HEALTH   UPDATES

Parvovirus, aka 'slapped cheek disease' is on the rise. These are the signs. Fri, August 16, 2024.   Cases of parvovirus B19, or more commonly the "slapped cheek disease," are rising, especially among children, in the United States.  The U.S. Centers for Disease Control and Prevention issued a health advisory warning about an increase in parvovirus B19 activity across the country, the greatest surge, children ages five to nine.

The highly contagious viral infection is usually mild in healthy people but can cause complications in certain individuals.  According to the CDC, the proportion of people of all ages in the U.S. with antibodies for parvovirus B19,

• rose from less than 3% during 2022–2024 to 10% in June 2024
• Among children ages five to nine, it increased from 15% to 40%.
• reported clusters of the virus associated complications among pregnant people
• and people with sickle cell disease.

What is human parvovirus B19?  Human parvovirus B19, a common and highly contagious seasonal respiratory infection, Dr. William Schaffner, professor of infectious diseases at Vanderbilt University Medical Center.  Infections are most common in the late spring and summer.

The infection is often referred to as "slapped cheek disease" due to the characteristic facial rash it can cause, but it may be referred as "fifth disease."  This is because it was fifth on a numbered list of viral childhood illnesses that cause rashes clinicians developed in the 1990s.

The flu-like symptoms typically last five days, during which a person is most infectious.  Later in the illness, a very distinctive bright red rash can appear on both cheeks of the face.  Per the Mayo Clinic, in the U.S., many adults are immune to parvovirus, likely a previous unnoticed infection during childhood.   

• About 50% of adults will have
• By the age of 20 - 70% will have antibodies by age 40

How does human parvovirus spread?  Human parvovirus B19 is highly transmissible and spreads from person to person through respiratory droplets.  The droplets, produced when an infected person coughs or sneezes, typically through close personal contact, per the CDC.  

Children typically spread it amongst themselves and bring it home from school and infect adults.   Less commonly, transmitted during pregnancy from mother to fetus, or through blood transfusions.

Parvovirus B19 infection typically does not cause symptoms or mild and flu-like or nonspecific.  Symptoms include:

• Fever
• Headache
• Cough
• Sore throat
• Runny nose
• Rash
• Joint pain

Joint issues.  Adults are less likely to develop a face rash and may experience other severe symptoms which include joint pain and swelling of the hands, wrists, knees or ankles.  These may look like rheumatoid arthritis.

How to prevent parvovirus.  There is no vaccine to prevent parvovirus B19.  Following basic hygiene practices and measures to prevent the spread of respiratory viruses can reduce the risk of parvovirus B19 infection.  These include:

• Frequent handwashing
• Covering coughs and sneezes
• Avoiding contact with sick people
• Keeping sick children at home

Gen X, millennials face higher risk of 17 cancers than older generations.  Researchers aren’t sure why but say a combination of factors, including obesity, more sedentary behavior, common medications or chemical exposures, is possible.   July 31, 2024, 3:31 PM PDT.  A study published in Lancet Public Health found that Gen X and millennials are more likely to be diagnosed with 17 types of cancer, including nine that have declined in older adults.  Researchers say obesity is likely a leading cause.

Rates of colorectal cancer — has been rising among younger people for decades, a troubling trend that sparked investigation into other types of cancer.  The data included 34 types of cancer, nearly 24 million diagnoses and more than 7 million deaths.

Seventeen of the 34 cancers, risks were two to three times higher in people born in 1990 for pancreatic, kidney and small intestine cancers, compared to people born in 1955.  Liver cancer diagnoses in women followed the same pattern. 

After declining for decades, these types of cancers ​​have begun to climb again:

• Colorectal
• Endometrial
• Non-cardia gastric
• Gallbladder
• Ovarian
• Testicular
• Anal
• Estrogen-receptor positive breast cancers
• HIV-linked cancer called Kaposi sarcoma 

The study found mortality declined or stable in younger generations for most cancers, but mortality rates increased among younger age groups for endometrial, intrahepatic bile duct, gallbladder, colorectal and testicular cancers, as well as liver cancer among women.  Endometrial cancer was the fastest growing for both diagnoses and mortality.

Dr. Otis Brawley, Bloomberg Distinguished Professor of Oncology and Epidemiology, Johns Hopkins University, “these cancers are linked to the obesity epidemic, the second-leading cause of cancer behind tobacco use. 

Among children, obesity rates grew from 5% to 17% in the same period.  Today, more than 40% of American adults and about 20% of children and adolescents are obese, the Centers for Disease Control and Prevention reports. 

Whooping Cough May Be on Pace for a 5-Year High in U.S.   Aug. 15, 2024.  Researchers say a combination of factors, including obesity, more sedentary behavior, common medications or chemical exposures, is possible for the rise.  Whooping cough, or pertussis, is back with a vengeance and could threaten people who are vaccinated against the disease, since protection fades over time.

According to the CDC, 10,000 cases of whooping cough have been reported in the U.S. so far this year, with weekly reports indicating cases have more than tripled 2023 levels as of June.  In 2023, there were 2,815 cases reported during the entire year.

Why the Whooping Cough Vaccine Is Important.  Whooping cough is a very contagious bacteria and vaccination is an important step to avoid it.  Public health officials believe the resurgence of whooping cough is likely due to declining vaccination rates, due to missed vaccines during the height of the COVID pandemic.  Diphtheria, tetanus, and pertussis vaccines (DTaP) have been given together since the 1940s, typically during infancy and during early childhood.

Whooping cough, caused by the Bordetella pertussis bacteria.  The bacteria attaches to tiny, hair-like extensions in the upper respiratory system called cilia and toxins released by them damage the cilia and cause airways to swell.  Early symptoms, similar to the common cold, eventually leads to coughing fits and a high-pitched “whoop” sound made when inhaling after a fit subsides.  Coughing fits can be so severe which can fracture a rib. 

• 1 in 3 babies under age 1 with whooping cough will need to be hospitalized.
• Of those hospitalized, 1 in 100 will die from complications. 
• Vaccinated people may get a less severe illness, compared to unvaccinated people,
• Babies and children are particularly at risk for severe and even potentially deadly complications.

VARIANT   UPDATES

COVID is surging again. Here’s the latest on new variants, updated vaccines, and masking.  AAMC, Aug. 14, 2024.  The latest, highly contagious subvariants are driving infections, but new vaccines expected this fall may help stem the tide of another wave — if people get immunized!  There’s one thing that’s predictable about the virus causing COVID-19, it will continue to evolve and find new ways to infect and reinfect the world’s population.

The latest mutations of SARS-CoV-2 — specifically KP.1, KP.2, KP.3, and their sub-lineages,  

accounted for most infections in the United States as of the first week of August, according to Centers for Disease Control and Prevention (CDC) surveillance.

Slightly greater transmissibility, partial escape from immunity and waning immunity from previous vaccinations and infections, set the stage for another summer COVID-19 surge, explains David Montefiori, PhD, director of the Laboratory for HIV and COVID-19 Vaccine Research and Development in the Department of Surgery at Duke University School of Medicine in Durham, North Carolina.

How are new variants different from previous strains?  SARS-CoV-2 is constantly evolving, but most of the mutations are inconsequential.  There are many subvariants we don’t even hear about, just the ones that are most common at a particular time.

The KP.2 and KP.3 variants, which are now dominant, are part of a strains referred to as FLiRT, because part of the virus where they mutated are subvariants of JN.1, a subvariant of omicron.

There’s little difference between the JN.1, KP.2 and KP.3, variants, with all three escaping immunity five- to tenfold, compared to the XBB variant.  Scientists are most concerned when mutations occur to the spike protein, which is what the virus uses to attach to and infect cells.

The spike protein is also the part of the virus that the vaccines have been developed to target. The FLiRT variants have several minor mutations to the spike protein, enough to trick antibodies, for a while but not enough to completely evade immunity. 

How long are you protected after getting a COVID-19 vaccine or infection?   Antibodies are triggered from a vaccination or an infection, generally lasting three to four months, according to Kawsar Talaat, MD, a vaccinologist and associate professor in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins School of Medicine in Baltimore.

COVID-19 cases are increasing this summer because people not recently vaccinated or infected, have fewer antibodies at the ready to fight off the first sign of the virus and more likely to experience symptoms - including fever, chills, sore throat, cough, congestion, body aches, gastrointestinal issues and fatigue.

Data showed vaccine induced immunity waning over time, indicating there’s a need to target the circulating variants.  As of May, 22.5% of adults in the United States reported receiving the updated 2023-2024 vaccine released last fall and tailored to the XBB variant, dominant at that time.  Many infected now have significantly reduced immunity to the current mutated virus. 

Those with healthy immune systems, previously vaccinated or infected are still less likely to experience the more severe cases of COVID-19 that result in hospitalization or death.  Thanks to the immune system’s second layer of defense, T cells, which attack and kill infected cells shutting down virus production. 

Will the new vaccines target the latest variant?  The FDA’s vaccine advisory committee debated options:

• to recommend manufacturers develop vaccines targeted towards JN.1,
• or targeted toward the FLiRT variants.

Complicating the decision was Novavax, an American biotechnology company, had already developed a JN.1-targeted vaccine but wouldn’t have time to change the formulation before the fall.  Novavax’s vaccine is the only protein-based COVID-19 vaccine that doesn’t use the newer mRNA technology Moderna and Pfizer-BioNTech used. 

The mRNA vaccines are very safe and can be more quickly adapted to the FLiRT variants.  In preclinical trials, Moderna found a previous version of the vaccine updated to target JN.1 also showed high levels of neutralizing antibodies against FLiRT variants.  All three manufacturers are awaiting FDA approval to begin distributing vaccines.

It is important to remain up-to-date on vaccinations.  Those older than 65 or who have weakened immune systems, a boost of the currently available vaccines will still provide substantial protection.  The CDC recommends those in high-risk categories to get a second dose of vaccine at least four months after their last booster and get the updated 2024-2025 vaccine once available.

Is it time to wear a mask again?  Mask mandates are in the past, but some physicians advise strategic masking.  Anthony Fauci, MD, former director of the National Institute of Allergy and Infectious Diseases, said he wears a mask when on a plane or in a crowded indoor place, because he is 83 years old and at high risk of severe COVID-19.  If you’re in a community where the virus is surging, it is smart to wear a mask if indoors or crowded conditions. 

What if I get COVID-19?  If you start to experience COVID-19 symptoms, the CDC recommends:

• isolating to prevent spreading the virus to others,
• taking an at-home COVID-19 test.
• Those in high-risk groups see their doctor for a prescription of the antiviral medication Paxlovid.  This includes:
• people 65 and older or
• anyone over age 12 with a condition that is a risk factor for severe COVID,
• those with diabetes, asthma, heart disease, obesity, or pregnancy
• Paxlovid treatment reduced hospitalization by 26% and death by 73%.

VACCINE   UPDATES

The CDC Director adopted the ACIP’s recommendations for use of the 2024–2025 COVID-19 vaccines in people ages 6 months and older as approved or authorized by FDA. The 2024–2025 vaccines are expected to be available in fall 2024.

Staying Up to Date with COVID-19 Vaccines.   JULY 3, 2024. 

WHAT TO KNOW

• CDC recommends the 2023–2024 updated COVID-19 vaccines—Pfizer-BioNTech, Moderna, or Novavax—to protect against serious illness from COVID-19.
• Everyone 5 years and older should get 1 dose of an updated vaccine to protect against serious illness from COVID-19.
• Children 6 months to 4 years may need multiple doses of vaccines to be up to date, including at least 1 dose of updated vaccine.
• People who are moderately or severely immunocompromised may get additional doses of updated vaccine.
• People 65 years and older who received 1 dose of any updated 2023-2024 COVID-19 vaccine (Pfizer-BioNTech, Moderna or Novavax) should receive 1 additional dose of an updated vaccine at least 4 months after the previous updated dose.

Vaccines you may need. 

• Recommendations for Everyone Aged 5 Years and Older
• 1 dose of an updated COVID-19 vaccine to protect against serious illness.  None of the updated 2023-2024 vaccines is preferred over another.
• Children aged 5 years – 11 years who are not vaccinated or have gotten previous COVID-19 vaccine(s)
• unvaccinated or have previously gotten a COVID-19 vaccine before September 12, 2023, should get 1 updated Pfizer-BioNTech or Moderna COVID-19 vaccine.
• People aged 12 years and older who are not vaccinated should get either:
• 1 Dose - Pfizer BioNTech (updated vaccine)
• 1 Dose - Moderna (updated vaccine)
• 2 Doses - 1st Dose of Novavax (updated vaccine), 2nd Dose of Novavax (updated vaccine) 3-8 weeks after 1st dose
• People aged 12 years and older who got previous COVID-19 vaccine(s)
• got Pfizer-BioNTech or Moderna vaccines before September 12, 2023, or Novavax vaccine before October 3, 2023, should get 1 updated Pfizer-BioNTech, Moderna, or Novavax vaccine.

Disclaimer‎ - People aged 12 years and older who have not previously gotten any COVID-19 vaccine doses and choose to get Novavax should get 2 doses of updated Novavax vaccine to be up to date.

• People Aged 65 years and Older
• not previously received any COVID-19 vaccine doses and choose to get Novavax should get 2 doses of updated Novavax vaccine, followed by 1 additional dose of any updated 2023–2024 COVID-19 vaccine to be up to date.
• Recommendations for Children Aged 6 Months – 4 Years, Who Are Not Vaccinated should get two or three doses of updated COVID-19 vaccine depending on which vaccine they receive.
• Pfizer-BioNTech
  • 1st Dose - Pfizer-BioNTech (updated vaccine)
  • 2nd Dose - Pfizer-BioNTech (updated vaccine) - 3–8 weeks after 1st dose
  • 3rd Dose - Pfizer-BioNTech (updated vaccine) - At least 8 weeks after 2nd dose

Note: Children this age may receive Moderna vaccines after the first or second Pfizer-BioNTech vaccine in some situations.

• Moderna vaccine:
  • 1st Dose - Moderna (updated vaccine)
  • 2nd Dose - Moderna (updated vaccine) - 4–8 weeks after 1st dose

Note: Children this age may receive Pfizer-BioNTech vaccines after the first Moderna vaccine in some situations.

• Children Who Got Previous COVID-19 Vaccine(s) before September 12, 2023, should get one or two doses of updated vaccine depending on which vaccine and the number of doses they’ve previously received.
• Pfizer-BioNTech
  • 1st dose - Pfizer-BioNTech
  • 2nd Dose - Pfizer-BioNTech (updated vaccine) - 3–8 weeks after 1st dose
  • 3rd Dose - Pfizer-BioNTech (updated vaccine) - 8 weeks after 2nd dose
• If you received two or more previous doses of Pfizer-BioNTech vaccine:
  • 1 Dose - Pfizer-BioNTech (updated vaccine) At least 8 weeks after last dose

Note: Children this age may receive Moderna vaccines after the first or second Pfizer-BioNTech vaccine in some situations.

• If you received one previous dose of Moderna vaccine:
  • 1 Dose - Moderna (updated vaccine) - 4–8 weeks after 1st dose
• If you received two or more previous doses of the Moderna vaccine:
  • 1 Dose - Moderna (updated vaccine) - At least 8 weeks after 1st dose

Note: Children this age may receive Pfizer-BioNTech vaccines after the first Moderna vaccine in some situations.

• People who got the Johnson & Johnson/Janssen COVID-19 vaccine
  • You are up to date when you get 1 updated COVID-19 vaccine.

How to Protect Yourself?  Getting vaccinated is your best bet!

IT’S NOT OVER!

Stay safe.  Mask.  Social distance. 

Frequent hand washing.  Avoid crowds

        ALWAYS CONSULT YOUR PERSONAL HEALTH CARE PROFESSIONAL

• https://www.aamc.org/news/covid-surging-again-here-s-latest-new-variants-updated-vaccines-and-masking
• https://www.cdc.gov/covid/vaccines/stay-up-to-date.html?s_cid=SEM.MS:PAI:RG_AO_MS_TM_A18_C-CVD-Variant-Brd:what%20is%20the%20new%20strain%20of%20covid:SEM00075&utm_id=SEM.MS:PAI:RG_AO_MS_TM_A18_C-CVD-Variant-Brd:what%20is%20the%20new%20strain%20of%20covid:SEM00075
• https://www.webmd.com/children/news/20240815/whooping-cough-may-be-on-pace-for-5-year-high-us
• https://www.sciencedaily.com/releases/2024/08/240801004050.htm
• https://www.yahoo.com/news/parvovirus-aka-slapped-cheek-disease-040401683.html
• https://www.nbcnews.com/health/cancer/cancer-gen-x-millennials-17-types-reverse-trend-rcna164376