James Amos

What’s Up with Intranasal Covid-19 Vaccines?

I saw the JAMA article on intranasal vaccines research for Covid-19. It starts off pretty supportive of the principle. However, at the bottom of the article, the outlook looks pretty stable for injectable vaccines for at least a good long while.

It’s an interesting read. Skip to the Many Questions section:

How these experimental mucosal vaccines stack up against mRNA vaccines, considered the standard of care, remains to be seen, Beigel noted. The NIAID intends to conduct phase 2 trials that would compare mucosal and mRNA vaccines head-to-head, “so you’d know for certain what you’re trading off,” he said.

Ideally, a mucosal vaccine would generate as good a systemic immune response as an mRNA vaccine as well as a robust mucosal immune response. But an excellent mucosal immune response might make up for a bit of a decline in the systemic immune response, Beigel explained. Perhaps a vaccine inhaled through the mouth and into the lungs could provide the best of both worlds—strong mucosal and systemic immunity—but there are no data yet to support that theory, he said.

“Everyone knows we need a better vaccine and would really like it if we could get something that interrupts transmission and stops even mild disease,” Beigel said. “Whether that’s attainable or not, we don’t know.”

I’m not knocking the concept by suggesting you read the Conflict of Interest Disclosures.

Reference:

Rubin R. Up the Nose and Down the Windpipe May Be the Path to New and Improved COVID-19 Vaccines. JAMA. Published online December 06, 2023. doi:10.1001/jama.2023.0644

The Santa Hat Juggling Duo Breaks the Internet!

Are we having any fun? You bet! We donned our Santa hats and did the 2-person 6 ball juggling until we fell over.

This is a fun pattern because, even when you mess up, it’s hilarious. When we count out loud, it sort of helps keep us in sync—but not always.

The last part of the video, we did the count sort of sotto voce as we moved from the toss and pass phase to finish with a cascade. This is in stark contrast to what we usually do, which is to keep tossing and passing until the inevitable drops happen.

As always, after the second right hand toss in the cascade, we pass from our right hand to the left hand of the partner. The count is “One, Two, Pass!”

As least that’s the plan. Often, we get line drives to the head, chest or the wrong hand. This is why safety goggles are handy. Ball collisions are frequent, which crack us up.

You know, juggling is often a one-person hobby or show. When you get two persons in the act, it’s ordinary juggling for two, which is a blast.

Then you’re having fun!

This is National Influenza Vaccination Week!

This is National Influenza Vaccination Week (Dec. 4-8, 2023) and the CDC word is:

“National Influenza Vaccination Week (NIVW) is a critical opportunity to remind everyone 6 months and older that there’s still time to protect themselves and their loved ones from flu this flu season by getting their annual flu vaccine if they have not already. CDC data shows that flu vaccination coverage was lower last season, especially among certain higher risk groups, such as pregnant people and children. When you get a flu vaccine, you reduce your risk of illness, and flu-related hospitalization if you do get sick. This week is meant to remind people that there is still time to benefit from the first and most important action in preventing flu illness and potentially serious flu complications: get a flu vaccine today. Check out CDC’s NIVW toolkit for more shareable resources and content.”

It’s also big news that a recent CDC co-authored study showed strong evidence for flu vaccine effectiveness. Among the university medical centers participating in the study was the University of Iowa Hospitals.

Watch for Jim and Sena Juggling in Santa Hats!

Announcing the upcoming not-to-be-missed, one of a kind, holiday extravaganza never before witnessed holiday extravaganza—Jim and Sena juggling in Santa Hats!

We’ve been rehearsing for this (or at least trying to) and one of the greatest challenges was laughing so hard we could barely stand up, let alone juggle.

There’s something hilarious about juggling balls colliding with each other.

Juggling Update!

Well, we’re using our new safety glasses retainers and they work out fine. We’re a little off the beam on the 2-person 6 ball pass juggle for some reason. Some days are diamonds, some days are stones, I guess.

Our mistakes are funny. We just make too many.

I’m still working on the shower juggle pattern. I might be making slow progress. It feels easier to do if I use the large plastic balls or the new smaller balls with a tough leather shell. They’re decorated with stars to give you confidence.

I think if they’re round and hold their shape better if they’re made of harder material, they might fly better.

I think it would also help if I threw them more accurately.

Christmas Trees Up!

Sena has the Christmas trees up! She got new ornaments and lights. The green tree is downstairs and the red tree is upstairs in the sun room.

There’s also this Amaryllis plant from last year that we’re hoping will bloom again. You never know.

Moderate Respiratory Illness Activity in Iowa

The CDC tracks respiratory illness and there is moderate activity in Iowa according the data tracker.

The weekly snapshot as of December 1, 2023 shows highlights including:

“COVID-19 test positivity (percentage of tests conducted that were positive), emergency department visits, and hospitalizations have increased nationally. A group of Omicron variants (XBB and its sublineages) are the predominant lineages detected in the U.S., with HV.1 being most common. The prevalence of another lineage, BA.2.86, is projected to account for 5-15% of currently circulating variants. CDC continues to monitor HV.1, BA.2.86, and all other lineages.
National test positivity, emergency department visits, and hospitalizations for influenza continue to increase.
RSV emergency department visits and hospitalizations continue to increase across the country. RSV-associated hospitalization rates remain elevated among young children and are increasing among older adults; of note, only 14.8% of adults 60+ report having received an RSV vaccine.
National vaccination coverage for COVID-19, influenza, and RSV vaccines increased less than one percentage point for children and adults, where indicated, compared to the previous week and remains low for both groups.
CDC has been monitoring increases in respiratory illness reported recently among children, including potential elevated rates of pediatric pneumonia in parts of the United States. These reported increases do not appear to be due to a new virus or other pathogen but to several viral or bacterial causes that we expect to see during the respiratory illness season. CDC will continue to work closely with our state and local public health partners to maintain strong situational awareness and will provide updates, as needed.”

Update on CDC Recommendation for Adult RSV Vaccination

I just checked to see if the Iowa Board of Pharmacy rules had changed about the recommendation that a physician and patient shared decision-making discussion should help clarify whether and why a prescription would be necessary to enable a patient over the age of 60 years to get the Respiratory Syncytial Virus (RSV) vaccine.

I found out that nothing has changed the position of the Iowa Board of Pharmacy on this issue, despite the CDC published list which now includes the RSV vaccine (which seemed to be the main issue against allowing pharmacists to administer the vaccine independently). I finally found the CDC Adult Immunization Schedule by Age web page. The section shows a table of vaccines recommendations broken down by age. Below the table is a list of the CDC recommended vaccines. Under the RSV category there is a Special Situation section with guidance for those over the age of 60 regarding those most likely to benefit from the RSV vaccine:

“Age 60 years or older: Based on shared clinical decision-making, 1 dose RSV vaccine (Arexvy® or Abrysvo™). Persons most likely to benefit from vaccination are those considered to be at increased risk for severe RSV disease.** For additional information on shared clinical decision-making for RSV in older adults, see www.cdc.gov/vaccines/vpd/rsv/downloads/provider-job-aid-for-older-adults-508.pdf.

For further guidance, see www.cdc.gov/mmwr/volumes/72/wr/mm7229a4.htm

**Note: Adults age 60 years or older who are at increased risk for severe RSV disease include those with chronic medical conditions such as lung diseases (e.g., chronic obstructive pulmonary disease, asthma), cardiovascular diseases (e.g., congestive heart failure, coronary artery disease), neurologic or neuromuscular conditions, kidney disorders, liver disorders, hematologic disorders, diabetes mellitus, and moderate or severe immune compromise (either attributable to a medical condition or receipt of immunosuppressive medications or treatment); those who are considered to be frail; those of advanced age; those who reside in nursing homes or other long-term care facilities; and those with other underlying medical conditions or factors that a health care provider determines might increase the risk of severe respiratory disease.”

While the rationale for the recommendation is clear, it’s interesting that Iowa is one of only 4 states in which pharmacists cannot administer the RSV vaccine independently (meaning a physician prescription is necessary). The RSV vaccine is in the CDC published vaccination schedule, which looks like it would satisfy the Iowa Code Section 155A.46 according to the Iowa Board of Pharmacy.

I still wonder whether it’s the shared decision-making discussion or the Iowa Code that’s the main reason a physician prescription is necessary to get the RSV vaccine.

It isn’t that I want the RSV vaccine. In fact, based on what I’ve read on the CDC Immunization Schedule, I don’t think I need it because I’m pretty healthy for a geezer. I just don’t understand why only 4 states require a physician prescription. Does that mean the pharmacists in the rest of the country are confident they can have a shared decision-making discussion with patients about the indication for the RSV vaccine?

Why You Might Have Noticed My Blog Was Missing in Action Recently

A couple of days ago, I tried switching my blog to a new theme. A theme is a kind of digital uniform for the blog. It’s a set of files and pictures that work together to display your blog content.

Every once in a while, I get an urge to change the theme. WordPress has a lot of themes, some free, some for a price.Usually, I can just put on a new theme like a new suit of clothes, pinch it a little and I’m done.

Not this time. I struggled with the new theme for hours. I thought it had features it didn’t have, partly because the initial description was a little misleading. I finally just went back to the old one, which was a lucky break.

While the theme construction was going on, some of you might have dropped by and noticed that my blog was either missing in action or severely crippled, with many essential parts missing. Sorry about that.

While the theme was out, some links evidently changed, mainly because certain web sites either dropped out or were modified. The changes were in the main menu at the top of the page (just to let you know, the new theme really didn’t have a menu per se). The menu looks like it lost weight. The blogs by Drs. Moffic and Pies got included in the main link for Psychiatric Times, which makes sense. One web site evidently no longer exists.

It’ll be a while before I mess around with my blog theme again, maybe until WordPress again tells me that I have to change it if they decide to discontinue it.

CDC Update on Covid-19 Variant BA.2.86

I saw a news item headline which mentioned Covid-19 Variant. BA.2.86. The CDC website tracking respiratory variants has a definitive update as of November 27, 2023:

“What to know about BA.2.86

The virus that causes COVID-19 is constantly changing over time. Sometimes these changes allow new variants to spread more quickly or effectively. If that occurs, the new variant may become more common relative to other variants that are circulating.
Since CDC’s first post on BA.2.86 in August 2023, the proportion of infections caused by BA.2.86 has slowly increased. In the CDC Nowcast posted Nov. 27, 2023, BA.2.86 is projected to account for 5-15% of currently circulating variants.
CDC projects BA.2.86 and its offshoots like JN.1 will continue to increase as a proportion of SARS-CoV-2 genomic sequences.
At this time, BA.2.86 does not appear to be driving increases in infections or hospitalizations in the United States.
CDC contributed to and agrees with the World Health Organization’s recent risk assessment about BA.2.86 suggesting that the public health risk posed by this variant is low compared with other circulating variants, based on available limited evidence.
Updated COVID-19 vaccines are expected to increase protection against BA.2.86, as they do for other variants.
As mentioned in previous updates, COVID-19 tests and treatments are expected to be effective against this variant, including its offshoot JN.1.
It is not possible at this time to know whether BA.2.86 infection produces different symptoms from other variants. In general, symptoms of COVID-19 tend to be similar across variants. The types of symptoms and how severe they are usually depend more on a person’s immunity than which variant causes the infection.
Regardless of what variants happen, CDC will continue to track them, working closely with partners around the world to understand how they are spreading and how they respond to vaccines and treatments.”