In his weekly clinical update, Dr. Griffin discusses how vaccination and vaccine hesitancy affects public health and disease spread in terms of mpox, the first human death from H5N1 in US, why one should not feed their pets raw pet food and the metapneumonia outbreak in China before reviewing the recent statistics on RSV, influenza and SARS-CoV-2 infections, the WasterwaterScan dashboard, where to find PEMGARDA, how nirmatrelvir-ritonavir/Paxlovid reduces adverse outcomes of COVID in patients with kidney disease, provides information for Columbia University Irving Medical Center’s long COVID treatment center, SARS-CoV-2 infection affects skin conditions including shingles and if long antiviral treatment affects long COVID.
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Links for this episode
- Mpox vaccination hesitancy, previous immunisation coverage, and vaccination readiness in the African region (eClincial Medicine)
- Global prevalence and correlates of mpox vaccine acceptance and uptake (Communications Medicine)
- First case of new mpox variant in France (Reuters)
- First “Bird flu” death in US (NY Times)
- Emerging threat of H5N1 to human health (NEJM)
- Don’t feed your pets raw food (County of Los Angeles Public Health)
- Oregon, nationwide raw pet food recall (CIRAP)
- Raw cat food avian flu, is this like raw milk? (CIDRAP)
- Human metapneumovirus surging in China (The Guardian)
- Viral video of viral chaos: human metapneumovirus in Chinese hospital (The Economic Times)
- Human metapneumovirus in China (NY Times)
- Acute respiratory infections including human metapneumovirus in northern hemisphere (WHO)
- Waste water scan for 11 pathogens (WastewaterSCan)
- US respiratory virus activity (CDC Respiratory Illnesses)
- Weekly surveillance report: clift notes (CDC FluView)
- RSV: Waste water scan for 11 pathogens (WastewaterSCan)
- RSV-Network (CDC Respiratory Syncytial virus Infection)
- US respiratory virus activity (CDC Respiratory Illnesses)
- Waste water scan for 11 pathogens (WastewaterSCan)
- COVID-19 deaths (CDC)
- COVID-19 national and regional trends (CDC)
- COVID-19 variant tracker (CDC)
- SARS-CoV-2 genomes galore (Nextstrain)
- Where to get pemgarda (Pemgarda)
- EUA for the pre-exposure prophylaxis of COVID-19 (INVIYD)
- Fusion center near you….if in NY (Prime Fusions)
- CDC Quarantine guidelines (CDC)
- NIH COVID-19 treatment guidelines (NIH)
- Infectious Disease Society guidelines for treatment and management (ID Society)
- Drug interaction checker (University of Liverpool)
- The effect of nirmatrelvir-ritonavir on short- and long-term adverse outcomes from COVID-19 among patients with kidney disease (OFID)
- Paxlovid tied to lower risk of hospital stay, heart problems, death in adults with kidney disease and COVID (CIDRAP)
- Molnupiravir safety and efficacy (JMV)
- Convalescent plasma recommendation for immunocompromised (ID Society)
- What to do when sick with a respiratory virus (CDC)
- When your healthcare provider is infected/exposed with SARS-CoV-2 (CDC)
- Managing healthcare staffing shortages (CDC)
- Steroids, dexamethasone at the right time (OFID)
- Anticoagulation guidelines (hematology.org)
- Daniel Griffin’s evidence based medical practices for long COVID (OFID)
- Long COVID hotline (Columbia : Columbia University Irving Medical Center)
- Chronic urticaria, vitiligo, alopecia areata, and herpes zoster following COVID-19 infection (Journal of Dermatology)
- Impact of extended-course oral nirmatrelvir/ritonavir in established Long COVID:
- (Communications Medicine)
- Letters read on TWiV 1182
- Dr. Griffin’s COVID treatment summary (pdf)
- Timestamps by Jolene. Thanks!
Intro music is by Ronald Jenkees
Send your questions for Dr. Griffin to daniel@microbe.tv
The post TWiV 1182: Clinical update with Dr. Daniel Griffin first appeared on This Week in Virology.
Be a little more precise when you talk about transmissions. Ebola is not transmitted by the “airborne route”. That would be like TB and measles by particles suspended for prolonged periods in air. Aerosol is a bit less precise–when I cough, I can produce an aerosol of what I call the “big chunks” that can land in your eye or on your oral or upper airway mucosa and could cause infection. Airborne requires relatively sophisticated respirators, like PAPRs etc. and sophisticated isolation rooms with negative air pressure and specific flow patterns. See the CDC page on transmission-based precautions. The “big chunks” require contact and droplet precautions, i.e. face shields and surgical nasks, or N95 masks, at most and infection is not by the airborne route. It is an important distinction.
Thank you, Dr. Katz. I’ve been actively dispelling the same mistaken characterizations of “airborne route” on many websites. I don’t know why there is such a popular fixation on “airborne” transmission except for all of the popular mythology about “Zombie apocalypses” etc. Very frustrating to be an infectious disease epidemiologist these days! Best, Charles the DrPH
There is a definition of aerosol transmission; here is Medscape’s:
Aerosol transmission has been defined as person-to-person transmission of pathogens through the air by means of inhalation of infectious particles. Particles up to 100 μm in size are considered inhalable (inspirable). These aerosolized particles are small enough to be inhaled into the oronasopharynx, with the smaller, respirable size ranges (eg, < 10 μm) penetrating deeper into the trachea and lung (Figure).[23,24] Aerosols are emitted not only by "aerosol-generating procedures,"[19] but may also be transmitted whenever an infected person coughs, sneezes, talks, or exhales. Pathogens transmitted by respiratory aerosols can travel short or long range from the source depending on the size and shape of the particles, the initial velocity (eg, cough vs exhalation), and environmental conditions (eg, humidity, airflow).
We do our best to talk about viruses spreading by aerosol. Sometimes we slip up, but we do understand the distinctions.
On the other hand, Michael Osterholm, whose OpEd in the Times we criticized in this episode, talks about 'transmission through the air' when in fact what he means is aerosol transmission.
Ebola virus is not spread between humans by aerosol transmission. Neither does HIV-1. Why these viruses cannot spread by that route is a very interesting question. However, I know of no human virus to acquire aerosol transmission after having spread otherwise (sex, IV drug use, contact with bodily fluids). That is why when MO and the press ask if Ebola virus will 'mutate' to be transmitted by aerosol, we shake our heads.
I was struck by the statement that supportive fluids were vital for helping patients recover from Ebola. The US is currently experiencing a shortage of normal saline which has been going on for months. I worry that if the US can’t manage to produce enough NS for its own current needs, it will be even more difficult to donate it to the Ebola-stricken countries. It’s frustrating how so much of this spread is for lack of very basic supplies: proper PPE and fluids.