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Tag: omicron variant

Published on Leave a comment on What About Me?

This week I realized covid shares a characteristic with my granddaughter. Sometimes, when she is the only child in a room full of adults taking about endless banalities, she interrupts us with a "What about me?" plea. Every week I gather potential topics for this blog from key medical journal email alerts, feeds from a few selected sources like CIDRAP, scanning the Washington Post, New York Times, and Wall Street Journal dailies, watching national news broadcasts when I can, and just generally keeping my eyes and ears open. I must see dozens of potential topics to include next week, and I bookmark a subset to reconsider at the end of the week.

This week I had a few more topics than usual, around 20, that I needed to winnow down. I quickly realized that all but 1 of them were related to covid. Try as I might to include topics on general infectious diseases, covid has succeeded in becoming the center of attention this week. I'll do my best to summarize a few of the pearls.

Covid Vaccine Updates

Pediatric healthcare providers can rejoice in some more good news: according to the AAP, Moderna has joined Pfizer in allowing free returns of unused covid vaccine doses, making it less financially risky for practices to order vaccine.

A few new studies confirm high vaccine effectiveness extending into the omicron era. First, a cohort study in 4 Nordic countries looked at mRNA covid vaccine effectiveness in adolescents completing 2 vaccine doses between approximately April 2021 and April 2023. A little over 500,000 subjects were included. Vaccine effectiveness against hospitalization was 72.6% (95% CI 62.5-82.7) with a suggestion that heterologous dosing (1 Pfizer dose and 1 Moderna dose) had slightly higher effectiveness at 86.0% (56.8-100). Similar numbers were seen when just the omicron time period was analyzed at follow-up periods of 6 and 12 months. It's important to note that hospitalizations were relatively rare, regardless of vaccine status, as expected in an adolescent population. (Norway isn't included below because too few hospitalizations occurred to allow for analysis.)

Another study looked at VE in US children (5-11 yo) and adolescents (12-20 yo), the latter group in both delta and omicron periods and the former group only during the omicron period (no vaccine was available for the younger group during the delta wave). It looked at a "real world" population, i.e. not part of a formal research study but rather examining vaccine usage as implemented after authorization/approval, using data available from 7 pediatric healthcare organizations. Again VE was high, For the Pfizer vaccine during the delta time period, VE against infection was 98.4% with narrow CI (those were the good-old days at least in this one feature, no covid vaccine has great VE against infection nowadays). During the early omicron period (up through November 2022), VE against infection was 74% in the younger children and 82% in the adolescents; durability of the protection was fairly stable over a 10-month follow-up period, although the CIs became very wide because so few events occurred.

Finally I'll mention a study in the "elderly" because it contains very recent data. In Denmark, VE reported as hazard ratios of the XBB variant-based vaccine (the one in use starting last fall) was highly effective against hospitalization in this older age group. Note the very short follow-up period, this information clearly is very preliminary and could change significantly as time passes.

Covid Epidemiology

The more interesting information about covid epidemiology this week comes from abroad. First, I loved this study from the UK because it used smartphone tracing technology, preserving confidentiality, to identify important determinants of covid transmission. A key finding was that the probability of person-to-person transmission increased with time, first linearly at 1.1% per hour of exposure but extending for several days. Household exposures were most likely to result in transmission. Distance played a role of course, but longer exposures at greater distances had about equal risk of transmission as shorter exposures at shorter distances. I could spend an entire blog post and more on this article. This information can provide excellent guidance for quarantining and distancing in the event of a large covid wave in the future. Remember that the original guidance earlier in the pandemic for distancing of 6 feet was mostly a best guess to prevent transmission, no great data to guide that advice.

A report from the UK government summarizes a wealth of data as the following (see page 3 of the pdf in the link):

"... COVID-19 Omicron variant cases were most infectious around symptom onset and up to 5 days after, but could potentially be infectious for longer, especially for cases that are hospitalised, immunocompromised, or otherwise high risk. Three studies looked at transmission before symptom onset. These suggested that between a third and a half of transmission events occurred before symptom onset in the index case. However, while some studies included substantial numbers of cases, most studies included relatively few cases, and the majority of studies included cases with Omicron variant BA.1 and BA.2, with only a small number of studies reporting evidence from 2023."

This information can help inform your discussions with all those parents who wonder about transmission to high risk family members and whether to risk exposure for a special event. If you want more data than you (or I) can handle about what's going on in the UK with covid, see this link. The Excel files are massive but very interesting for those of you who want to take a deep dive.

The final mention of epidemiology is a source for concern and caution. The Pan American Health Organization, PAHO, that is the branch of the WHO overseeing public health in the Americas, reported on respiratory illness activity in the southern hemisphere which is now in summer season. The key take-home point here is that, although North American is driving a lot of the SARS-CoV-2 positivity now, there is significant covid illness in Central and South America. This implies that covid is not quite a winter respiratory virus, at least not yet.

Covid Bottom Lines

As we enter our 4th year of covid, I realized I've learned a few key lessons to be applied for the future:

  • It's difficult to compare illness rates and other outcomes in the US over the years, primarily because we aren't collecting information in the same way as we did early in the pandemic. Wastewater data are mostly obtained as they were before, but this is at best a qualitative data source.
  • Covid vaccines are the most closely studied and monitored in history with now over 5 billion people worldwide receiving at least one dose. Every credible study/report has confirmed that, regardless of age or underlying risk factors, vaccinated individuals will have better outcomes than being unaccinated and infected, even after being infected multiple times. This takes into account all adverse events following vaccination itself. For virtually every individual, vaccination is the better choice. From a public health perspective, vaccination of some low risk groups may not be cost effective. This is why the UK, for example, does not provide vaccine for some healthy children; UK health authorities have decided the money is better spent on other aspects of health care.
  • Although there are similarities, SARS-CoV-2 is not just like influenza virus. The mutation rate is much higher, meaning that we still face a faster moving target for new vaccine and therapeutic drug development. Also, as mentioned above, seasonality isn't yet clear. So far SARS-CoV-2 isn't just a winter respiratory virus.
  • Even though the omicron era seems to have brought less disease severity, SARS-CoV-2 is still a major killer, now at a rate of about 1500 deaths per week.

Please encourage everyone to be up-to-date on covid and all other vaccines.

WRIS

Winter Respiratory Infection Season clearly is still with us. I await more data to see if the winter school break resulted in fewer, greater, or had no effect on WRIS infection numbers. However, I did notice a report from China that provided evidence that school breaks lessened influenza transmission during the years 2015-2018.

RSV-NET: CDC is still projecting a downturn nationally, but too early to be certain of this.

FluView still shows significant influenza-like illness activity, at least as of a week ago. It's definitely not too late to be vaccinated.

And ... More What About Me

It's my blog, what could be a more pitiful plea for attention? So, speaking of me, note that the CDC published the 2024 adult immunization guide that not only includes old codgers such as yours truly but also extends down to 19 years of age.

One last bit, an update to my bird feeder adventures I mentioned last week. I had a great few days of multiple bird species sightings, followed by a squirrel invasion - those dastardly rodents cleaned out the birdseed supply in a couple days. I've now been researching squirrel deterrents, being careful to not actually hurt them although I admit to having occasional sciuricidal thoughts. It looks like I'll be moving the feeder and engaging in some high-wire techniques to squirrel-proof the new location, hoping I don't end up with a spectacular ladder fall and resultant visit to my local ER.

Published on Leave a comment on Winter Distractions

My soon-to-be daughter-in-law recently gave me a bird feeder - not just any bird feeder, but a smart one that has a camera connected to my wifi that takes photos and videos of any birds that show up. I had my first visitors this morning, a few days after I stocked it with birdseed.

In the meantime, winter is here.

WRIS

A lot going on with our Winter Respiratory Infection Season, including some new items.

CDC issued new (or actually old) guidance for use of the long-acting monoclonal antibody nirsevimab for preventing RSV infection in young infants. The change was prompted by the announcement of greater availability of nirsevimab because the manufacturer released an additional 230,000 doses this month. Previously the guidance had indicated that the product should be prioritized for just a subset of infants at higher risk, but now recommendations are to go back to the original plan to administer to all infants less than 8 months of age as well as to infants 8-19 months of age with high risk conditions:

  • Children who have chronic lung disease of prematurity who required medical support (chronic corticosteroid therapy, diuretic therapy, or supplemental oxygen) any time during the 6-month period before the start of the second RSV season
  • Children with severe immunocompromise
  • Children with cystic fibrosis who have severe disease
  • American Indian and Alaska Native children

If supply is still limited in your particular area, then prioritization should be used as before. Still a bit vague but very important are all the nuances for ordering, administering, and being reimbursed for the product.

Along that same line, RSV may have peaked nationally.

Even with some good news about RSV slowing down, there's still plenty to go around. Also, influenza continues to drive a lot of healthcare usage for all ages around the country. Here is the percentage of emergency department visits due to the various respiratory infections:

Be aware that this site allows you to look just at your local jurisdiction - here is Maryland:

Covid

This week covid deserves a separate heading with a few new twists. Wastewater tracking once again has accurately predicted a surge in infections.

The JN.1 variant has increased rapidly and is projected to be the predominant covid strain in the US, but without any indication (yet) that it has increased virulence.

This might be a good time to review a bit about variants and also some recent covid findings. Variant nomenclature is confusing to me, I can only imagine how the general public sees this. Here is an evolutionary tree from the same CDC weblink as above.

The nomenclature is from the Pango system, but most people are more familiar with the WHO classification: the delta variant (remember those horrible days?) is B.1.617.2 near the left of the diagram. Omicron is represented in both BA.1 and BA.2. Now here's the important part when we consider new variants, immune-escape, and vaccines: JN.1 has developed on the BA.2 side, just like XBB but on a different branch of the tree. Remember that our current vaccines are based on XBB. As I've mentioned previously, XBB vaccine antibody seems to neutralize JN.1 pretty well in the test tube, but all vaccine (and natural infection) immunity declines significantly within a few months after vaccination or immunization. I would still expect the current vaccine to be pretty good for protecting against severe disease with JN.1 infection.

Although near and dear to my heart, I don't usually talk about old folks in this blog. However, a study of old folks in the Netherlands lends support to the idea that current vaccines are effective against new variants. Without going into details, you can see this study has very recent data and show excellent effectiveness for hospitalization and ICU admission for old folks. It's likely this benefit translates to the younger population that of course has lower rates of hospitalization overall.

Another recent study sheds some light on a question I've been wondering about for some time, namely how common asymptomatic covid infection might be in the omicron era. You might recall that one of the early surprises in 2020 was that asymptomatic infection was both common and very important for viral spread. That made the pandemic much more difficult to control. Now we have data from Hong Kong where rather unique epidemiologic circumstances prevailed. With a population of 7.5 million, Hong Kong officials had still had managed to prevent covid spread very effectively prior to the omicron era, with only about 0.5% of the population having been infected. That ended in early 2022, but it also offered researchers an opportunity to look at rates of asymptomatic infection during the omicron period because virtually none of the population had been infected previously. Using antibody testing, they estimated that 16% of the population was infected during the first 6 months of 2022 and that the percentage of asymptomatic cases was at least 42% (taken from those with reported SARS-CoV-2 infections) and possibly as high as 72% (looking at combined reported and unreported infections). Wow. That doesn't necessarily mean we would have those same rates of asymptomatic infection in the US where we've had a very different epidemiologic curve over the years, but I think it's likely we have a lot of asymptomatic covid surrounding us now.

Some good news about long covid, AKA PCC (post-COVID-19 condition) in children. This Canadian study looked at pediatric emergency department data and found that PCC was present in only 0.67% at the12-month follow-up periods in children testing positive for SARS-CoV-2. That's not the only good news part of this; the rate in a control group of children testing negative for covid was 0.16%, suggesting once again that other infections can trigger some of these long term symptoms. We have NIH-funded studies in the US ongoing now, with good control groups, that should go a long way in giving us guidance for managing PCC as well as other long-term conditions triggered by infections.

The Tipping Point

FDA officials, including Peter Marks who is the director of CBER, recently published a viewpoint article about a vaccination tipping point, i.e. the fact that vaccine hesitancy issues have resulted in a severe decrease in immunization coverage, opening us up to major outbreaks soon. I mention this both because it perfectly supports my views expressed in recent weeks but also it gives me a chance to give credit where credit is due. The term "tipping point," as applied here, often has been credited to Malcolm Gladwell. However, his popularization of the term in a sociologic context earlier this century should go to Morton Grodzins who first adapted this for use in explaining racial integration of neighborhoods in the middle of the 20th century. I'm hoping Gladwell credited him.

In Case You Missed These

Two other articles caught my eye this past week. First is a quality improvement article about shortening treatment duration for children with community acquired pneumonia and skin and soft tissue infections. If you're one of those practitioners who still treats these for 10 days (because we have 10 fingers), check it out.

Secondly, I was attracted to a report about variation in rates of how primary pediatric providers use pediatric subspecialty consultations. Although not the main focus of the report, I was most drawn to the mention that the top 2 conditions for using a pediatric infectious diseases specialist were positive tuberculin skin test and inactive tuberculosis. This jives with my personal experience and certainly points to opportunities to lessen use of subspecialty health care. Multiple resources exist for managing latent tuberculosis infection, including the AAP's Red Book, the CDC, and UCSF's Pediatric TB Resource Page.

For the Birds

My first video stars at the bird feeder were a white-breasted nuthatch, maybe a tufted titmouse (looks a lot like the nuthatch, I couldn't figure it out), and a house finch. When I received the bird feeder, I immediately wondered how best to avoid attracting squirrels and other rodents. I did a bit of web searching and then journeyed to my local bird authorities at the Woodend Nature Sanctuary who of course turned out to be the most helpful. I armed my feeder with capsaicin-treated safflower seeds, not a favorite of squirrels and the like, plus birds can't taste the hot pepper. So far the birds seem to like it.

As for me, it appears I've fallen down another rabbit hole, similar to my butterfly fascination. My wanderings have now included a look at how climate change is affecting our bird populations, as projected by the Audubon Society (apologies for using his name, now controversial, but the Society hasn't yet changed it) in their field guide.

Here is how things will change for the white-breasted nuthatch's winter range with a 1.5 C increase in temperature.

For the tufted titmouse

and the house finch

With more severe temperature increases, the ranges are altered more dramatically. I still hope for some action that will reverse these trends.

Published on Leave a comment on The Future is Bright

2023 wasn't exactly the best of years, but at least we didn't slip back into pandemic circumstances. I fear we will see some "old" infections become new again in 2024. General immunization rates are falling; even before that, we saw plenty of pertussis and even some tetanus, but now we may become reacquainted with measles and varicella, among other vaccine-preventable diseases. Time for some of those younger pediatric healthcare providers who have never seen children with these infections to hit the textbooks again - how's that for a New Year's resolution!

Still, we have lots of reasons to hope for improvements in 2024. Maybe AI won't take over the world but instead will help us practice more effectively.

Short Course Therapy for Febrile UTI in Children

The literature just got a bit muddier with regard to treatment duration for pediatric UTI with a new study from Italy. Investigators in 8 pediatric emergency departments randomized 142 children ages 3 months to 5 years with fever and UTI to receive either 5 or 10 days of oral amoxicillin/clavulanate. The study wasn't blinded, and the randomization occurred on day 4 of therapy when urine culture results were available. UTI was defined as a single organism growing at >100,000 cfu/ml in clean catch urine or > 10,000 cfu/ml in catheterized urine, and subjects were followed for 30 days after completion of antibiotic. After a planned interim analysis the study was stopped early due to finding of noninferiority of the short course therapy.

As you can see, the short course group had numerically lower rates of UTI recurrences during this time period. However, this study's results contradict another study, with a somewhat more reliable study design and definitions, that showed short course therapy to be inferior. I reviewed this earlier study in my July 2, 2023 post. The editorial accompanying the new study is an excellent discussion of weighing the relative merits of the 2 studies. Suffice to say, the jury is still out, and I would stick with 10 days of therapy for febrile UTI in most children.

More Evidence for Using Nirsevimab to Ameliorate Bad Outcomes from RSV

Investigators in 3 European countries conducted a randomized trial of the long-acting monoclonal antibody nirsevimab showing benefits in preventing RSV-associated hospitalization, especially in younger infants. Note that subjects for this study were not eligible for receiving nirsevimab currently in these countries; they were all healthy infants less than 12 months of age, born at > 29 weeks gestation, who were entering their first RSV season.

This was a pragmatic trial, meaning that it was carried out under more "real-world" practice situations rather than within the strict confines of "explanatory" trials used with most therapeutic research studies. It lends more evidence to benefits of nirsevimab for young children.

WRIS (Winter Respiratory Illness Season)

Most pediatric healthcare providers across the country know that we are in the midst of a busy WRIS. This also is a time when data are least reliable due to the extended holiday season - reporting lags a bit, so trends seen now are more likely to be revised in the next few weeks. Still, it's worth a look.

Researchers in Stockholm, Sweden, looked at pediatric hospitalization rates for the 3 "tripledemic" viruses during the period 8/1/21 to 9/15/22 and found that rates were higher for RSV than for omicron covid (the time period was entirely omicron in Sweden) or influenza; note especially the numbers for younger children. I'll be interested to see if this pattern is seen in the US this winter.

CDC has a new (to me) section charting epidemic growth status for covid and influenza, i.e. it depicts, by locale, the growth rates but not the absolute numbers of these pathogens. Another interesting tidbit.

Along the same lines is a monthly crystal ball page from CDC, a bit of sticking their necks out to predict what's in our future for respiratory illnesses. The last report is from November 29:

Lots of uncertainties here, but I appreciate the attempt.

Now for a look at our usual sources for data.

FLUVIEW

Circulating strains are still well-matched to this year's vaccine.

Covid wastewater is increasing, and several healthcare facilities across the country have reinstituted masking and other mitigation practices due to high rates in their communities.

RSV is the one "tripledemic" component that seems to be decreasing in most areas.

So, WRIS this year seems to be a double-whammy rather than a tripledemic, still more than enough to strain healthcare resources. I can only dream how much better people's health would be with widespread vaccine acceptance.

We're Still Safe from the AI Bots

I tried to use an AI program, Microsoft Copilot's Suno, to compose a song about this blog. Specifically, I asked it to create a song about the Pediatric Infection Connection blog using the blues genre. Here's what I got.

Their link doesn't exist, nor is there a pediatric infectious disease specialist Dr. Sarah Jones certified by the American Board of Pediatrics. I did find a Sarah Jones infectious diseases pharmacist at Boston Children's Hospital, but she doesn't appear to have a blog and I don't know if she has children.

I think, for the next year, we'll still be able to keep AI from fooling all of us.

Have a Happy and Safe New Year!

4

Published on 4 Comments on Synbiotics?

I'm only mildly ashamed to admit that when I saw a recent publication of a randomized controlled trial of symbiotic therapy for post-acute COVID-19 syndrome (PACS), I had no idea what the term meant. Now I know more, and the study brings up some intriguing thoughts but no direct answers.

First, let's talk about a couple other issues.

Winter Respiratory Illness Season

I'm inventing a new acronym, WRIS, just because I can. CDC went so far as to issue a Health Alert Network posting reminding all of us about the low vaccination rates for covid, influenza, and RSV as well as the availability of treatments for the first 2 infections. So far, flu vaccine coverage in the pediatric age range (6 months to 17 years) is about 36%, pretty poor. The post has a lot of good information throughout, but if you're pressed for time please at least take a look at Table 2 with its links for suggestions for discussions with the unimmunized.

Looking at CDC's weekly viral report page, respiratory illnesses continue to increase. Nationally, emergency department visits for WRIS continue to rise, driven largely by influenza. RSV may be past its peak.

RSV hospitalizations might be coming down, though the data are preliminary:

Influenza-like illness remains high in many states in the South:

Lastly, covid is till out there with high levels in wastewater suggesting we'll see a bigger bump in illness soon.

Although I've presented the national picture, be aware that many of these sites have the ability to display findings by state and other jurisdictions, so you can see what's going on in your area.

Is Pediatric Omicron Infection More Contagious Than We Thought?

That's certainly the implication of a recent study looking at duration of viral shedding in infected children over a 90-day period in early 2022. It's important to note that the study looked only at duration of positivity of PCR at high levels thought to link to infectivity, and also at rapid antigen test (RAT) positivity over time. So, it wasn't a direct measure of whether these children actually transmitted infection at home or in school. With this caveat in mind, they found that 25% of children still had presumed infectious viral loads by day 7 of illness, a bit longer than guidelines recommend for isolation. RAT positivity was a mixed bag as usual (the watermark in the graph just denotes "accepted manuscript" as this paper was published for early online access).

This article shouldn't change practice per se. Looking back at publications of covid spread from children, the results are highly variable with some studies suggesting children have little role in spread. With this much variation in study results, likely the issue is multifactorial, making it difficult to come to any broad generalizations that apply across ages, settings, and time.

Meningococcal B Vaccine and Shared Clinical Decision Making

A few weeks ago I mentioned that healthcare providers don't have enough information at their fingertips to allow parents and patients to truly participate in decisions about vaccination. A new publication about meningococcal serogroup B disease rates helps inform the discussion for meningococcal B vaccine. As you may recall, the ACIP and AAP recently updated meningococcal B vaccination information with the approval of a new pentavalent vaccine. Meningococcal B disease in the US is relatively rare, making risks pretty low overall regardless of vaccination status.

The authors looked at rates of meningococcal disease in persons 18-24 years of age in the years 2014-2017, so not altered by any pandemic considerations. They found 229 confirmed or probable meningococcal disease reports, for an overall rate of 0.18 per 100,000 person years. 120 of the 226 cases for which they had college status were undergraduates, the group at highest risk of meningococcal B infection in the US and the main target for any vaccine intervention. Of those 120 students, 89 had infection with serogroup B.

Students attending 2-year colleges did not have an increased risk of infection compared to non-college students. Only 4-year college attendees had increased risk, and the risk was higher among first-year students and among "Greek life" participants, probably because those groups have a bit more crowding and sharing of beverages, etc.

The authors had some excellent advice in their discussion:

"These findings might be useful for patients, parents, and clinicians when discussing whether to vaccinate adolescents against serogroup B before they go to college. Adolescents planning to live on campus at a 4-year college, particularly ones planning to engage in Greek life or attend schools known for their social life, may benefit more from vaccination. Immunity from MenB vaccines is known to wane quickly, but concentration of risk among first year college students means there is an opportunity to prevent relatively more disease by vaccinating students shortly before they go to college so that the timing of maximum protection overlaps with the highest period of risk."

"Requiring or recommending vaccination against serogroup B disease might not be a tenable policy decision for all colleges, but our findings suggest that 4-year colleges with large numbers of students participating in Greek life or with a high party school ranking might be most likely to benefit from such policies, as these schools were significantly more likely to experience serogroup B cases or outbreaks."

Did you catch that party school mention? Another aid for parents referenced in the study was a ranking of party schools. Those with high rankings presumably represent higher risk for meningococcal B disease. No surprise to me, my undergraduate school didn't make the list.

What I really wanted to know was the Number Needed to Vaccinate (NNV), i.e. how many students would need to be vaccinated to prevent 1 additional case of meningococcal B disease. I knew it would be high because this is such a rare event. It took a little work because I needed a denominator - I knew the number of cases, but I didn't know how many were in the risk group. I had to go to a supplementary table in the article, then look at web links to try to choose a reasonable denominator. I settled on the number of full-time students in undergraduate schools in 2017; it included both 2-year and 4-year colleges. That number, from the National Center for Education Statistics, was 12,085,000. Let's assume the MenB vaccines are 100% effective (they are not, but all are pretty close and I got tired of calculations) and that none of those 89 students in the study were vaccinated (the authors couldn't determine precisely the vaccination rates in their study). NNV is the reciprocal of the absolute risk reduction, which is the rate of infection in the control group (89/12,085,000) minus the rate in the experimental (vaccine) group, which we are assuming to be zero. Crunching those numbers gives us an NNV of 135,786. That is to say, we would need to vaccinate that number of students entering full-time college with a meningococcal B vaccine to prevent 1 additional infection. That NNV number is astronomical and orders of magnitude above NNV for other recommended vaccines. If we were doing a cost-benefit analysis of meningococcal B vaccine, it wouldn't jive at all, but what isn't taken into account is the panic that develops when a case of meningococcal disease occurs on a college campus. Also, I made a lot of assumptions in coming to that number, so it's really just a very rough ballpark. Any decision would need to balance vaccine risks (virtually zero; anaphylaxis from vaccination found 33 cases in 25,173,965 vaccination events in one study, a similar ballpark to the rate of meningococcal B disease above.) This all goes to show that using absolute risk reduction can be more informative than looking at relative risks, which are ratios. For example, in the meningococcal B rates study, participation in Greek life carried a 9.8-fold increase in infection risk compared to other students - a high number that doesn't convey the extremely low infection rates. News stories invariably talk about relative risks rather than absolute risks - bigger numbers sell more papers/advertisements.

So, you can see why those quoted discussion points from the authors are so important. If a parent/potential college student asked me about meningococcal B vaccine, I'd start with saying meningococcal disease is very rare but also very dangerous, with a high fatality rate if one is infected. The risk of getting the infection is very low, about equal to risk of having a life-threatening allergic reaction to any vaccine, both being very rare. [The provider could insert in here if they've ever seen in case of anaphylaxis with a vaccine.] If the plan is to attend a 4-year college, live in a dormitory or fraternity/sorority, and have an active "party" life, the risks for infection are higher though still rare. Some people might value having some more piece of mind and choose to receive vaccination; others may not. Regardless, if at school one hears that you have been exposed to someone with meningococcal infection, you need to follow specific guidance from the local health department or student health team without delay - antibiotic and/or vaccination might be life-saving.

What I Learned About Synbiotics

I'm exhausted after too much number crunching, let's look at a new study that certainly is food (pun intended) for thought. A few definitions first:

Prebiotic - a nondigestible food ingredient that promotes the growth of beneficial microorganisms in the gut

Probiotic - live microorganisms ingested to improve the gut microbiome

Synbiotic - a combination of prebiotic and probiotic substances

The randomized, double-blind, placebo-controlled study looked at 463 adult patients in Hong Kong who were previously diagnosed with covid and fulfilled a standard definition of PACS. The experimental group received twice daily oral doses ("sachets") consisting of 3 probiotic bacteria and 3 prebiotic compounds; the control group received vitamin C with inert additives such that the packets of oral doses were identical in appearance, smell, and weight. The choice of synbiotic elements was based specifically on prior Hong Kong microbiome studies that suggested beneficial elements. The main outcome of interest was change in PACS symptoms at 6 months.

Although there was no difference in quality of life or physical activity between the 2 groups, the treatment did seem to have a beneficial effect on several symptoms and was correlated with favorable microbiome changes.

Maybe some progress, we'll need to see more studies on synbiotic therapy for long covid, hopefully expanded to many different populations. I think I'll go get some yogurt for lunch.

Published on Leave a comment on Hiatus

I've been thinking for a while about taking a break to reassess this blog. First, I'm not sure if the focus is optimal and whether this blog serves any unique function that isn't available elsewhere on the web. Second, I've not been happy with the design of the web site for some time, plus I've heard about problems with the subscription sign up widget not working now. I don't know that there is any good time for a pause, but now seems pretty good both from my schedule and from covid's (unpredictable) schedule.

I expect this may take at least a month or so - I want to work within the GWU system where my site is housed to look at tracking data and fixes available there, as well as to think about an entirely new site if I do decide to continue. I will provide an update post when I have a better idea of timing.

At the time I am writing this, we are all waiting for expected FDA approval of this fall's covid vaccines directed against the XBB lineage. ACIP has a meeting set for September 12 to discuss this, so I expect FDA's notice any second now! Also watch for the ACIP meeting on maternal RSV vaccination on September 22.

Nothing strikingly new on the variant front. Press releases from Pfizer and Moderna state their fall vaccines offer some immunity against BA.2.86 in addition to XBB lineages, and investigators have announced (on social media!) similar good news from in vitro studies. As usual, I'm waiting for actual data that I can assess myself.

Here is a quick update on noteworthy items from this week:

Influenza vaccine 2023 preliminary effectiveness in southern hemisphere looks very good, especially for kids. This bodes well for those who elect to receive flu vaccine for the upcoming season.

Covid variant BA.2.86 caused an outbreak in a nursing home in the East of England region of the UK - in the link, scroll down about 1/3 of the way. The attack rate was 86.6% (33 of 38 residents); so far 22 of the 33 positives have been sequenced and are BA.2.86. 29 of the 33 had received a spring covid vaccine booster. Only 1 resident required hospitalization. From the limited data presented, it appears that this very high risk population had relatively mild courses of illness.

During my hiatus, you may want to look at a few of those gazillion sites that I've found useful.

ProMED - https://promedmail.org/

CIDRAP Newsletter - https://www.cidrap.umn.edu/newsletter

CDC COVID Data Tracker - https://covid.cdc.gov/covid-data-tracker/#datatracker-home

CDC Health Alert Network - https://emergency.cdc.gov/han/updates.asp

Biobot Network of Wastewater Treatment Plants (includes both covid and mpox) - https://biobot.io/data/?utm_source=substack&utm_medium=email

United Kingdom COVID notifications - https://www.gov.uk/email-signup?topic=/coronavirus-taxon

Remember that comparing covid numbers now to those from last winter or prior years can be very misleading because of dismantling of some tracking systems as well as unreported home testing and lack of testing in general. Even covid tracking for ED visits, hospitalizations, and deaths all are significantly changed. Probably only the wastewater methodology has remained similar over the few years, so I'm watching those trends more closely.

And one final optimistic note I picked up from David Brooks of the NY Times in his August 31 opinion piece (subscription required). The title was "People are More Generous Than You Think" and he referred to a scientific publication in a psychology journal that I found pretty surprising. For all I know he cherry-picked this article to come up with a heartening message, I didn't take the time to do a formal lit search and I certainly don't keep up with this subject matter.

In the study, almost 200 people in total, from 3 low-income and 4 high-income countries, were selected to receive $10,000 for whatever they wanted to use if for. The only strings attached were that they must report to the investigators how they used the money and they agreed to be randomized to either share their use of the money on Twitter or keep quiet about what they used it for. The investigators figured that the group publicizing this on Twitter would spend less of the money on themselves. That wasn't the case however. On average the individuals spent $6400 of the total on others, including $1700 on charitable donations. By and large, spending of those from lower income countries didn't differ that much from the higher income group, though the latter had slightly higher gifts to charity. The article really brightened my day, take a peek at it.

Take care and stay well,

Bud

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