All of a sudden I'm unable to whine about the weather; we're in an unseasonably pleasant spell in Maryland. It's cool, slightly lower humidity, enough to have the windows open during most of the day. Maybe that will help me be less cranky about some of last week's infectious disease news.
Vaccination Coverage in Young Children
If you paid attention to any news source you know that CDC released new data on vaccination rates in kindergarten-aged children in the US, including rates of exemptions from vaccinations. As an example of how graphs can be misleading, the 50,000-foot view doesn't look alarming, not much change compared to the 2011-12 school year. Even though it's an interactive graph, CDC did not provide a way to blow up the upper part of the y-axis to really see what's happening.
Slightly less misleading is a statewide picture for the 2024-25 school year; remember that for measles the goal is at least 95% coverage (i.e. the dark blue states) to make outbreak spread unlikely.
I say only slightly less misleading because we all need to be cognizant that it's the pockets of under-vaccinated populations, below the state level, that have fueled the major measles problems this year and in 2019. Both involved religious sects eschewing vaccinations that then allowed tremendous spread within those communities and beyond.
More revealing is the trend in vaccine exemptions, especially non-medical exemptions. A rise in exemptions of just a few percentage points is enough to tip the scales over to a high risk situation, especially for measles transmission.
The American Academy of Pediatrics (with a list of over 50 involved experts) came out with a policy statement on vaccine exemptions. None of their 7 key recommendation points are particularly controversial, but I was hoping to see some guidance for pediatric providers in how to counsel families seeking non-medical vaccine exemptions. This is a tough problem; in general those families are likely to adhere to the most extreme anti-vaccination views, but I don't think healthcare providers should just abandon those families.
Speaking of Measles
I take no solace in knowing that Canada is much worse off (4206 cases) than the US (1333 cases), also largely due to outbreaks supplied by pockets of unvaccinated religious sects such as in Ontario.
Canada has now broken into the top 10 countries, and the only one in the western hemisphere, for highest numbers of measles cases worldwide. (Numbers below cover only through June.)
Influenza News
While awaiting the next flu season, a very large group of investigators under the nom-de-plume (my somewhat inaccurate label) of the Influenza-Associated Acute Necrotizing Encephalopathy (IA-ANE) Working Group reported on 41 children diagnosed with IA-ANE at 23 centers during the last 2 flu seasons in the US. Mortality was 27%, and two-thirds of survivors had moderate to severe disability in follow-up. About three-quarters of the children had no significant past medical history and were thought to be normal and healthy. Most intriguing to me was that, of the 32 children tested for genetic risk alleles, 15 were positive.
Most of us haven't even heard of these alleles, but if you're interested the authors have more information in eTable 5 of Supplement 1. The article is an important step forward in understanding severe influenza complications and finding better preventive and treatment strategies. IA-ANE is a relatively rare condition but points to another benefit of influenza vaccine. Only 6 of the 38 children in the study with available vaccine history had received flu vaccine.
At about the same time last week, AAP released recommendations for influenza vaccination for next season, as well as an accompanying technical report. Nothing shocking here, but nice to have written guidance especially given the relative silence/confusion surrounding ACIP. The group did comment on ACIP's withdrawal of recommending thimerosal-containing flu vaccines. Those vaccine products comprise only a small number of vaccine doses given in the US. I quote part of the AAP commentary here:
"Thimerosal from vaccines has not been linked to any neurologic condition. Despite the lack of evidence of harm, some states have legislation restricting the use of vaccines that contain even trace amounts of thimerosal and in June 2025, the Advisory
Committee on Immunization Practices recommended that children and adults only receive influenza vaccine in single-dose formulations that are free of thimerosal as a preservative. The benefits of protecting children against the known risks of influenza are clear. Therefore, to the extent permitted by state law, children should receive any available formulation of IIV rather than delaying vaccination while waiting for reduced-thimerosal content or thimerosal-free vaccines."
The battle of dueling recommendations continues and mostly serves to fan the flames of vaccine hesitancy.
The Parisian
I just finished the above novel by Isabella Hammad, published in 2019. It is historical fiction, mostly concerning Palestine in the time between the 2 World Wars. It's a long novel and doesn't lend itself well to just skimming, so not a great beach read, but I loved it. I highly recommend it, but then I've had to follow it with a quick and entertaining Inspector Morse novel by Colin Dexter which always has me checking quaint British words, classical music (e.g. Vier letzte Lieder), and obscure (to me) literary quotations.
