Apparently the English version of this nursery rhyme dates to 1659, a little before my time.
Our rain gauge totaled 4" this morning, after an intense 2 hours of rain last night. The local forecasts hadn't predicted this, so I decide to consult my 2025 Old Farmer's Almanac, sort of a ouija board of weather and other cosmic events. I wasn't surprised to see that their July weather forecast for my area was off a bit: average precipitation for the month, with July 18-22 listed as sunny, then heavy rains north (Maryland is at the southern end of their Atlantic Corridor). Of course I found a rabbit hole to fall into while I was thumbing through the book.
Otherwise it's a quiet summer.
Success in Senegal
The World Health Organization announced that Senegal has joined a growing list of countries that have eliminated trachoma, the leading infectious cause of blindness worldwide. Private donations of azithromycin from Pfizer greatly contributed to this success. Senegal is the 25th previously endemic country to eliminate trachoma, but 32 countries remain at risk. Most (90%) of the estimated 103 million at risk people reside in Africa.
COVID Still Low
I felt obliged to mention this given that some news media have breathlessly reported an uptick in covid. Let this serve as a reminder that an uptick from one low level to another low level does not a surge make.
The CDC's Modeling and Forecasting page explains this very well. They use a calculation based on a time-varying reproductive number abbreviated Rt. "While Rt tells us if the number of infections is likely growing or declining, it does not reflect the burden of disease." [Bolding is mine.] Here's the map as of July 8:
I also clicked on Maryland to get the inserted table and the graph below. As stated in the Table, even though Maryland is likely growing, the percentage of ED visits for covid were still very low.
Covid seasonality hasn't yet declared itself, now over 5 years since the pandemic started.
Covid Planning in the UK
Speaking of seasonality, the UK hammered home this point in their new covid vaccination recommendations for 2026-2027. (They are really planning in advance!) Even I wouldn't qualify to receive covid vaccine in the UK that year. It's important to note that, as I've said in the past, these recommendations are based purely on cost effectiveness, not on whether there is any net benefit from vaccination for individuals. Unfortunately, with fewer data (fewer resources to track infections, fewer people being vaccinated, fewer people hospitalized, etc.) to guide these studies, the UK still uses a cost-effectiveness study with data from March 2023 - March 2024 to make their estimates. US data from that time period suggest net benefit from covid vaccination at all age groups; the difference in approach is based on the cost to prevent 1 bad outcome from covid infection - it's becoming more and more expensive.
That said, the UK recommendations for 2026-7 are to provide covid vaccination to all adults 75 years and older, residents in a care home for older adults, and immunocompromised people ages 6 months and older.
With regard to seasonality, here is what the UK says about it: "There continues to be no evidence of seasonality in COVID-19 epidemiology."
General Vaccine News
I wanted to highlight a couple new studies, both moderately enlightening though not likely to budge the entrenched anti-vaccination groups. The first study is a Danish national cohort study looking at cumulative aluminum exposure from vaccines and chronic health issues. Aluminum has been used for decades as an adjuvant in many nonlive vaccines. As befitting a setting with a robust national health service, investigators were able to follow about 1.2 million children born in Denmark between 1997 and 2018 and residing in Denmark at least to age 2 years. They looked for evidence of 50 chronic disorders in the national database, though they did not look at individual medical records.
Injection of high doses of aluminum into rats showed neurotoxicity, and studies in humans with very high exposure (dialysis, occupational inhalation, IV via parenteral nutrition) also have suggested harm. A much smaller US study looking at aluminum in vaccines and various outcomes did suggest an association with asthma.
The amount of aluminum exposure for the Danish cohort children was in the few mg range.
Adjusted hazard ratios did not suggest any increase risk of chronic conditions; in some instances a decreased risk was seen.
The study is very reassuring, but I doubt it will have much effect on vaccine hesitancy trends.
The second study I wanted to mention is nothing new, but it is a timely and excellent review of the complexity of issues the test-negative study design (TND) often used by CDC and others to measure vaccine effectiveness. A couple members of the new ACIP group talked around this during last month's meeting but didn't really provide specifics. The 2 authors of the review article are from the University of Hong Kong, far removed from CDC, although 1 author has consulted for multiple vaccine companies.
I liked their representation of TND study steps:
Without getting too bogged down in details, the slippery banana peel in TND studies is that people have different behaviors with regard to when they seek medical attention and whether they choose to be vaccinated, and this variation must be taken into account. Depending on how a clinical case is defined for a given study, the VE can vary widely, probably based on how well the definition provides correction for these varying behaviors. TND studies, though expensive, require fewer resources to carry out compared with prospective cohort or case-control studies. The latter study designs are likely to be less prone to some of the error in VE estimates inherent with TND.
At the moment we are in a particular conundrum with planning better VE studies. Grant funding and human resources at the federal level are now greatly reduced. We are left with an easy avenue for anti-vaccination groups to criticize TND studies coupled with greater barriers to carrying out trials utilizing alternative methodology.
Tuskegee Study: Should Unethical Research Publications Be Retracted?
The Tuskegee Study, started before the penicillin era but then denying access to penicillin to enrollees later, is perhaps the darkest hour of medical ethics in US medical research history. We are in an era of relatively high rates of retractions of scientific publications, mostly related to altered or imprecise data. This new report discusses and offers advice to journals about what to do with published studies later declared to be unethical. It's the best summary I've seen of all the Tuskegee publications, covering 1936 - 1973. The study wasn't stopped until 1972, still hard for me to comprehend.
The study's authors suggest that journals adopt clear policies for dealing with unethical research publications, not a very controversial viewpoint but certainly overdue. A problem remains in that most older studies would violate current ethical standards that we now consider routine, such as informed consent. The concept of informed consent first appeared in the US in the early 20th century in a few court cases, but it wasn't until the Nuremberg trials following World War II and other legal cases in the US in the late 1950s that the concept became more imbedded in US human research. See this article for a historical overview.
Wow Your Friends at Cocktail Parties
Well, perhaps not, but I still couldn't resist this new formula for determining the day of the week for any date starting with the year 1753. It's very simple arithmetic, just adding up the last 2 digits of the year + one-quarter of those 2 digits (discard any remainder) + given day of the month + the Key Number for the month. Take that sum and divide by 7; the remainder of that division codes to the day of the week with Sunday being 1, Monday 2, all the way to Saturday which is 0.
Unfortunately it's really not that simple and involves knowing those Key Numbers for each month that follow no pattern (January is 1 but 0 in a leap year, September is 6, October is 1, etc.) and different correction factors for weekdays before 1900 and before 1800, plus another correction for 2000-2099.
So, you can ask me at our next social gathering to calculate the day of the week for your birthdate, but I'll only be able to answer you if I've saved the link to an automated spreadsheet like this.
Have a nice (dry) week.