Spurred by lay press comparisons to current events, I finally re-read F. Scott Fitzgerald's The Great Gatsby, just about 50 years after my first reading. Not only does it have a great last line, it truly is a great piece of literature.
News Niblets
It appears we have a first for bird flu - human infection with influenza A H5N5. This strain has been present in birds for a long time, but an "older adult with underlying health conditions" now appears to be the first human infection with H5N5, according to Washington state health officials. The likely source is the patient's backyard poultry flock that had been exposed to wild birds, but we don't have full investigation results yet. It's not any cause for alarm, just another milestone in the bird flu saga.
Ethiopia now reports its first outbreak of Marburg disease, one of the hemorrhagic fever virus illnesses similar to Ebola. Marburg virus disease has been reported previously in several African countries; the name comes from the original 1967 outbreak in laboratory workers in Germany, spreading to what is now Serbia.
I've been waiting to comment on the infant botulism outbreak that's been in the news, hoping for more details. It looks like it's going to take a while to sort out, but one brand of infant formula seems to be implicated. It's hard to test for the toxin, but I can't help but wonder if budget cuts have slowed this process further. I'd like to know whether the outbreak is related to processing at this one formula company or if it might be a problem with contamination of ingredients that could pose a risk for consumption of other infant formulas. This is the distribution of the 23 cases with known exposure to the implicated formula, ByHeart Whole Nutrition Infant Formula.
Hot off the presses, the next ACIP meeting is now scheduled for December 4 and 5. The preliminary agenda is pretty vague but also ominous.
WRIS (and Measles)
CDC is back, at least to pre-shutdown levels, and some of the respiratory illness reporting has been updated. Things are still relatively slow. Expect flu and RSV to ramp up pretty soon.
CIDRAP, among other sources, has noted that an influenza A H3N2 subclade K is circulating. It isn't clear how well this year's vaccine is matched for this subclade, though that should be fairly easy to predict with in vitro testing.
Measles soldiers on in the US.
More on Pediatric Covid Vaccine Effectiveness
This report is very brief but also important. A boatload of investigators analyzed data from a multisite electronic health record database to assess VE of the 2023-2024 mRNA covid vaccines in immunocompetent children 9 months to 17 years of age. They specifically looked at the outcome for lab-confirmed emergency or urgent care visits associated with SARS-CoV-2 infection. A picture is worth a thousand (or more) words.
In a real-world setting, vaccine was effective for all age groups, though waned with longer time after vaccination. Moderna vaccine might have had higher VE in the younger ages, though confidence intervals did overlap. Of course, we'd also like to know safety data to have a better appreciation for risk/benefit of vaccination, but this study didn't address that.
Acetaminophen During Pregnancy
This is a first for me in these pages. I'm highlighting a study that didn't directly look at a pediatric infectious disease. I'm going out on this limb because I think it highights very well how cherry-picking of data, so common with current HHS officials, can lead to erroneous conclusions.
The study is an "umbrella" review of systematic reviews of maternal exposure to paracetamol (acetaminophen, e.g. Tylenol) during pregnancy and risk of autism spectrum disorder and attention deficit hyperactivity disorder in the offspring of these pregnancies. What the heck is an umbrella review?
Simply put, it's a review of reviews. More helpful, perhaps, is to understand that the intention is to summarize and assess quality of prior systematic reviews and/or meta-analyses, usually on a broad research question rather than a very narrow issue. Umbrella reviews focus on quality of included studies and aim to provide a more comprehensive view of relative strengths and weaknesses of interventions or associations.
Key point - an umbrella review includes a comprehensive review of quality of included studies utilizing pre-determined, standardized assessment tools.
With regard to the use of acetaminophen during pregnancy, this umbrella review helped to explain why studies should utilize sibling controls to determine risks of ASD and ADHD. When matched siblings without gestational acetaminophen exposure are included, risk for adverse neurodevelopmental outcomes disappear. HHS officials had essentially ignored this important consideration, probably because it didn't fit their predetermined conclusions.
By the way, in doing some background searching on this topic, I came upon a startling page on the CDC website:
Reading the entire page, I couldn't find anything that even referred to or clashed with this "biological reality." Wow.
I Choose the Glass Half-Full
"So we beat on, boats against the current, borne back ceaselessly into the past."
Multiple lay press reports and editorials referred to The Great Gatsby at the time of the shutdown when the "haves" were organizing grand ballroom events and parties while the "have-nots" waited in lines to get food during the government shutdown. I knew that somewhere in my house I had an old copy of the book, and finally I found it.
What I had forgotten was that the last and only time I had read this book was for a college course I took, probably in 1974 or 1975. I know this because my name and residential college at my university was written inside the cover, and the text was filled with mysterious annotations I had made. Apparently I was planning to write a paper on the importance of color in the book, but I have no recollection of doing that. It's interesting to me now that the color gold in the book is most associated with the "old money" characters who are truly at the top of the pecking order; Gatsby's new money (represented by yellow) still won't carry him into this elite class.
Also, I was amused to see that the full retail price I paid for this book was $1.65.
But back to that last sentence, a subject for many scholars over the years. It could be interpreted as stressing the futility of life and the lie of the American Dream - the haves will always be on top. That's the glass half-empty view. Choosing the glass half-full might be a stretch and requires a different interpretation of the word "borne" as a rebirth rather than a burden that holds us back. If we keep hanging in there, better times will come. I will try to hang on and look forward to the day when we won't need to worry so much about politics, obfuscation, and disinformation impacting public health.
