Bundibugyo virus

...

Democratic Republic of Congo, August 2026.

So basically what they're doing is they're looking at these different, they call them operational indicator values.

Um, and these are different areas where you get a sense of is this thing under control.

Um, and so they look at these operational, oper- operational indicator values for the 21-day period, July 31st to August 21st.

Um, and so the average percent of alerts investigated within 24 hours was, uh, was 83%, and targets to get that over, over 90%.

She was told to do that by RFK Jr.

One of several.

Yes, one of several.

All right, measles.

Two more kids die and one more theater show.

And this is from your local epidemiologist substacked by Caitlin Jetlina.

And we read, last year I got a text from a friend in public health.

I'm going to leave in a link to this.

But I can imagine people who have to work night shifts or whatever, they could say I'm stressed all the time.

It's really unfortunate that we didn't have a vaccine because this, this Bundibugyo virus was just under the radar.

Yeah.

Yeah.

Yeah.

And we're gonna find out here in a moment, but yeah, so, um, CDC, 5,584 cases, 2,680 confirmed deaths.

We've got that really, um, high, um, increase going on.

Um, but I can talk about a couple articles.

Hm

Carolinas are the most.

South Carolina has a huge amount going on there.

Yeah.

Kind of our big area at the moment.

But we have a couple interesting things in the measles section.

And part of it, I think, is hopefully this is like us sort of educating, you know, this message we send.

And so, you know, vaccines, right? Do vaccinated cases transmit measles? A systematic review and meta-analysis was published in Expert Review of Vaccines.

Okay.

Folks, use your vote.

Yeah.

We really have to do something.

I mean, this is, this is a, this is a call to arms.

We have children suffering.

You know, that when you mix politics and medicine, you end up, yes, with hospitalized and dead children.

All right.

Yep.

I will never compromise on that." So let's see, the first time she refuses to obey RFK, let's see if she gets fired.

It, it's gonna be a, a hope.

I hope she does well.

I mean, I really, uh, you know, I think we're all hoping, you know, finally we have, uh, a proper CDC confirmed director.

Um, you know, it seems recently that RFK Jr. has been walking back a few things.

I'm not sure if he's as popular with his base as he used to be.

Uh, he, he was on that, uh, I think it was a CNN interview where he basically said, "Hey, um, you know, people should get vaccinated," and then I think his, um, MAHA people are not so happy that sort of under him and Trump is more pesticides in the, in the waters and in our food.

This administration wants everyone sick.

Mm-hmm.

So.

And we're starting to see, you know, the, the, from very low to low in, you know, Washington, California, Nevada, Texas, a few other places, so we'll keep, we'll keep following this.

All right, and a couple interesting other articles I'm gonna, you know, a little bit about COVID and long COVID.

So, uh, one was the, um, the article, "Remdesivir and All-Cause Graft Loss Among Kidney Transplant Recipients with Symptomatic COVID-19," published in JAMA Network Open.

Um, and you know, there, there was this, um, sort of thing about, "Hey, Remdesivir, it's really expensive.

Let's try to rimit- limit people getting Remdesivir.

Thank you, and thank you for all you do."

Yes.

And it's gonna be one of those things where, um, you know, as time goes by, will, [laughs] will it become seasonal? Will we have, like, thousands and thousands of cases peaking at certain times of the year? Uh, yeah.

Influenza, a couple things.

I promised I would talk about influenza with my, uh, bow tie on, and we're actually gonna be talking about influenza vaccine effectiveness, um, and a couple things.

So first is just in general, the article, Influenza Vaccine Effectiveness Against Outpatient Acute Respiratory Illness With Lab-Confirmed Influenza, United States, 2024-2025 Season, published in CID.

So the, the, as far as influenza A H1N1, PDM09, and influenza-A H3N2, uh, these viruses predominated during the, uh, the last season.

These investigators ex- estimated the influenza vaccine effectiveness in the United States against mild to moderate outpatient influenza illness by influenza type and subtype during that season.

Why don't we take those first?

So I guess the first question is, are there different strains of these bacteria we're talking about today that you're more afraid of or less afraid of? Or as a clinician, or just in general, which one of these guys really scares you to treat a patient?

yeah so let me let me walk through so everyone will feel really comfortable with the names and what they are right so let's start off with listeria right people have maybe heard of listeria before you know and and part of this plays into who's drinking the milk so listeria is a particular bacteria that we worry about in we say extremes of age but it's not really extremes of age it's like little kids and people over the age of 50. over the age of 50 i don't think it's extreme of age i think that's you know proper proper mature age So it's pointed out, right? I mean, so you've got cows, which I really love cows, but they're kind of stinky, right? And you've got the teats where it's coming out.

And the whole idea that that's going to be completely clean and there's no bacteria on there.

And then somehow your hands are going to be completely clean.

And then you're going to somehow get that milk into some kind of a vessel.

And then that's going to stay completely clean.

And then you're going to keep it nice and, you know, nice and chilled so that the bacteria don't double every eight hours, right? Which they can do at at not even that warm a temperature with Listeria, for instance.

I'd be on

Yeah

... big outbreak there, um, back during a time, sort of a dark time in the history of Colorado.

We had a Klan governor, if you can imagine that.

Fort Collins was the home of the KKK newspaper, you know? It's, you know.

So, uh, and so, so CIDRAP has this nice discussion, so l- let me just, uh, share a bit of that, uh, 'cause I think this is really important, right? When, when we're, we're at risk or while we're starting to see these, uh, vaccine preventable illnesses, um, come back into the US.

Uh, so many people today know of polio, which paralyzed up to 58,000 Americans a year at its peak.

Uh, thanks to vaccination, the disease was eliminated in the United States in 1979 and throughout the Western Hemisphere in 1994.

But then when she got COVID, she was in it all the time.

Yeah

... big outbreak there, um, back during a time, sort of a dark time in the history of Colorado.

We had a Klan governor, if you can imagine that.

Fort Collins was the home of the KKK newspaper, you know? It's, you know.

So, uh, and so, so CIDRAP has this nice discussion.

So let, let me just, uh, share a bit of that, uh, 'cause I think this is really important, right? When, when we're, we're at risk or while we're starting to see these, uh, vaccine preventable illnesses, um, come back into the US.

Uh, so many people today know of polio, [clears throat] which paralyzed up to 58,000 Americans a year at its peak.

But then when she got COVID, she was in it all the time.

Well, it's good.

Yeah.

Now, what's the science, right? I mean, that's, that's why we're here.

Th- this is, you know, this decision was based on science.

It was based on the results of a phase three double-blind, active control trial published in May in the New England Journal of Medicine in the article Efficacy and Safety of an mRNA Seasonal Influenza Vaccine in Adults.

So we're gonna talk a little bit about this, and then we're gonna, I'm gonna sort of like, you know, the straw man.

Like, what's, what's the criticism? What are, what are they, they gonna say? So in this study, robust study, 40,703 participants, um, we end up basically with half and half.

It's cleaner preparation, right? It's not old technology and, uh, as you said, you could change the vaccine more quickly as well.

Well, it's good.

Yeah.

Now, what's the science, right? I mean, that's, that's why we're here.

Th- this is, you know, this decision was based on science.

It was based on the results of a phase three double-blind, active control trial published in May in the New England Journal of Medicine in the article Efficacy and Safety of an mRNA Seasonal Influenza Vaccine in Adults.

So we're gonna talk a little bit about this, and then we're gonna, I'm gonna sort of like, you know, the straw man.

Like, what's, what's the criticism? What are, what are they, they gonna say? So in this study, robust study, 40,703 participants, um, we end up basically with half and half.

It's cleaner preparation, right? It's not old technology, and, uh, as you said, you could change the vaccine more quickly as well.

Uh, what, what do you think about that, Danny? Do you really need to have a consumer perspective and social and community-- Isn't this all about whether the vaccines work and they're safe or not?

That, that's really was the narrow focus previously.

Was not, you know, marketing and consumer preferences.

It really was a, um, an expert panel letting us know, are these vaccines safe? Are they effective? Um, should they be recommended? Um, yeah.

All right.

HPV.

Um, this is kinda nice.

Yep.

Uh, what, what do you think about that, Danny? Do you really need to have a consumer perspective and social and community-- Isn't this all about whether the vaccines work and they're safe or not?

That, that's really was the narrow focus previously.

Was not, you know, marketing and consumer preferences.

It really was a, um, an expert panel letting us know, are these vaccines safe? Are they effective? Um, should they be recommended? Um, yeah.

All right.

HPV.

Um, this is kinda nice.

Yep.

Did it mean that I'm functionally cured, that I really, to all intents and purposes, have no HIV and that the medication, as long as I take it for life, acts as, if you like, as a therapeutic vaccine? Or is something else going on? How do you explain it to your patients?

Yeah.

So, you know, it's going to be interesting, like different people, different audience members, you know, whether you're a physician, you're primary care, you're the HIV specialist, you're the patient listening to this.

I think it's important to understand where this conversation fits in.

And Ben and I, it was a while ago, we started talking, what do we think is a really critical thing to talk about? And this is, this is Ben.

This whole concept, because there's been several milestones in our understanding and treatment of HIV.

And I grew up in Greenwich Village, early 1980s.

We regularly retest you.

Yeah

... "the last six years." So hopefully we c- we'll keep doing that.

All right, well, we've got a bunch to talk about.

We'll start off with, with a news item, Health and Ec- Economic Burden of Emerging Infectious Disease in the USA, US Territories, and Globally.

Um, and this is from the BMJ.

Um, and just to give people context, pandemics caused the largest historical and projected unweighted and weighted full burdens in the USA and globally.

Among non-pandemics across unweighted and weighted burdens, dengue and cholera imposed the largest historical and projected full burdens globally.

Yeah.

Yeah

...

the last six years." So hopefully we c- we'll keep doing that.

All right, well, we've got a bunch to talk about.

We'll start off with, with a news item, Health and Ec- Economic Burden of Emerging Infectious Disease in the USA, US Territories, and Globally.

Um, and this is from the BMJ.

Um, and just to give people context, pandemics caused the largest historical and projected unweighted and weighted full burdens in the USA and globally.

Yeah.

Yeah

...

the last six years." So hopefully we c- we'll keep doing that.

All right, well, we've got a bunch to talk about.

We'll start off with, with a news item, Health and Ec- Economic Burden of Emerging Infectious Disease in the USA, US Territories, and Globally.

Um, and this is from the BMJ.

Um, and just to give people context, pandemics caused the largest historical and projected unweighted and weighted full burdens in the USA and globally.

Yeah.

So they're saying this is a Christian country now, this U.S. Well, you know, religion means you care about other people, not charge them.

Yeah.

That actually was what I was sort of thinking about, you know, this whole idea, we're a Christian nation.

I don't see this as being in line with the teachings of Christ, I just have to say.

So, all right.

Okay.

Let's, you know, I was going to say, let's be, anyway, the vaccine that prevents dementia.

Oh my, that's not good.

Not charge them.

Yeah, that, that actually was what I was, uh, sort of thinking about, you know, this, this whole idea, we're a Christian nation.

I don't see this as being in line with the teachings of Christ, I just have to say, so.

All right.

Um, okay.

Let's, let's, you know, I, I w- was gonna say, let's, let's, let's be, uh...

Anyway, the vaccine that prevents dementia.

Oh my, that's not good.

Yeah, it's a big problem.

It's huge, yeah.

If you don't, if you don't have a, an accurate test, I mean, you, the, the clinicians were thinking like, "Hey, this is concerning.

We're having these, you know, cases that appear, and then the test comes back negative." Well, yeah.

Okay, so let's keep going.

So in response to reports of high numbers of suspected cases and deaths in these outbreaks, CDC simulated scenario projections to understand possible future morbidity and mortality.

A branching process model, um, was used, um, and they're basically gonna look at three putative cumulative death counts and projected for four possible intervention scenarios ranging from poor, 20%, to extremely high, 95% levels of isolation and treatment of symptomatic persons.

It's, it's a serious disease, right?

Yeah, it's a big problem.

It's huge, yeah.

If you don't, if you don't have a, an accurate test, I mean, the, the clinicians were thinking like, "Hey, this is concerning.

We're having these, you know, cases that appear, and then the test comes back negative." Well, yeah.

Okay, so let's keep going.

So in response to reports of high numbers of suspected cases and deaths in these outbreaks, CDC simulated scenario projections to understand possible future morbidity and mortality.

A branching process model, um, was used, um, and they're basically gonna look at three putative cumulative death counts and projected for four possible intervention scenarios ranging from poor, 20%, to extremely high, 95% levels of isolation and treatment of symptomatic persons.

It's, it's a serious disease, right?

Yeah.

Yeah.All right, measles, measles.

Couple gl- little bit more on measles this time.

So measles are up to 2,077 so far this year.

Uh, it's another 44 cases, um, just in the, in the last sort of measured week.

Uh, you go to the CDC, they've got us at 1,983.

Um, but I wanted to comment about what's going on in some other places.

Epistemonikos.

Mm

... we do, we do have an Ebola tracker, which, which is not, not really up to date, because if you're looking at the, um, updates from the WHO, um, you know, we're seeing probably over 200 deaths already.

We're seeing, um, over 1,000, um, infected.

Uh, but let's go through a little bit about what, what's, what's going on here.

Um, and so I'm gonna start a little bit with, like, how are, how are we responding in the U.S.? What is the U.S. CDC doing? And so we, we read that the U.S.

CDC seeks staff for Ebola screening as outbreak response expands.

Um, CDC Acting Director, uh, Jay Bhattacharya said in, in this email that the agency had activated a level two emergency response on May 18th to, uh, this outbreak of the Bundibugyo strain of the Ebola virus in the Democratic, uh, Republic of the Congo and Uganda, and was expanding recruitment beyond its usual emergency responder pool as screening of selected international arrivals ramps up.

It's the end of May, and we're already almost to what we were in all of last year.