{"id":9448,"date":"2019-11-25T14:13:24","date_gmt":"2019-11-25T19:13:24","guid":{"rendered":"https:\/\/blogs.nejm.org\/hiv-id-observations\/?p=9448"},"modified":"2019-11-26T08:48:44","modified_gmt":"2019-11-26T13:48:44","slug":"vaccine-defenders-uu-holds-up-zika-is-gone-and-other-id-things-to-be-grateful-for-2019-edition","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/vaccine-defenders-uu-holds-up-zika-is-gone-and-other-id-things-to-be-grateful-for-2019-edition\/2019\/11\/25\/","title":{"rendered":"Vaccine Defenders, U=U Holds Up, Zika Is Gone, and Other ID Things to Be Grateful For, 2019 Edition"},"content":{"rendered":"<div id=\"attachment_9455\" style=\"width: 331px\" class=\"wp-caption alignright\"><a href=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2019\/11\/Screen-Shot-2019-11-25-at-6.56.32-AM.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-9455\" class=\"wp-image-9455\" src=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2019\/11\/Screen-Shot-2019-11-25-at-6.56.32-AM.png\" alt=\"\" width=\"321\" height=\"223\" srcset=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2019\/11\/Screen-Shot-2019-11-25-at-6.56.32-AM.png 739w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2019\/11\/Screen-Shot-2019-11-25-at-6.56.32-AM-300x208.png 300w\" sizes=\"auto, (max-width: 321px) 100vw, 321px\" \/><\/a><p id=\"caption-attachment-9455\" class=\"wp-caption-text\">A High Wind in the Park, London, 1819.<\/p><\/div>\n<p>An <a href=\"http:\/\/freakonomics.com\/podcast\/why-is-my-life-so-hard\/\" target=\"_blank\" rel=\"noopener noreferrer\">excellent episode<\/a> of the Freakonomics podcast introduced me to the headwinds vs tailwinds asymmetry, and how we humans perceive life.<\/p>\n<p>It goes like this:\u00a0We go for a walk, a run, or a bike ride, and the wind faces us dead-on, making the exercise a struggle.<\/p>\n<p>(In windy Boston, the wind is <em>always<\/em> in my face. Always always always.)<\/p>\n<p>When the route changes, there&#8217;s a brief moment of relief, but it&#8217;s short-lived. What we remember about the experience is the headwind, certainly not the boost the tailwind might have given us on the way home.<\/p>\n<p>The <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27869473\" target=\"_blank\" rel=\"noopener noreferrer\">researchers on that podcast<\/a> argue that this same blindness to various good things, privileges, and benefits is how we perceive <em>all<\/em> of our life. We&#8217;re intrinsically wired to complain about the barriers and struggles.<\/p>\n<p>In short:<\/p>\n<blockquote><p>Barriers and hindrances command attention because they have to be overcome; benefits and resources can often be simply enjoyed and largely ignored.<\/p><\/blockquote>\n<p>While evolution might have hard-wired this attitude in us for survival purposes, it can also make us into a bunch of unappreciative whiners.<\/p>\n<p>Which is why the flip-side &#8212; expressing gratitude &#8212; is so important. Research consistently shows it makes us happier. And it definitely makes us better company, an important consideration as we approach the holiday season.<\/p>\n<p>In that spirit, in what&#8217;s become a Thanksgiving Holiday tradition, I list below a series of ID\/HIV things to be grateful for in late 2019. And hey, <a href=\"https:\/\/twitter.com\/PaulSaxMD\/status\/1196047553793540097?s=20\" target=\"_blank\" rel=\"noopener noreferrer\">there&#8217;s <em>so much<\/em> to be grateful for!<\/a><\/p>\n<ul>\n<li><strong>Brave, authoritative, and respected voices continue to speak out against the anti-vaccine movement.<\/strong> There are many such voices out there, and IDSA has done a terrific job as an organization, but I want to highlight especially <a href=\"https:\/\/www.tmc.edu\/news\/2018\/11\/a-vaccine-doctor-whos-an-autism-dad\/\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>Dr. Peter Hotez.<\/strong><\/a> He appears regularly in public and in print to defend vaccines, risking his own safety; he has also written a <strong><a href=\"https:\/\/nnlm.gov\/all-of-us\/book-selections-and-health-resources\/vaccine-health\/vaccines-did-not-cause-rachels-autism\" target=\"_blank\" rel=\"noopener noreferrer\">moving and personal book<\/a><\/strong> entitled <em>Vaccines Did Not Cause Rachel&#8217;s Autism: My Journey as a Vaccine Scientist, Pediatrician, and Autism Dad.<\/em> Check out the ratings for this book on Amazon, and you&#8217;ll find a painful dichotomy &#8212; either 5 stars or 1 star &#8212; with the negative comments demonstrating how vicious the anti-vaccine movement can be.<\/li>\n<\/ul>\n<blockquote class=\"twitter-tweet\" data-width=\"500\" data-dnt=\"true\">\n<p lang=\"en\" dir=\"ltr\">Ugh, stalked today\/tonight at a NY peds infect dis conference by a couple saying they represent Children&#39;s Health Defense, filming me, asking provocative questions. I never know how to best handle it other than to try answering their questions and be respectful? No win situation <a href=\"https:\/\/t.co\/g7KiiSkqye\">pic.twitter.com\/g7KiiSkqye<\/a><\/p>\n<p>&mdash; Prof Peter Hotez MD PhD (@PeterHotez) <a href=\"https:\/\/twitter.com\/PeterHotez\/status\/1198425481382703104?ref_src=twsrc%5Etfw\">November 24, 2019<\/a><\/p><\/blockquote>\n<p><script async src=\"https:\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"><\/script><\/p>\n<ul>\n<li><a href=\"https:\/\/www.statnews.com\/2019\/04\/12\/the-data-are-clear-ebola-vaccine-shows-very-impressive-performance-in-outbreak\/\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>An Ebola vaccine works!<\/strong><\/a> In perhaps no other disease will a vaccine play such a critical role in getting control of an outbreak. This is wonderful, very welcome progress!<\/li>\n<li><a href=\"https:\/\/www.nih.gov\/news-events\/news-releases\/science-clear-hiv-undetectable-equals-untransmittable\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>U = U (undetectable equals untransmittable) continues to hold up.<\/strong><\/a> Perhaps the most transformative finding in the history of HIV medicine &#8212; that people on successful HIV treatment don&#8217;t pass the virus on to others sexually &#8212; remains a rock-solid fact. I&#8217;ve included U = U here before several times, but why not continue to celebrate it?<\/li>\n<li><strong>HIV incidence in many urban regions in the USA drops.<\/strong> In New York City, for example, 1,917 people were diagnosed in 2018, <em>a 67 percent decline<\/em> from 2001. Treatment as prevention and PrEP are yielding these impressive results.<\/li>\n<li><a href=\"https:\/\/wwwnc.cdc.gov\/travel\/page\/zika-information\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>Zika is all but gone.<\/strong><\/a> Remember <strong><a href=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/twelve-zika-questions-one-id-doctors-answers-sort-of\/2016\/02\/07\/\" target=\"_blank\" rel=\"noopener noreferrer\">how crazy things were in 2016?<\/a><\/strong> Especially for couples who wanted to have children? And for us ID doctors (and primary care and OBs) trying to advise them? Yes, Zika <em>could<\/em> come back (and likely one day will), but let&#8217;s be grateful for our current situation compared to that insane period.<\/li>\n<li><strong>New antibiotics, some with new mechanisms of action, expand our treatment options.<\/strong> No, they&#8217;re not perfect, and some are only incremental advances, or targeted at rare clinical situations &#8212; but great anyway to have lefamulin, pretomanid, omadacycline, eravacycline, meropenem-vaborbactam, imipenem-relebactam, cefiderocol (with some <a href=\"https:\/\/www.medpagetoday.com\/infectiousdisease\/generalinfectiousdisease\/82754\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>confusing data<\/strong><\/a> on this last one, still to be sorted out). Now let&#8217;s try to fix the economics of antibiotic drug development!<\/li>\n<li><strong>Additional studies continue to demonstrate the clinical benefit of ID consultation on outcomes. <\/strong>Just a few recent examples &#8212; <strong><a href=\"https:\/\/www.thelancet.com\/journals\/laninf\/article\/PIIS1473-3099(19)30405-0\/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">candidemia<\/a><\/strong>, <strong><a href=\"https:\/\/doi.org\/10.1093\/ofid\/ofz408\" target=\"_blank\" rel=\"noopener noreferrer\">sepsis<\/a><\/strong>, and <strong><a href=\"https:\/\/academic.oup.com\/ofid\/advance-article\/doi\/10.1093\/ofid\/ofz495\/5628896\" target=\"_blank\" rel=\"noopener noreferrer\">long-term outcomes in <em>Staph aureus<\/em> bacteremia<\/a><\/strong>. The parade goes on and on!<\/li>\n<li><strong>A &#8220;Shorter is Better&#8221; philosophy about duration of antibiotic therapy moves into clinical practice.<\/strong> And with this updated super list from Dr. Shorter-is-Better himself, Brad Spellberg, why not?<\/li>\n<\/ul>\n<blockquote class=\"twitter-tweet\" data-width=\"500\" data-dnt=\"true\">\n<p lang=\"en\" dir=\"ltr\"><a href=\"https:\/\/twitter.com\/aurdinh?ref_src=twsrc%5Etfw\">@aurdinh<\/a> Okay, Aurelien, 7th pyelo study added to table and to website.  Thanks for bringing your study to my attention. Latest version of Table (updated 11\/14\/19) below. <a href=\"https:\/\/t.co\/Q5Rmub2HRP\">pic.twitter.com\/Q5Rmub2HRP<\/a><\/p>\n<p>&mdash; Brad Spellberg (@BradSpellberg) <a href=\"https:\/\/twitter.com\/BradSpellberg\/status\/1195073137752317952?ref_src=twsrc%5Etfw\">November 14, 2019<\/a><\/p><\/blockquote>\n<p><script async src=\"https:\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"><\/script><\/p>\n<ul>\n<li><strong>Pragmatic clinical trials in ID give us important new strategies for therapy.<\/strong> The most notable examples in the past year are the <strong><a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1808312\" target=\"_blank\" rel=\"noopener noreferrer\">POET<\/a><\/strong> and <strong><a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1710926\" target=\"_blank\" rel=\"noopener noreferrer\">OVIVA<\/a><\/strong> trials, demonstrating the noninferiority of oral to IV therapy for endocarditis and osteomyelitis. More of these, please!<\/li>\n<li><a href=\"https:\/\/www.immunize.org\/askexperts\/\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>The &#8220;Ask the Experts&#8221; section on the Immunization Action Coalition remains a gold mine of useful information. <\/strong><\/a>\u00a0I&#8217;ve mentioned it before, but that doesn&#8217;t mean I can&#8217;t still be grateful! Barely a week goes by without my consulting this site.<\/li>\n<li><strong>Shorter treatment courses for latent TB gain traction.<\/strong> Drug interactions aside, who doesn&#8217;t prefer 4 months of rifampin to 9 months of INH? Can <strong><a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1806808\" target=\"_blank\" rel=\"noopener noreferrer\">1 month of isoniazid\/rifapentine be far behind?<\/a> <\/strong><\/li>\n<li><strong>New guidelines for diagnosis and treatment of Lyme Disease are imminent.<\/strong> The draft guidelines have already been released &#8212; final version expected soon.<\/li>\n<li><strong>Dolutegravir-based regimens are increasingly available globally.<\/strong> In many settings that previously had only efavirenz (first-line) and lopinavir\/ritonavir (second line), dolutegravir represents <em>major<\/em> progress &#8212; for both treatment-naive and treatment-experienced patients. It will be important to see how this big change in strategy works out, which is the primary goal of <strong><a href=\"https:\/\/t.co\/5WZwUrsLVu?amp=1\" target=\"_blank\" rel=\"noopener noreferrer\">this observational study.<\/a><\/strong><\/li>\n<li><strong>ID fellows continue to amaze us.<\/strong> Smart, mission-driven, and hard working, they take on the most complicated cases in the hospital with aplomb. As my down-the-hall neighbor Dr. Sigal Yawetz says:<\/li>\n<\/ul>\n<blockquote class=\"twitter-tweet\" data-width=\"500\" data-dnt=\"true\">\n<p lang=\"en\" dir=\"ltr\">And most notably the amazing bright ID fellows we interview and recruit each year. And the work done by former trainees. Our field continues to attract bright minds and that&#39;s most exciting, looking towards the future.<\/p>\n<p>&mdash; Sigal Yawetz MD (@sigal_md) <a href=\"https:\/\/twitter.com\/sigal_md\/status\/1196065495566495745?ref_src=twsrc%5Etfw\">November 17, 2019<\/a><\/p><\/blockquote>\n<p><script async src=\"https:\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"><\/script><\/p>\n<p>Happy Thanksgiving! What are you grateful for this year?<\/p>\n","protected":false},"excerpt":{"rendered":"<p>An excellent episode of the Freakonomics podcast introduced me to the headwinds vs tailwinds asymmetry, and how we humans perceive life. It goes like this:\u00a0We go for a walk, a run, or a bike ride, and the wind faces us dead-on, making the exercise a struggle. (In windy Boston, the wind is always in my [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,4,5,6,10],"tags":[1161],"class_list":["post-9448","post","type-post","status-publish","format-standard","hentry","category-health-care","category-hiv","category-infectious-diseases","category-medical-education","category-research","tag-thanksgiving"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/9448","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=9448"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/9448\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=9448"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=9448"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=9448"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}