Category: Vaccine

This article appeared on our sister site, Drug Topics.

Earlier this month, the FDAs Vaccines and Related Biological Products Advisory Committee recommended that all US flu vaccines transition from quadrivalent to trivalent vaccines for the 2024-2025 flu season.1

The trivalent vaccines formula will still contain the influenza A(H1N1), A(H3N2), and B/Victoria-lineage vaccine virus, but omit the influenza B/Yamagata virus because it is no longer actively circulating.

FDA has been engaging and interacting with manufacturers of FDA-approved seasonal flu vaccines and providing scientific and regulatory advice to them to facilitate the timely availability of approved safe and effective trivalent seasonal flu vaccines for the 2024-2025 US flu season, said the FDA in a news release.2 FDA anticipates that there will be an adequate and diverse supply of approved trivalent seasonal flu vaccines for the United States in the coming season.

Each year, scientists review and update the composition of the US flu vaccine to target the strains predicted to be most prevalent in the coming flu season. Based on past reviews, this will not be the first time that patients seeking flu shots will be given trivalent vaccines.

Starting with the 1978-1979 season through the 2012-2013 season, US flu vaccines contained 3 vaccine viruses: influenza A(H1N1), A(h3N2), and a B-lineage vaccine virus either from the B/Yamagata or B/Victoria lineage.1 Quadrivalent flu vaccines first became available in the US during the 2013-2014 flu season and have remained as the standard composition until the current flu season (2023-2024).1

Transitioning from quadrivalent to trivalent vaccines will increase the current production capability by 200 million doses, allowing more patients to be vaccinated from the flu.3 This expansion in access may help alleviate the substantial health burden that the flu exacts on the US this past flu season was classified as moderate severity for adults and high severity for children by the CDC4as well as mitigate vaccine shortages and distribution inequities often experienced by developing countries.3

Each year, the virus causes millions of infections, hundreds of thousands hospitalized, and billions of dollars lost in health care costs and missed days of work.3

Vaccines, which have been long considered a first-line defense against the flu, have been recommended in the US for more than 50 years for everyone 6 months and older, with rare exception.1 They have been clinically proven to reduce the severity of the virus and the risk of developing potentially serious complications.

Some experts say that public health measures to curb the spread of SARS-COV-2 during the COVID-19 pandemic, such as lockdowns, travel restrictions, and mask mandates, might have unintentionally reduced the spread of Yamagata B.3 The strain had not been detected to be actively circulating in global surveillance after March 2020,1 suggesting these measures may have halted its circulation entirely.

Since changes in vaccine composition can sometimes lead to confusion or misinformation, effective communication, such as that conducted through public health campaigns or physician-patient discussions, is crucial to promote vaccine uptake.5 Health care providers and public health officials can ensure patient safety by explaining the rationale behind the composition change and emphasizing trivalent vaccines continued effectiveness against the flu.

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The US Will Transition to Trivalent Vaccines for Next Year's influenza Season - Contagionlive.com

Measles cases are surfacing across Canada. Heres what you need to know about what measles is, how it spreads and symptoms to watch out for.

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Measles a highly contagious respiratory illness caused by the rubeola virus. Measles is probably the most transmissible virus affecting human beings, said McGill University professor of medicine Dr. Brian Ward.

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Measles is airborne. It can be transmitted in schools, on buses, even during a passing interaction, Ward said. If youre in a Place des Arts (a major performing arts centre in Montreal) auditorium, and theres one person at the same show as you, and they are starting to sniffle or cough or sneeze with measles, and youre susceptible, you will probably get it.

Before vaccines and routine childhood immunizations were introduced, measles infected most people before the age of 20 and caused more than two million deaths worldwide each year.

The virus lives in the nose and throat mucus of an infected person and spreads through the air when an infected person breathes, coughs, sneezes or talks. According to the U.S. Centers for Disease Control and Prevention, the virus can live for up to two hours in the airspace after an infected person leaves an area.

Infected people can transmit measles to other people from four days before, through four days after the rash appears. On average, an infected person can pass the virus on to 15 to 18 others who havent been vaccinated or are not immune.

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Symptoms include a high fever, cough, runny nose, watery eyes or pink eye. They appear seven to 14 days after contact with the virus.

The telltale measles rash appears three to five days after the first symptoms and typically starts off as flat red spots on the face at the hairline, which then spread downward, from head to toe.

People are infectious before they start to show symptoms, and highly infectious for several days when theyre symptomatic, before the body takes over and clears the virus, Ward said.

Infants who arent old enough to get the measles vaccine, kids and teens who havent gotten two doses of the vaccine, pregnant women and people with weak immune systems are most at risk.

Common complications in children include an ear infection and diarrhea. One in 10 may develop pneumonia. One in 1,000 can developed post-infectious encephalomyelitis, or swelling of the brain, that can lead to permanent neurological deficits like deafness, paralysis or difficulty thinking or speaking.

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One to three of every 1,000 children infected will die from respiratory or neurological complications.

A single dose is about 93 per cent effective against measles; two doses starting after 12 months are about 96 to 97 per cent effective, which means that three to four per cent of those vaccinated can still get measles.

Generally, in Canada, kids are vaccinated at 12 months of age and then again between four and six years of age.

The measles vaccine contains a live, attenuated virus, meaning you dont want to give it to pregnant people, said Dr. Caitlin Dunne, a reproductive specialist with the Pacific Centre for Reproductive Medicine in Vancouver. Women who are planning to get pregnant should wait a month, post-vaccination, before trying to conceive.

If a woman contracts measles during pregnancy, it can lead to birth complications like preterm birth and low birthweight infants, as well as serious pneumonia or respiratory illness in the mother, Dunne said.

When women are planning pregnancy, or are already pregnant, doctors check their blood for antibodies against rubella, or German measles, which can cause serious birth defects, such as brain abnormalities. If someone is not properly immunized or immune to rubella, it may indicate as well that theyre also not immune to measles, Dunne said, which could put the woman or her pregnancy at risk.

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The best advice is to get your vaccines on schedule and if youre not sure if youve been vaccinated, see your health-care provider. They may recommend a booster or a blood test to see your level of immunity, particularly if you are immunocompromised, a younger person or planning a pregnancy.

The vaccines were invented in the mid to late-60s; different provinces introduced the shots at different times. After 1970, basically all provinces were rapidly introducing (measles vaccines), said Ward, of McGill. Because measles was so transmissible, the assumption we work on is that anybody born before 1970 was infected at one point in their lives, and immunity after the disease is considered life-long.

Immunity after vaccination falls off very slowly, Ward said. There are a small number of people who have had two doses of vaccination who will, at some point in their life, become susceptible again, probably not within 10 to 15 years of being vaccinated, but maybe 30 years after vaccination, Ward said.

But if the vast majority of people around you are vaccinated and public health people put that number at around 95 per cent then the chance of you being exposed is very, very small.

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If people are travelling overseas to an area where measles is actively circulating, in most cases the recommendation is to get an extra dose of vaccine, Ward said. If you dont need it your body wont even see it, and if you do need it, itll prevent you from getting a really bad disease while youre overseas, Ward said.

They still have pretty good protection against measles, Ward said. If we start to see larger outbreaks, particularly in younger kids, I think what will happen is that provinces like Ontario that have that second dose at school entry will provide an extra dose earlier on.

People should stay home at least four days after the rash first appears, drink plenty of fluids (water, juice, soup, especially with fever) and get plenty of rest. Get emergency care if your child has a fever higher than 40.5 degrees Celsius, trouble breathing, confusion or clumsiness or a severe headache, according to John Hopkins Medicine.

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What to know about measles one of the most contagious diseases - National Post

In a recent study published in the Morbidity and Mortality Weekly Report (MMWR), researchers from Illinois, the United States of America (US), reported the incidence of five measles cases among unvaccinated children who resided in the same building but did not socialize with each other.

Notes from the Field:Measles Outbreak Cook County, Illinois, OctoberNovember 2023. Image Credit:adriaticfoto/ Shutterstock

Measles is an infectious disease preventable by vaccination and poses a significant health risk. In the US, it is advised that children receive two doses of the measles, mumps, and rubella (MMR) vaccine, typically administered between the ages of 12 and 15 months and again between 4 and 6 years. The present study describes a concerning case of measles outbreak among five unvaccinated children from two families residing in the same building who did not socialize with each other.

On October 5, 2023, Patient A, a 2-year-old immigrant from Yemen, was diagnosed with an unspecified viral illness at the emergency department (ED) of Hospital A, following negative test results for influenza, coronavirus disease 2019 (COVID-19), and respiratory syncytial virus. Patient A had not been administered the MMR vaccine and had symptoms of fever, cough, and coryza. On October 8, Patient A visited Hospital B's ED due to exacerbated respiratory symptoms and tested positive for rhinovirus/enterovirus. Patient A was then admitted again to Hospital A for respiratory distress.

Notably, Patient A developed a maculopapular rash while hospitalized the next day. On October 10, the family disclosed that they had been in contact with an individual diagnosed with measles before entering the US. Measles was confirmed via real-time reverse transcription-polymerase chain reaction (RT-PCR), and the patient was discharged.

Between October 5 and 11, the child was potentially exposed to 247 healthcare workers and 177 patients and kin. This included 13 infants aged under one year, five immunocompromised children, and one unvaccinated child aged over one year. Two of these children were given the MMR vaccine within three days of exposure, while 13 received immune globulin as a precautionary measure.

Patient A's domestic contacts included two siblings who had not received the MMR vaccine and were found to be susceptible to measles through serologic testing. The siblings were Patient B, aged four years and Patient C, aged nine. The siblings contracted measles during quarantine, with varied symptoms. Although patient B required an ED visit for supportive care, neither child was hospitalized. All the residents of the building were alerted on October 17.

On October 30, Patient D (another child aged two years) visited the ED with symptoms and resided on a different floor of the same building as Patient A. The child had not received the MMR vaccine, as its parents objected based on concerns about the side effects of the vaccine. Measles was confirmed through RT-PCR.

Interestingly, despite living in the same building, the families of both sets of patients had different cultural backgrounds and languages. Both families denied having any contact with each other. While their apartment units did not share ventilation, they shared laundry facilities and building entrances.

On October 31, Patient D's unvaccinated one-year-old sibling, named Patient E, was tested due to isolated coryza. The child attended a child-care facility on October 30 while symptomatic and confirmed measles through RT-PCR. Post-exposure prophylaxis was administered to susceptible individuals, including immune globulin for one child and an early second dose of MMR vaccine for others. Patient E did not develop a fever until November 6, and a rash appeared on November 9, nine days after the positive test result and notification of the child-care facility.

While testing for measles is typically done when prodromal symptoms occur, such as cough, fever, coryza, or conjunctivitis, the isolated coryza experienced by Patient E may not have been measles-related. As measles testing before fever onset is uncommon, determining the accurate contagious period for this patient was challenging. Patient E did not need hospitalization.

Five children contracted measles in this outbreak. They were unvaccinated despite being eligible for the MMR vaccine owing to cultural barriers, limited access to healthcare, and vaccine refusal. Outbreaks have been observed previously among close-knit communities, but the present families were not a part of such networks. Public health responses typically involve tailored approaches, like culturally appropriate education materials and translation services. However, these efforts are expensive and time-consuming. This outbreak highlights measles' high contagiousness, even among children not in each other's contact.

In conclusion, the study emphasizes the need for all children and susceptible individuals to receive two doses of the MMR vaccine at appropriate intervals. Clinicians should suspect measles in patients with febrile rash illness and ensure vaccination to prevent future outbreaks.

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Measles outbreak in Illinois underscores critical need for vaccination - News-Medical.Net

Youre reading The Checkup With Dr. Wen, a newsletter on how to navigate covid-19 and other public health challenges. Click here to get the full newsletter in your inbox, including answers to reader questions and a summary of new scientific research.

Last weeks column on the Florida surgeon generals cavalier approach to controlling his states burgeoning measles outbreak prompted many readers to express a concern that I share: anti-vaccine sentiment is growing and threatens decades of public health progress.

Joseph from Oregon has a different view. Youve been writing that people should gauge individual risk when it comes to covid, he wrote. Why isnt it the same with measles? Your article says that the vaccine is 97 percent protective. Vaccinated kids dont need to worry, so why isnt it up to parents to decide whether to give their kids the shot?

Joseph raises an interesting point that goes to the fundamental tension in public health of weighing individual freedom vs. whats best for society. Individual freedom should generally take precedence, but there are some circumstances where policymakers have to decide in favor of protecting the public.

I was thinking about this question when I took my kids to an indoor play gym over the weekend. For those unfamiliar with the concept, think of a regular jungle gym but bigger and all indoors, with slides, ball pits, trampolines and multilevel climbing structures. The ones in my area become very crowded, with hundreds of kids and parents packed into relatively small spaces.

As soon as I signed my 6-year-old son in, he ran off with some friends and disappeared in the throng of excited kids. I wasnt so worried about keeping an eye on him, but I did worry about my 3-year-old daughter. I knew that if I let her out of my sight, it could take a while to find her.

My husband told me not to worry; in his view, this kind of play is exactly what these indoor gyms are designed for. Another mom who overheard our conversation agreed with him; her young child was playing wherever she wanted, without her mom hovering over her as I was doing with my daughter. On the other end of the spectrum are parents who wouldnt even think to come to these indoor gyms for safety reasons.

All of these are reasonable individual decisions. The fact that they should be made by parents about their own kids is something few would take issue with.

Now lets take a totally different scenario. Lets say that there were a couple of kids who were hitting other kids and pushing toddlers off climbing structures. Even if their parents had no issues with this behavior, they pose a threat to others, and few would argue against intervention.

The question of where measles and covid-19 lie on this continuum of individual choice comes down to three factors: how dangerous is the disease, what is the risk posed to others and how effective are the mitigation measures.

While Joseph is right that the measles vaccine is highly protective, it is not 100 percent effective, which means that some vaccinated individuals might still get infected. Also, there are babies and young children who are too young to be vaccinated. The unvaccinated, if exposed to measles, have a nearly 90 percent chance of becoming infected, and infection poses many harmful consequences including a 1 in 5 chance of hospitalization, permanent neurological defects and death.

Crucially, targeted mitigation measures of boosting vaccinations and quarantining exposed people work to contain measles, as they have in recent outbreaks in New York, Ohio and Pennsylvania. In addition, its possible to stop measles from propagating by achieving herd immunity, which is what the United States has been successful in doing.

This is not the case with covid. The nature of the coronavirus is such that no level of population immunity will stop the disease from circulating. In addition, the coronavirus vaccines, while protective against severe disease, have limited effect on reducing infection. Large-scale population measures such as required masking, vaccines and isolation periods have not contained the virus, and indeed have spawned such substantial backlash that other public health interventions including the measles, mumps and rubella (MMR) vaccination are now harder to implement.

To go back to the indoor play gym analogy, the interventions required to stop measles in Florida are akin to stopping a couple of kids from playing until they are no longer harming others. Yes, it restricts their freedom, but its a temporary measure imposed on a small number of people because the risk to others outweighs the individuals right to self-determination.

On the other hand, using societal interventions to try to control covid at this point would be more analogous to shutting down all playgrounds in perpetuity, knowing that the aggressive behavior would continue outside their premises. The interventions are wrong not only because most would perceive them as government overreach, but because they simply wont work.

This is why it makes sense to me to view risks around covid as individual decisions, and why the risk-benefit calculation is different for preventing the resurgence of previously eliminated deadly diseases such as measles and polio.

As Rose from Minnesota reminds us, I remember all too well the days when every child got measles and chicken pox and our parents kept us out of public pools because they feared we would be next to be paralyzed from polio. We all lined up and got our shots because our parents saw what these diseases can do. We simply cannot afford to go back in time. I couldnt agree more.

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Opinion | Balancing personal freedom and public good is different for measles than covid - The Washington Post

As the number of measles cases increases across the country, Chicago has become the latest U.S. city to be at the center of an outbreak.

As of Thursday morning, eight measles cases have been confirmed, with at least seven among children and adults at a new arrivals shelter, according to the Chicago Department of Public Heath.

The Centers for Disease Control and Prevention has sent a team to help public health officials respond to the outbreak, with staff arriving Tuesday, according to the federal health agency.

At least 45 measles cases have been reported across 17 states so far this year, according to CDC data. Due to delays in reporting national data, this number does not include the current outbreak in Chicago. Numbers are now close to the total number of cases -- 58 -- reported for all of last year.

Measles was considered eliminated in 2000 because most Americans were vaccinated against the disease or had some level of immunity. Over the last several years, however, vaccination rates have dipped and pockets of unvaccinated and undervaccinated communities have led to sporadic outbreaks across the U.S.

Public health experts told ABC News these localized outbreaks can be hard to contain.

"As an infection control practitioner and a physician, I just feel like ... you're kind of always waiting for the next measles outbreak," Dr. Jennifer Grant, an infectious disease physician and system medical director for infection prevention and control at Endeavor Health in the greater Chicago area, told ABC News. "It just feels like we have a perfect storm of declining vaccination, that there is always a possibility that a measles outbreak could happen anywhere."

The first measles case in Chicago was confirmed on March 7 in a city resident whose source of infection is unknown, according to the CDPH.

Since then, seven cases have been confirmed at a new arrivals shelter in Pilsen, in the lower west side of the city, health officials said.

Because it can take about 11 to 12 days from someone being exposed to developing symptoms, experts said it might take some time to see the full impact of the outbreak.

"I think it is safe to say that the majority of those who have come down with cases of measles are unvaccinated," Dr. Aniruddha Hazra, an associate professor of medicine in the section of infectious diseases and global health at UChicago Medicine, told ABC News. "I think the big concern is that this is not telling us the fuller picture of the current outbreak in Chicago and likely there are potentially more cases and ... likely more exposures in the city."

A CDC team arrived in Chicago this week to support local officials by providing guidance for monitoring symptoms and quarantine or isolation practices as well supporting the ongoing vaccination campaign, the CDPH said.

Hazra said the CDC has its own epidemiological intelligence service that goes to places around the country where outbreaks are occurring and offers both financial support and manpower support.

"Contact tracing is backbreaking work; it takes a lot of time, a lot of manpower to get done," he said. "There is significant benefit for contact tracing and case investigation with measles, just given the prolonged incubation period and the time between when someone is exposed to when someone actually presents with symptoms and then can be contagious or transmissible to others."

"Being able to capture folks in that window, making sure they're able to quarantine and self-isolate, that is so important to help reduce the spread of outbreak," Hazra added. "So, the CDC being able to deploy additional folks to come here to assist and collaborate with our public health department is really critical."

The CDC currently recommends that everyone receive two doses of the measles, mumps and rubella (MMR) vaccine with the first dose between ages 12 and 15 months and the second dose between ages 4 and 6.

One dose of the measles vaccine is 93% effective at preventing infection if exposed to the virus. Two doses are 97% effective.

If someone has had two doses of the MMR vaccine, they do not need to receive a booster dose and are essentially protected for life, public health experts told ABC News.

For any adult not sure of their immunization status, the experts recommended speaking to a primary care provider. Antibody levels may be drawn to assess immunity, and if someone is not immune, they may be eligible for at least one MMR dose.

It's currently not recommended for pregnant women to receive the MMR vaccine if they are not immune to measles.

"We do recommend discussing with your doctor whether or not [antibody levels] can be drawn and to make sure that you're not in any situation where you might be presented to measles because that could be a very concerning situation" if pregnant, said Dr. Nicholas Cozzi, EMS medical director at Rush University Medical Center in Chicago.

In the case of the measles outbreak at the shelter, experts have stressed not conflating the outbreak with anti-migrant sentiment because many people in these shelters have likely not had access to vaccines or have had barriers to access in their native countries.

"This is really a call for us to be providing better medical care to these populations," Dr. Gary Reschak, a pediatrician at Northwestern Medicine Huntley Hospital, told ABC News. "A lot of these people who are coming here ... did not have access to the same health care and the easy access to vaccines that we take for granted."

Public health experts said there has been a "perfect storm" in the U.S. of vaccine hesitancy, vaccine access and vaccine fatigue.

Grant said during the COVID-19 pandemic, countries around the world, including the U.S., lost a lot of ground when it came to maintaining rates of routine childhood vaccinations due to lack of access and people being fearful of accessing health care settings during the early days of the pandemic due to risk of COIVD exposure.

She added that people may be experiencing fatigue from receiving the original COVID-19 vaccine and subsequent boosters, which may have spilled over into feelings about routine vaccines.

Cozzi also pointed to a now-debunked paper from the U.K. in 1998, which allegedly found that MMR vaccines cause autism. The paper was discredited, retracted from the journal where it was published, and its primary author lost his medical license. More than a dozen studies have tried to replicate the findings and failed to find a link.

Despite no evidence that vaccines cause autism, some parents may still be hesitant for their children to receive the MMR vaccine.

"That was debunked, it was proven to be false, but we see the rise of medical misinformation, and that was one of the earliest signs that that was occurring," Cozzi said.

"Measles as a virus is something that I think a lot of [people] just don't appreciate how extremely contagious it is," Reschak said. "It goes beyond like your colds and your flus."

Measles is highly contagious and can spread through the air when an infected person coughs or sneezes, according to the CDC.

It is so contagious that if an infected person comes into contact with people who aren't protected, 90% of them will also become infected. In a congregate setting, like a shelter, this can mean quick spread.

"So, with this level of contagiousness, it really does spread like wildfire, and that's why when you have outbreaks like this, you have to do very good tracking of the cases and trying to isolate people who may have been exposed and are at risk for spreading measles," Reschak said.

These outbreaks can potentially put a strain on the healthcare system because measles can be deadly.

According to the CDC, one in five unvaccinated people with measles are hospitalized, one in every 20 children with measles contracts pneumonia and one in every 1,000 children with measles suffers encephalitis, or swelling of the brain.

These complications can lead to ear infections, deafness, neurological complications or even death. Nearly one to three of every 1,000 children with measles will die from respiratory and neurologic complications.

"These are just huge, huge numbers that put a major strain on the health care system as well as the families themselves," Reschak said. "So, keeping it as isolated and keeping these outbreaks as sequestered as possible is in everyone's interest."

A November 2023 CDC report found that for the 2022-23 school year, about 93% of children in kindergarten had met the vaccination requirements, about the same number seen for the previous school year but lower than the 94% rate in 2020-21 and 95% rate in 2019-20.

Additionally, exemptions from school vaccination requirements increased to 3% during the 2022-23 school year, which is the highest vaccination exemption rate ever reported in the U.S., according to the CDC.

"Unfortunately, I believe that if we don't start getting more children vaccinated more consistently, we will start seeing more of these outbreaks pop up," Reschak said. "We are really approaching that threshold where, I can't say this with certainty, but I'm concerned that it's possible measles can become endemic to the United States again."

This is why experts say it's so important to receive the MMR vaccine to both protect yourself and those most at risk of severe disease in your community.

"Measles is an equal opportunity virus, irrespective of your legalization status," Cozzi added. "It just concerns itself if you're under-vaccinated or unvaccinated. Measles, if you're unimmunized, is incredibly dangerous."

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Why does the US keep experiencing measles outbreaks? - ABC News

Windhoek, Namibia

A top Namibian health official tells VOA the southern Africa country is set to begin distribution of the HPV vaccine to adolescent girls in April as a preventative measure in the fight against cervical cancer.

Namibia has a population of about 1 million women ages 15 years and older who are at risk of developing cervical cancer.

Each year, about 375 women in Namibia are diagnosed with the disease, and the fatality rate is over 50%.

The Human Papillomavirus Vaccine, known as HPV, has been proven to greatly lessen the chance of getting cervical cancer.

Ben Nangombe, executive director at Namibias Ministry of Health and Social Services, says health workers will begin vaccinating about 183,000 girls between the ages of nine and 14 next month.

He says the ministry has been allocated $7 million to procure single dose vaccines for this purpose.

Mehafo Amunyela, who works at the #Be Free Youth Program in the capitals Katutura Township, told VOA that vaccine hesitancy could be a hurdle to fully immunizing the target population. She said she hopes that through awareness campaigns, children and their families can be educated about the advantages of getting the vaccine.

We saw the reaction of the public toward the COVID vaccine when it came out, but I think we need to be honest with ourselves and remember that the reason we dont have illnesses like polio is because of vaccines, that they worked then, and they still do now, she said.

The Cancer Association of Namibia says the vast distances between most towns and villages in Namibia could present another logistical challenge in the immunization program.

The association says to achieve the target of immunizing 183,000 girls, awareness campaigns should be undertaken in the different indigenous languages spoken in the country.

With the rollout of the HPV vaccine, Namibia is on the path to do its part in meeting the World Health Organizations goal of vaccinating 90% of girls worldwide by 2030, with the long-term goal of eliminating cervical cancer within the next century.

Although cervical cancer is preventable and curable, the disease claimed 350,000 lives worldwide in 2022 according to the WHO.

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Namibia to Begin HPV Vaccine Rollout in April - Voice of America - VOA News

Photo Credit: Design Cells

The following is a summary of Immune responses to SARS-CoV-2 mRNA vaccination in people with idiopathic CD4 lymphopenia, published in the February 2024 issue of Allergy & Immunology by Rocco, et al.

For a study, researchers sought to evaluate the immunogenicity of mRNA vaccines in individuals with idiopathic CD4 lymphopenia (ICL) across varying CD4 T-cell counts.

Samples were collected from 25 patients diagnosed with ICL and 23 ageand sex-matched healthy volunteers (HVs) after receiving their second or third dose of mRNA vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Anti-spike and anti-receptor binding domain antibodies were quantified, and T-cell receptor sequencing and stimulation assays were conducted to assess SARSCoV2specific T-cell responses.

Among the ICL participants, with a median age of 51 years and a median CD4 count of 150 cells/L, 11 had CD4 counts 100 cells/L. Anti-spike IgG antibody levels were lower in patients with ICL than HVs after 2 and 3 vaccine doses. However, individuals with ICL and CD4 counts >100 cells/L did not significantly differ from HVs in anti-spike IgG levels. Spike-specific T-cell responses, as measured by T-cell receptor sequencing, were reduced in individuals with ICL. Nonetheless, the activation-induced markers and cytokine production of spike-specific CD4 T cells were comparable between ICL participants and HVs after 2 or 3 vaccine doses.

Patients with ICL and CD4 counts >100 cells/L exhibited robust humoral and cellular immune responses following SARS-CoV-2 vaccination. Conversely, those with more severe CD4 lymphopenia showed attenuated vaccine-induced immunity, suggesting the potential need for additional vaccine doses and other risk mitigation strategies.

Reference: jacionline.org/article/S0091-6749(23)01383-0/abstract

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Assessing Immune Response to SARS-CoV-2 mRNA Vaccination in ICL - Physician's Weekly

FIRST ON THE DAILY SIGNALThe professional association for city managers issued a public censure against a Michigan city official in part because he promised firefighters and police that he wouldnt impose a hypothetical vaccine mandate but would instead follow alternative COVID-19 protocols. Now, hes suing to restore his good name.

I was honestly heartbroken to see the [International City/County Management Association] publicly censure me, faulting me for violating a vaccine mandate that didnt exist, James Freed, city manager of Port Huron, Michigan, told The Daily Signal in a written statement.

The International City/County Management Association serves as the major professional association for city managers across the U.S. The organization claims to be politically neutral, but Freed says that it censured him in part as retaliation after he complained about an ICMA leaders left-wing political activity on Twitter, the social media platform now called X.

The management association appears to have believed that Michigan Gov. Gretchen Whitmer, a Democrat, had imposed a vaccine mandate, although she did not. The association censured Freed in part for vowing that he wouldnt enforce such a mandate. The censure mentioned Freeds response to Whitmer after the governor falsely claimed that his city had violated COVID-19 protocols.

Freed spoke to The Daily Signal before the Supreme Court ruled in his favor on an unrelated matter regarding his decision to block another user on Facebook.

The story traces back to November 2018, when Freed noticed that a Twitter account with the handle @ICMAEthics started liking posts that opposed Republicans.

Freed wrote a letter to Martha Perego, the ICMAs director of member services and ethics who ran the account. He noted the accounts increasingly partisan activity, saying its handle leads the public to believe that this type of social media activity and behavior represents the members of our association.

I am requesting that either you delete and unlike any political activity and statements that may conflict with our Code of Ethics, or simply change your Twitter handle to something that does not appear to represent ICMA, Freed wrote to Perego.

Marc Ott, executive director of the International City/County Management Association, wrote a letter to Freed one month later, saying he had directed Perego to remove political activity from the Twitter account and disconnect it from the ICMA. Freed thought that was the end of the matter.

Yet ICMA launched an investigation into Freed, claiming that he had violated the management associations code of ethics by sharing information about an official ethics complaint in an improper venue. Freed had shared his concerns about the @ICMAEthics Twitter activity in a private Listserv for the Michigan Municipal Executives Association.

On Jan. 28, 2018, Jessica Cowles, ICMAs ethics adviser and an assistant to Perego, called Freed to notify him that the management association had launched an ethics investigation into his behavior. In the call, which Freed recorded and made available on the City Manager Unfiltered podcast, Freed repeatedly told Cowles that he had no intention of filing a formal ethics complaint against Perego. But Cowles didnt appear to receive the message.

In June 2019, the ICMA Committee of Professional Conduct cleared Freed of the accusations in the complaint. Later that year, the ICMA investigated another ethics complaint against Freed, claiming that his social media posts were political. The ICMAs Committee of Professional Conduct ultimately cleared Freed in that complaint, as well.

In his lawsuit against the International City/County Management Association, Freed argues that these investigations were frivolous acts of retaliation and signs of things to come.

During the COVID-19 pandemic, Freed followed the guidance of health agencies, but faced a fine and ridicule from Michigans Democratic governor, Whitmer, over a false report that he had not done so.

Matthew Hartman, an inspector at the Michigan Occupational Safety and Health Administration, issued a $6,300 fine to Port Huron, where Freed is city manager, after visiting on July 21, 2020. Hartman later testified under oath that he burned his notes from that visit, the Detroit News reported.

Hartman had not witnessed any city employee who wasnt wearing a face mask or was violating COVID-19 rules, but he claimed that employees he interviewed said they saw such violations. He also said he destroyed emails from his supervisor regarding the case.

Hartman confessed this in a deposition to Todd Shoudy, an attorney for Port Huron. Shoudy later notified Michigans occupational safety and health agency that he planned to depose its director, Bart Pickelman. Six days later, the agency announced it would dismiss the case against Port Huron.

Freed urged the state Legislature to investigate the Michigan Occupational Safety and Health Administrations governance structure.

My heart breaks for all the small businesses and mom-and-pops that didnt have an expert legal team, who didnt have the resources to put MIOSHA under oath, Freed told The Detroit News at the time. Port Hurons appeal cost between $15,000 and $20,000.

MIOSHA dropped the fine in November 2021.

Whitmer, Michigans governor, had said the agency fined only employers who flouted COVID-19 rules.

On the same day MIOSHA dropped the fine, Freed posted a Breitbart story on Instagram, tagging Whitmer.

@gewhitmer you shouldnt mess with a father who cares about the world his little girl grows up in, the city manager wrote.

Also in November 2021, the U.S. Labor Departments Occupational Safety and Health Administration issued an emergency temporary standard requiring large employers those with 100 employees or moreto make employees take a COVID-19 vaccine or get tested regularly for the disease. OSHAs emergency temporary standard didnt apply to Port Huron, but Freed anticipated that MIOSHA would apply similar rules.

I did everything I could to protect my employees during the COVID-19 pandemic, Freed told The Daily Signal.

He said he prepared to follow the testing regimen that OSHA presented as an alternative to the vaccine requirement. Even though OSHAs temporary standard didnt apply to Port Huron, he anticipated that MIOSHA would adopt the temporary standard.

Freed said many city employees told him they would quit if he forced them to take a vaccine, so even though he had taken a COVID-19 vaccine himself, he decided on the option that didnt mandate the vaccine for others. The city manager sent a letter to employees stating, I will never enforce a vaccine mandate upon my employees.

Freed predicted that a federal judge would issue an injunction against any such mandate, and that the Supreme Court also would rule against it. The Supreme Court unanimously blocked the rule in January 2022.

Freed insisted that Congress makes laws, not unelected bureaucrats.

I felt the liberty and personal choice of my employees warranted protection, and I needed to send a clear message to my employees that I would not force them to be vaccinated in order to avoid losing critical employees that would have been difficult to replace, Freed told The Daily Signal.

On July 5, 2022, the International City/County Management Association publicly censured Freed, in part for his apparent unwillingness to enforce a vaccine mandate that didnt exist. The association sent a press release to media and issued a post on its website announcing the censure. Freed has highlighted the differences between the documents.

The ICMA Executive Board voted to censure Freed on June 11, 2022.

The board determined Mr. Freeds personal social media post directed to Michigans governor following the citys successful appeal of a state workplace safety violation did not reflect the highest standards of ethical conduct and integrity and was especially inappropriate for an ICMA-credentialed manager, the association said in the press release.

The board concluded Mr. Freeds preemptive declaration to city employees that he would never implement a specific law or policy when it is the managers duty to do so is contrary to the principles outlined in Tenet 3 of the [ethics] code, the statement continued. Finally, the board found his commentary to a colleague on the Michigan Municipal Executives listserv failed to adhere to his ethical obligation to treat colleagues with professional respect.

The ICMAs website post went into greater detail on the first two counts against Freed. For the post about Whitmer, the association claimed Freed failed to fulfill his ethical responsibility to ensure that his conduct builds trust and respect with elected officials as well as the public.

When it came to the issue of a vaccine mandate, the ICMA acted as though Freed had vowed not to enforce an existing law.

The management association said on its website: The board concluded (1) a member has an affirmative duty to follow the law as outlined in Tenet 3s commitment to honesty and integrity; (2) a member may choose to resign from their position if they find they cannot implement a law or policy because it conflicts with their personal or professional beliefs; and (3) a manager has a responsibility to ensure their conduct enhances public trust in their position, their organization, and the local government management profession. The board determined his preemptive declaration to city employees that he would never implement a specific law or policy was contrary to the principles in Tenet 3.

Before the public censure, the International City/County Management Association allowed Freed to appeal its recommendation for a censure. He did appeal, and the ICMA rejected his appeal.

Among other things, the association took issue with his complaint that unelected bureaucrats do not make laws because it overlooked the fact that the governor is an elected official. Whitmer played no role in OSHAs emergency temporary standard, however.

During Freeds June 11, 2022, appeal hearing, ICMA board members sent text messages condemning him as a douchebag and saying they wanted to punch him in the face.

William Fraser, city manager of Montpelier, Vermont, messaged Pam Anthill, city manager of Encinitas, California.

He just looks like a douchebag, Fraser wrote to Anthill.

He is, Anthill responded.

I already want to punch him in the face, Fraser added.

Fraser told The Daily Signal he regrets making those comments.

During the hearing about Mr. Freeds ethics violations, I sent a private text message to a colleague which was uncomplimentary to Mr. Freed, he wrote in a statement Thursday. I very much regret making those comments.

Notwithstanding those remarks, I voted against issuing a public censure to Mr. Freed, Fraser added. I am no longer a defendant in Mr. Freeds civil suit and have completed my term as a member of the ICMA executive board.

Fifteen days after the ICMA formally censured Freed, the Port Huron Mayor and City Council sent the association a letter in which it stood by Freed.

In consultation with our legal counsel, we strongly disagree with your findings, the mayor and council wrote.

No law or pending law was preemptively declared to be violated, the elected city leaders added. You provided no such evidence to support your claim. On the contrary, our city manager took steps, by words and action, to comply with all current laws and any pending laws, while at the same time respecting the civil liberties of our dedicated employees.

Additionally, although you may not like professional criticism of elected or appointed officials, it is lawful [and] ethical by ICMA standards and constitutionally protected, the city leaders wrote. Our city manager did not breach or erode public trust.

The mayor and council members declared their confidence and trust in Freed, asking the ICMA to retract your baseless censure.

Despite the city councils support, Freed worries that the public censure may prevent him from getting a job in any other jurisdiction. While the city council has supported him, the censure may still stymie his career.

Freed sued ICMA and others in September 2022, alleging defamation, false light invasion of privacy, and conspiracy against him. The Port Huron city manager seeks $75,000 per defendant ($25,000 per claim), plus costs, interest, and attorneys fees. That doesnt include emotional and embarrassment damages, which the jury must decide.

Even though ICMAs case against me is based on their false understanding of the situation on the ground in Michigan at the time, the professional organization has refused to revoke the public censure which is very damaging to my professional reputation, Freed told The Daily Signal. Sadly, I am left with no other recourse but to sue to restore my good name and protect my ability to provide for my family.

Neither the International City/County Management Association nor Anthill nor Whitmers office responded to The Daily Signals request for comment by publication time.

Have an opinion about this article? To sound off, please emailletters@DailySignal.comand well consider publishing your edited remarks in our regular We Hear You feature. Remember to include the URL or headline of the article plus your name and town and/or state.

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ICMA Censures James Freed Over Nonexistent Vaccine Mandate - Daily Signal

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