Item

A notable week for new vaccine recommendations for immunocompromised individuals, but could be confusing for some. Also, a bit of new information about a medical mystery that's been brewing the past few months.

3rd Dose of COVID-19 Vaccine for Moderately to Severely Immunocompromised People

Both FDA and ACIP weighed in this week to recommend a 3rd dose of mRNA vaccine to a subset of immunocompromised people. (Not enough data at this time to make any judgment for those who received Janssen/Johnson&Johnson vaccine.) These individuals as a group tended not to respond with robust immunity after the standard 2-dose regimen, and now we have some new data suggesting a modest improvement after a 3rd dose. Note however that this is just a modest improvement, many individuals still may not be protected after the 3rd dose and all should continue to use masks, social distancing, and good judgment in avoiding crowds, etc., as if they were not immunized. It is tough to exactly spell out what moderate/severe immunocompromise is, but essentially all of these patients are being followed closely by whomever is prescribing their treatments and would be able to advise them on an individual basis. CDC provides excellent explanations.

Ever Seen a Case of Melioidosis?

I haven't, and I hope I don't. It's a serious infection caused by Burkholderia pseudomallei that normally is seen mostly in adults with underlying conditions residing in eastern Asia, northern Australia, and to a lesser extent in Africa, the Caribbean basin, and Central and South America. This past week the CDC reported the 4th case of melioidosis in the US this year not connected with any travel or other risk factors for the disease or to each other. These isolated cases have occurred in Texas, Kansas, Minnesota, and Georgia. Two of the 4 cases have occurred in children. Furthermore, genetic testing has shown all 4 isolates to be closely related so likely from a common source, as yet unidentified.

The clinical presentation often is nonspecific, with severe pneumonia and/or a typical septic shock presentation. Sometimes draining abscesses can develop. The organism is high risk to lab personnel and they should be warned if meliodosis is suspected. Also, many of the automated and high-tech laboratory identification machines can misidentify this organism; I suspect all the clinical labs in our area are aware of this since so many notifications have gone out, but if by chance you have a severely ill patient with a bacterial culture growing any Burkholderia species (especially B. cepacia or B. thailandensis) or Chromobacterium violaceum, Ochrobactrum anthropi, Acinetobacter spp., Aeromonas spp., and maybe even Pseudomonas spp., please check with the lab.

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