RSV vaccines effective in seniors. Novavax Covid-19 vaccine approved for 2024-2025.
That and other stories in "Five on Friday" for September 6, 2024...
Item 1: RSV vaccines effective in older adults.
Vaccines against RSV are a relatively new part of our toolkit to fight respiratory diseases and last season was our first opportunity to get real-world data. A new study in the Journal of the American Medical Association found that in recipients ages 60 and up, the RSV vaccines were 75% effective in decreasing hospitalization. Given the estimate that up to 160,000 people are hospitalized in the US each season, it follows that perhaps 120,000 of them could have been prevented by universal vaccination.
However, the study design leaves some uncertainty (it’s a “test negative design,” which is useful but has some limitations) and so the effect might be either smaller or larger. There is always the concern that these studies fail to capture differences between vaccinated people and unvaccinated people, despite all efforts to control the groups being compared. If vaccine recipients were healthier than their unvaccinated counterparts, that could make the vaccines look better than they are, for example. Here, though, the opposite might have occurred, as vaccine recipients were more likely to be older and immunocompromised than their unvaccinated counterparts. That would imply that the vaccine recipients were sicker to begin with, meaning that the vaccine had to overcome that, but still managed to yield 75% lower rates of hospitalization. If there were not other hidden variables—and that’s an unknown—it could be that these vaccines actually worked even better than the data suggest.
One wrinkle is that vaccine uptake was quite low last season. This is not surprising given that last year was the first year it was available. But it means that it’s more likely that there remain hidden variables that could alter these findings. Again, though, that could mean the vaccines either don’t work as well as reported here or that they work even better. Lastly, we are not yet sure how often RSV vaccination is needed. The CDC is not currently recommending yearly shots for high-risk individuals. So, if anyone had an RSV vaccine last year, another dose is not currently recommended.
Item 2: Novavax Covid-19 vaccine authorized for 2024-2025.
The FDA authorized the 2024-2025 Novavax Covid-19 vaccine last week. This is good news for anyone who has lingering concerns about mRNA vaccines. One downside is that changing the "recipe” for more traditional vaccines like the Novavax formulation simply takes longer for scientists. As a result, the 2024-2025 Novavax Covid-19 vaccine encodes for the spike protein of the JN.1 strain of the Omicron variant, which has not been circulating for a while now. Meanwhile, Pfizer and Moderna were able to make a “last minute” switch away from JN.1 for their 2024-2025 vaccines, swapping in a version of a newer variant strain called KP.2. That implies that the Moderna and Pfizer shots will be more likely to prevent infections, although we don’t know whether there will be much difference in other outcomes. While I think all of these options are fine, it would be great if we had clinical data to back up these decisions.
Item 3: What I’m reading: Paralympics categorizations.
The Paralympic Games in Paris are winding down in a few days. It has been good to see increased coverage of the events in the media, and social media has played a role. If you have not encountered blind soccer, for example, check it out. It’s pretty fascinating. Swimming and badminton also looked amazing, from highlights I’ve seen.
Separately, an article in the New York Times entitled, “The Trials of a Paralympian Whose Disability Doesn’t Always Show” captured my interest. First, I learned some basics about how Paralympic competition is organized in terms of varying abilities to make sure that competition is fair. But this article went to a deeper philosophical place concerning the very nature of what a disability is.
As an emergency physician, it is neither my role nor expertise to determine who is designated as disabled or not. What I have seen in my practice is an enormous spectrum in how people see themselves. I’ve met patients who I would consider disabled in some way, but who do not consider themselves disabled at all. And I’ve met patients who identify as disabled, but in ways that were not apparent to me until pointed out. That doesn’t make any of these people wrong, of course. The point is, that it’s not as simple as one might assume and there is often more going on than meets the eye or on initial impression.
Map this onto the high-stakes athletic competition of the Paralympic Games. I found the issues the article covered to be fascinating and I understand the perspectives on all sides. I’d be interested in your views, as there are no easy answers here.
Item 4: National Sickle Cell Awareness Month.
September is National Sickle Cell Disease Awareness Month. Here’s a statement on that from the Biden Administration and some very useful information from the Sickle Cell Disease Association of America, including some descriptions and the difference between sickle cell disease and sickle cell trait (which has important implications). According to the Sickle Cell Disease Association of America, “100,000 Americans live with sickle cell disease, a chronic condition that causes the red blood cells to harden and form a sickle shape. This sickling causes severe and unpredictable pain, intense fatigue, frequent infections and more.”
As an ER doctor, I have seen all of this, including the “and more” part. Sickle cell disease can and does cause organ and life-threatening complications, and the effects can be truly devastating. But there’s a lot we can do to help, and that’s a part of my job I take pride in, when I’m able to contribute.
While anyone can have sickle cell disease (it is genetic), around 1 in 13 African Americans carry at least one copy of the gene that causes it. This makes genetic counseling important for anyone considering starting a family.
Recently there have been some potentially game-changing treatment breakthroughs. I hope we get follow up data on these innovations soon, because they have important implications on the future of this and related conditions.
Item 5: Poll of the Week.
Here are the results from the last poll. Thanks for your votes! The correct answer is 19.
Item 5a: Poll of the Week for this week!
Medical trivia time. No Google or other resources allowed!
That’s it. Your “Friday Five!”
Feedback! Do you like the “Five on Friday” format? 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? Other musings or thoughts?
Please contribute to the Comments!
How do I know if I have RSV, versus, say, a "bad cold?"
Wish you’d gone deeper here, maybe interviewed a vax expert, as my understanding is that KP3.1.1 is about as closely related to JN.1 as KP.3 so no reason to think novavax less effective (and might be more).