Dr. Kevin Most: Gone Viral

Dr. Kevin Most

When a news story or video gets popular, it is said to “have gone viral”. It is interesting that the saying just amplifies what we already know and that is that viruses spread quickly and in many directions. As we enter the virus season, I thought I would share some news about viruses that has come out in the past 2 weeks and has many doctors concerned.

Last year a new drug to fight influenza was released, the drug Baloxavir. Many had high hopes for it as it was a drug that with a single dose could potentially shorten the duration of symptoms dramatically. A paper published this past week shared that a concern has been raised that the drug has a possibility of achieving resistance while still causing infection and allowing for the resistant strain to be spread to others. The study shared the story of a case in Japan where a child was given the drug shortly after the onset of symptoms and a positive test, he was getting better for a few days and then had a relapse of his symptoms. The child was tested again and found to have the mutated strain still causing infection, and what was worse was that the younger sister came down with influenza and the strain was from her brother and resistant to the medication.

We see a lot of resistance in both viruses as well as bacteria, the resistance will usually take some time to form as the medication may be used inappropriately or at an incorrect dose. In this case the drug was appropriate for the infection and was given at the correct dose.

Baloxavir is being considered a “blockbuster” as we have not seen any new influenza drugs in many years.
The medication has great potential and was studied extensively. The single dose is great for compliance and the results show that if given within the first 48 hours of symptoms will give substantial relief and minimize complications. It will lessen the symptoms as well as shorten the amount of time of illness. The focus group for this drug is those over the age of 65 and those with chronic medical problems. We currently have 4 medications to treat the flu but the treatment is not a substitution for the flu vaccine which is truly preventative.

The question being raised now is will this drug be good as a protective measure against getting the flu if a known exposure has occurred. With a flu season that is expected to be bad will we see this drug be prescribed in the hopes of preventing the flu? It has not been tested for this indication, nor would one know exactly when to take the dose for any type of protection. Overuse may lead to more resistance which is a concern.

High Dose Vaccine shortage versus delay

This year’s vaccine was delayed as we have discussed in the past, the concern raised by experts has had many seniors getting their vaccines. This influx coupled with the late vaccine has caused some shortages of the high dose vaccine designed for seniors. There are areas across the US with shortages of the high dose. We know we will eventually have all of the doses needed so this more of a delay than a shortage. Experts are recommending that seniors get vaccinated now and do not wait for the high dose, if a delivery date is not imminent. The senior high dose is about four times as strong as the standard dose. If the senior looks around and finds the access points are out of the high dose vaccine getting the standard dose is better than waiting at this point. Getting a follow up booster may be an option but should be discussed with your doctor based on your medical condition.

With high levels of influenza activity already being seen in the south and southeast the time to be vaccinated is now if you have not already. Remember the predictions for this year have a strain that can impact seniors and those with chronic illnesses dramatically. We will have information soon as to the accuracy of this year’s vaccine.

Measles

Measles, that simple little rash that we all have heard of that some children get. That statement is far from the truth and in the United States we have not had much to worry about as responsible parents made sure their child was protected from this virus with a simple vaccine. Let’s make sure we understand more about this virus, before we had the vaccine available in the US, 3-4 million individuals were infected, 50,000 were hospitalized, 1,000 had encephalitis and 500 died. The widespread compliance of the MMR vaccine in the US has allowed us to protect our children from this disease that continues to cause over 150,000 deaths a year globally.

This year is a record breaking year for Measles cases in the United States, as of early November we were approaching 1,300 cases. This is the highest number of cases in the past 27 years. It has been seen in 31 states and outbreaks have occurred in 10 of those states including Illinois. The vast majority of those who came down with cases were unvaccinated individuals. We have seen this increase as measles is still prevalent around the world and the amount of international travel has only increased.

To show you what I mean, in the Democratic Republic of Congo, this year they have had close to 250,000 cases with close to 5,000 deaths, mostly children. Remember this is a highly contagious disease that can cause pneumonia, deafness and brain infections, in fact 20% of those infected with the virus will have some complication. In 2017 worldwide Measles caused over 100,000 deaths, mainly in Africa and Asia.

Maternal Protection from Measles to Newborns

We give the Measles vaccine at 12 months of age, this is in the MMR vaccine. Prior to hitting that age, it has been felt that immunity has been extended to the newborn from the mothers immune system. This would protect these babies until the time they could be vaccinated. A study came out in late November that showed that our thoughts on that protection is wrong. The study looked at 200 infants and the results have raised concern around the world. This recent study was done to verify what was thought about newborns and the protection from measles extended by their mother. The blood tests actually showed that the immunity does not last a full year, in fact some lost their protection within a month and what was more concerning is that all of the infants had lost their immunity by the age of 6 months.

This is extremely concerning as we assumed that newborns were protected until they were old enough to be vaccinated and have a good response. This study now opens the questions about moving the vaccination time for measles up to possibly 6 months of age, is the child’s immune system advanced enough at that time to make antibodies for protection, or will studies show that we will have to continue at the 12 month mark and understand that these infants will have a 6 moth window where they will not be protected from this potentially deadly virus . We couple that concern with the obvious concern of the rapidly growing number of Measles cases around the world.

This is concerning as we have discussed the contagious nature of this virus as well as the increasing numbers of individuals we are seeing with measles in this country. The concept of “herd immunity” where if we have enough individuals immunized the virus can be contained and not spread is being challenged. This year as of early November we have had over 1,250 cases in the US, a typical year is closer to 200.

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