Coronavirus Updates August 2024

[missy]

Good morning. I don't remember if I started an August thread so if I did apologies. But I couldn't find it


"

Covid-19 is now the 10th leading cause of death​

And, yes, it’s still more severe than the flu.​

ANDREA TAMAYO AUG 15

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Throughout the pandemic, many have longed to understand Covid-19 in the context of flu. It makes sense—they’re both respiratory viruses with similar symptoms transmitted in similar ways. Flu is a familiar risk—we knew where it stood in our repertoire of threats, making it a helpful comparison for calculating the risk of a novel threat.
Covid-19 is here to stay, but the risks—severe disease, death, and long covid—have declined dramatically.
So, in anticipation of the upcoming fall season, this begs the question: Is Covid-19 still more severe than the flu? Yes, but the gap is narrowing.

Covid-19 is now the 10th leading cause of death​

Last week, CDC published 2023 provisional data on causes of death. This is basically a first draft of data—the numbers may shift with more death certificate reviews, but they typically don’t change dramatically.
What did CDC find? Last year Covid-19 plunged to the 10th leading cause of death—down from 4th in 2022 and 3rd in 2021. When looking at raw numbers, there was a nearly 70% decrease in one year! (245,614 deaths in 2022 vs. 76,446 in 2023.) We’ve come a long way.

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(Source: CDC; Annotations by YLE)
This dramatic decline in deaths wasn’t just in the U.S. We’ve seen deaths plunge across the globe thanks to immunity (from vaccination and infection) and treatments like monoclonal antibodies and antivirals.

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(Source: Our World in Data)

While this is incredible news, Covid-19 is still more deadly than flu​

Below is the percentage of deaths attributed to flu (blue) and Covid-19 (orange). We still see a whole lot more orange compared to blue.

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(Source: CDC; Annotations by YLE)
This is the case across almost all ages except between 1- 14 years old.

​

However, death surveillance may be biased. For example, more people may write Covid-19 on death certificates than flu.
So, the Veterans Affairs St. Louis Health Care System examined health records of 11,000 patients this past 2023-2024 season. They found that 6% of patients hospitalized with Covid-19 died within 30 days of admission versus 4% of patients with flu. In other words, the risk of death from Covid-19 was 35% higher than from flu among hospitalized patients.
However, there are two silver linings:

1. The gap between flu and Covid-19 is decreasing. In the prior year (2022), scientists noted a 60% higher risk of death for hospitalized Covid-19 patients.
2. Hospital outcomes are becoming more similar. Another studycompared hospital outcomes of patients in 2021 (Delta) to 2022 (Omicron) and found that the severity of outcomes decreased, meaning that fewer and fewer people had to be admitted to the ICU, fewer received invasive treatment, and fewer died over time.

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(Source: Open Forum Infectious Diseases; Annotations by YLE)
While the threat of severe Covid-19 to our individual lives might have decreased, the burden on our healthcare system and economy continues to persist. A report from McKinsey & Company estimated endemic Covid-19 would add $220 billion to our total healthcare costs by 2027, mostly driven by outpatient costs.

Flu isn’t necessarily something to brush off, either​

Although Covid-19 is still more severe than flu, it’s important to remember that flu causes a lot of preventable morbidity and mortality. Each year, between 140,000 and 710,000 are hospitalized for flu in the U.S., and 12,000 to 52,000 Americans die. The economic burden of flu is estimated at $11.2 billion per year.

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(Source: CDC; Annotations by YLE)
Flu can also cause “long flu” just like Covid-19 can (albeit at different rates—there’s a higher risk of long Covid than long flu, which YLE touched on previously).

The flu- vs. Covid-19 vaccine paradox​

Despite Covid-19 being more severe than flu, far fewer people are vaccinated for Covid-19 than flu. Last fall, 1 in 4 U.S. adults received the updated Covid-19 vaccine, while 1 in 2 received the flu vaccine. This interesting (and disappointing) paradox is mainly driven by loss of trust, vaccine hesitancy, pandemic fatigue, and limited access.

​

Bottom line​

Even as Covid-19 falls in death rankings, it’s still more severe than the flu. Fortunately, for both, we have vaccines. But we need to actually utilize them so these viruses stop costing lives and disrupting our economy and overall well-being year after year.



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[missy]

"

ABIM Revokes Two Physicians’ Certifications Over Accusations of COVID Misinformation​

Publish date: August 15, 2024
By
Alicia Ault

The American Board of Internal Medicine (ABIM) has revoked certification for two physicians known for leading an organization that promotes ivermectin as a treatment for COVID-19.
Pierre Kory, MD, is no longer certified in critical care medicine, pulmonary disease, and internal medicine, according to the ABIM website. Paul Ellis Marik, MD, is no longer certified in critical care medicine or internal medicine.
Dr. Marik is the chief scientific officer and Dr. Kory is president emeritus of the Front Line COVID-19 Critical Care Alliance, a group they founded in March 2020. The FLCCC gained notoriety during the height of the pandemic for advocating ivermectin as a treatment for COVID. It now espouses regimens of supplements to treat “vaccine injury” and also offers treatments for Lyme disease.
Ivermectin was proven to not be of use in treating COVID. Studies purporting to show a benefit were later linked to errors, and some were found to have been based on potentially fraudulent research.
The ABIM declined to comment when asked by this news organization about its action. Its website indicates that “revoked” indicates “loss of certification due to disciplinary action for which ABIM has determined that the conduct underlying the sanction does not warrant a defined pathway for restoration of certification at the time of disciplinary sanction.”
In a statement emailed to this news organization, Dr. Kory and Dr. Marik said, “we believe this decision represents a dangerous shift away from the foundation principles of medical discourse and scientific debate that have historically been the bedrock of medical education associations.”
The FLCCC said in the statement that it, along with Dr. Kory and Dr. Marik, are “evaluating options to challenge these decisions.”
Dr. Kory and Dr. Marik said they were notified in May 2022 that they were facing a potential ABIM disciplinary action. An ABIM committee recommended the revocation in July 2023, saying the two men were spreading “false or inaccurate medical information,” according to FLCCC. Dr. Kory and Dr. Marik lost an appeal.
In a 2023 statement, Dr. Kory and Dr. Marik called the ABIM action an “attack on freedom of speech.”
“This isn’t a free speech question,” said Arthur L. Caplan, PhD, the Drs. William F. and Virginia Connolly Mitty Professor of Bioethics at NYU Grossman School of Medicine’s Department of Population Health, New York City. “You do have the right to free speech, but you don’t have the right to practice outside of the standard of care boundaries,” he told this news organization.
The ABIM action “is the field standing up and saying, ‘These are the limits of what you can do,’” said Dr. Caplan. It means the profession is rejecting those “who are involved in things that harm patients or delay them getting accepted treatments,” he said. Caplan noted that a disciplinary action had been a long time in coming — 3 years since the first battles over ivermectin.
Wendy Parmet, JD, Matthews Distinguished University Professor of Law at Northeastern University School of Public Policy and Urban Affairs, Boston, said that misinformation spread by physicians is especially harmful because it comes with an air of credibility.
“We certainly want people to be able to dissent,” Ms. Parmet told this news organization. To engender trust, any sanctions by a professional board should be done in a deliberative process with a strong evidentiary base, she said.
“You want to leave sufficient room for discourse and discussion within the profession, and you don’t want the board to enforce a narrow, rigid orthodoxy,” she said. But in cases where people are “peddling information that is way outside the consensus” or are “profiting off of it, for the profession to take no action, that is, I think, detrimental also to the trust in the profession,” she said.
She was not surprised that Dr. Kory and Dr. Marik would fight to retain certification. “Board certification is an important, very worthwhile thing to have,” she said. “Losing it is not trivial.”
Dr. Kory, who is licensed in California, New York, and Wisconsin, “does not require this certification for his independent practice but is evaluating next steps with attorneys,” according to the statement from FLCCC.
Dr. Marik, whose Virginia medical license expired in 2022, “is no longer treating patients and has dedicated his time and efforts to the FLCCC Alliance,” the statement said.
Dr. Caplan served as a director, officer, partner, employee, advisor, consultant, or trustee for Johnson & Johnson’s Panel for Compassionate Drug Use (unpaid position) and is a contributing author and advisor for this news organization. Ms. Parmet reports no relevant financial relationships.

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[missy]

"

Antibody could offer sweeping protection against evolving SARS-CoV-2 virus​

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Published August 16, 2024 | Originally published on MedicalXpress Breaking News-and-Events

Researchers at Northeastern say they've discovered how an antibody could provide broad protection against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the virus responsible for COVID-19—even as it evolves to outwit other of the body's chemical defenses.
Researchers studied the structure of the spike protein of SARS-CoV-2—the outer projections of the [COLOR=rgb(0 126 115/var(--tw-text-opacity))]virushttps://medicalxpress.com/tags/virus/' membrane that is responsible for viral entry into a human cell. Following the outbreak of the COVID-19 pandemic, scientists were quick to identify how the spike protein helps hook the virus on to a cell, binding to an enzyme called the ACE-2 receptor.
[COLOR=rgb(32 37 41/var(--tw-text-opacity))]CME Activity: [/COLOR][COLOR=rgb(0 126 115/var(--tw-text-opacity))]Optimizing Care for Prurigo Nodularis - Evidence-Based Treatment Approaches and Personalized Strategies[/COLOR][COLOR=rgba(32, 37, 41, 0.4)] RealCME[/COLOR]
But it wasn't until researchers began studying the structure of the spike protein that they began to learn more about its somewhat limb-like design—that these protruding strands undergo a rearrangement as they "pull" a cell toward it and initiate fusion.
"For an infection to occur, the spike protein must jump out and grab a [COLOR=rgb(0 126 115/var(--tw-text-opacity))]human cell[/COLOR]," says Paul Whitford, an associate professor of physics at Northeastern, who co-led the theoretical aspects of the study, [COLOR=rgb(0 126 115/var(--tw-text-opacity))]published[/COLOR]in Science.
What the researchers showed was that a specific antibody—known as CV3-25—disrupts the cell infection process by targeting a particular site on the spike protein that is largely conserved across the different viral strains, according to the study.
The receptor binding domain, the critical portion of the [COLOR=rgb(0 126 115/var(--tw-text-opacity))]spike protein[/COLOR] that lets the virus "bind" and ultimately enter the cell, typically changes as the virus evolves, Whitford says. The region that often remains the same is vulnerable to CV3-25.
Think of it as like the virus' Achilles heel.
The results suggest that the broadly neutralizing antibody could hold the key to manufacturing a vaccine that protects against a rapidly evolving virus.
"This is a naturally occurring antibody that was found in specimens taken from people," Whitford says.
The computational work was a joint effort undertaken by the Center for Theoretical Biological Physics at Northeastern and Rice University, a National Science Foundation Physics Frontiers Center. The multi-university team also partnered with a group of researchers at Yale University as part of the overall study.
Whitford's background is in using [COLOR=rgb(0 126 115/var(--tw-text-opacity))]theoretical models[/COLOR] to study "large molecular assemblies"—chemical structures that include viruses and their surface structures. In the vast world of the infinitely small, Whitford has focused primarily on studying the workings of the ribosome, a biomolecular machine responsible for producing the proteins that make up living organisms.
Earlier this month, U.S. health officials said that COVID-19 is no longer a pandemic, but is now "endemic." That means the virus is likely to stick around, only now it's well-managed. But Whitford says more contagious and potentially deadly strains of the virus may still emerge.
"It is still a very significant problem, but one that can now be managed against the backdrop of many public health threats and not as sort of a singular pandemic threat," Aron Hall, deputy director for science at the Centers for Disease Control and Prevention's coronavirus and other respiratory viruses division, said recently, according to NPR. "And so how we approach COVID-19 is very similar to how we approach other endemic diseases."
The findings are significant because scientists have yet to produce a vaccine that protects against all current and future variants of the virus, Whitford says.
"Currently, we're keeping the virus at bay, but it keeps mutating," Whitford says.
Whitford says the antibody could be "the next big target" for the design of new vaccines.
"It opens up a new vaccine strategy," he says. "While current vaccines try to block the arms, our results show how you can tie the legs instead, which gives us a new weapon for combating this ever-changing virus."
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[oceaneyes]

Thank you for this update!

 

[kenny]

Thank you for this update!

+1
missy, I also appreciate the work you do to keep us updated on COVID.
I just wish so much of the public wouldn't let their guard down.

 

[dk168]

Thank you for this update!

+1, thanks missy for the update.

DK

 

[missy]

"
COVID Levels Are 'Very High' in Majority of US States
Lisa O'Mary
August 19, 2024

More than half of US states are reporting signs that COVID levels are poised to continue their summerlong rise.

The latest CDC wastewater monitoring data shows that 27 US states are detecting "very high" levels of SARS-CoV-2, the virus that causes COVID. The label "very high" indicates the highest viral activity level used by the agency. There are four lower levels that can be reported: minimal, low, moderate, and high. Nationwide, the lowest level being reported is moderate, and there are no states reporting low or minimal levels.

"If you see increased Wastewater Viral Activity Levels of SARS-CoV-2, it might indicate that there is a higher risk of infection," the CDC warns.


How Do COVID-19 mRNA Vaccines Work?
Some of the COVID-19 vaccines are known as mRNA shots. How are they different from traditional vaccines? And do they contain the real virus?

There are other signs that the summer COVID wave is nowhere near ending its now 13-week consecutive climb. The rate of positive COVID tests reported to the CDC is now more than 17%, up from 0.3% in early May. The rate of positive COVID tests is at its highest level since about 2 years ago. The region of the US that includes Texas, Oklahoma, New Mexico, Louisiana, and Arkansas had the highest combined regional positive rate of 24% for the week ending August 3.

The CDC recommends staying alert as to whether respiratory viruses like COVID are causing a lot of illness in a person's community. The CDC still offers a county-level search tool to understand local COVID levels to help people make decisions about prevention efforts, such as wearing a mask in public.


An updated COVID vaccine that is recommend for all people ages 6 months and older will be available later this fall.

SOURCES:
CDC: "COVID-19 NWSS Wastewater Monitoring in the U.S. (Data last updated 2024-08-09)," "COVID Data Tracker Home," "Respiratory Illnesses Data Channel: Current county-level information."

Johns Hopkins University & Medicine: "Coronavirus Resource Center: Daily State-by-State Testing Trends."

"

 

[missy]

+1
missy, I also appreciate the work you do to keep us updated on COVID.
I just wish so much of the public wouldn't let their guard down.

+1, thanks missy for the update.

DK

Thank you both! I appreciate you letting me know it is helpful.

 

[missy]

"

Covid still high, mpox emergency, and parvovirus enters the chat​

State of Affairs: August 20​

KATELYN JETELINA AUG 20

​

Lots is happening in the public health world! Here’s your latest update.

Covid-19: Very high​

Viral activity in wastewater—our best indicator of Covid–19 spread—is still “very high,” marking a very impressive summer wave. In fact, levels in the West are now the worst on record since the Omicron tsunami in 2021.
There are signs of declining rates in the South and Midwest and a plateau in the West. However, recent wastewater signals can be unstable (look at that rollercoaster in the West below), so I’m not getting too excited yet.

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(Source: CDC; Annotations by YLE)
In addition, we are getting mixed signals from other metrics. Emergency department visits have shown signs of slowing down, but test positivity hasn’t yet.
Hospitalizations are also increasing, which isn’t surprising given that it’s a lagging indicator, but levels remain lower than the winter peak. This past week, we lost 1,000 Americans to Covid-19.

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(Source: CDC; Annotations by YLE)

Note for the data gurus: Last April, hospitals were no longer required to report Covid-19 data, decreasing reporting from 90% to 38% of hospitals. However, there’s good news: Starting November 1, hospitals will report again! Thanks to all who submitted comments to Health and Human Services. It made a difference.

Mpox: An International Emergency ​

Last week, Africa CDC declared their first-ever public health emergency for mpox. The World Health Organization (WHO) followed by also declaring a public health emergency of international concern, signaling that the WHO Emergency Committee believes the current mpox outbreak in Africa is:

1. Unusual and unexpected
2. Has the potential for cross-border transmission, and
3. Requires coordinated international response.

This is the right call, and is important, as it (hopefully) draws attention and much-needed resources to the outbreak.
Back up—how did we get here? Mpox (formally known as monkeypox) has been endemic in Central Africa for decades, with rare, sporadic human cases of mpox after contact with infected animals.
However, in 2022, the virus—and specifically a strain considered less severe called Clade II—mutated and caused a massive international outbreak by spreading among a tight-knit social network: men who have sex with men (MSM). Education efforts, immunity, and antivirals have kept mpox spread low since. In 2024, the U.S. has had 1,657 cases of Clade II.

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Figure by YLE
This brings us to today. Clade I—the other mpox strain, historically more severe—is now exploding in Africa, accounting for more than 17,400 cases and 500 deaths. (The true number is likely much higher due to significant under-detection and under-reporting.) Recently, Clade I has spread to non-endemic African countries, and over the weekend, 1 travel case was detected in Sweden.
The majority of cases are the Clade Ia subvariant, with more than 80% of cases being among children and accounting for 85% of deaths. The second subvariant, Clade Ib, is spreading among adults.
No Clade I cases—regardless of subvariant—have been identified in the U.S.

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What do we NOT know?

• What is Clade I’s dominant mode of transmission? There is overwhelming evidence that Clade II is spread through close contact, like sex. For Clade I, the at-risk population is different. Situation reports show transmission through multiple means: sexual contact, household contact, non-sexual contact (like healthcare exposures), and animal exposures. Experts on the ground do notsee epidemiological evidence of airborne spread in Africa; they see, for example, cases of kids hunting squirrels or people in close contact in houses, like four kids in one bed. While there are documented cases of airborne transmission, what is possible isn’t always probable.
• How does the fatality rate apply to this Clade and other geographies? Historically, Clade I has a *very* high case fatality rate of 10% (compared to Clade II with <1%). However, it’s unclear whether this high rate is due to the intrinsic properties of the strain or is an artifact of under-detection, poor access to treatment, lack of healthcare, and poor nutrition in Africa. Data, such as an animal model and one small epidemiological study, have confirmed Clade I is more genetically virulent.
• How effective is TPOXX (the antiviral) against Clade I? A recent study in the Democratic Republic of the Congo found that while TPOXX was safe, it did not significantly shorten the duration of pox lesions in Clade I cases. The overall death rate and lesion duration among participants were lower than expected among all participants regardless of whether they received TPOXX or placebo, likely due to the high-quality care provided during the trial.
• How big will this outbreak be? Due to travel routes, we expect more international cases, especially in European countries. According to CDC modeling, any outbreak of mpox Clade I is expected to be smaller among the MSM community than the 2022 mpox Clade II outbreak.

Scientific teams are working on more lab and epidemiological studies as quickly as possible, which is incredibly challenging in resource-constrained areas.
So, what are we supposed to do? What matters now is that African countries can access vaccines, treatments, and the resources to run important studies to stop this epidemic.
In the U.S., only Clade II is spreading, so those eligible for the mpox vaccine have not changed: gay, bisexual, and other men who have sex with men, transgender or nonbinary people. Make sure you get both doses to be fully protected. For everyone else, there’s nothing to do for now.

Parvovirus B19: Increasing​

In the U.S., parvovirus B19—a very common airborne respiratory virus, also known as fifth disease or “slapped cheek” rash—has increased to higher than “normal” in recent months, particularly in children ages 5 to 9. CDC urgedphysicians to be on the lookout.
The exact reason for the current rise is unknown, but the virus typically spikes every 3-4 years, usually as it starts to warm (late winter to early summer).

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Image: Mayo Clinic
Importantly, this virus is not dangerous to the general public. In fact, 50% of people have immunity by the time people reach 20 years old. However, three groups are at high risk because the virus attacks the cells that make red blood cells. This can result in short-lived anemia before the immune system controls the infection.

• Pregnant: The virus can cause heart failure in the fetus and miscarriage.
• Immunocompromised: The anemia can be long-lasting.
• People with conditions that speed up the breakdown of red blood cells (like sickle cell): The anemia will likely be more severe and might require blood transfusions.

Unfortunately, this virus mainly spreads asymptomatically before flu-like symptoms arrive. Because the virus spreads through the air, masking is expected to help.

Bottom line​

Covid-19 infections are still surging, and another virus—parvovirus B19—is also rising. There are things you can do—stay up to date on vaccines, mask indoors and in crowded areas, and get that indoor air flowing. Concurrently, the international community has another mpox emergency—for the U.S., though, those at high risk are still men who have sex with men. As always, we’ll keep you updated as things change.

"

 

[missy]

"

A guide to fall 2024 vaccines​

KATELYN JETELINA AUG 22 ∙

This fall, we will have vaccines for all three fall respiratory viruses: flu, RSV, and Covid-19. It’s getting hard to keep track of all of them. So here are the what, who, and when for each, informed by the most up-to-date science.

There are some nuances for those looking for ultimate protection, but in the end, the best vaccine is the one you get!

Seasonal influenza (flu)​

​

What: The vaccine covers three strains of seasonal flu and is offered by fourpharmaceutical companies. Selecting vaccine strains for rapidly changing viruses, like flu or Covid-19, is both an art and a science, so the vaccine formula doesn’t always align perfectly with the circulating virus. However, this year’s composition was an excellent match to the flu strains in Australia (which is a good predictor of the upcoming Northern Hemisphere season). Flu vaccines reduce the risk of needing to go to the doctor by 40% to 60%.

Who: Everyone 6 months and older. Special formulations provide added protection for older adults. Children should get two shots one month apart during their first flu season.

When: Protection wanes throughout the season, so October is the best time to get vaccinated. The complete list of timing recommendations for specific populations (pregnant people, older adults, young children) is available here.

Which one: The vaccines are all very similar, and you won’t gain much from shopping around. The nasal spray flu vaccine may work a bit better in children.A recent study suggested that the adjuvanted flu vaccine (Fluad) might work better in older adults.

COVID-19 vaccine​

What: The fall Covid-19 vaccines have an updated formula targeting JN.1 (Novavax) or KP.2 (Pfizer or Moderna). We don’t know their effectiveness in humans yet, but updated vaccines provided ~60% additional protection last fall.

This season is more complicated because there are two slightly different Covid-19 choices. There are pros and cons to each:

• mRNA vaccines (Pfizer or Moderna) are more up-to-date, targeting the latest Omicron subvariants, and are presumably more effective against infection (in the short term). Both manufacturers made a JN.1 vaccine but found that the KP.2 was better in inducing antibody responses against current variants. The Pfizer vaccine is probably better than Moderna for those at higher risk of myocarditis (i.e., younger men).
• The traditional protein vaccine (Novavax) cannot be updated as quickly, so it had to go with the older subvariant version. Novavax’s data suggest that this is probably okay, as even this older variant version gave good responses against current variants. For some (including me!), the side effects of mRNA vaccines can be intense. I’ll be getting Novavax for this reason.

We don’t know if Novavax performs better (or worse) than mRNA vaccines. The very few studies we do have come to different conclusions.

Who: Everyone 6 months and older.

When: These are expected to be available soon. Word on the street is the mRNA vaccines may even be approved by FDA this week. Novavax should closely follow. However, “now” isn’t necessarily when you should get them:

• If you were recently infected, wait 4-6 months. It doesn’t hurt if you get it earlier, but some research shows that waiting allows our antibody factories to update more effectively.
• If you were not recently infected, the timing is a tough call. Either get it now—we are in the middle of a huge infection wave—or wait to increase protection against the winter wave (which may be closer to November). I will be getting mine when it becomes available.

​

RSV vaccine for older adults​

What: This season, there are three RSV vaccines: GSK, Pfizer, and Moderna. There are pros and cons to each:

• GSK and Pfizer use traditional biotechnology (protein-based), which was available last year, so we have lots of “real world” data confirming safety and effectiveness. There is a small (but real) risk of Guillain-Barre syndrome—the risk is about the same as with flu vaccines.
• Moderna is an mRNA vaccine expected to become available this season. It did not have a Guillain-Barre syndrome safety signal, but protection wanes more quickly.

Who: This is not an annual vaccine—If you got one last year, you do not need one this year. Studies showed getting a second dose didn’t meaningfully enhance protection. People ages 60 and older “may” get the vaccine. Those over 75 years “should.”

When: RSV vaccines show some initial waning in the first few weeks after vaccination but then stabilize at a high level of protection for more than one year, so getting one now should protect you throughout the entire season (and then some).

​

RSV vaccine for pregnancy​

What: One vaccine is available: Pfizer. Protection is passed from the mother to the baby so that the baby is protected in the first 6 months of life, which is the riskiest time for severe RSV. Thousands of pregnant women got it last year, confirming the safety and high effectiveness (70-85%).

When: During 32-36 weeks of pregnancy from September to January. This vaccine can be given simultaneously with other routine vaccines for pregnancy (Tdap, Covid-19, and influenza). Some data shows that getting an RSV vaccine at the same time as Tdap may reduce the antibody response to pertussis. So, it may be worth considering getting the Tdap vaccine a few weeks before, but there is no formal recommendation.

​

RSV monoclonal antibody for infants​

What: Beyfortus (nirsevimab) is not a vaccine (i.e., it doesn’t teach the body to make an immune response)—it is a preventive medication (providing antibodies directly and proactively). Last year’s real-world data showed that severe RSV in infants was drastically reduced; one study achieved 98% effectiveness. This is a game-changer for babies!

Who: All infants under 8 months should get it for their first RSV season, unless the mother received the RSV vaccine during pregnancy. High-risk children between 8 months to 19 months should also get it. If the mother got the RSV vaccine during pregnancy, getting a monoclonal antibody is not recommended unless the infant is at very high risk.

When: Generally, as close to RSV season as possible (protection holds up for at least 5 months). Last season, there was a supply issue, but it should be ironed out this year.

​

Bottom line​

Get protected! It is one of the best things you can do this fall and winter to stay healthy and minimize disruption. As always, for specific questions or guidance, be sure to talk with your healthcare provider.


"

 

[missy]

"

COVID Vaccine and MS Relapse Risk: New Data​

Edited by Manasi Talwadekar
August 23, 2024

TOPLINE:​

There is no link between the COVID-19 vaccination and an increased risk for multiple sclerosis (MS) relapse in most patients. However, there is a small increase in the risk for relapse following receipt of the COVID-19 booster in those with high MS activity.

METHODOLOGY:​

• Researchers conducted an observational study using data from the French National Health Data System.
• 124,545 patients with MS were identified on January 1, 2021; 82.3% received at least one dose of a COVID-19 vaccine.
• Analysis included data following the first three doses of COVID-19 vaccines.
• The primary outcome was MS relapses requiring hospitalization and treatment with high-dose corticosteroids within a 45-day risk period after each vaccine dose.

TAKEAWAY:​

• There was no association with increased relapse risk following the first or second dose of the COVID-19 vaccine or the booster dose.
• In a subgroup analysis, booster dose was associated with a 28% higher risk for relapse in patients who had two or more relapses in the previous 2 years (incidence rate ratio, 1.28; P = .006), especially untreated patients.
• To confirm these findings, researchers also conducted a case-time control study, which did not show an increase in risk for relapse after any of the three doses.
• Investigators found an association between vaccination and decreased relapse risk (odds ratio, 0.90; P = .01).

IN PRACTICE:​

"Our findings are reassuring that these vaccines can be used without any worry about the risk of relapse," lead author Xavier Moisset, MD, PhD, of Clermont Auvergne University in Clermont-Ferrand, France, said in a press release, adding "the absence of such a risk is encouraging for people with MS that they may receive booster shots when needed, especially if booster shots are to be repeated in the future."

SOURCE:​

The study was led by Moisset and colleagues and was published online on August 14 in Neurology.

LIMITATIONS:​

The main limitation was the reliance on hospital care and drug reimbursement data, which lacked clinical information. Benign relapses may have been underreported. Additionally, pseudo-relapses may have been mistakenly identified as actual relapses.

DISCLOSURES:​

The study did not receive any specific funding. Some authors declared receiving financial and nonfinancial support from various pharmaceutical companies. Additional disclosures are noted in the original article. Full disclosures are available in the original article.

"

 

[missy]

"

Top 6 questions answered about fall vaccines​

Waiting, co-administration, kids, Novavax, and free at-home antigen tests​

KATELYN JETELINA AUG 27

1. How long after a Covid-19 infection/vaccination should I wait?​

We have frustratingly scarce scientific guidance on timing. What we do have tells us this:

• Minimum wait: 2-3 months. A Covid-19 vaccine doesn’t add much benefit within 2-3 months of infection. We don’t have to wait 2-3 months after infection—we won’t “exhaust” or “overwhelm” our immune system. But waiting will reinforce our B cells (our antibody factory that stores some long-term memory).
• Maximum wait: 8-12 months. The longer we wait, the more we get out of the vaccine. One study found that waiting 8 months increased neutralizing antibodies 11 times more than waiting 3 months after infection, which would increase the likelihood of preventing infection. Another study found that a 12-month interval improved vaccine effectiveness against hospitalization. But, of course, waiting is a gamble, especially for high-risk people.

Try not to overthink it. 4-6 months is usually the sweet spot. Your healthcare provider is an excellent resource for discussing timing!

2. What if I was not recently infected? And why are vaccines becoming available after the Covid-19 summer peaked? ​

The U.S. government is trying to force our seasonal flu model to fit Covid-19, but it’s not working well. Covid-19 is clearly not a once-a-year thing—it’s now settled in two waves per year. These vaccines were initially planned in anticipation of the winter wave, but the FDA pushed the release up because we’ve had such a big summer wave.

This makes it very hard to decide when to get the Covid-19 vaccine if you have not recently had an infection or vaccination: Get it now or wait until late fall. I’ve struggled with the decision but decided to wait until Halloween. It will still take some time for vaccines to make it to doctors’ offices, and then a vaccine will still take two weeks to work. By then, we will (hopefully) be well on our way down the current wave. Since I’m not high-risk, I might as well wait to catch the next wave, which will coincide with fun holiday activities I don’t want to miss.

(Dr. Jen Dowd—one of my favorite scientific communicators— just wrote a great post for those seeking more advice on timing. Check it out here.)

Regardless, if the U.S. wants Covid-19 vaccines to have a dramatic population-level effect—like how flu vaccines reduce the impact of flu yearly on hospitals and individual disruptions—we need to have vaccines before a wave. Implementation would be challenging but not impossible.

3. Can I get the flu and Covid-19 vaccine at the same visit?​

Yes! This is called co-administration, and it’s recommended for convenience—you don’t have to visit the pharmacy or doctor twice.

Studies have been conducted on the safety and effectiveness of co-administration with Covid-19 vaccines. In one database, about 454,000 people got the flu and Covid-19 vaccines. Both worked great. The rate of side effects was the same or a little higher among those who co-administered; however, no specific safety concerns were identified.

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(Source: CDC)
There is no combined shot. (Some companies are working on it. Maybe next year?)

4. Is it worth it for kids? What do other countries do? ​

In the U.S., everyone 6 months and older is eligible for Covid-19, similar to other countries (like Canada or Japan). Kids in the U.K. or Australia qualify for the Covid-19 vaccine if they have a pre-existing condition. (Note: Not all kids get the flu vaccine in these countries either mainly due to the cost—the government pays for the vaccine, so they must consider this.)

• Death: Covid-19 is about as deadly as the flu among kids but far less risky than for older adults (or those under 6 months old). Covid-19 is more risky for those under 6 months, which is why it’s important to get the vaccine during pregnancy.

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• Effectiveness: They work for kids. Last season, the pediatric vaccines provided ~60% additional protection against going to urgent care for Covid-19, compared to not getting the vaccine.

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(Source: CDC)

• Safety: Unfortunately, the public hasn’t seen myocarditis (i.e., inflammation of the heart muscle) data for last season yet, but there’s no reason to think it’s changed—while there is a safety signal among young men, the risk dropped dramatically for boosters. An analysis last year showed that the benefits still outweigh the risks. The most common causes of myocarditis are viral infections, where it’s typically much more severe.
• Missed school days: I’m frustrated that we don’t have robust data for other outcomes, such as reduced sick days. Since vaccination prevents ~20% of infections in the first few months, we can assume vaccines reduce sick days “a bit.” But other than that, we don’t know, which is unhelpful for parental decision-making.

5. Are you sure that Novavax isn’t better than mRNA vaccines? ​

Both are good shots. I’m uncomfortable saying one is immunologically better than the other. We’ve had some head-to-head studies (here, here, here, and here) showing lots of similarities and some subtle differences:

Similarities

• Both provide a solid first line of defense (i.e., neutralizing antibodies), which helps prevent infection in the first months (but is not perfect.)
• Both strengthen a solid second line of defense (i.e., T cells), which helps prevent severe disease.

Differences

1. Negative: Novavax produced lower levels of a specific antibody called IgG. This may contribute to more infections after Novavax than mRNA vaccines.
2. Positive: Novavax had a more durable response over time (waned less quickly).
3. Positive: Novavax has fewer side effects, like pain and muscle aches. For this reason alone, I will be getting Novavax this fall.

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Side effects from varying combinations of COVID-19 vaccines. Figure from the Lancet, with YLE annotations. Original source here.

6. Free antigen tests will be available again this season. ​

The U.S. government plans to give each household four free at-home Covid-19 tests again this season. This should open in late September. I will be sure to update you when you can order your tests.

There are flu/Covid-19 combined at-home antigen tests now. There isn’t one for RSV yet.

Bottom line​

Fall is almost here! Make a plan to get your vaccines. The best vaccine is the one you get. Our priority is preventing severe disease among high-risk individuals, but staying up to date has secondary benefits for everyone!

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