This Week in Public Health

Ok, I’ve changed the name of this series of medically related posts; it used to be This Week in COVID. The name change acknowledges the change in threats to the public’s health as well as the changing content in Dr Klotman’s weekly video addresses as well as my own interests.

The highlights this week are:

Bird Flu

• The first US case of severe bird flu, an elderly person in Louisiana, has died. The individual had a strain of H5N1 Flu found in wild birds but not dairy cows. The patient’s viral strain genome had some unique mutations that facilitate human infection.
• So far there is no evidence of person-to-person transmission of any H5N1 variant.
• The 13-year-old girl in British Columbia who developed a similar severe H5N1 infection survived a long ICU stay and has recovered.
• The CDC has recommends wearing PPE (masks, goggles, face shields) for individuals working around birds or cattle.
• Cat owners whose pets are indoor/outdoor should be aware that cats that eat infected birds can acquire H5N1 that way. Infected felines, including “big cats” often die.

HMPV

• There has been a large outbreak of Human Meta Pneumovirus (HMPV) in China.
• HMPV is an RSV-like viral respiratory infection that’s been around for 60 years.
• The China outbreak is not a novel virus like SARS or COVID.
• HMPV is a childhood disease that, like RSV, can be severe.
• Most adults have minimal symptoms, but it can be severe in folks 65+.

Respiratory Virus Season

• As in many prior years, Influenza, RSV, and COVID are all on the upswing. Influenza cases outnumber RSV cases which outnumber COVID cases this week.
• Most of the flu cases are Influenza A – strains H1N1 and H3N1, both of which are in this year’s Flu vaccine.
• Texas Flu activity is High to Very High at this time.
• COVID activity is trending upwards with both diagnosed cases and hospitalizations.

Norovirus

• Norovirus is a virus often associated with diarrheal illness aboard cruise ships.
• It’s the most common cause of foodborne illness (vomiting & diarrhea) in the US.
• New strains show up regularly as a result of mutations and recombination events.
• Norovirus accounts for about 900 deaths each year – mostly among the elderly.
• We get this disease from food handlers (think cruise ships) as well as contaminated items (ie. fomites: think The Velveteen Rabit) and even contaminated surfaces (hand rails, food trays, etc.)
• Norovirus activity is at a 10-year high.

Personal Notes

Susan and I had the pleasure of sharing dinner yesterday with Dr Enrique Spindel and his wife Monika yesterday. We chatted about many topics including Influenza and public misinformation regarding the vaccine.

Over the years, I have encountered individuals, including nurses, who believed that they had developed Flu after vaccination because the vaccine caused it. Sigh. Depending on the year and the age group, vaccination confers protection to only some percentage of the vaccinated. Among the young, when the vaccine is well-matched to the circulating strains, perhaps 80+% of people vaccinated become immune. Among those of us 65+, a good immune response may occur in only 25% of those vaccinated. So, the most common reasons for getting the Flu after taking the Flu shot are: 1) an inadequate immune response, 2) getting infected with a Flu strain that was not in the vaccine.

As for Norovirus, let me say that I have never been on a cruise ship, but I have had a bout of norovirus illness. I was about 60yo. I was on a business trip and had gone to my favorite Seafood restaurant in Corpus Christi. I ordered Oysters on the half shell, a half-pound of U-peel’em shrimp, and a wedge salad. I returned home within 24hrs and the next morning, at work, became violently ill. The illness lasted about 48hrs and was most unpleasant.

Most foodborne illness is transmitted by the fecal-oral mechanism. Food handlers. please wash your hands!

As for respiratory virus season, please wear your masks when among strangers, crowds, and indoor spaces. There are two big downsides to getting older: 1) Losing the people you love and 2) being far more vulnerable to every damn disease than we were when we were younger.