I have little to no use for social media although I do understand that many in the US see TikTok as a valuable source of entertainment and income. When I had a blog with the AAP I was "forced" to sign up for a Facebook account but never used it. I already spend a lot of time tracking new data from multiple, more reliable, sources. Do I sound like a typical boomer?
The darkening of US TikTok access, presumably to be restored in a day, is but one of many striking events this coming week. I'll be watching closely to see what happens with our public health infrastructure and pandemic preparedness over the coming months and years.
Avian Influenza
Six months ago, or even 3 months ago, I never would have thought I'd be discussing the H5N1 situation so prominently. Although we still have no evidence of human-to-human transmission, which would be a game-changer, looking at how our leaders respond to this potential threat is a bellwether for our public health infrastructure will protect us going forward.
Here's the current status:
Our public health infrastructure has given us some important steps in the past week.
- The FDA announced that cat and dog food manufacturers "consider H5N1 in food safety plans." The wording isn't clear to me, considering something is not the same as a requirement, but wording later in the document suggests it is requiring manufacturers to reassess how their unpasteurized raw products could place pets and their owners at risk for H5N1; transmission to pets from such products has been documented already. The webpage also contains a useful list of publications.
- CDC issued a new advisory asking hospitals to accelerate subtyping of influenza A infections in hospitalized patients, particularly for these with severe illness where the high viral loads increase the possibility of mutation and recombination events that could increase virulence and transmissibility. This shouldn't be too difficult for hospitals - many multiplex test platforms include testing for influenza A H1 and H3, the seasonal strains, so a patient testing positive for influenza A and negative for H1 and H3 needs prompt followup to test for H5. H5 testing is not as widely available and would require help from public health labs. This advisory is very timely and important particularly as we see co-circulation of seasonal influenza with avian influenza.
- CDC also reiterated their guidance for use of combination therapy (oseltamivir plus baloxavir) for some human infections with H5N1, mainly for immunocompromised patients but also to be considered for hospitalized patients.
All of this surveillance requires resources (i.e. money); let's hope the new administration recognizes that. As an aside, I noted that the UK is embarking on a large pandemic response exercise as preparation for future outbreaks.
Protect Your Hispanic Patients
OK, one more semi-political comment and then I'll get off my soap box. Dr. Danielle Ofri, a primary care doctor in NYC, wrote a nice opinion piece in the NY Times last week (requires subscription or a free account to read). With the uncertain threats of coming deportations, she notes that "fear alone can keep patients from seeking care." Not only is this harmful for individual patients and families, it will be incredibly expensive if individuals delay healthcare visits and we are faced with treating illnesses at a later stage in disease. One state (sadly, my place of birth) requires public hospitals to ask about US residence status, a rather chilling deterrent to seeking care, but patients are not required to answer. Dr. Ofri recommends those providers making the latter point clear first, before asking the question.
Consequences of in utero Zika Infection
A new article from investigators in Brazil found that children born to mothers infected with Zika virus during pregnancy demonstrated increased rates of neurodevelopmental delay even when they did not have evidence of the congenital Zika syndrome. The risk was significantly higher for infants born to mothers infected during the first trimester of pregnancy.
More on CWD
Last week I mentioned chronic wasting disease spreading in cervids in the US, with a tongue-in-cheek (pun intended) caution about eating venison; cooking does not inactive prion-mediated disease. Now comes a new report from Norway showing CWD prion detection in muscle tissue from moose, red deer, and reindeer. Pass on cervid meat ingestion in Scandinavia!
New Vaccine Education Resource for Clinicians
Well, maybe not so new, but I just found out it's available to anyone. The Pediatric Infectious Disease Society Foundation has a large number of educational modules available to all who register. Check it out if you're interested.
WRIS
Our winter respiratory infection season plods along. I've been somewhat amused with news reports about surges in human metapneumovirus infections, which of course happens every winter. However, no one is mentioning the common cold coronavirus infections (HCOV) that are just a common now as HMPV. Here's a quick look at percent positive tests nationally, also searchable by region. HCOV is a little higher than HMPV; I guess HCOV is the Rodney Dangerfield of winter respiratory viruses.
My Bucket Lists
I have many bucket lists, none of them in writing, but this past week a new report brought to mind the bucket list I'm most ashamed of. It's my infectious diseases bucket list, a mental listing of infections I hope to see during my lifetime. It's shameful because it requires someone to be sick in order for me to cross off a list item. One of the biggies on the list is seal finger. I'm guessing most readers have never heard of it.
Researchers in Denmark and Australia reported a rather severe episode of seal finger caused by Mycoplasma phocimorsus associated with a cat scratch. This 54-year-old Danish woman developed tendinous panaritium (I had to look that up, it's basically a paronychia/whitlow/felon with contiguous spread) several days following a cat scratch, but then it progressed to very extensive infection requiring multiple extensive surgical procedures. I don't think it's a misprint in the article that stated she developed all this in 2013; likely the delay in reporting depended on new methodology. The authors seem to be the same team that originally discovered in 2023 that this organism was associated with seal finger. The unusual element in the current case report is its association with a cat scratch, I think only reported a couple times previously. The authors of the current report state that their patient's isolate appears to be a different Mycoplasma species than what was detected in the other 2 reports.
Courtesy of BBC News. The Royal Society for the Prevention of Cruelty to Animals recommends observing seals from a distance of no less than 100 meters.