shape
carat
color
clarity

Coronavirus Updates September 2024

missy

Super_Ideal_Rock
Premium
Joined
Jun 8, 2008
Messages
56,377
"


Needle-free COVID-19 intranasal vaccine provides broad immunity, study finds​


Published August 27, 2024 | Originally published on MedicalXpress Breaking News-and-Events

A next-generation COVID-19 mucosal vaccine is set to be a gamechanger not only when delivering the vaccine itself, but also for people who are needle-phobic.
New Griffith University research, "A single-dose intranasal live-attenuated codon deoptimized vaccine provides broad protection against SARS-CoV-2 and its variants"
in Nature Communications, has been testing the efficacy of delivering a COVID-19 vaccine via the nasal passages.
Professor Suresh Mahalingam from Griffith's Institute for Biomedicine and Glycomics has been working on this research for the past four years.
"This is a live attenuated intranasal vaccine, called CDO-7N-1, designed to be administered intranasally, thereby inducing potential mucosal immunity as well as systemic immunity with just a single dose," Professor Mahalingam said.
Optimizing Care for Prurigo Nodularis - Evidence-Based Treatment Approaches and Personalized Strategie
"The vaccine induces strong memory responses in the offering long-term protection for up to a year or more.
"It's been designed to be administered as a single dose, ideally as a booster vaccine, as a safe alternative to needles with no in the short or long term."
Live-attenuated vaccines offer several significant advantages over other vaccine approaches.
They induce potent and long-lived humoral and cellular immunity, often with just a single dose.
Live-attenuated vaccines comprise the entire virus, thereby providing broad immunity, in contrast to a single antigen which is used in many other vaccine platforms.
Lead author Dr. Xiang Liu said the vaccine provides cross-protection against all variants of concern, and has neutralizing capacity against SARS-CoV-1.
"The vaccine offers potent protection against transmission, prevents reinfection and the spread of the virus, while also reducing the generation of new variants," Dr. Liu said.
"Unlike the mRNA vaccine which targets only the spike protein, CDO-7N-1 induces immunity to all major SARS-CoV-2 proteins and is highly effective against all major variants to date.
"Importantly, the vaccine remains stable at 4°C for seven months, making it ideal for low- and middle-income countries."
The vaccine has been licensed to Indian Immunologicals Ltd, a major vaccine manufacturer.
Dr. K. Anand Kumar, co-author of the publication and Managing Director of Indian Immunologicals Ltd. Said, "We are a leading 'One Health' company that has developed and launched several vaccines for human and animal use in India and are currently exporting to 62 countries."
"We have completed all the necessary studies of this novel COVID-19 vaccine which offers tremendous advantages over other vaccines.
"We now look forward to taking the vaccine candidate to clinical trials."
Professor Lee Smith, Acting Director of the Institute for Biomedicine and Glycomics, said he was delighted with the research findings.
"These results towards developing a next-generation COVID-19 vaccine are truly exciting," Professor Smith said.
"Our researchers are dedicated to providing innovative and, crucially, more accessible solutions to combat this high-impact disease."
 
rats first
 
"

Updated COVID Vaccines: Who Should Get One, and When?​

Sandra Adamson Fryhofer, MD

DISCLOSURES | September 06, 2024


New updated COVID vaccines are now available, but who can get them, who should get them, and when? Two updated mRNA COVID vaccines, one by Moderna and the other by Pfizer, have been authorized or approved by the US Food and Drug Administration (FDA) for those aged 6 months or older.

Both vaccines target Omicron's KP.2 strain of the JN.1 lineage. An updated protein-based version by Novavax, also directed at JN.1, has been authorized, but only for those aged 12 years or older.

The Centers for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization Practices (ACIP) recommends a dose of the 2024-2025 updated COVID vaccine for everyone aged 6 months or older. This includes people who have never been vaccinated against COVID, those who have been vaccinated, as well as people with previous COVID infection.



The big question is when, and FDA and CDC have set some parameters. For mRNA updated vaccines, patients should wait at least 2 months after their last dose of any COVID vaccine before getting a dose of the updated vaccine.

If the patient has recently had COVID, the wait time is even longer: Patients can wait 3 months after a COVID infection to be vaccinated, but they don't have to. FDA's instructions for the Novavax version are not as straightforward. People can get an updated Novavax dose at least 2 months after their last mRNA COVID vaccine dose, or at least 2 months after completing a Novavax two-dose primary series. Those two Novavax doses should be given at least 3 weeks apart.

Patients can personalize their vaccine plan. They will have the greatest protection in the first few weeks to months after a vaccine, after which antibodies tend to wane. It is a good idea to time vaccination so that protection peaks at big events like weddings and major meetings.

If patients decide to wait, they run the risk of getting a COVID infection. Also keep in mind which variants are circulating and the amount of local activity. Right now, there is a lot of COVID going around, and most of it is related to JN.1, the target of this year's updated vaccine. If patients decide to wait, they should avoid crowded indoor settings or wear a high-quality mask for some protection.


Here's the bottom line: Most people (more than 95%) have some degree of COVID protection from previous infection, vaccination, or both. But if they haven't recently had COVID infection and didn't get a dose of last year's vaccine, they are sitting ducks for getting sick without updated protection. The best way to stay well is to get a dose of the updated vaccine as soon as possible. This is especially true for those in high-risk groups or who are near someone who is high risk.

Two thirds of COVID hospitalizations are in those aged 65 or older. Hospitalization rates are highest for those aged 75 or older and among infants under 6 months of age. These babies are too young to be vaccinated, but maternal vaccination during pregnancy and breastfeeding can help protect them.

We're still seeing racial and ethnic disparities in COVID-related hospitalizations, which are highest among American Indians, Alaska Natives, and Black populations. People with immunocompromising conditions, those with chronic medical conditions, and people living in long-term care facilities are also at greater risk. Unlike last year, additional mRNA doses are not recommended for those aged 65 or older at this time, but that could change.

Since 2020, we've come a long way in our fight against COVID, but the battle is still on. In 2023, nearly a million people were hospitalized from COVID. More than 75,000 died. COVID vaccines help protect us from severe disease, hospitalization, and death.

Let's face it — we all have booster fatigue, but COVID is now endemic. It's here to stay, and it's much safer to update antibody protection with vaccination than with infection. Another benefit of getting vaccinated is that it decreases the chance of getting long COVID. The uptake of last year's COVID vaccine was abysmal; only about 23% of adults and 14% of children received it.

But this is a new year and a new vaccine. Please make sure your patients understand that the virus has changed a lot. Antibodies we built from previous infection and previous vaccination don't work as well against these new variants. Antibody levels wane over time, so even if they missed the last few vaccine doses without getting sick, they really should consider getting a dose of this new vaccine. The 2024-2025 updated COVID vaccine is the best way to catch up, update their immunity, and keep them protected.

Furthermore, we are now entering respiratory virus season, which means we need to think about, recommend, and administer three shots if indicated: COVID, flu, and RSV. Now is the time. Patients can get all three at the same time, in the same visit, if they choose to do so.

Your recommendation as a physician is powerful. Adults and children who receive a healthcare provider recommendation are more likely to get vaccinated.

"
 
"

Newly discovered antibody protects against all COVID-19 variants​

Published September 5, 2024 | Originally published on MedicalXpress Breaking News-and-Events[/COLOR]
Researchers have discovered an antibody able to neutralize all known variants of SARS-CoV-2, the virus that causes COVID-19, as well as distantly related SARS-like coronaviruses that infect other animals.
As part of a new study on hybrid immunity to the virus, the large, multi-institution research team led by The University of Texas at Austin discovered and isolated a broadly neutralizing plasma antibody, called SC27, from a single patient. Using technology developed over several years of research into antibody response, the team led by UT engineers and scientists obtained the exact molecular sequence of the antibody, opening the possibility of manufacturing it on a larger scale for future treatments.
CME Activity: Unraveling Prurigo Nodularis - Pathogenesis, Evaluation, and Impact on Quality of Life[COLOR=rgba(32, 37, 41, 0.4)] RealCME

"The discovery of SC27, and other antibodies like it in the future, will help us better protect the population against current and future COVID variants," said Jason Lavinder, a research assistant professor in the Cockrell School of Engineering's McKetta Department of Chemical Engineering and one of the leaders of the new research, which was recently published in Cell Reports Medicine.
During the more than four years since the discovery of COVID-19, the virus that causes it has rapidly evolved. Each new variant has displayed different characteristics, many of which made them more resistant to vaccines and other treatments.
Protective antibodies bind to a part of the virus called the spike proteinthat acts as an anchor point for the virus to attach to and infect the cells in the body. By blocking the spike protein, the antibodies prevent this interaction and, therefore, also prevent infection.
SC27 recognized the different characteristics of the spike proteins in the many COVID variants. Fellow UT researchers, who were the first to decode the structure of the original spike protein and paved the way for vaccines and other treatments, verified SC27's capabilities.
The technology used to isolate the antibody, termed Ig-Seq, gives researchers a closer look at the antibody response to infection and vaccination using a combination of single-cell DNA sequencing and proteomics.
"One goal of this research, and vaccinology in general, is to work toward a universal vaccine that can generate antibodies and create an immune response with broad protection to a rapidly mutating virus," said Will Voss, a recent Ph.D. graduate in cell and molecular biology in UT's College of Natural Sciences, who co-led the study.
In addition to the discovery of this antibody, the research found that hybrid immunity—a combination of both infection and vaccination—offers increased antibody-based protection against future exposure compared with infection or vaccination alone.
The work comes amid another summer COVID spike. This trend shows that while the worst of the pandemic may have passed, there's still a need for innovative solutions to help people avoid and treat the virus.
The researchers have filed a patent application for SC27.


"
 
"
Alzheimer's-like brain changes found in long COVID patients
Published September 3, 2024 | Originally published on MedicalXpress Breaking News-and-Events
New research from the University of Kentucky's Sanders-Brown Center on Aging shows compelling evidence that the cognitive impairments observed in long COVID patients share striking similarities with those seen in Alzheimer's disease and related dementias.

The study, published in Alzheimer's & Dementia, highlights a potential commonality in brain disorders across these conditions that could pave the way for new avenues in research and treatment.

CME Activity: Unraveling Prurigo Nodularis - Pathogenesis, Evaluation, and Impact on Quality of Life RealCME

The study was a global effort, and brought together experts from various fields of neuroscience. Researchers at the UK College of Medicine led the study, including Yang Jiang, Ph.D., professor in the Department of Behavioral Science; Chris Norris, Ph.D., professor in the Department of Pharmacology and Nutritional Sciences; and Bob Sompol, Ph.D., assistant professor in the Department of Pharmacology and Nutritional Sciences. Their work focuses on electrophysiology, neuroinflammation, astrocytes and synaptic functions.

"This project benefited greatly from interdisciplinary collaboration," Jiang said. "We had input from experts, associated with the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART), across six countries, including the U.S., Turkey, Ireland, Italy, Argentina and Chile."

Jiang and the collaborative team focused their work on understanding the "brain fog" that many COVID-19 survivors experience, even months after recovering from the virus. This fog includes memory problems, confusion and difficulty concentrating. According to Jiang, "The slowing and abnormality of intrinsic brain activity in COVID-19 patients resemble those seen in Alzheimer's and related dementias."

This research sheds light on the connection between the two conditions, suggesting that they may share underlying biological mechanisms. Both long COVID and Alzheimer's disease involve neuroinflammation, the activation of brain support cells known as astrocytes and abnormal brain activity. These factors can lead to significant cognitive impairments, making it difficult for patients to think clearly or remember information.

The idea that COVID-19 could lead to Alzheimer's-like brain changes is a significant development.

"People don't usually connect COVID-19 with Alzheimer's disease," Jiang said. "But our review of emerging evidence suggests otherwise."

The research reveals that the cognitive issues caused by COVID-19 reflect similar underlying brain changes as those in dementia. The study's insights emphasize the importance of regular brain function check-ups for these populations, particularly through the use of affordable and accessible tools like electroencephalography (EEG).

The study not only highlights the shared traits between long COVID and Alzheimer's, but also points to the importance of further research.

"
 
"

Novavax availability



Novavax Covid-19 is now available!

FDA approved Novavax's updated fall Covid-19 vaccine. This vaccine is the only protein-based (i.e., traditional) option with an updated formula targeting the latest circulating Covid-19 subvariants. Check out YLE’s guide to fall 2024 vaccines to decide if this vaccine is right for you.

  • The challenge is always finding Novavax vaccines. I had luck at Costco last year. Word on the street is that Costco will have it available at all pharmacies this year. Vaccines.gov may have other options for you, too. (It will take a week or two to stock fully.)
  • Timing for Covid-19 vaccines this season is tricky. I’m still waiting until Halloween to get my Covid-19 and flu shots.

"
 
"

Pediatricians Scale Back on COVID Shots
Jackie Fortiér
September 05, 2024

When pediatrician Eric Ball opened a refrigerator full of childhood vaccines, all the expected shots were there — DTaP, polio, pneumococcal vaccine — except one.

"This is where we usually store our COVID vaccines, but we don't have any right now because they all expired at the end of last year and we had to dispose of them," said Ball, who is part of a pediatric practice in Orange County, California.

"We thought demand would be way higher than it was."


Pediatricians across the country are pre-ordering the updated and reformulated COVID-19 vaccine for the fall and winter respiratory virus season, but some doctors said they're struggling to predict whether parents will be interested. Providers like Ball don't want to waste money ordering doses that won't be used, but they need enough on hand to vaccinate vulnerable children.

The Centers for Disease Control and Prevention recommends that anyone 6 months or older get the updated COVID vaccination, but in the 2023-2024 vaccination season only about 15% of eligible children in the U.S. got a shot.

Ball said it was difficult to let vaccines go to waste last year. It was the first time the federal government was no longer picking up the tab for the shots, and providers had to pay upfront for the vaccines. Parents would often skip the COVID shot, which can have a very short shelf life compared with other vaccines.


"Watching it sitting on our shelves expiring every 30 days, that's like throwing away $150 repeatedly every day, multiple times a month," Ball said.

This year, Ball slashed his fall vaccine order to the bare minimum to avoid another costly mistake.

"We took the number of flu vaccines that we order, and then we ordered 5% of that in COVID vaccines," Ball said. "It's a guess."

That small vaccine order cost more than $63,000, he said.

Pharmacists, pharmacy interns, and techs are allowed to give COVID vaccines only to children age 3 and up, meaning babies and toddlers would need to visit a doctor's office for inoculation.

It's difficult to predict how parents will feel about the shots this fall, said Chicago pediatrician Scott Goldstein. Unlike other vaccinations, COVID shots aren't required for kids to attend school, and parental interest seems to wane with each new formulation, he said. For a physician-owned practice such as Goldstein's, the upfront cost of the vaccine can be a gamble.

"The cost of vaccines, that's far and away our biggest expense. But it's also the most important thing we do, you could argue, is vaccinating kids," Goldstein said.

Insurance doesn't necessarily cover vaccine storage accidents, which can put the practice at risk of financial ruin.

"We've had things happen like a refrigerator gets unplugged. And then we're all of a sudden out $80,000 overnight," Goldstein said.

South Carolina pediatrician Deborah Greenhouse said she would order more COVID vaccines for older children if the pharmaceutical companies that she buys from had a more forgiving return policy.

"Pfizer is creating that situation. If you're only going to let us return 30%, we're not going to buy much," she said. "We can't."

Greenhouse owns her practice, so the remaining 70% of leftover shots would come out of her pocket.

Vaccine maker Pfizer will take back all unused COVID shots for young children, but only 30% of doses for people 12 and older.

Pfizer said in an Aug. 20 emailed statement, "The return policy was instituted as we recognize both the importance and the complexity of pediatric vaccination and wanted to ensure that pediatric offices did not have hurdles to providing vaccine to their young patients."

Pfizer's return policy is similar to policies from other drugmakers for pediatric flu vaccines, also recommended during the fall season. Physicians who are worried about unwanted COVID vaccines expiring on the shelves said flu shots cost them about $20 per dose, while COVID shots cost around $150 per dose.

"We run on a very thin margin. If we get stuck holding a ton of vaccine that we cannot return, we can't absorb that kind of cost," Greenhouse said.

Vaccine maker Moderna will accept COVID vaccine returns, but the amount depends on the individual contract with a provider. Novavax will accept the return of only unopened vaccines and doesn't specify the amount they'll accept.

Greenhouse wants to vaccinate as many children as possible but said she can't afford to stock shots with a short shelf life. Once she runs out of the doses she's ordered, Greenhouse said, she plans to tell families to go to a pharmacy to get older children vaccinated. If pediatricians around the country are making the same calculations, doses for very small children could be harder to find at doctors' offices.

"Frankly, it's not an ideal situation, but it's what we have to do to stay in business," she said.

Ball, the California pediatrician, worries that parents' limited interest has caused pediatricians to minimize their vaccine orders, in turn making the newest COVID shots difficult to find once they become available.

"I think there's just a misperception that it's less of a big deal to get COVID, but I'm still sending babies to the hospital with COVID," Ball said. "We're still seeing kids with long COVID. This is with us forever."


"
 
"

Does everyone *really* need routine vaccinations?

Your questions on Hep B, HPV, rubella, measles, and U.S. universal vaccinations


In Friday’s “The Dose” article, YLE noted that routine vaccinations are declining. Afterward, we received many great comments centered around a root question: I understand vaccines have saved many lives, but does everyone really need them?
In many ways, vaccines are victims of their success. Given the drama and polarization surrounding vaccines, it can be hard to find answers that aren’t simplistic, defensive, or angry. And, as everyone discovered during the pandemic, disease risks are often not uniform.
Here are a few of your top questions answered!

“Why are vaccines mandated for diseases that aren’t endemic, like rubella?”

Rubella is the “R” in the MMR vaccine. It’s caused by a virus that spreads in airborne droplets from coughing or sneezing. It’s not endemic in the United States anymore. So yes, the risk is extremely low. Yet, it is mandated for children in all 50 states. Why?
Think of population immunity like a water dam built to prevent flooding. Once it’s built, we won’t have flooding anymore. But if the next generation comes along and says, “Hey, there’s not flooding anymore—do we really need this dam?” and decides to get rid of it, the flooding would return quickly.
Rubella is still alive and well in other parts of the world. In the U.S., we have rubella cases yearly, but only from international travelers. However, outbreaks don’t happen often in the U.S. because population immunity—an invisible shield—stops them in their tracks. In other words, vaccination is the reasonrubella isn’t endemic.
Once a virus is eliminated and has no risk of returning—like smallpox—we stop vaccinating for it.

“The NYT image you shared has always bothered me because it doesn’t consider the probability of getting measles is very low. If we consider that, do the vaccine's benefits still outweigh risks?”

This is a fantastic question. The calculation is mathematically and ethically tricky.
This is because the individual decision to get vaccinated changes the risk-benefit calculation for everyone. In other words, your probability of encountering measles is low because so many people around you are vaccinated.

[td]
[/td]
[td]
[/td][td]
[/td]​
Data visualization by Kristen Panthagani; data sources here, here, and here

But you’re right—the risk of exposure makes a difference. Let’s look at two scenarios: nobody vaccinated and everybody vaccinated. Before the measles vaccine, nearly every child in the U.S. got measles by age 15, because it’s so contagious. So risk of exposure was near 100% (to be conservative, say 95%). At 100% vaccination, the risk of measles goes to zero. Using the risks in the NYT image, here’s what we get after accounting for exposure risk during childhood:
[td]
[/td]
[td]
[/td][td]
[/td]​
Is there a situation where the probability of an individual getting a complication from measles infections roughly equals the likelihood of an adverse event from a vaccination? The math to calculate this is really tricky — it depends on not just vaccination coverage, but the risk of an outbreak, the density of the population, the size of an outbreak, etc. Even if this scenario happened, the average vaccine side effect isn’t equivalent to the average measles outcome—for example, fever-related seizures, while understandably scary to watch, fortunately often don’t require hospitalization or result in long-term problems.
At the community level, the benefits of measles vaccination far outweigh the risks. Fighting against infectious diseases is a team sport.

“Could you comment on babies getting the Hep B vaccine even if they aren’t high risk?”

The highest risk factor for Hep B (or HBV) is a history of sexually transmitted infections or multiple sex partners. So, if you’ve only had one partner for a decade, is this even applicable to your baby?
Yes, because the hep B virus is a tricky booger:

  1. The majority of people with HBV globally are unaware they have it. Many who do have it don’t know how they contracted it. If we only give it to people who believe they are high-risk, we will miss many cases.
  2. Hep B virus requires only a very tiny dose to cause infections, which means that even though it is bloodborne and sexually transmitted, it can be spread casually, like through sharing a toothbrush.
  3. It’s very stable in the environment, capable of remaining infectious for weeks and even months on surfaces.
  4. The outcomes can be severe. Mother-to-baby transmission at birth is the most common cause of chronic HBV infection, which can lead to liver cancer, liver failure, and death. If babies contract Hepatitis B disease near birth, 95% develop the chronic form.
The HBV vaccine induces protective immune responses in nearly everyone (80-100%). The vaccine risks are extremely low—the only safety signal found is rare allergic reactions (1 severe allergic reaction for every 2-3 million doses).

“Are there any long-term studies on whether HPV vaccine impacts infertility?”

Some of these concerns stemmed from a case series that was published in 2012, describing six girls who developed primary ovarian insufficiency (POI) from 8 months to 2 years after they received the first human papilloma virus (HPV) vaccine dose. This stirred public concern that the HPV vaccine could cause infertility.
However, case series often generate more questions than answers because they can’t assess causality (correlation doesn’t equal causation). Fortunately, no rigorous lab or epidemiological follow-up studies have found a link:

  • No effect of HPV vaccination on fertility has been found in 3 studies in rodents.
  • A strong study in North America followed women planning on getting pregnant. Some of the women (and their partners) had their HPV vaccines, some of them didn’t. The scientists found no difference in infertility. In fact, in some groups, vaccinated women had higher fertility.
  • Another large study found that 120 of 199,078 female patients at hospitals had POI. There was no difference between those with the HPV vaccine and those without.

“Why does the U.S. have sweeping recommendations when other countries have more targeted vaccine recommendations?”

It’s fair to wonder why. We are all high-income countries. We all have the same vaccines. We are all looking at the same data. How could public health officials come to different conclusions across countries?
Three main reasons:

  1. Behavioral: Universal vaccination recommendations work better than targeted vaccinations because of convenience and education. The U.S. used to have targeted Hep B vaccine recommendations, but uptake was poor. After a universal recommendation, there was a big decline in disease, and many lives (and livers) were saved. The same thing happened with the flu vaccine; universal recommendations increased uptake among high-risk groups. For this reason, in 2025, the U.K. is moving to universal flu vaccinations.
[td]
[/td]
[td]
[/td][td]
[/td]​
  1. Financial: Many countries’ governments pay for vaccines, so the cost-benefit analysis is a big consideration when making policy decisions—for some countries, it would be too expensive for the government to vaccinate everyone, so they try to find where the money will have the biggest impact.
  2. Safety net: The U.S. has much less wiggle room because of worse healthcare access, social support, healthcare capacity, and health. Casting a larger net through universal vaccine recommendations is more critical than in other countries. I’ve covered this in another YLE post here.

Bottom line

The effect of vaccines is often invisible—infections prevented, childhood deaths that never happened. It’s important to look back and remember why we do what we do. Thank you for your questions, and keep them coming! We’re here to answer them.


"
 
"
Bloomberg Prognosis

Waiting for Covid answers

I was exposed to Covid at a family get-together in upstate New York last month. Two days later, I woke up feeling awful — sniffles, fatigue and fever. So I swabbed both nostrils with the last Covid test in our cabinet.
To my great surprise, it was negative, and I went back to sleep. When I tested again two days later, it turned positive in seconds. I started to wonder: Are home Covid tests bad at detecting the latest variants?
The short answer is no, the doctors I spoke with told me. But that answer comes with a big caveat. It turns out the way the immune system interacts with the virus these days means home tests may not turn positive until several days after you get sick.
“That first negative test doesn’t mean you don’t have Covid,” says Elizabeth Hudson, regional chief of infectious diseases at Southern California Permanente Medical Group. “We really noticed it earlier this year.” Now, it can take several days for people with symptoms like mine to get a positive result from a home test, she says.
Here’s why: While gold-standard PCR assays detect minute quantities of virus, home antigen tests require a larger amount to turn positive. Early in the pandemic, viral levels peaked when symptoms appeared, says Nira Pollock, co-director of the Infectious Diseases Diagnostic Laboratory at Boston Children’s Hospital. But now that most people have at least some immunity, viral load peaks later.
“The tests perform the same way and they are detecting the same amount of virus,” she says. “It is just when the virus peaks in your nose seems to be different.”
In a study of 348 people with Covid that Pollock and her colleagues published last year, median viral load didn’t crest until around the fourth day of symptoms. The study estimated that home antigen tests would only detect around 30% to 60% of cases on the first day of symptoms, rising to 80% to 93% of cases on day four.
In other words, there are lots of false negative tests early in the illness.
The need for repeat Covid testing isn’t new. Since 2022, US regulators have required home tests’ labels to recommend repeat testing for people whose first result is negative.
If you’re sick and your first home test is negative, you have a few options besides waiting and repeating the test, says Thomas Russo, chief of infectious diseases at the University at Buffalo’s medical school. You can go to urgent care and request a PCR test. Or, if you are older or in a high-risk group due to a pre-existing condition, just call your doctor, who might be willing to prescribe Pfizer’s Paxlovid pills without a confirmatory test, he says.
One thing you should never do when you have Covid-like symptoms, doctors say: use a single negative test as a permission slip to visit elderly relatives. Just don’t go. —Robert Langreth

"
 

Your “weather” report for the week

Covid-19 infection levels are “high,” while flu and RSV have yet to take off.
[td]
[/td]
[td width="1306px"]
[/td][td]
[/td]​
Consider wearing a mask to protect yourself against Covid-19. It may be a good time to get your fall vaccines. Check here for a YLE guide on timing.

Good news: More people are dialing 988

September 8th was 988 Day—a day to raise awareness of the 988 Suicide & Crisis Lifeline, which only 18% of adults are aware of. The three-digit number has been available for two years at no charge.
Dialing this number connects people with a network of crisis call centers, so that when a person calls, a trained crisis counselor answers, provides emotional support, and helps connect people with other resources. More and more people have been using this resource, which means more people are seeking help and more suicides are being prevented.
[td]
[/td]
[td width="1108px"]
[/td][td]
[/td]​
(Source: KFF; Annotations by YLE) Note: Before 988, there was a hotline, but it had a longer number and was not mandated by law. See the fantastic historical infographic here.

Everyone can act to help save the life of someone who may be suicidal with these five steps:
  • Ask
  • Be there
  • Keep them safe
  • Help them connect
  • Follow-up
In other mental health news, the Biden Administration announced new regulations that hold insurers accountable for mental health care coverage. The regulations will require health insurance plans to report more information on why they limit or deny mental health claims.

H5 infected a Missourian, but we don’t know how

CDC confirmed another human case of H5 (also known as bird flu)—marking the 14th American to test positive. (Before this year, we had one case in our history.)
This case is unique because the person had no known contact with animals. In other words, we don’t know how they got infected. The risk remains low to the general public because there are no signs of onward spread.
At this time, we epidemiologists have more questions than answers:

  1. How did this person get infected? Discovering this entails patient interviews with a long list of questions. (Did she drink raw milk? Attend any animal event? Etc.) In this case, there are no signs or signals with a clear route of exposure.
  2. What clues can the virus provide? Sometimes, the genomics of a virus (gathered after swabbing the patient) can provide clues. The problem is that laboratory scientists don’t have a large enough sample in this case, so it’s hard to get a full picture. From what we have, the virus that infected this patient is close to what’s circulating among cows. But, we don’t even know if it’s H5N1. (It could be H5N3, for example.)
  3. How many people are we missing? The patient had significant underlying health problems, so was hospitalized. This case happened to be picked up by the hospital surveillance system. This is great, but how many human cases have we missed this year?
We need to ramp up testing to prevent this from becoming a pandemic.


 
Glad to see science has found a potential way to kill all covid! I picked up a bad cold last week with sore throat and runny nose. I was sure it was Covid AGAIN. Thankfully not! I should be immune until Nov 1.
 
"

The Dose: This week's public health explained (Sept 20)

Your “weather” report for the week

Covid-19 has stalled at high levels, likely due to kids attending school. We usually see a longer tail this time of year. Flu and RSV remain low.
[td]
[/td]
[td width="1296px"]
[/td][td]
[/td]​
Consider wearing a mask to protect yourself against Covid-19. It may be a good time to get your fall vaccines. Check here for a YLE guide on timing.


Don’t let the Florida surgeon general sway your decision to get vaccinated

This week, the FL surgeon general emailed providers contradicting the scientific consensus on the safety and effectiveness of the mRNA Covid-19 vaccines.
I counted over 14 rumors in his email. (He doesn’t have a good track record of evidence-based recommendations; see past YLE posts here and here.) Here, we address a few rumors from the email:

  • The Covid-19 vaccines aren’t exactly matched to current strains, but this doesn’t mean they aren’t useful. Covid-19 mutates quickly, so we will always be “chasing” variants. We’ve seen year after year that the Covid-19 vaccines will still work a little for infection protection and a lot for severe disease and death.
  • We don’t have randomized control trials (RCTs) for approving updated vaccines for two reasons:
    • It’s not feasible (especially for a mutating virus) and requires a lot of time, money, and volunteers.
    • The changes from the last iteration are small—the difference of a few amino acids, like a few letter edits in a Word document. We aren’t changing the number of words in the paper (like dosage of RNA) or the platform (like from Word to Excel).
  • A recent study did show that the Covid-19 vaccine increases the risk of postural orthostatic tachycardia syndrome (POTS), but the same study showed that Covid-19 infections increase the risk of POTS fivefold.
  • Vaccine mRNA cannot change your DNA— it lacks three specific tools.
So on and so forth. He isn’t necessarily wrong, but his interpretations are incorrect, lacking context, or irresponsible.
Regardless, the good news is that if you want to avoid mRNA COVID-19 vaccines, there is another option! Novavax is a protein-based (i.e., traditional) vaccine. Unfortunately, the FL surgeon general failed to include this critical information so Floridians could make evidence-based decisions.

Expect excess mortality to remain high—get your Covid-19 vaccine, especially those over 65 years

Actuaries, like life insurance companies, have kept a close tab on excess mortality since the beginning of Covid-19. As you can imagine, this impacts their risk calculus (and thus your monthly payment). This week, a German report estimated that excess mortality in the U.S. will remain higher than pre-pandemic levels for the next decade.
On one hand, this makes sense—we have a new disease in our repertoire. However, given that we have vaccines and treatments, we can return to pre-pandemic levels.
[td]
[/td]
[td width="1352px"]
[/td][td]
[/td]​
Excess deaths report; Swiss Re Institute; Annotated by YLE

Question grab bag

If my Covid antigen at-home test is positive for a long time (14, 21, 28 days), am I still contagious?

Unfortunately, we don’t have good data on this. But, most likely, you’re still contagious. Covid-19 antigen tests are very good at detecting infectious Covid-19 virus. (PCRs, conversely, are good at telling whether you have the virus, regardless of infectiousness.) Be sure to wear a mask.
 
"

Woman charged for spreading COVID-19, killing others

[COLOR=rgba(32, 37, 41, 0.7)]By Stephanie Srakocic | Fact-checked by Davi Sherman
| Published SeptemAn Austrian woman has been found guilty of negligent homicide after infecting a neighbor with COVID-19.
[/COLOR]

  • Virological testing after the neighbor’s death showed a DNA match between COVID-19 virus in the defendant and her neighbor.

  • The woman faced similar charges in a 2023 case.

An Austrian woman has been found guilty of fatally infecting her neighbor with COVID-19. The ruling marks the woman’s second COVID-related offense.[1] In the summer of 2023, she was charged with intentionally endangering others through communicable diseases. She was sentenced to three months suspended imprisonment, but she was acquitted of grossly negligent homicide. Last week, a judge found her guilty of grossly negligent homicide for another transmission incident.
The woman was accused of transmitting COVID-19 to her neighbor, who had cancer, in 2021. Due to Austrian privacy rules, the woman's and her neighbor's names have not been released.
CME Activity: Unraveling Prurigo Nodularis - Pathogenesis, Evaluation, and Impact on Quality of Life[COLOR=rgba(32, 37, 41, 0.4)] RealCME

The neighbor later died of COVID-linked pneumonia. Virological testing showed that the virus DNA in the deceased neighbor and the accused woman was a match. This allowed experts to assert that the defendant had “almost 100%” transmitted the infection.
Going to trial
During the trial, the judge heard testimony from the deceased’s family, who stated that the neighbors had met in a stairwell on December 21, 2021, when the defendant would have known she had COVID-19. They said that this interaction caused the transmission.[1]
Neal Flomenberg, MD, Chief Scientific Officer at Tevogen Bio, says that brief interactions can easily spread infectious respiratory conditions such as COVID-19. “While some viruses require more direct contact, others, particularly respiratory tract viruses, can be quite easily spread. Being sneezed on, coughed on, or even simply breathed on can be enough to send minute viral particles through the air from one person to the next,” he says.
The woman, now 54, denied these charges, claiming that she had not been out of bed all day because she was ill. Additionally, she claimed that she was unaware she had COVID-19. Instead, she believed she was fighting a case of bronchitis, an infection she reportedly experienced annually.[1]
However, these claims were refuted by the woman’s physician. He told local authorities that the woman had tested positive for COVID-19. According to the physician, after receiving her rapid test results, the woman remarked that she “certainly won’t let herself be locked up.”
Speaking to the defendant, the judge stated, “I feel sorry for you personally -- I think that something like this has probably happened hundreds of times…But you are unlucky that an expert has determined with almost absolute certainty that it was an infection that came from you.”
The judge sentenced the woman to four months suspended imprisonment. She will also have to pay an €800 fine (about $886.75). However, this verdict is not yet final.
When is transmitting a virus a crime?
The idea that virus transmission can sometimes be a criminal offense isn’t new. In the early days of the COVID-19 pandemic, some health experts argued that laws criminalizing transmission could be beneficial. In a March 2020 memo, United States Deputy Attorney General Jeffrey Rosen said that intentionally exposing and infecting other people with COVID-19 could potentially “implicate the Nation’s terrorism-related statutes.”[2] In April 2020, Australian Health Minister Greg Hunt released a public statement warning that purposeful transmission of COVID-19 to healthcare workers could result in criminal prosecution, including life imprisonment.[2]
Even before the pandemic, the transmission of viral infection as a criminal act had been an ongoing conversation. Notably, as of 2023, exposing others to HIV can lead to prosecution in 34 US states and in multiple nations worldwide.[3] In 13 states, it’s a crime not to share one’s HIV-positive status with sexual partners. In some states, violating laws related to HIV exposure can result in life imprisonment. Some states also include other STDs in these laws.
Many of these laws, however, have become outdated as treatments for HIV have improved and as our understanding of the virus has increased. Thirteen states have updated or repealed their laws since 2014. Changes have included provisions for advances such as PrEP use, as well as clearer definitions of intent to transmit.
Federal isolation and quarantine
There are currently 10 communicable diseases that the federal government lists as requiring isolation and quarantine.[4] Federal, state, and local authorities are authorized to help enforce these regulations. Breaking a federal isolation and quarantine law is punishable by fines and imprisonment. Diseases currently subject to federal regulation include:

  • Cholera
  • Diphtheria
  • Infectious tuberculosis
  • Plague
  • Smallpox
  • Yellow fever
  • Viral hemorrhagic fevers
  • Severe acute respiratory syndromes
  • Flu that can cause a pandemic
  • Measles
Viral infections can transmit easily from one patient to another. Dr. Flomenberg says that although some patients may believe that taking precautions is no longer necessary, this isn’t the reality.
“Some members of society unfortunately feel that if they don’t have to quarantine or wear a mask, or as long as their social life isn’t compromised, the issue is resolved. This is not true for the vulnerable amongst us who may be infected by these very same individuals.” “Perhaps the freshness of the COVID experience will get us to take this issue more seriously in general,” he adds.
What this means for you
Educating patients on infection control and the importance of mitigation, such as staying home when sick and receiving vaccines, can help. Michael Loeffelholz, PhD, Vice President of Scientific Affairs at Cepheid, says that awareness of symptoms can be key to reducing spread.
“People need to be more aware of even mild symptoms from a respiratory virus infection—runny nose, scratchy or sore throat, to name a couple—and take measures to avoid spreading the virus to others, such as washing their hands often, wearing a mask, and avoiding close contact with others.”
"
[/COLOR]
 
"

Why did Americans expect a perfect COVID vaccine?

Expectation management and two different definitions of "immunity"



This is post 2 of 4 in this mini-series looking back at the public health communication around the Covid-19 vaccines, why trust was lost, and where communication broke down. The goal is not to point fingers or lay blame, but rather get a view from outside our bubble to see how messages were perceived. Read the first post here—level setting on a reduction of trust in vaccines.

Why did so many Americans expect an essentially perfect Covid-19 vaccine?

To be sure, the perfect vaccine is a strawman argument frequently used to discredit vaccination—only perfectly safe and perfectly effective vaccines are allegedly acceptable, and anything less is considered a failure.
But for the COVID vaccines, there was more to this belief than anti-vax talking points. Many people who had gladly received a COVID vaccine felt confused and betrayed when breakthrough cases emerged. Looking back, it wasn’t just misinformation that confused people—well-intended public health messages and even miscommunication over the meaning of words set expectations far too high.


Problem #1: Expectation management

On June 30, 2020, the FDA released guidance on what standards COVID vaccines must meet to gain FDA authorization: 50% efficacy. And that’s not just efficacy against infection—even a 50% reduction of severe disease or death would have met the FDA’s threshold. Dr. Fauci said a vaccine with 70% or 75% efficacy would be “terrific.”
Were the public’s expectations set? No. There was so much other pandemic news—hospitals were overloaded, new rumors were popping up daily, and we were going 2,000 mph trying to keep up with communicating to the public. We didn’t know if we would get a vaccine in six months or three years, never mind the details about how well it would work. Setting the public’s expectations about vaccine efficacy and anticipating concerns was, understandably (but mistakenly), much lower on the priority list than the biotechnology itself.

Better than we dared to hope

Then, in late 2020, expectations were blown out of the water. The results of the Moderna and Pfizer trials came out: not one, but two vaccines with OVER 90% EFFICACY!!! It cannot be overstated just how good this news was. Over 300,000 people had died from COVID-19 in the U.S., and finally, some hope was on the horizon.

Very good. But not perfect.

Amid this fully justified enthusiasm, the groundwork was laid for a communication blunder that later left many feeling confused and betrayed.


[td]


[/td]​

Source: Pharmaceutical Technology
The >90% efficacy above referred to efficacy against symptomatic infection. A second outcome was also reported: 100% efficacy against severe disease and death. In reality, the clinical trials were not big enough to accurately measure this—they were statistically powered around symptomatic COVID-19 infection, not hospitalization or death. This “100%” number was a ballpark, not a precise estimate.
But soon, it became a widely circulated talking point. To encourage people to take the first vaccine available to them and not wait for their favorite vaccine, people were reminded: all three COVID vaccines were 100% efficacious in preventing severe disease and death.



Source: X, CNBC, USAToday
The public’s expectations were set: 100% efficacy was what they were promised. To make matters worse, messaging started mixing up the data regarding symptomatic infection and severe disease/death, leading to public’s assumption of a foolproof vaccine.

Problem #2: Two different definitions of “immunity”

Adding to this confusion was the word “immunity.” In science, immunity describes one of humankind’s most complicated biological systems. There are multiple types of immunity, and the degree of immunity someone has can vary dramatically depending on a wide variety of factors.
But in everyday language, “immunity” often implies something much simpler: complete protection from something. As one person in an informal poll put it, “Immunity is like in a zombie movie, when you can be right next to the zombies and they can’t get you.”
Experiences with childhood vaccinations reinforce this simpler interpretation of immunity as perfect protection. Rates of diseases like mumps, measles, and polio are extremely low for vaccinated people in the U.S. for two reasons: the vaccines have high (but not perfect) efficacy, and people are unlikely to encounter those diseases in the first place due to herd immunity from vaccination.
For many, this leaves the impression that immunity from vaccination = you’re not gonna catch the disease, ever. The hidden effect of herd immunity makes those childhood vaccines seem essentially perfect.
Enter the COVID vaccines. People were told it gives them “immunity,” and they expected immunity like they were accustomed to—essentially no risk of catching the disease, at all. Video game immunity, a flawless shield of protection. Hearing COVID vaccines provided “100% protection” reinforced this belief.


Reality

Of course, like all vaccines, the COVID vaccines were not perfect. And we didn’t have herd immunity. By summer 2021, COVID was everywhere—a vaccine can be even 99.9% effective, but if nearly everyone is getting exposed, breakthrough infections are going to happen in the thousands. Waning immunity meant that >90% efficacy did not stick around forever, and new variants kept coming to town, partially evading the vaccine’s defenses. While some did try to warn about the possibility of new variants and waning immunity, the easy and simple messaging of “100% effective,” reinforced by the belief that immunity meant essentially perfect protection, was so much louder.

“These must not be vaccines”

When breakthrough infections started to happen, many believed they had been misled—they were expecting nearly perfect immunity, and that is not what they got. Vaccines, they knew, were supposed to protect them, so this led to the rumor that the COVID vaccines aren’t actually vaccines.

Failure or success?

The vaccines were saving hundreds of thousands of lives, but weren’t quite as good as they initially seemed. Public health stuck to the first part: reinforcing the dramatic effect of vaccination on reducing severe illness and death. But many in the public felt betrayed by the second part: they were promised something even better—100% protection = 0 risk of death. When people brought that up, many were ignored or dismissed, or even worse: chastised for not understanding immunology and spreading misinformation.


[td]


[/td]​

Source: Our World in Data

How to do better next time

  • Communicate uncertainty in what we do and don’t know. Avoid promising 100%—it is a promise we can rarely keep.
  • Realize words like “vaccine-preventable disease,” “immunity,” “prevents,” and “works” are frequently misinterpreted to mean essentially perfect protection, and be careful using them.
  • Recognize that odd rumors like “the COVID vaccines aren’t actually vaccines” are often a sign of genuine confusion—that people don’t understand the messages we’re telling them.
  • Set expectations, loudly. And don’t be afraid to say vaccines aren’t perfect.

Bottom line

Early messaging about the COVID vaccines and confusion over vaccine immunity set the public’s expectations far too high, leading to profound disappointment down the road. To earn and keep the public’s trust, we need to avoid overly simple messaging and communicate uncertainty, especially during a rapidly developing public health crisis.
"
 
Sorry this is out of order but here is post one in the four part series. Post two is above

Why is trust in vaccines declining?

A look back at the pandemic, what was said, and where communication broke down.


"
This is post 1 of 4 aimed at holding up a mirror to Covid-19 vaccine communication to identify lessons learned. We must do better next time.

The Covid-19 vaccines are undoubtedly among the most impressive medical feats in history. One model estimated that Covid-19 vaccines prevented 20 million deaths worldwide in their first year alone. As a physician-scientist, watching the scientific world come together to produce not one but multiple vaccines in a matter of months in the midst of a global pandemic has been truly awe-inspiring.
But that is not how many people remember them.
[td]
[/td]​
Figure 1a from Watson et al. Lancet Infect Dis, 2022, annotation by KP

Despite developing multiple effective vaccines that saved millions of lives during a global pandemic, trust in vaccines, even beyond Covid-19 vaccines (like routine childhood vaccinations) got worse, not better.
[td]
[/td]​
Fig 3, State of the World’s Children 2023, UNICEF, annotation by KP

Misinformation played a huge role, but it was not the only problem

It’s easy to blame it all on misinformation and disinformation, which undoubtedly played a role. The list of rumors about the Covid-19 vaccines is certainly impressive—every week, there was a new alleged “ingredient” that was somehow toxic, and the level of creativity that inspired the various false rumors would be laudable if it weren’t so dangerous.
I’ve spent hundreds of hours debunking various Covid-19 vaccines rumors and don’t want to minimize the impact these rumors had on sowing distrust in vaccines.

But that’s not what this series is about.

Misinformation, or miscommunication?

A lot of “misinformation” that was circulating could more aptly be described as “miscommunication”—public health officials saying one thing and the public hearing something entirely different.
  • I thought Covid-19 vaccines gave us immunity like our childhood vaccines do—why are vaccinated people getting sick?
  • I thought you said all the vaccines give us 100% protection against severe disease and death—why are most Covid-19 deaths now among vaccinated people?
  • If the vaccines prevent infection, why do vaccinated people still need to wear masks?
  • If I was okay after a Covid-19 infection, am I okay getting measles and other diseases then, too? Are we overreacting?
These are all valid questions that deserve explanations. The answers provided were often confusing, constantly changing, or fell short, leaving the (false) impression in many people’s minds that Covid-19 vaccines don’t actually work, and that the scientific community was pushing a failed vaccine, calling other vaccines into question as well.

Poor communication is a gateway to misinformation

When valid questions aren’t answered adequately or from a place of empathy, it’s not unreasonable that trust declines. And when trust starts declining, people may be more open to believing rumors they hear. Plain old miscommunication can set people on a path to believing misinformation and disinformation.
[td]
[/td]​
Figure by KP

Misinformation is not going away, and we can (and will) keep addressing rumors as they come. But the generation of these rumors is, for most of us, completely out of our control. In the public health and medicine field, we should be far more interested in looking at what is within our control: our communication, and how we can do better.
The first step is figuring out what went wrong. In this series of posts, we will look back at the story of the Covid-19 vaccines and the communication problems around them. Some pandemic communication blunders were obvious (flip flopping on masks, for example), but others got less attention, and were only obvious to those who were disappointed and confused. The goal is not to point fingers or assign blame—it was h.a.r.d. to communicate to a polarized nation during a deadly pandemic when yesterday’s data was already outdated. But we need to get a view from outside our bubble and understand how messages were perceived, so we don’t miscommunicate next time.

Bottom line

Miscommunication during a public health emergency can inadvertently destroy trust. Now, with the advantage of hindsight, we need to look back and see what went wrong so we can do better today.

"
 
"

Just as COVID Levels Start to Dip, a New Variant Emerges​

Lisa O'Mary

September 26, 2024



— A new COVID-19 variant called XEC is on the rise, and it has experts who track variants on alert.

Each time a new variant makes a grand entrance onto tracker lists, health officials take notice because it may mean there's an important change in behavior of SARS-CoV-2, the virus that causes COVID.

Countries reporting rising detections of XEC include Germany, the United Kingdom, and the Netherlands, Australian data scientist Mike Honey posted on the platform X this past week.


XEC's "characteristic mutations" have been detected in at least 25 states, CBS News reported, with New Jersey, California, and Virginia labs reporting 10 or more cases each. New Jersey detections at least in part stem from the CDC's testing program for international travelers at Newark Liberty International Airport.

Still, XEC hasn't gained enough traction in Europe, the US, or any other part of the world for it to be listed as a stand-alone variant on official watch lists maintained by the CDC, European Union, or World Health Organization.





However, Eric Topol, MD, executive vice president of Scripps Research and editor-at-large for Medscape, WebMD's sister site for medical professionals, believes XEC is the next variant "to get legs."


The rate at which a new variant takes the stage doesn't always predict how severe it will be. Around this time last year, health officials sounded alarms about another Omicron variant called BA.2.86, dubbed Pirola, that ultimately didn't make major waves.

"CDC is not aware of any specific symptoms associated with XEC or any other co-circulating SARS-CoV-2 lineage," a CDC spokesperson said in a statement to CBS News.

The current dominant variant in the US is called KP.3.1.1, accounting for an estimated 53% of US COVID cases. Its parent lineages are KP.2 and KP.3, and all of these belong to the Omicron family. The SARS-CoV-2 virus mutates over time, and scientists use the names and labels to identify groups of viral variants based on their similarities and on which strains a mutated descendant came from.

KP.3.1.1 has been the predominant COVID variant since early August, when it topped the list with 19%, just barely outpacing its parent KP.3. As the nation heads into respiratory illness season, when flu and RSV also typically rise, the CDC said in its 2024-2025 Respiratory Disease Season Outlook publication that officials don't expect any unusual severe impacts from the three big viruses.

"CDC expects the upcoming fall and winter respiratory disease season will likely have a similar or lower number of combined peak hospitalizations due to COVID-19, influenza, and RSV compared to last season," the report stated.

COVID levels in the US remain high, according to wastewater detections, which is a retreat from the CDC's label of "very high" earlier in the summer. About 15% of COVID tests reported to the CDC are positive, and that rate has been trending downward, as have been COVID-related emergency room visits and hospitalizations.

SOURCES:​

CDC: "COVID Data Tracker," "2024-2025 Respiratory Disease Season Outlook."

"New COVID Variant XEC Now in Half of States. Here's What to Know."




"
 
"

CDC: Kids Born During the Pandemic Got Fewer Routine Vaccinations​

— Declines in vaccination may lead to resurgence of preventable diseases, agency warns​

by Katherine Kahn, Staff Writer, MedPage TodaySeptember 27, 2024


A photo of nurses vaccinating an infant.

Fewer children born during the first 2 years of the COVID-19 pandemic received recommended vaccines compared with those born in the 2 years before the pandemic, according to CDC data.

Compared with vaccine coverage during 2018 and 2019, estimated coverage for children born in 2020 and 2021 declined by 1.3 to 7.8 percentage points, depending on the vaccine, reported Holly Hill, MD, PhD, of the CDC's National Center for Immunization and Respiratory Diseases, and colleagues in the Morbidity and Mortality Weekly Reportopens in a new tab or window.


The estimated differences in vaccine coverage by the age of 24 months for children born in 2018-2019 and those born in 2020-2021 were:

  • Influenza vaccine, two or more doses: -7.8 percentage points
  • Combined seven-vaccine series: -3.2 percentage points
  • Rotavirus vaccine: -2.0 percentage points
  • Diphtheria, tetanus, pertussis (DTaP) vaccine: -1.8 percentage points for three or more doses; -2.5 percentage points for four or more doses
  • Haemophilus influenzae type b (Hib) conjugate vaccine: -2.2 percentage points for the primary series; -3.2 percentage points for the full series
  • Pneumococcal conjugate vaccine: -1.8 percentage points for three or more doses; -2.7 percentage points for four or more doses
  • Hepatitis A vaccine, one or more doses: -1.6 percentage points
  • Measles, mumps, and rubella (MMR) vaccine: -1.7 percentage points
  • Poliovirus vaccine: -1.5 percentage points
  • Varicella vaccine: -1.3 percentage points
  • Hepatitis B vaccine, three or more doses: -1.5 percentage points
"Analyses of [National Immunization Survey-Child]opens in a new tab or windowdata for earlier birth cohorts have not revealed such widespread declines in routine childhood vaccination coverage," Hill and co-authors wrote.


On a brighter note, despite the decreases, vaccine rates for poliovirus, MMR, DTaP, Hib, and hepatitis B remained above 90% for children born in 2020-2021.

However, only 56% of children nationwide received two or more doses of influenza vaccine in 2020-2021, down from 63% in 2018-2019.

The CDC's Advisory Committee on Immunization Practices (ACIP) currently recommendsopens in a new tab or window routine vaccination against 15 potentially serious illnesses for children by age 24 months.

"Recent decreases in coverage with most of the ACIP-recommended childhood vaccines could lead to a resurgence of vaccine-preventable diseases such as measles, varicella, and rotavirus and their associated morbidity and mortality," Hill and team noted, citing the recent surge in measlesopens in a new tab or window in the U.S. As of September 26, there have been 264 measles casesopens in a new tab or window reported in the U.S. in 2024, and 88% of those were in people who were unvaccinated or with unknown vaccination status.

Separately, the CDC recently announced that cases of whooping cough (pertussis) this year exceedopens in a new tab or window levels seen before the pandemic.


In their study, Hill and colleagues also found disparities in vaccine coverage by race and ethnicity for those born in 2020-2021. Black, Hispanic or Latino, and American Indian or Alaska Native children had lower vaccine coverage than white children for four or more doses of the DTaP vaccine, four or more doses of the pneumococcal conjugate vaccine, the rotavirus vaccine, and the combined seven-vaccine series. Influenza vaccine coverage with two or more doses was also lower among Black (43%) and Hispanic (53%) children than among white children (60%). Asian children had the highest levels of flu shot coverage, at about 71%.

Health insurance seemed to influence vaccine uptake, Hill and co-authors noted. For 2020-2021, children who were uninsured or covered by Medicaid or other non-private insurance had lower vaccine coverage than those with private insurance. Moreover, children living at or below the poverty line had lower coverage rates, ranging from 2.7 percentage points lower for the MMR vaccine to nearly 20 points lower for two or more doses of the flu shot.


Looking at birth cohorts in different U.S. HHS jurisdictions, nearly all coverage across eight vaccine measures decreased from 2018-2019 to 2020-2021.

"Because children born during or after the period of major disruption of primary care from the COVID-19 pandemic might have missed some vaccinations, providers should review children's histories and recommend needed vaccinations during every clinical encounter," Hill and colleagues wrote.

"Addressing financial barriers and other access issues along with vaccine hesitancy and misinformation concerns is important to increasing vaccination coverage and reducing disparities," they added.

Higher provider participation in the Vaccines for Children programopens in a new tab or window could help mitigate financial barriers by increasing access to no-cost vaccines, they pointed out. Several other recommended strategies to improve vaccine uptake include use of standing orders and other prompts, reminder/recall systems, strong physician recommendations to vaccinate, and giving vaccines in alternative settings.

The study relied on data from the National Immunization Survey-Child, a nationwide survey of U.S. parents or guardians of children ages 19 to 35 months. The researchers collected data during household telephone interviews and reviewed vaccination records from the children's healthcare providers. Among sampled households, the response rate was 27% and adequate provider data were available for 48% of children with completed interviews. A total of 28,688 children were included in the analysis.


  • author['full_name']

    Katherine Kahn is a staff writer at MedPage Today, covering the infectious diseases beat. She has been a medical writer for over 15 years.

"
 
"

MedPod Today: New COVID Variant; FDA Eye Drop Warning; CRNA Scope Creep?​

—​

by Rachael Robertson, Enterprise & Investigative Writer, MedPage TodaySeptember 27, 2024





The following is a transcript of the podcast episode:

Rachael Robertson: Hey everybody, welcome to MedPod Today, the podcast series where MedPage Today reporters share deeper insight into the week's biggest healthcare stories. I'm your host, Rachael Robertson.

Today, we're talking with Sophie Putka about a new COVID variantopens in a new tab or window. And after that, Kristina Fiore shares her reporting about some concerns about amniotic fluid in eye dropsopens in a new tab or window. Last but not least, Jennifer Henderson will tell us about conversations happening in California about certified registered nurse anesthetists' scope of practiceopens in a new tab or window.


On to the show.

There's another COVID variant circulating, and it's starting to take over the other dominant variants this cold season. It's called XEC, and it's a descendant of other Omicron variants, and cases have been steadily growing in Germany, where it was first spotted. Sophie is here to tell us a bit more about this latest COVID update.

Sophie, what do we know so far about XEC?

Sophie Putka: Yeah. So I spoke to Amesh Adalja, MD, an infectious disease physician from Johns Hopkins, and he told me XEC is not too different from the other variants in circulation. He told me that whatever advantage it does have over these other variants represents a "fairly minor evolution," although by definition, it may be more immune evasive, which would give XEC a small advantage in transmission, like the other dominant variants that came before.


Robertson: So where are we seeing it right now, and is it making its way over to the U.S.?

Putka: So right now, XEC is mostly being spotted in central Europe, where it was at around 10% of cases last week, so probably a little bit more than that now. And it actually hasn't been picked up by the CDC's variant tracker yet, but another estimate puts it at almost 2% of cases in the U.S., and most of these are concentrated on the coasts. So right now, the most dominant variants in the U.S. are still the other Omicron descendants, KP.3.1.1 and KP.2.3, at 52.7% and 12.5%, going by CDC estimates.

Robertson: What about our vaccines? Are they still good for protection against XEC?

Putka: So far, Rachael, experts say the answer is yes. The COVID vaccines we have available right now were designed for slightly different subvariants, like KP.2 for Pfizer and Moderna's most updated shots, and JN.1 for Novavax's. But Adalja told me they'll still protect against serious illness and hospitalization, which he said was "the primary function of our current first generation COVID vaccines."


Even so, he said, the rapid mutation of the virus means it will always be getting better at infecting people and we should be focusing on a way to protect against infection, not just severe disease, like coming up with a universal COVID vaccine, maybe made with different technologies. So XEC is just the latest version of these continuing mutations, but it's not looking like it will make much of a meaningful difference for people's day-to-day lives.

Robertson: Well, thank you for that reporting, Sophie.

Putka: Thank you, Rachael.

snip....

This episode was hosted and produced by me, Rachael Robertsonopens in a new tab or window. Sound engineering by Greg Laubopens in a new tab or window. Our guests were MedPage Today reporters Sophie Putkaopens in a new tab or window, Kristina Fioreopens in a new tab or window, and Jennifer Hendersonopens in a new tab or window. Links to their stories are in the show notes.

MedPod Today is a production of MedPage Today.
"
 
"

COVID Preventive Drug Should Work Against Circulating Variants, FDA Now Says​

— The agency has issued a revised fact sheet for healthcare providers​

by Katherine Kahn, Staff Writer, MedPage TodaySeptember 27, 2024


A computer rendering of antibodies attacking a COVID virus.

The FDA has determined that the monoclonal antibody pemivibart (Pemgarda) is likely to be effective against currently circulating SARS-CoV-2 variants, including KP.3.1.1 and LB.1.

"Based on current CDC Nowcast estimates and variant spike receptor binding domain similarity to tested variants, FDA anticipates Pemgarda will retain activity against the currently circulating variants in the U.S.," the agency said in a press releaseopens in a new tab or window.

This is welcome news for patients at risk for severe COVID-19, such as those with immunocompromising conditions. Pemivibart remains the only available monoclonal antibodyopens in a new tab or window for the prevention of COVID-19 in this population.


In late August, the FDA had revised the emergency use authorization (EUA) for pemivibart, adding a limitation of authorized useopens in a new tab or window over concerns that KP.3.1.1 may have had substantially reduced susceptibility to the drug. The FDA indicated that pemivibart should only be used for pre-exposure prophylaxis of COVID-19 in immunocompromised patients when the combined national frequency of SARS-CoV-2 variants with substantially reduced susceptibility to the drug is less than or equal to 90%.

However, in the several days following that EUA revision, drugmaker Invivyd announcedopens in a new tab or window that in vitro testing showed pemivibart has neutralization activity against the variants in question. The company submitted the data to the FDA.

On Thursday, the agency issued a revised fact sheet for healthcare providersopens in a new tab or window that now includes updated pemivibart neutralization EC50 values for currently and recently circulating SARS-CoV-2 variants.

As of September 14, the most frequently reported SARS-CoV-2 variant in the U.S. is KP.3.1.1, followed by KP.2.3, LB.1, and KP.3. The latest CDC Nowcastopens in a new tab or window estimates that KP.3.1.1 comprises about 53% of circulating variants.


"KP.3.1.1 and LB.1 exhibit EC50 values that are 3.2- to 2.4-fold higher than that of JN.1, respectively, indicating that pemivibart is likely to retain adequate neutralization activity against KP.3.1.1 and LB.1," the FDA wrote in a memoopens in a new tab or window. "KP.2.3 and other untested variants are likely to exhibit similar susceptibilities to pemivibart."

  • author['full_name']

    Katherine Kahn is a staff writer at MedPage Today, covering the infectious diseases beat. She has been a medical writer for over 15 years.
    "
 
"

This new COVID-19 strain is set to hit the US

By Lisa Marie Basile | Fact-checked by Davi Sherman
Published September 27, 2024


Key Takeaways

  • The new COVID-19 variant, XEC, is making its way across Europe. In France, it accounts for over 20% of all COVID-19 cases.
  • The strain isn’t surging in the US, where it makes up only about 1% of all cases. The symptoms of XEC are similar to those of previous strains, and experts think that vaccinations will protect against this new strain.
  • Experts say that a winter COVID-19 surge is possible, so patients should stay safe and be mindful of their own risk level.
An emergent COVID-19 variant, XEC, is spreading across the globe.[1]The variant is a blend of the KP.3.3 and KS.1.1. variants. Cases are mostly being reported across Europe, having first appeared in Italy in May and been formally identified in Berlin in August.
In Europe, XEC has made up about 8% of all cases this month, double that of last month’s case numbers. It’s most widespread in France, making up around 21% of all tracked cases.
The good news? “It is not emergent in the United States,” David Cutler, MD, a board-certified family medicine physician at Providence Saint John’s Health Center in Santa Monica, CA, says. Currently, sources say that, as of mid-September, XEC comprises just about 1% of COVID-19 cases in the US.[2] For context, it doesn’t even have its own spot on the Centers for Disease Control and Prevention’s COVID-19 data tracker.[3]
KP.3.3 is an offshoot of the KP.3 Omicron variant family, which was surging in the US this summer.[4] These variants, including XEC, share many of the same qualities as other Omicron variants, meaning they are easily transmittable but less severe than, say, earlier pandemic strains. [5][1] Some variants, like this one, Dr. Cutler says, “tend to be more infectious but not more severe because [the variant] wants to let the host live in order to spread the virus.”
Mark Cameron, PhD, Associate Professor in the Department of Population and Quantitative Health Sciences at Case Western Reserve University, tells MDLinx that the XEC variant may just have the power to drive infections through the fall and winter. “But we need to know more about the XEC variant, and perhaps those still to come. As yet another Omicron family member, being up to date on the latest COVID-19 boost is a protective measure we can take right now,” he says.
Scott Roberts, Assistant Professor of Infectious Diseases at Yale School of Medicine, explains that the increase in transmission is “likely due to XEC bypassing some of our immune defenses, as it is somewhat distinct from current variants. But this is no different from any other novel variant we have seen in the past few years.”
The symptoms of XEC appear to be the same as those of previous strains, including fever or chills, fatigue, cough, breathing issues, sore throat, congestion, new loss of taste or smell, muscle or body aches, headache, and gastrointestinal issues.[6]
Dr. Roberts explains that since XEC is a recombinant strain of two Omicron strains, the current vaccines should provide protection against it—although, with time, we will know more.
Beyond getting vaccinated, patients should also know the risks associated with long COVID. “Long COVID risk with XEC is likely to be the same as any other variant,” Dr. Roberts adds. “Note that even mild cases of COVID can lead to long COVID, and vaccination is the best weapon we have against long COVID. Other strategies have not panned out, but the vaccine has.”
Even though we are currently living in the “new normal,” Dr. Cutler says, the US has still seen between 500 and 1,000 people die from COVID-19 within the past month.[3] For this reason, patients have to identify their risk level and act accordingly in order to protect themselves.
Amy Edwards, MD, Associate Professor in the Department of Pediatrics at the Case Western Reserve University School of Medicine, tells MDLinxthat patients should continue to protect themselves from the virus, especially going into the cooler months when viruses tend to proliferate. “Wash your hands, get your COVID-19 shot, stay home when you are ill, and wear a mask if you are feeling unwell but not sick enough to stay home,” she says. “Avoid crowded, poorly ventilated events. If you want to wear a mask for protection, it needs to be a very well-fitted N95.”
What this means for you
In the end, it’s worth remembering that COVID-19 is unpredictable. Just because XEC isn’t currently an issue in the US, this doesn’t mean that it won’t become more prevalent.
“Anybody who thinks they can predict what COVID-19 is going to do is deluding themselves,” Dr. Cutler says. He notes that we may soon get a better picture of how XEC—or other variants—are spreading, as hospitals will be required by the Centers for Medicare & Medicaid Services, to report COVID-19 cases beginning November 1, 2024.[7]

Sources (7)
 
GET 3 FREE HCA RESULTS JOIN THE FORUM. ASK FOR HELP
Top