Think we are getting tripped up on definition of #herdimmunity: form of indirect protection from an infection that occurs when a significant % of population has become immune to an infection (through vax or previous infection). 74 cases/9.05 million Israel ourworldindata.org/coronavirus/co…
(with openings and mingling) with a 63% 1st dose vaccination rate >16 years old (Pfizer only approved down to 16) means those unvaccinated (not yet or children) have INDIRECT protection from infection because virus not circulating much ourworldindata.org/covid-vaccinat…
This is why children back in school without masks/ distancing: they are not protected by vax but by levels of virus circulating to be so low it is close to 2019. Do you see what I mean by definitions? Call it containment but protects others for more & more adults to be immune
So let's go back to my picture of herd immunity: more and more of us adults are getting pink, protecting the white sheep. I am wondering if we are confusing herd immunity with ERADICATION which we have done for only one virus (smallpox). I like Biden's 70% 1st dose metric >18 yrs
And of course, immunity means a combination of natural infection + vaccination - that is in the textbook definition of herd immunity. We wanted to get there mainly through vaccination but of course places like CA had high surges (we were hit hard in winter)
To this point, as @JenniferNuzzo points out, since US started vaccinating oldest first, % of all cases in younger groups increased 1st prior to tipping point. Now cases in adults AND kids decreasing. Vaccinating adults (of the herd) protects children: downloads.aap.org/AAP/PDF/AAP%20…
Remember, #herdimmunity is form of indirect protection from an infection that occurs when significant % of population becomes immune (through vaccine or natural infection); unvaccinated (children in this case) protected by low cases; don't confuse with eradication please
Indeed, only virus that has been eradicated is smallpox. I have heard people say we must eradicate every #covid19 virus from face of earth but low cases will keep unvaccinated protected if we get herd immunity & at some point, countries with high vax must turn to other diseases.
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HOW LONG DOES IMMUNITY LAST? To COVID vaccines or infection? We do not really know but there have been some really nice papers lately that give us more information. Please remember immunity divided into antibodies (which can come down & not work as well against variants)
IgA is one in the nose & mouth ("mucosa") that is raised by shots (vaccines) to certain extent but rise higher after natural infection; IgG is the one that is "humoral" or in the bloodstream. Many threads on here about cellular-mediated immunity: B & T cells cover all variants
This recent preprint is really important and summarized by @florian_krammer below in depth. Main take-aways: Breakthrough infections induce IgA (we knew) but protection from vaccine long-lasting even against former variants to severe disease/mortality
RSV VACCINE FOR OLDER ADULTS: Respiratory syncytial virus (RSV) respiratory virus (most common after flu pre-COVID). 2 subtypes, A&B (1 dominates/season). Droplet; Recurrent infections. Most severe in neonates & adults >65; FDA approves 1st RSV vax today msn.com/en-us/news/us/…
RSV vaccine 3 trials of new RSV vaccine, all published in the @NEJM recently so just to keep them straight- here is the vaccine which just got approved May 3 by the FDA for older adults. Remember our T/B cells so protection against severe disease higher! nejm.org/doi/full/10.10…
A single dose of the RSVPreF3 OA vaccine had an acceptable safety profile and prevented RSV-related severe respiratory illness by 94% in adults>=60 years (71% against RSV infection, likely to fall with time as antibodies fall but severe disease protection will remain)
NASAL VACCINES: To explain nasal vaccines, we have to explain the immune system first.
IgA is an antibody that helps attack the pathogen and exists in mucosal surfaces (like nose/mouth)
IgG is an antibody that is in the bloodstream bbc.com/news/world-asi…
Cellular immunity is fantastic, redundant (so even if one cell line down in immunocompromised, have other), generated by either vaccine or infection; Comprised of
T cells- so in breadth from vax - works even across spike protein with its mutations
And the 2nd type of cell produced by vaccines or infection -B cell- amazing thing about B cells is that - if see omicron or one of its subvariants in future- they make antibodies adapted to that variant or subvariant (aided by T cells); adaptive immunity
PUBLIC HEALTH POLICY: Seem to be at reckoning phase of COVID response- what worked, what didn't. Which interventions will be used in future pandemic responses? Interventions asked of public need good medical evidence for them (e.g. RCTs preferably, systematic reviews) to impose
In our field, Cochrane reviews represent best way to sum up the medical evidence to date by performing meta-analyses or systemic reviews of currently-available data; here is Cochrane on masks & other interventions for respiratory viruses including COVID cochranelibrary.com/cdsr/doi/10.10…
Many asked past 3 years how CDC developed policies on masks (& age to mask), distancing (feet), ventilation, schools-> all non-pharmaceutical interventions. Originally theory-based. Now 3 years in, have data (RCTs highest level) to form policies from both US and other countries
VACCINE DISCRIMINATION: We need to stop vaccine requirements for US entry like almost every other country. Am finishing COVID chapter for our ID "bible" & vaccines prevented transmission early on with alpha, but not enough now with current variants to justify such discrimination
Moreover, shame, stigma, blame (remember COVIDiots?), coercion, discrimination not good public health tools. When used for HIV, public health & ID physicians decried them but tactics used a lot in COVID. This book tries to explore & correct that for future barnesandnoble.com/w/endemic-moni…
Concept of #harmreduction in pandemic responses means watching carefully if vulnerable people (like students, older people, low-income populations, migrants, sex workers, prisoners, those with disabilities, refugees, minorities) harmed more by response nature.com/articles/s4146…
FEAR: Some media & public health officials concerned Americans aren't fearful of COVID now. But the vaccines & therapeutics DO WORK. If we can't celebrate biomedical advances & imbibe their effectiveness (we have better tools for COVID than flu), what is point of developing?
In HIV medicine, when therapies came out, we didn't say to people- stay fearful; make this the controlling principle of your life. The book #Endemic I wrote (coming out July 11, 2023) hails these biomedical advances & the age we are in to fight pandemics to reassure the world
This is a rather brilliant summary of the issue from @benryanwriter