1. Belatedly looked at this week's FluView from @CDCgov. There's something to watch here.
A child or teen in Ohio contracted a swine flu virus — an H1N2. Public health investigations can find no link between the person & pigs, ie didn't live on a farm, didn't attend a state fair.
2. Public health has concluded it is possible this person was infected by another person. According to @CDCgov, they can see no evidence of ongoing person-to-person spread. But this bears watching. The 2009 flu pandemic was caused by a swine #flu virus.
3. There are a number of cases every year of people contracting a swine #flu virus in the US. Ten reported so far this year. Typically they occur in people who live or work on a farm with pigs, live with someone who works with pigs or has had contact with pigs at a fair.
1. Good day. #ACIP is meeting today to vote on recommendations about who should receive a booster shot of the Pfizer #Covid vaccine. The meeting starts at noon ET. I will be live tweeting. @US_FDA's EUA for the Pfizer booster is veeeeeery broad. statnews.com/2021/09/22/fda…
2. The meeting is underway. Doran Fink of @US_FDA is now explaining FDA's EUA for the Pfizer booster, which was issued last night.
My observation: The group of people eligible for a booster under this EAU is very broad. 16-17 yos are excluded but many over 18 will be eligible.
3. @CDCDirector is addressing #ACIP. She acknowledges that the committee has to make decisions, sometimes with a huge amount of data, sometimes with "a paucity."
She mentions pregnant people.
My observation: Oddly, there was no mention of them in the FDA EUA.
1. Good morning. #ACIP is meeting today and tomorrow. Today, at least, I will be live tweeting. @US_FDA has not yet indicated what it is going to do with Pfizer's application for a booster license. So it's really completely up in the air at this point how this turns out.
2. You'll recall FDA's advisory committee, #VRBPAC, voted that there wasn't enough data to approve the Pfizer application to give a booster to everyone 16 & older. VRBPAC did agree there was enough data to authorize boosters for people 65 & older & people at high risk.
3. But as I mentioned, FDA hasn't indicated what it's going to do. It is not bound to follow #VRBPAC's advice, but it will cause a real stir if it does not. If it doesn't follow VRBPAC's advice, it may set up a situation where a second advisory committee #ACIP disagrees with FDA.
1. Some unsettling #rabies exposure stories in a post from the invaluable @ProMED_mail tonight.
Some people in RI were feeding a raccoon that later testing showed was infected with rabies.
People: Do not feed raccoons. They do not need your help. local21news.com/newsletter-dai…
2. A grey cat that was hanging around a campground in Frederick County, Md, tested positive for #rabies. There were reports the cat was biting & scratching people between Aug 24 & Sept 3. People exposed or people whose pets were exposed to the cat should contact their MD or vet.
1. Being as it's Friday, there will be a #flu update from @CDCgov later this morning. I'll add to this when it comes out.
Just looking at the weekly Covid & #influenza report from @PHE_uk. In a normal flu season, one might see a little flu activity in early Sept. Nope.
2. @CDCgov's FluView is up. Actual confirmed cases of #flu remain very low. There is, however, a fair amount of influenza-like illness, or ILI, activity. The report suggests it may have plateaued among 0-4 & 5-24 yr olds. Will be interesting to watch this, now that school is in.
3. @CDCgov reports another 2 cases of infection with swine #flu viruses have been detected, both in Iowa. Neither was sick enough to need hospital care; both recovered. Both had traceable links to pigs.
1. Let's talk a little #flu. Or more specifically, let's talk about ILI — #influenza-like illnesses. Those are cold & flu-like ailments caused by a stew of viruses: influenza, rhinoviruses, adenoviruses, parainfluenza, human coronaviruses & respiratory syncytial virus — RSV.
2. @CDCgov releases its weekly #flu updates Friday morning. This week's (covering Aug. 22-28) showed there is more ILI activity now (red arrow) than there was at any point last winter during the traditional cold and flu season. Does that mean flu has returned? In a word, no.
3. I assume different parts of the country may be seeing different combos of bugs, but here's what's being seen in Utah, from Intermountain Healthcare's GermWatch. Lots of rhinoviruses (the most common cause of the common cold) & RSV. No flu or human CoVs. intermountainhealthcare.org/health-informa…
1. #ACIP meets today. I'll be tweeting on the meeting in this thread.
When it was first announced, this was going to be a 2-day meeting; now only 1.
If you want to listen to the meeting, you can do so from here: video.ibm.com/channel/VWBXKB…
2. Contrary to popular opinion, this #ACIP meeting isn't primarily about whether Americans who got mRNA vaccines need a 3rd dose starting in Sept., as per the policy announced by the Biden administration. Only 45 minutes of the 6.5 hour meeting has been set aside for boosters.
3. Why so little discussion about boosters? Not a lot of data at this point.
Pfizer only recently applied to @US_FDA for a 3rd shot; Moderna hasn't yet applied. #ACIP will review the data Pfizer submitted to FDA when it becomes available to ACIP, chair Grace Lee told me.
1. The last couple of days have been so busy I haven't updated on #Ebole in Côte d'Ivoire. Here goes:
At present there is 1 confirmed case, a young woman who travelled by bus (buses?) from Guinea to Abidjan. There is also a suspect case. I'd bet that's a case.
2. @WHOAFRO says there are also 9 contacts who've been identified and are being monitored. I would be surprised if that total doesn't change a lot. This woman had a long journey & at a point was on a bus with 70 people. This is likely a complex investigation.
3. I was told just now by @WHO that there still isn't confirmation of the species of #Ebola involved. Not sure why that isn't known yet. The working assumption has to be that it's Ebola Zaire because they are using vaccines that target the Zaire species. Won't work for others.
1. A short thread about the newly announced case of #Ebola in Cote d'Ivoire (Ivory Coast).
The diagnosis was confirmed by the Institut Pasteur in Cote d'Ivoire. This does not have the feel of a suspect case — the announcement sounds like @WHOAFRO is confident this is Ebola.
2. A critical point made by @MoetiTshidi, regional director of @WHOAFRO, is that this is the first time since 2014 that an #Ebola cases has been diagnosed in a major city. (I need to refresh my memory about the North Kivu outbreak.) Abidjan population: +4M.
Urban Ebola = not good
3. The @WHOAFRO statement says there's no indication this case, a man who traveled from Guinea, was linked to the Guinean #Ebola outbreak from earlier this year. Work is underway to determine the source of infection.
1. #ACIP is meeting now to vote on a recommendation that some severely immunocompromised people be given a 3rd dose of mRNA vaccine in their primary series, because they do not get enough protection from 2 doses. FDA cleared the way for this LATE last night.
I will be tweeting.
2. Here's the story we published last night about this change to the EUAs for the Pfizer and Moderna vaccines. The 3rd dose should be given at least 28 days after the 2nd dose in the series.
No change was made to the 1 dose Johnson & Johnson vaccine. statnews.com/2021/08/12/fda…
3. #ACIP has a new chair today. Grace Lee from Stanford takes over from José Romero, Arkansas' health secretary.
The committee is down 3 members today. The term of 3 previous members expired but 3 replacements haven't yet been "onboarded" -- which I think is a paperwork thing.
1. @WHO put out a meaty release today on the confirmation of Guinea's first detected #Marburg case. A thread.
The first known case, described in the local media as a 46 yo father of five, developed symptoms on July 25. No word yet on the source of his infection.
2. This #Marburg case occurred at Gueckédou, which is near where the 2014-16 #Ebola outbreak is thought to have started. Guinea's health system is underfunded, which helped Ebola take off there. But Gueckédou now has a lab to test for viral hemorrhagic fevers. Beneficial legacy.
3. The man sought medical care but his illness wasn't diagnosed as #Marburg. He was tested for malaria — a common occurrence when health workers don't know a viral hemorrhagic fever is circulating. After his Aug. 2 death, Marburg was diagnosed pretty quickly.
1. Short thread on flu-like activity in the U.S. #Flu has been at historically low levels around the world during the pandemic. At some point, it will come back. When? Not sure.
Interesting FluView today, @cdcgov's weekly flu report. cdc.gov/flu/weekly/
2. From about late May thru the end of Sept, @CDCgov issues a pared down weekly #flu report, because it's off-season for flu. So there isn't a lot of detail to explain this.
This graph shows out-patient visits for influenza-like illnesses, a.k.a. ILIs.
3. It looks like right now there are more people going to doctors or clinics for ILIs than there were at any point last winter during what would normally be flu season. That red line is the 2020-21 flu season. (In @CDCgov reporting terms, flu season runs from Oct. through Sept.)
1. @SoceFallBirima confirms there is a possible case of #Marburg in Guinea, at Gueckédou — where the 2014-16 West African #Ebola outbreak was first reported.
Samples have been sent to a reference laboratory for confirmation.
This would be West Africa's first Marburg outbreak.
2. For those who don't know Marburg fever, it is very similar to #Ebola — a dangerous hemorrhagic fever that transmits through contact with a sick or dead person's bodily fluids. Marburg outbreaks have been less frequent and generally smaller than Ebola outbreaks.
3. Things to know about #Marburg: There is no licensed vaccine & no approved drugs to treat it. There's been work on experimental vaccines & some Phase 1 trials, which suggests there may be some human grade vaccine available. How much would be a question.
1. @CDCgov's vaccine advisors, #ACIP, are meeting today. I'll try to tweet, but also writing so tweets may be spotty.
Issues are: The suspected link between the J&J #Covid vaccine & Guillain Barre syndrome & whether immunocompromised people should get an additional dose of vax.
2. On the issue of whether immunocompromised people should get +1 dose of #Covid vax, don't expect a decision today. The emergency use authorizations that allow use of the vaccines specify how many doses can be given. Until @US_FDA changes that, #ACIP can't recommend more doses.
3. J&J presented #ACIP some new immunogenicity data for their 1 dose vaccine just now, with data by variant type. The T-cell responses are similar across all variants, the company shows. Persistent humoral and cellular immune responses, over 8 months.
1. @CDCgov announced today that a case of #monkeypox has been detected in Dallas. The person recently returned to the US from Nigeria. The person was traveling alone.
2. @CDCgov, state/local health authorities are looking for people who traveled on 2 flights with the person who later was diagnosed with #monkeypox. The 1st was a direct red-eye flight from Lagos, Nigeria to Atlanta that arrived July 9. The second was from ATL to Dallas July 9.
3. #Monkeypox is related to smallpox. It is less dangerous, but it's not not dangerous. About 1 in 100 people infected with the strain that has infected the person in Dallas die from it.
1. @WHO DG @Drtedros says the world is in a perilous position re: #Covid19. The global toll has topped 4M, vaccine nationalism has left many countries with little access to vaccine. That health workers in many countries are still unvaccinated is "morally abhorrent."
2. "Now is the time for the world to come together ... to end the acute phase of this pandemic," @drtedros said during today's @WHO#Covid19 press conference. "It's not charity," he said of working out ways to share vaccines & therapies. "It's the best way to end the pandemic."
3. @WHO's expert panel on vaccines, SAGE, recommends that older people & health workers around the world be vaccinated before young children, because the risk to the former is so much greater, Anne Lindstrom (spg?) from WHO tells the daily newser.
1. The impact of #Covid19 vaccines on the US epidemic. This graphic, from today's #ACIP meeting, speaks volumes.
I will try to tweet from the meeting, but it might be intermittent. First up: myocarditis & pericarditis in some people who've received mRNA vaccines.
2. #ACIP will also be discussing #Covid19 booster shots. Committee was just told it's not yet clear *if* boosters will be needed, but that it's important to plan for boosters if it becomes clear they are needed.
3. #ACIP hearing an explanation of traditional (ie not vaccine-related) myocarditis & pericarditis. The former is mostly seen in males & rates are higher in 15-18 yos than in younger children.
1. Earlier this week @CDCgov served notice it is suspending importation of dogs from countries with a high canine #rabies risk.
An event happened this week that is a stark illustration of why CDC is taking that step.
2. The day @CDCgov's notice appeared in the Federal Register, a Pennsylvania lab reported that a dog imported to the US from Azerbaijan on June 10 tested positive for #rabies. This is exactly what the new policy is trying to prevent.
3. The dog was part of a shipment of 33 dogs & 1 cat. Those animals will have to be found & quarantined for months. Animals that have been in contact with them may need to be revaxxed against #rabies. This is a TON of work. The animals were distributed across 8 states.
1. Guinea's latest #Ebola outbreak is over, @WHO declared today. The outbreak flared earlier this year in an area that 5 yrs earlier had been engulfed in the biggest Ebola event in history. This one was historic too — triggered by virus from a survivor. statnews.com/2021/03/12/bom…
2. The outbreak was declared in mid-February, one of two #Ebola flare ups African countries fought this year as they battled Covid. The other was in DRC, in the area of the 2018-2020 North Kivu-Ituri outbreak. It has also been stopped.
3. There were immediate fears that #Ebola would spread across Guinea's borders, as the virus did in 2018. But the Guineans, with help from @WHO & other partners, kept this from becoming a big outbreak. There were probably 23 cases in this outbreak, 12 of them fatal.
1. A #flu thread:
There remains almost no influenza activity in the US this year. Nearly three-quarters of a million flu tests have been conducted; just over 1,600 have been positive. Last week 27 people in the country tested positive for flu.
2. These graphs come from @CDCgov's weekly #flu report, FluView. The red arrow points to this year's epidemic "curve" such as it is. Many years there is a fair amount of flu B at this time. I guess it could still come but I'm not worrying about it. cdc.gov/flu/weekly/ind…
3. Only 1 child in the United States has died from #flu this winter. Extraordinary.
1. Count your blessings time.
It's Friday, @CDCgov's FluView has been published & wow. Wow. Wow. Wow.
There continues to be almost no #flu activity in the U.S. Given that there's plenty of #Covid19 activity, you cannot explain this simply by masks + social distancing.
2. Lots of people are being diagnosed with #Covid19 — 186,000 on Jan. 21 — so clearly people are contracting respiratory pathogens. Just not #flu so much.
23 positive flu cases in the US in week 2 (ending Jan 16) - less than 2 dozen - is crazy low.
3. Also crazy low: So far this year the hospitals in the national flu surveillance network have reported 136 people hospitalized with serious #flu infections. Last year by week 2 of the flu season, 5,786 people had been hospitalized for flu.