Category: science

What’s Up with Seasonal Vaccines This Fall?

I just read an interesting article in JAMA on this fall’s Covid-19 vaccine. Most of it is from the FDA meeting in June (Rubin R. This Fall’s COVID-19 Vaccines Will Target Omicron XBB Subvariants, but Who Needs Them Remains to Be Seen. JAMA. Published online July 05, 2023. doi:10.1001/jama.2023.10053).

One expert was quoted, indicating that there will be “…an elaborate discussion” at the CDC ACIP meeting about who should get the new monovalent XBB.1.5 vaccine. I don’t see that the meeting is scheduled yet.

There are some other interesting quotes to pass along:

“Back in March and the first half of April, XBB.1.5 represented more than 80% of circulating SARS-CoV-2 in the US, according to CDC estimates. Its dominance began to slip in late April, and as of late June, XBB.1.5 represented little more than a quarter of circulating SARS-CoV-2 variants. By then, though, XBB.1.5 and 9 other XBB subvariants together accounted for a total of 96% of circulating SARS-CoV-2 in the US. Fortunately, members of the XBB family of subvariants are antigenically similar to each other, so a vaccine against XBB.1.5 should protect against the rest of them as well, the WHO committee noted.”

“By the third quarter of 2022, an estimated 96.4% of approximately 143 000 blood donors in a nationwide, longitudinal cohort had SARS-CoV-2 antibodies from previous infection or vaccination or both, according to an analysis published in June in Morbidity and Mortality Weekly Report.

Or, as Sawyer told JAMA, “[t]he whole US has had this virus in one form or another.”

Because of the high prevalence of SARS-CoV-2 antibodies in the population, Paul Offit, MD, in an interview predicted “a focused recommendation by the CDC” regarding who should receive the XBB.1.5 vaccine.”

“Offit said he expects that the CDC will recommend the new monovalent XBB.1.5 vaccine for groups at the greatest risk for severe disease, reflected in continuing hospitalizations for COVID-19. Those groups likely would include people who are 75 years or older, people with severely compromised immune systems, and pregnant people, Offit said.”

“At least for people 60 years or older, the fall vaccine situation will be more complicated than it was a year earlier, Schaffner noted. That’s because at its regular monthly meeting in June, ACIP voted to recommend that this age group have the option of being vaccinated against respiratory syncytial virus (RSV) after consulting with their physician or pharmacist.”

That would mean that there would be 3 vaccines coming in the fall: RSV, Covid-19, and influenza. Sena and I have been doubtful about why a conversation with a physician would be necessary for the RSV vaccine. We don’t know whether that means you couldn’t get it without a physician’s order. There are also questions about coadministration of the RSV and Covid-19 vaccines.

Because the time is coming soon for seasonal vaccines, we’re hoping the questions will be answered soon.

Thoughts on Extraterrestrial TV Shows

A couple of nights ago, I watched a few TV shows on the Travel Channel about UFOs, extraterrestrial abductions, implants, and whatnot. I think there was some sort of marathon given that it was the Independence Day weekend.

Anyway, I was surprised to see Marc D’Antonio on a show called Alien Invasion: Hudson Valley. The story is about a community of people there who report many encounters with extraterrestrials. I’m used to watching The Proof Is Out There on the History Channel, hosted by congenial and humorously skeptical Tony Harris. On that show, D’Antonio is one of the “analysts” who appraise photos submitted as evidence for the paranormal. He’s always pretty skeptical and presents a scientific demeanor.

However, D’Antonio is also a MUFON investigator (which I found out later) and on the Hudson Valley show, he gave a detailed account of having been visited by an extraterrestrial, lost time, and woke up later in his bed, covered in his own blood, later seeing a doctor who removed some big foreign object from his nose, which he reported had probably been implanted there by the extraterrestrial. He told the anecdote matter-of-factly and I was struck by his non-scientific attitude.

I guess he and many others like him are actors in this flood of UFO TV shows which are very entertaining and give the appearance of being investigative in their purpose. D’Antonio appeared to be an actor, which led me to doubt the authenticity of his role on The Proof Is Out There.

They kicked around the idea that extraterrestrials were implanting objects in people to track the ones who are Rh negative blood type. They suggested that extraterrestrials need to use humans as some kind of blood bank. That reminds me of a line from Men in Black II:

Newton: Gentlemen, before I start the tape, one more thing—what’s up with anal probing? I mean, do aliens really travel billions of light years just to…

On the other hand, the Hudson Valley thing was a confusing mix of ghost hunters and alien hunters. They used a device that I think they called an electromagnetic field (EMF) meter, which you can purchase on Amazon along with many other ghost hunting gadgets. The women actors shrieked predictably as they reported feeling invisible hands stroke their hair.

I thought the show was supposed to be about extraterrestrials, not ghosts. They tried to cover the bases by tossing out terms like interdimensional beings, ghosts, and extraterrestrials. Most IMDb reviewers generally panned the show as being unbelievably bad, which is right.

A program previous to that was about some podiatric surgeon named Roger Leir who removed a lot of foreign objects out of somebody’s foot and then claimed they were implanted by aliens. Leir sent the objects to a lab, which identified them as being made of common elements. Somehow, he got the idea they were from outer space.

But they didn’t mention that in the show. They brought in some other expert who claimed they were parts of alien nanotechnology. The only thing I could find out about that was on, oddly enough, an Ohio State University web page article about Leir that seemed out of place on the OSU website. The article was seemingly supportive of his claim that the objects were alien implants.

I think the shows should be more clearly identified as being entertainment in nature, not investigative. If they want to get more viewers, they might try adopting the Mountain Monsters approach, which is to make a parody about the subject. At least the humor would valuable.

Braunschweiger and Miracle Whip Nostalgia Sandwich

Sena bought two items at the grocery store that brought back memories: Braunschweiger and Miracle Whip.

You may recall the Miracle Whip vs Mayonnaise challenge blog posts last August-September. Miracle Whip took a beating and it’s partly because I suspect the makers changed the recipe for it.

I can’t change that. On the other hand, I used to make sandwiches using slices of plain white bread and Braunschweiger. There are dozens of brands of Braunschweiger. I’ve never heard of Field, but it hardly matters. I think they’re all pretty much the same.

On the other hand, try telling that to the food science experts at Iowa State University. We found a YouTube video of a guy explaining what they look for when judging Braunschweiger. He went on about how it has to be a certain color (reddish is better), it can’t be spreadable, and it has to be flown in from a distant galaxy and so on.

But we also found a couple of videos that show the spread of opinion on what people think of the taste of Braunschweiger. One of them showed a guy in Texas who tried it for the first time. He toasted the bread (something I’ve never done), sliced the meat, placed it between the bread slices without any kind of condiment—took a while to roll it around his mouth and finally praised it highly.

That contrasted with a video of a father and son who made a hilarious and overdone spectacle of themselves gagging their way through a taste test.

There are a lot of recipes out there using Braunschweiger. Many of them look really tasty. Nostalgia is the word for my version. I don’t do anything fancy with it. I slap Miracle Whip on the bread, slap Braunschweiger slices on them and have lunch.

I ate a lot of lunch meat sandwiches when I was growing up. I didn’t know about nitrates and nitrites back then and didn’t worry about carcinogens from them. I still don’t. If you want the lowdown on nitrates and nitrites in your diet and the relationship to diseases like cancer as well as their benefits, you can read a very thorough and recent review of it (Karwowska M, Kononiuk A. Nitrates/Nitrites in Food-Risk for Nitrosative Stress and Benefits. Antioxidants (Basel). 2020 Mar 16;9(3):241. doi: 10.3390/antiox9030241. PMID: 32188080; PMCID: PMC7139399.). There is no slam dunk decision on whether it’s totally evil or not—note the word “benefits” in the title.

I recommend you not watch any overly dramatic YouTubes or read any scary science articles about it. Keep it simple. Just enjoy your Braunschweiger and Miracle Whip sandwich. You can also enjoy it with mayonnaise, if you’re so inclined. Sena and I did a taste test and this time the Miracle Whip tasted just like it did when I was a kid! Sena actually liked Braunschweiger. She ruined it with mayo, but that’s just her.

Raccoon in the Mulberry Tree

I was not sure what exactly I saw this between 6:30 and 7:00 this morning shaking the mulberry tree branches in our backyard. It seemed too big to be a squirrel and I dismissed the thought, telling myself that it was most likely the usual squirrel getting its mulberry breakfast.

Just prior to this incident, I had seen and heard what I thought was a blue jay in the mulberry tree. It gave a series of short whistles while bobbing up and down on the branch. I had never heard a blue jay make whistle notes, just the usual screeches. I doubted what I saw and heard. I checked my bird book, “Birds of Iowa: Field Guide” by Stan Tekiela. It didn’t mention anything about blue jays making short whistling notes and bobbing up and down as they did so. I didn’t bother to get up and try to get a video of it. It would have been through the window of our sun room and the jay didn’t sit for more than a few seconds.

So, I looked it up on the web. It turns out blue jays make a variety of noises besides the jeer. They bob up and down as a part of a courtship ritual. They make what is termed a “pump handle call” and I found a video which duplicates what I saw and heard.

Anyhow, getting back to the critter in the mulberry tree, it turned out to be a large raccoon. It was eating mulberries and I tried to take video of it as it was climbing down the tree. This reminded me of an essay by E.B. White entitled “Coon Tree.” If you’ve ever read essays by E.B. White, you probably know already that this one is about a lot more than raccoons.

It’s basically about the conflict between nature and technology. The main essay was published in 1956 and a post script was added in 1962. The coon represents nature which White idealizes and contrasts with references to new inventions, including nuclear devices which represent the destructive side of technology.

I guess we can forget for the moment that raccoons can carry diseases like rabies and roundworm. I’m also reminded of an old TV commercial in the 1970s about margarine (an alternative to butter) in which an actor says angrily, “It’s not nice to fool Mother Nature!” The idea was that margarine (which was a new invention in the late 19th century) was healthier than the natural spread, butter—although the trans fat in it makes the comparison a bit more complicated.

White also says something interesting about unsanitary homes, claiming that children who live in them become more resistant to certain diseases like polio than the kids who grow up in clean homes. The polio scourge raised its ugly head recently in New York, which renewed the recommendation by the Centers for Disease Control recently that people who didn’t get vaccinated against polio should get vaccinated—regardless of how dirty your home was.

And then there is the artificial intelligence (AI) technology. I wonder what E.B. White would say about that? AI can improve detection of some diseases and assist in medical research. On the other hand, AI can still make mistakes and it needs human surveillance.

I read you can sometimes use loud noises to keep raccoons out of your yard. For example, you could try recordings of blue jays.

Selected Highlights of CDC ACIP Meeting on Covid-19 Vaccines

Today I’m highlighting a few items of interest to older adults from the summary slide set on Covid-19 vaccines presented on June 23, 2023 at the CDC ACIP meeting last week. Information for other age groups are included in the slide set.

Covid-19 continues to be a major health threat for the population, especially older adults and the immunocompromised. Vaccines are still the most effective intervention. However, the bivalent vaccine uptake was very low; most people didn’t get it.

A new Covid-19 monovalent vaccine with an XBB.1.5 composition, is expected to be available this fall.

In the fall, the vaccine manufacturers will switch to the commercial marketplace. In order to continue making Covid-19 vaccines available to the uninsured, there is a Bridge Access Program for Covid-19 Vaccines and Treatments” which is described at the HHS website.

Covid-19 Variants in the News

Sena alerted me to a CBS news item with the headline “CDC tracking new Covid variant EU.1.1.” The story seemed a bit misleading because the FDA just announced approval of vaccines for XBB.1.5. beginning in the fall.

I checked the CDC Data Tracker for variants and noticed XBB.1.5 is still the most common Covid-19 subvariant in the U.S.

While the EU.1.1 is on the list of subvariants tracked, it’s pretty far down the line and is much less common than the news headline seems to suggest. And it’s not clear the new vaccine for XBB.1.5 wouldn’t protect against EU.1.1 as well.

Thoughts on the Passing of Dr. Russell Noyes Jr.

I recently found the obituary of my mentor, Dr. Russell Noyes, Jr. MD. He died on June 21, 2023. This is the first time I’ve ever said that he was my mentor. I probably just didn’t realize it until I found out he passed.

Dr. Noyes was my teacher during the time I was learning consultation-liaison psychiatry back in the 1990s at The University of Iowa Hospitals & Clinics. His knowledge was vast. He contributed greatly to the scientific literature on anxiety disorders. He also wrote about near death experiences.

Dr. Noyes retired in 2002. As his students, we chipped in to get him a retirement gift. It was a large bookstand. We were just a little uncertain about whether a bookstand was the right gift for someone who was a tireless researcher and teacher. He was also an avid gardener and musician. He soon returned to work in the department, staffing the outpatient clinic. He also continued to regularly attend grand rounds and research rounds. Years later at a grand rounds meeting, someone asked him about his retirement. Dr. Noyes retorted, “I don’t believe in retirement.”

I remember I could hardly wait to retire. Since then, I’ve been ambivalent about retirement, but not so much that I ever seriously considered returning to work. I sometimes have dreams about being late for college lectures because I can’t find my way to them. A couple of times lately, I’ve had dreams about not being able to find my way through a hospital to conduct a consultation evaluation. I don’t know what that means.

I was an avid student of consultation-liaison psychiatry but I was not a scientist. That was part of the reason I left the university in 2005 for a position in a private practice psychiatry clinic. He cried at the going away party my students and co-workers held for me. I still have a little book in which well-wishers wrote kind messages. Dr. Noyes’ note was:

“Jim

We’re going to miss you. You are the consummate consultation-liaison psychiatrist and your leaving is a great loss to the Department. We wish you the best and hope to see you at the Academy meetings.

Russ”

His sentiment was one of the main reasons I soon returned to the department, only to leave again a few years later—and return again after a very short time. I came back because he was a consummate teacher and I wanted to learn more from this beacon of wisdom.

Many who knew him, including me, often saw him riding a bicycle on Melrose Avenue to and from work at the hospital. We wondered why he didn’t drive instead. His son James wrote a beautiful remembrance of him and posted it on the web in 2006. It’s entitled “My Dad (Russell Noyes, Jr).”

James says his dad was a terrible driver. This triggered a memory of how it was Russ’s wife, Martie, who drove the rental car when we rode with them from the airport to the hotel where an Academy of Consultation-Liaison Psychiatry meeting was to be held. I remember gripping the armrest and wishing we’d hired a taxi as Martie steered erratically through heavy traffic.

Dr. Noyes knew how to guide his learners through their careers. He also knew how to write and was a stern editor. Even as I wrote this remembrance, I could see how he might have critiqued it. I tried to do it on my own, and of course I failed. It will have to do.

Brief Remarks on CDC ACIP Vaccines Meeting This Week

My impressions of the first couple of days of the CDC ACIP meeting on vaccines will be brief. My wife and I were interested in learning more about the new Respiratory Syncytial Virus (RSV) vaccine. It sounds like the vaccine was upvoted with only a few no votes. Most committee members thought the vaccine was a good idea. It sounds like the decision to get the RSV vaccine should be in the context of a shared-decision making conversation with your doctor.

We didn’t get a chance to hear the presentation on the Polio vaccine. The slides were available and it looks like most people are vaccinated. The recommendation is that if you’re not already vaccinated or incompletely vaccinated, or you’re a health care worker likely to encounter patients with polio, a laboratory worker who might handle material with the polio virus in it, or traveling to regions where you might contract it, then the vaccine would be recommended.

Here is a link to the presentation slides.

CDC ACIP Meeting Today on Vaccines

The ACIP meeting on several vaccines begins today and runs through Friday, 8:00 a.m-5:30 p.m. on the 21st-22nd and 8:00 a.m.-12:40 p.m. on the 23rd, ET.

The committee will discuss vaccines for Respiratory Syncytial Virus in adults, Polio, and Influenza vaccines on the 21st. There will be a vote for each.

They will discuss vaccines for Pneumococcal, Dengue, Chikungunya, Respiratory Syncytial Virus (pediatric and maternal) on the 22nd. They will vote on the pneumococcal vaccine.

They will discuss Mpox, Meningococcal, and Covid-19 vaccines on the 23rd.

Four Seasonal Vaccines for Older Adults?

There are a number of seasonal vaccines recommended for older adults in the U.S. They include vaccines for influenza, pneumonia, and the newest one is Respiratory Syncytial Virus (RSV).

I noticed that during the recent FDA meeting to decide on approval of another vaccine for the XBB variant of Covid-19, many experts objected to the use of the word “periodic” in the voting question.

Those objecting to it did so because of the implicit suggestion that Covid-19 is a seasonal virus. Not all experts agree on that. I gather it takes time to determine whether or not an infectious agent should be considered seasonal or not.

If the XBB variant of Covid-19, RSV, pneumonia, and influenza are all considered seasonal, then there are 4 vaccines for which older adults would be eligible.

The consensus among most experts is that you can take both influenza and Covid-19 vaccines at the same time. Most of us older adults also get the pnemococcal vaccine as well.

Will the RSV vaccine be added to the list? Should you get all 4 at the same time? Or should they be spaced out? Should you get the influenza and Covid-19 vaccines together and wait a week or two before getting the RSV and pneumococcal vaccines?

The increase in recommendations for vaccinations could be burdensome for those without health insurance. Vaccine uptake will probably continue to be a challenge.