Infants under 6 months old remain among highest-risk groups for Covid-19 hospitalization.
That and other stories in "Five on Friday" for September 27, 2024...
Item 1: Infants remain among highest risk group for Covid-19.
The CDC released data and analysis on Covid-19 hospitalizations among infants ages 0-5 months yesterday. As in the past, other than seniors ages 75 and up, infants are the group with the highest rate of hospitalization per capita, reflecting the fact that infants in this group are not old enough to be vaccinated and have no prior immunity from previous infections. However, maternal vaccination during pregnancy appears yet again to be protective, as we’ve seen in other data in the past. Most of the infants hospitalized were those whose mothers had not received a Covid-19 vaccine during pregnancy. All of the infant deaths (9 out of 1,148 with full data) occurred in those whose mothers had not been vaccinated during pregnancy. Also, among cases involving infants whose mothers had received vaccinations during pregnancy who were hospitalized for Covid-19, there seemed to be a correlation with when the dose was given, with the most hospitalizations occurring among mothers who received a vaccine in the first trimester, somewhat lower numbers in those who got their dose in the second trimester, and the least among those who were vaccinated in the third trimester. This suggests that antibodies fade, and third trimester dosing may be the best. We’ve seen this before in other data.
Analysis. Pregnancy should be an indication for an additional Covid-19 vaccine dose. It currently is not and that is wrong. I will continue to beat this drum, just as I have been since 2022, when Dr. Sonja Rasmussen, Dr. Denise Jamieson, and I published an editorial in one of the American College of Obstetricians and Gynecologists top journals. Right now, if you’re pregnant you can get a dose of the vaccine, just like anyone else. But imagine a person who is not pregnant now (or doesn’t know they are) who watches the news and hears that they should go get a Covid vaccine now. What if they become pregnant soon? They’ll be in the second or third trimester in late winter and spring. By then, their vaccine antibodies will have waned markedly. However, they won’t be eligible for another dose, because they already got their yearly one now. This is absolutely crazy. The CDC should get it together and allow pregnant individuals to get an extra dose during their second or third trimester. Why they haven’t moved on this remains a mystery to me, as pregnancy and infancy are dangerous times.
Item 2: H5N1. Are we missing cases?
Bird flu continues to be a problem mostly of animals. But people, mostly working with farm animals, have contracted H5N1, albeit so far with mild illness. A recent case in Missouri caught my eye for two reasons. First, it was the first one in which the patient had no known contact with farm animals. So, nobody knows how they got it. (It’s a relief that the patient recovered, because they were described by the CDC as having had “severe underlying conditions”.) Second, it appears that two healthcare workers and a household contact of the patient also became ill, although not all of them had classic influenza symptoms, and so testing was not done for all of them (including the household contact). This is alarmingly bad public health practice. I truly cannot fathom why the household contact was not tested, nor the second healthcare worker because “the illness had resolved before the investigation began.” Oh my god, CDC, just test these people! Fortunately, blood tests may now shed some light. Updates are expected.
Analysis. The idea that the CDC did not test household contacts of a known H5N1 patient boggles my mind. We are extravagantly lucky that H5N1 is not spreading in humans right now. But if it starts to happen—either because of changes in conditions (these are indeed seasonal viruses) that make it more likely or viral changes—we are going to need public health officials to do whatever they can to prevent spread. The way these investigations have unfolded does not bode well. My message to public health officials is this: don’t get fancy with symptoms and timing. Just test close contacts of anyone with a confirmed case of H5N1. You’ll find mildly symptomatic and asymptomatic cases.
There have been 14 documented human cases of H5N1 in the US this year. I’m sure there have been more. That said, I do not think it is tons more. If there were hundreds or thousands of cases, we’d see spikes in illnesses where we otherwise would not expect them. That has not happened so far, but we’re playing with fire.
Item 3: White House hosts firearm safety event, and moves to make the nation safer for children.
A year ago, the Biden Administration opened the White House Office of GunViolence Prevention. Yesterday the President and Vice President Harris hosted an event in the East Room of the White House in which they announced some steps the government is taking to improve firearm safety in the US. Key actions include:
Improving school-based active shooter drills. As a parent, there is little that makes my blood boil more than the notion that my children would ever have to participate in an active shooter drill. It seems so senseless and pointless. I am relieved that, so far, my 6-year-old does not know about such things. It’s only a matter of time, though, and it breaks my heart. Active shooter drills that involve participation from kids are likely not evidence based (i.e., probably useless) and may even be harmful, because they traumatize while likely add zero safety benefit.
Medicaid reimbursement for doctors who counsel parents on safe gun storage. Starting in October, states will be able to (if they want) “choose to use Medicaid to pay a health care provider for counseling parents and caregivers on firearm safety and injury prevention.” This is good. Every second a doctor spends with a patient is valuable. Given that firearms are the leading cause of death in US children and adolescents, this is likely time and money well spent.
For more, here’s the readout from the event.
Item 4: Reminder! Join me for a Live Q&A about the Supreme Court and healthcare law.
Today at 2pm ET, I’ll be speaking with Lawrence Gostin, JD about some important US Supreme Court cases that affect healthcare in the US. We’ll cover recent cases and take your questions. To join us, please follow @Medpage on Instagram and navigate over at 2pm.
Item 5: Poll of the Week.
Here are the results from the last poll. Thanks for your votes! The correct answer is Nigeria. This was also a bit of a geography quiz. Nigeria has a population of 228 million people, the most of any nation in Africa. So, that might have been a hint.
Item 5a: Poll of the Week for this week!
Medical trivia time. No Google or other resources allowed.
That’s it. Your “Friday Five!” Questions? Comments? Please chime in!
Feedback! Have any ideas for next week’s Poll of the Week? Any great articles you have read elsewhere that you want to share with the Inside Medicine community?
Thank you for saying things that need to be said. How might readers help advocate for improved guidance/access for C19 immunization during pregnancy and for more diligent, common sense H5N1 surveillance? Thank you for your work.