geoffrey modest medical blogs

  A recent article reviewed the resurgence of tetanus in the US that is associated with inadequate tetanus vaccine administration: see tetanus resurgence JAMA2026 in dropbox, or doi:10.1001/jama.2026.9347 A few background issues: -- tetanus is ubiquitous in nature -- clinical tetanus develops in humans when the spores of the Clostridium tetani bacteria germinate in anaerobic environments; the spores release the tetanus toxin tetanospasmin     -- the typical scenario is having a contaminated or deep wound providing anaerobic conditions     -- the diagnosis of tetanus is a clinical one: there are no diagnostic tests that support or rule out tetanus -- this toxin affects the sympathetic nervous system by interfering with the release of neurotransmitters, resulting in sustained muscular contraction and spasms -- this effect involves many different muscles, leading to respiratory failure from chest wall spasms, diaphragmatic dysfunction, laryngospasm and airway obs...

  --as we quickly approach the post-science darkening ages, i thought it would be useful to recirculate an old blog on measles. But first, some comments on the anti-vaxxers and polio:       -- per the NY Times: "The lawyer helping Robert F. Kennedy Jr. pick federal health officials for the incoming Trump administration has petitioned the government to revoke its approval of the polio vaccine, which for decades has protected millions of people  from a virus that can cause paralysis or death…that campaign is just one front in the war that the lawyer, Aaron Siri, is waging against vaccines of all kinds ”: https://www.nytimes.com/2024/12/13/health/aaron-siri-rfk-jr-vaccines.html       --it is abundantly clear that the polio epidemic in the US in the 1950s led to both lots of morbidity and mortality back then, that lots of post-polio muscular problems until now, that the vaccine invented then by Jonas Salk dramatically stemmed the virus...

the CDC just published their updated, 2020 immunization schedule for adults. there are a few changes from last year: influenza for 2019-2020 season: no preferential recommendation for one vaccine over another. the live attenuated intranasal vaccine is okay up to age 49, for most people without imunocompromising conditions including HIV or functional asplenia, but also those pregnant, are caregivers of severely immunocompromised people, have taken antiviral influenza meds in prior 48 hours, or have cochlear implants. hepatitis A: now includes all with HIV. HPV: should do catch-up vaccines in all adults (ie, including males) til age 26, and shared clinical decision-making through age 45 MMR: new language that health care workers born after 1957 without evidence of immunity should get 2 MMR doses, 4 weeks apart; those born before 1957 and no evidence of immunity "consider" 2-dose schedule Meningococcal ...