This sentence is surprisingly muddy: “Chronic kidney disease is hugely impactful on RSV severe disease, which was surprising but may be helpful if you’re on the fence about the vaccine and have CKD. “ What do you mean to say?
Could you explain more clearly for a layman the sentence “Chronic kidney disease is hugely impactful on RSV severe disease, which was surprising but may be helpful if you’re on the fence about the vaccine and have CKD”. As I have CKD as many older adults do. Tim
I am a vaccine believer. I have had every covid vaccine that has been made available. And I have greatly welcomed and appreciated your thoughts on COVID and vaccines and public health measures and recommendations. Unfortunately I have lost a lot of confidence in the CDC - not in the wisdom of taking the vaccines. I still believe that's good sense and would like to be permitted to take them at least three and maybe four times a year. Particularly if they could be updated twice a year rather than once. But I think your thoughts on the CDC are overstating the case for them in general. I have lost a lot of trust in their pronouncements over the last two years for reasons detailed by others (and I don't mean anti vaxxers and disinformation people) which I won't repeat here in the interest of time and space. The CDC is a bureaucracy and acts like most bureaucracies despite its non-profit, public minded nature. I am disappointed that you seem to have been somewhat coopted by the "reigning" authorities and often echo their line - in fact where you disagree its in the direction of less protection than the CDC would offer. I wish you would examine your posts since you were given so much attention by the CDC and other experts and appeared on TV as an expert etc. and see if you can discern a change in "tone" from your earlier comments. I will continue to read your posts because it's so hard to get even basic information from the CDC website and public comments that your input is welcome. But I lament that I no longer find you to be the "devils advocate" that you used to be.
Thanks for this feedback. I’m sad to hear that you’ve lost confidence or respect or whatever is linked to my tone change. But, I will say, that I’m incredibly happy that I don’t have the same tone than in 2020 or 2021. I think it’s slowly changed, given the changing level of urgency, frustration, and worry. We are in a different place with covid. Ive also learned life times in the past four years about how things work, about policy, about communication, about my voice. I’m a curious person and consider myself a lifelong learner. I’m proud that i’ve learned and grown and still enjoying this. And yes, I made the conscious decision to help the CDC. I knew I would get comments like I’ve “drank the koolaide” but I refuse to complain without providing or being part of solution. This is bigger than me. I want public health to succeed. We need to be on the same team.
Just a quick ask….. I am a non physician health care provider (nurse practitioner) and I LOVE your blog. I was the Covid officer for our organization and have followed you for years. At this point in time, more than 25% of primary care providers in the US are non physicians, and this number is growing every day. I would just ask that, in future posts, you try to use more inclusive language ( perhaps providers instead of physicians). We are all a big team!
Thanks so much for this feedback! I try my darnest and, will be honest, didn't know >25% are non-physicians. But, this is exactly why I said "clinical care provider" instead of physician in the Bottom Line. Am I missing it somewhere else?
Wow that was fast!!!! Not so much in this post specifically ….just general feedback from posts as a whole (I couldn’t quite figure out how to post a general comment that wasn’t specifically related to this most recent topic ). And please don’t feel singled out. My colleagues and I try to provide feedback to the masses on this issue. Nurse practitioners and physician assistants tend to be hidden and at times marginalized. The more we try to use inclusive language, the better! Thanks for considering. And, like I said in my previous post, I have relied on your knowledge and amazing blog for the last four years. It’s been so informative and so helpful both in my professional career and in my life outside of work. Thank you for all that you’re doing!
Did you get your math right? I don't understand what you wrote here.
"There were 21 cases of GBS (out of 9,500,000 vaccinations). This is likely an underestimate of the “true” rate because there’s typically underreporting of these surveillance systems.
This is more than two times higher than the “background rate”—2 cases per 1 million are expected regardless of vaccination.
Seems like 9.5 million time the background rate of 2 cases per million would mean 19 cases of GBS would be expected to occur naturally in those who got the vaccine. That's not more than 2 times the background rate. That means only 2 more cases. Right?
It's clear Katelyn read comments on Feb. 29, the same day I posted this. Maybe she did not see my comment. So far no response from her and no correction in the article.
thank you for this--and all you do! I waited to get the RSV due to the not strong endorsement and the safety signal issues. I am not in the highest risk group, so this really helps inform my thinking about it. You are a gift--just a wonderful communicator.
There seem to be two commonalities between the covid and RSV vaccines:
1) Adverse events for the Pfizer vaccines seem to be higher in the real world versus their trials - why is that? Do the trials need to be redesigned or is the company not completely forthcoming with bad news?
2) Vaccines based on the mRNA technology seem to wane more quickly - which maybe isn’t as big a deal for a seasonal threat like RSV, but is a huge deal for a year-round threat like covid
There’s also the question of whether the public has lost faith in anything based on the mRNA technology thanks to mandating vaccines that didn’t stop transmission and didn’t prevent infection.
What are recommendations for RSV VAX for RSV for pts w an underlying chronic immune neuropathy (like Charcot Marie Toth) but are fully ambulatory and in early 70’s without renal issues. I had advised against it due to GBS. But perhaps this is too conservative?
Thank you for this. I was eligible for the RSV vaccine this year but decided to wait and see what happened in the real world. I know many people who ended up in the hospital this year. Will be getting it next year.
Changing the subject to ask if there is any research to say how durable Novovax is this vaccine season. Thanks for all you do!
Can’t the general public watch it? I watched part of it at work, but I thought it was a public link.
My dad got GBS following a flu vaccine years ago. It was pretty terrifying not knowing what was causing the paralysis, but he recovered without requiring a trach or vent. My mother has chronic kidney disease, and I was surprised at those charts. So glad I talked to her about her getting the vaccine and she did.
I was only able to watch part of it but I’m assuming there was no discussion about immunocompromised under age 65? The mortality and hospitalization rates for immuno with RSV pneumonia are not good. Considering the abysmal uptake, I can’t imagine the downside of opening it up to us.
what is a safety signal???
Good question. An adverse event (side effect) caused by the vaccine
aha! thank you :)
This sentence is surprisingly muddy: “Chronic kidney disease is hugely impactful on RSV severe disease, which was surprising but may be helpful if you’re on the fence about the vaccine and have CKD. “ What do you mean to say?
Could you explain more clearly for a layman the sentence “Chronic kidney disease is hugely impactful on RSV severe disease, which was surprising but may be helpful if you’re on the fence about the vaccine and have CKD”. As I have CKD as many older adults do. Tim
numbers are comforting until you're the exception to the rule.
I am a vaccine believer. I have had every covid vaccine that has been made available. And I have greatly welcomed and appreciated your thoughts on COVID and vaccines and public health measures and recommendations. Unfortunately I have lost a lot of confidence in the CDC - not in the wisdom of taking the vaccines. I still believe that's good sense and would like to be permitted to take them at least three and maybe four times a year. Particularly if they could be updated twice a year rather than once. But I think your thoughts on the CDC are overstating the case for them in general. I have lost a lot of trust in their pronouncements over the last two years for reasons detailed by others (and I don't mean anti vaxxers and disinformation people) which I won't repeat here in the interest of time and space. The CDC is a bureaucracy and acts like most bureaucracies despite its non-profit, public minded nature. I am disappointed that you seem to have been somewhat coopted by the "reigning" authorities and often echo their line - in fact where you disagree its in the direction of less protection than the CDC would offer. I wish you would examine your posts since you were given so much attention by the CDC and other experts and appeared on TV as an expert etc. and see if you can discern a change in "tone" from your earlier comments. I will continue to read your posts because it's so hard to get even basic information from the CDC website and public comments that your input is welcome. But I lament that I no longer find you to be the "devils advocate" that you used to be.
Thanks for this feedback. I’m sad to hear that you’ve lost confidence or respect or whatever is linked to my tone change. But, I will say, that I’m incredibly happy that I don’t have the same tone than in 2020 or 2021. I think it’s slowly changed, given the changing level of urgency, frustration, and worry. We are in a different place with covid. Ive also learned life times in the past four years about how things work, about policy, about communication, about my voice. I’m a curious person and consider myself a lifelong learner. I’m proud that i’ve learned and grown and still enjoying this. And yes, I made the conscious decision to help the CDC. I knew I would get comments like I’ve “drank the koolaide” but I refuse to complain without providing or being part of solution. This is bigger than me. I want public health to succeed. We need to be on the same team.
Just a quick ask….. I am a non physician health care provider (nurse practitioner) and I LOVE your blog. I was the Covid officer for our organization and have followed you for years. At this point in time, more than 25% of primary care providers in the US are non physicians, and this number is growing every day. I would just ask that, in future posts, you try to use more inclusive language ( perhaps providers instead of physicians). We are all a big team!
Thanks so much for this feedback! I try my darnest and, will be honest, didn't know >25% are non-physicians. But, this is exactly why I said "clinical care provider" instead of physician in the Bottom Line. Am I missing it somewhere else?
Wow that was fast!!!! Not so much in this post specifically ….just general feedback from posts as a whole (I couldn’t quite figure out how to post a general comment that wasn’t specifically related to this most recent topic ). And please don’t feel singled out. My colleagues and I try to provide feedback to the masses on this issue. Nurse practitioners and physician assistants tend to be hidden and at times marginalized. The more we try to use inclusive language, the better! Thanks for considering. And, like I said in my previous post, I have relied on your knowledge and amazing blog for the last four years. It’s been so informative and so helpful both in my professional career and in my life outside of work. Thank you for all that you’re doing!
Your thoughts on the ACIP mentioned physicians, scientists and the CDC.
Did you get your math right? I don't understand what you wrote here.
"There were 21 cases of GBS (out of 9,500,000 vaccinations). This is likely an underestimate of the “true” rate because there’s typically underreporting of these surveillance systems.
This is more than two times higher than the “background rate”—2 cases per 1 million are expected regardless of vaccination.
Seems like 9.5 million time the background rate of 2 cases per million would mean 19 cases of GBS would be expected to occur naturally in those who got the vaccine. That's not more than 2 times the background rate. That means only 2 more cases. Right?
I was just thinking the same thing. 2 x 9.5 = 19.
One ACIP report has totally different numbers (https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2024-02-28-29/07-RSV-Adults-Melgar-508.pdf):
GSK Arexvy: 10 GBS cases (95% CI 2–18) per 1 million doses administered
Pfizer Abrysvo: 25 GBS cases (95% CI 7–43) per 1 million doses administered
Background: 5 GBS cases per 1 million doses administered
I wonder if there might have been an editing glitch.
I came to the comment section to see if I was the only one to think THIS.
It's clear Katelyn read comments on Feb. 29, the same day I posted this. Maybe she did not see my comment. So far no response from her and no correction in the article.
thank you for this--and all you do! I waited to get the RSV due to the not strong endorsement and the safety signal issues. I am not in the highest risk group, so this really helps inform my thinking about it. You are a gift--just a wonderful communicator.
There seem to be two commonalities between the covid and RSV vaccines:
1) Adverse events for the Pfizer vaccines seem to be higher in the real world versus their trials - why is that? Do the trials need to be redesigned or is the company not completely forthcoming with bad news?
2) Vaccines based on the mRNA technology seem to wane more quickly - which maybe isn’t as big a deal for a seasonal threat like RSV, but is a huge deal for a year-round threat like covid
There’s also the question of whether the public has lost faith in anything based on the mRNA technology thanks to mandating vaccines that didn’t stop transmission and didn’t prevent infection.
Don’t forget the very scary side effects (for some of us) unlike anything we had experienced before or since.
Ty so much!
What are recommendations for RSV VAX for RSV for pts w an underlying chronic immune neuropathy (like Charcot Marie Toth) but are fully ambulatory and in early 70’s without renal issues. I had advised against it due to GBS. But perhaps this is too conservative?
Yikes. I had the RSV shot pretty much as it became available.
I have CKD,; stable at the border of Stage 3A and 3B for about 7 years now. Very focused on keeping it that way.
Thank you for this. I was eligible for the RSV vaccine this year but decided to wait and see what happened in the real world. I know many people who ended up in the hospital this year. Will be getting it next year.
Changing the subject to ask if there is any research to say how durable Novovax is this vaccine season. Thanks for all you do!
Can’t the general public watch it? I watched part of it at work, but I thought it was a public link.
My dad got GBS following a flu vaccine years ago. It was pretty terrifying not knowing what was causing the paralysis, but he recovered without requiring a trach or vent. My mother has chronic kidney disease, and I was surprised at those charts. So glad I talked to her about her getting the vaccine and she did.
I was only able to watch part of it but I’m assuming there was no discussion about immunocompromised under age 65? The mortality and hospitalization rates for immuno with RSV pneumonia are not good. Considering the abysmal uptake, I can’t imagine the downside of opening it up to us.
Did they break down CKD by stage?
Did they discuss the RSV vax for pregnant people and/or infants? Curious how that is playing out. Thanks!
RSV for infants is a totally different medication. The two adult vaccines are only recommended for 60+ people, very few of whom are pregnant.
The summary here doesn't mention childhood vaccine for RSV being discussed yesterday or today.
https://www.cdc.gov/vaccines/acip/meetings/slides-2024-02-28-29.html
Do you have data on atrial fibrillation rates after the RSV vaccine in the real world data? I know the rates were higher in the initial studies.