The ACIP 2016 Update is out for Adult Immunizations. Note the expanded recommendations for asplenia/functional asplenia and immunosuppression, especially the convoluted (not ACIP’s fault) recommendations for dosing the two available pneumococcal vaccines, and the addition of the serogroup B meningococcal vaccine. Download the charts here:
New photo images and updated information!
The news about Zika virus and a marked association with microcephaly is all pretty disturbing, and I have gotten questions about whether we could have a problem in Florida. I think we have an idea from what’s happened with dengue & Chikungunya, which are spread by the same Aedes mosquitos. Chikungunya (another virus from Africa) also spread very quickly through South & Central America & the Caribbean over the last few years.
In U.S. territories, Dengue is endemic in Puerto Rico, Hawaii now, and has established limited local transmission in the Keys, based on antibody screening of that population. About 10% of FL Keys residents surveyed in 2009 had dengue antibodies. Chikungunya has also occurred in very very limited fashion in FL compared to the Caribbean & Puerto Rico.
In 2015, there was 1 locally acquired dengue & 0 Chikungunya in Florida; Puerto Rico had 198 cases of Chikungunya. Contrast this with 2014: 12 locally acquired cases in Florida, 4242 in Puerto Rico, and 38 in the U.S. Virgin Islands. I expect these numbers should be just as low for Zika virus with enhanced surveillance and mosquito control efforts.
Reasons none of these is widespread in the U.S.:
- Mosquito control programs.
- Modern housing with screens & AC.
- Aggressive public health tracking of cases & mosquito spraying around the areas where those individuals live (“ring” control measures).
- Aedes aegypti is the more effective transmitter of these viruses, but is less common here than Aedes ablopictus.
CDC has issued Interim Guidelines for Pregnant Women and an Enhanced Precautions Travel Alert. I suggest to avoid the lower Keys (my own opinion), Caribbean, Central & South America if you are trying to become pregnant and through delivery.
Follow what’s happening weekly with all Arboviruses in FL here.
Share this brochure with friends and neighbors about reducing mosquito breeding around your residence & preventing bites. DEET, picaridin, and IR3535 are safe for use in pregnancy—follow label directions. These are day and night biting mosquitos. Enhanced mosquito avoidance measures are always a good idea in Florida anyway, because we have encephalitis viruses seasonally.
As a healthcare professional and Florida constituent, I ask you to please voice support to your legislators for our (or wherever you live, your) mosquito control programs. In 2011, Florida mosquito control programs lost almost half their state funding, & state funding for mosquito control research was eliminated. The public is just not aware of how very deep a debt of gratitude we owe these programs for making Florida such a lovely state to live in.
All the best,
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Industrial farming practices in the U.S. are one of my pet peeves, from an environmental and health standpoint, as well as my “foodie” sensibilities.
Freshly laid, unfertilized farm eggs actually keep best unwashed until they are cracked, & will keep at room temperature for weeks. An egg, even unfertilized, is alive, exchanging air through the shell & living off yolk nutrients. Think about it, they are designed to be living incubators for a chick. They will slowly dehydrate & lose quality, but they will live and remain edible for a long time. (How do they tell if an egg is unfertilized?)
Americans – Why do you keep refrigerating your eggs? nicely summarizes the interesting & little-advertised facts about how American industrial farming practice requires us to scrub, chlorine wash, & refrigerate eggs at 40F, so as to reduce the risk of Salmonellosis and other infections. In Europe, less industrialized farming practices & vaccination of poultry against Salmonella has dramatically reduced this problem. Washing eggs is illegal, & they are kept at 70F to reduce condensation that might promote bacteria. Kept dry at this temperature, the coating on the egg from laying protects them from dehydration & bacterial entry for a long time on store shelves.
Unfortunately, in the U.S. even backyard flocks have been contaminated with Salmonella & are usually unvaccinated, so the risk is not so low. I keep my farm eggs unwashed but refrigerated to retard bacteria (wash before use, of course). I love eggs from pasture-raised chickens & ducks; they’re richly flavored & higher in omega-3 fatty acids & antioxidants from their naturally “buggy” diets. Discard any egg if it’s slimy, discolored, has an odor (it shouldn’t at all), or has new powdery spots on it.
My esteemed colleague, clinician, researcher and FL native Dr. Anthony Cannella speaks tomorrow morning at the University of Florida Emerging Pathogens Institute Seminar Series in Gainseville, discussing the links between individual immune response and development of disease, which may either protect, or promote an uncontrolled and lethal manifestation of disease. Dr. Cannella has been studying human T-cell (Th1) and humeral responses in pathogens like Brucella and Coccidioides for the past several years, and I believe he’s onto something critical.
Antimicrobials are not the answer. There are only so many metabolic pathways to chemically block in living organisms, and far more ways for them to evolve resistance. Sometimes even as simple as waking a sleeping gene archived from an ancestor that armed itself against a similar defense raised by plants of eons past. The antibiotic pipeline has gone dry, with little more than a few “me-too” drugs in development at best.
For a long time, I’ve believed that the next step in the evolution of medicine and the battle against infection, lies in unlocking the secrets of immunity. How does that one person at work who never gets a flu shot and never gets sick get away with it? While a woman in her 20’s dies of influenza within a week? How does one person arrive at the ER dying of sepsis from a Staphyloccal cellulitis, while a nursing home resident tolerates repeated bacteremias without so much as a leukocytosis? Why do so many children get away with swimming with Naegleria every year, but a few succumb? Is it just the particular strain of pathogen? The volume of invader? The person? Or all of it?
What causes an immune system to respond so aggressively that it kills its owner? How do we harness it? Can we? Should we? Dr. Cannella is doggedly on the hunt, and I am grateful. Follow him on Twitter @apc_md, and go see him speak if ever you can. He’s one of those scientists you can actually understand, and he loves Medicine and people. A really cool person, you’ll like him.
Fight the good fight, Doc.