geoffrey modest medical blogs

  The CDC reported a spike in hepatitis A infections in men who have sex with men (MSM), see https://www.cdc.gov/mmwr/volumes/70/wr/pdfs/mm7024a2-H.pdf  )    Details:   --from 1994-2011, there was a 95% decrease in hepatitis A infections from 12 cases/100K population to 0.4 cases/100K  --from 2012-2015, the number of cases plateaued  --from 2016-2018, the incidence increased 294% vs 2013-2015      --most cases occurred in high-risk people (MSM, homeless, injection and noninjection drug users)     --from Jan 2017-Nov 2018, the CDC reported 260 cases of confirmed hep A (symptoms of viral hepatitis and positive IgM against hepatitis A virus, HAV) in MSM in 8 states (had been 16 cases from all 50 cases during 2013-2015), in California, Colorado, Georgia, Maryland, New York, North Carolina, Pennsylvania and Virginia. These states reported 1,229 additional cases without indication of MSM status    ...

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 ...

As has hit the press over the past few months, there has been a widespread increase in measles cases in the US: 940 cases confirmed in 26 states, as of 5/24/19 (see  https://www.cdc.gov/measles/cases-outbreaks.html ) . Of note: --this is an increase of 60 cases over the prior week --this is the greatest number of cases reported since 1994 (and since 2000, when measles was declared “eliminated”) --  The states that have reported cases to CDC are Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, New Mexico, Nevada, New Hampshire, New Jersey, New York, Oklahoma, Oregon, Pennsylvania, Texas, Tennessee, and Washington.   ie, the whole west coast, the south/west regions (all the way through OK and TX), the more eastern middle of the country (eg IA, MO and through to KY and TN), southeast (FL, GA) and northeast (all but VT) --this is a dramatic increase:  ...

​A retrospective analysis from the CDC  was done of hospitalizations for hepatitis A, using the National Inpatient Sample -- the largest population-based hospital inpatient database in the US, with annual data from about 1000 non-federal hospitals  (see  hepatitis A hospitalizations  hepatol  2015  in  dropbox , or  HEPATOLOGY  2015;61:481-485). they looked at data from 2002 to 2011. results: --hospitalizations for hep A decreased from 0.72/100K to 0.29/100K (which has been attributed to universal vaccination of kids 12-23 months old) --BUT there was          --an increase in the mean age of the hospitalized patient (37.6 to 45.5 years), with increases in those 40-64 and >64 yo groups but decreases in those <18 and 18-39 yo         --an increase in discharge comorbid medical conditions and other liver diseases  ...