Eric writes:

Hi TWIV,

Thanks for all you do. I will miss Dickson’s wit, and his non-judgmental positive attitude. A polymath indeed.

Wanted to ask about a topic I remembered in a pediatric infectious disease discussion 30 years ago in med school. At the time a comment was made about the idea of possibly distributing one IPV or even two in all children for hard to reach areas then follow with opv to finish series as it was more feasible to deliver.

I remember in that discussion comments made that vaccine induced polio disease dramatically dropped after 1 ipv followed by next dose opv and after 2 ipv ? no risk or almost no risk. 

Is there any evidence for this? Could it be of any benefit or just another chance for opv harm? If true – does adding GI tract involvement with OPV after IPV make a difference in immunity. With combination of opv after ipv in series would there be any significant effect on GI shedding of the virus, risk of vaccine derived polio to vaccinee,  and risk to others from feces. 

Thank you

Eric Clark MD

Raihan writes:

Dear TWIV team,

Episode 1195 was a perfect tribute to Dickson. Like many listeners I too have had a career that was influenced by him. 

I remember listening to the first episodes in 2008 and hearing the 2 of you Bantering about science. So much has changed but my admiration for the Both of you has nothing but grown.

I was holding Back my tears when all of you were signing off. I could even hear Dickson chiming in with you when you said, “It’s viral”. 

Words can’t capture what my heart wants to express. Just thank you. I am forever Beholden to you. 

BBBest wishes,

Raihan

(long time listener, lapsed email writer, forever a fan)

Ida writes:

Hi. I am an internist in the Boston area, and an avid fan of TWiV. I appreciate your review of Tessandier et al’s study on HPV dynamics, which sheds some intriguing light on an aspect of HPV that doesn’t get much attention.

I did want to clarify something on the clinical end, though. Current guidelines recommend that anyone with a cervix have Pap tests looking for cellular changes every 3 years from age 21 to 30. HPV testing with or without Pap testing is recommended every 5 years from age 30 to 65. More frequent testing does not seem to be valuable, unless the person being screened has abnormal test results or has some other factor putting suggesting an especially high risk.

The medical establishment has struggled for a long time with the question of whether the pelvic exam has a value apart from the Pap & HPV test. As far as we know, offering regular pelvic exams to women who are not having any local problems does not improve health outcomes in any way. 

Paps may show yeast infections and they may suggest the presence of bacterial vaginosis. But we do not treat either condition without symptoms, and if a woman has symptoms, we use other tests to make the diagnosis.

In rare cases, a Pap may show uterine cells in a post-menopausal patient, and that finding could lead to an early diagnosis of uterine cancer. But this is akin to diagnosing lung cancer after doing an abdominal CT scan. You may occasionally save a life, but that doesn’t make it a useful screening tool.

Ida

Anne writes:

I heard an interview with John Green on the March 12 Public Health on Call podcast (a very informative podcast about issues affecting public health).  He has written a book about tuberculosis (Everything is Tuberculosis) which I think deserves a TWiV bump (or TWiM).

Here are the notes from that podcast episode:

John Green is a New York Times bestselling author and YouTuber known for writing books like The Fault In Our Stars. His latest book is about tuberculosis. In this episode: A conversation with John Green about why he chose to write about TB, the current state of public health and its challenges, and how the disease and its prevalance reflects so much back on us in terms of who we are as a society.

John Green is the award-winning, #1 bestselling author of books including Looking for Alaska, The Fault in Our Stars, Turtles All the Way Down, and The Anthropocene Reviewed. With his brother, Hank, John has co-created many online video projects, including Vlogbrothers and the educational channel Crash Course. John serves on the board of trustees for the global health non­profit Partners In Health and spoke at the United Nations High-Level Meetingon the Fight to End Tuberculosis. John lives with his family in Indianapolis. You can visit him online at http://johngreenbooks.com or join the TB Fighters working to end tuberculosis at http://tbfighters.org .

Regards,

Anne