Bugs of a Feather Flock Together

Where measles goes, others follow

This is the 100th edition of Clear and Present Thinking. It’s highly unlikely anyone has read them all, including me, but if you are still following the story—thanks for the vote of confidence.

In recents posts we discussed the ongoing measles epidemic, and I mostly concentrated on the US problem; but the epidemic of measles is world wide with 49 countries reporting outbreaks, which in many dwarfs the situation here. While the US has recorded 121 cases in the first three months of this year (a mean increase of 17 fold compared to the same time interval average of 2020-2023), countries such as Kazakhstan, Azerbaijan, Iraq and India have each recorded over 20,000 cases in the last six months, and the trend is increasing. The UK has identified over 1000 measles cases, with the epidemic starting in the West Midlands, now having spread to London as feared. The UK Health Service estimates that 85% of the country is vaccinated for measles (well below the 95% necessary to prevent widespread community transmission), but some estimates place the level of vaccination at only 50% in large areas of London, particularly low in immigrant communities—so this epidemic has a long way to run there, and around the world.

I discussed the mortality, morbidity and complications of measles in a previous post, but given the magnitude of this epidemic around the world, there is another important consequence to measles infection worth reviewing. Acute measles infection causes an immediate compromise in overall immune functioning—not really unique as other severe infections do the same. Think of the high frequency of secondary bacterial pneumonias quickly following Influenza or COVID as an example. Measles, however does seem to have a unique ability to cause a long lasting (1-2 years) paralysis of the immune system, which has been called “immune amnesia”. It has been known for a long time that a wide variety of other infections are increased in frequency following MV (measles virus) infection, but our understanding of how that occurs has significantly advanced in recent years. Following an acute decrease in lymphocytes during initial infection, there is a rebound as immunity to MV develops. The lymphocytes found following infection however, are overwhelmingly programmed to recognize the MV at the expense of the usual population of immune cells targeting other pathogens which the individual had previously developed immunity to. The B and T memory cells protecting us from infections we had earlier overcome, are deleted as the powerful and lifelong immunity to measles takes hold, and this effect is both long lasting and clinically significant. For more details if this interests you, follow the link below.

https://asm.org/articles/2019/may/measles-and-immune-amnesia

This past week the Chicago Board of Health for the first time reported that cases of tuberculosis have been identified in “several” migrant shelters. Continuing their lack of transparency and failure to report important public health information, the city has not released data on the number of cases or the locations. That of course opens the question of whether these cases of TB are the result “immune amnesia” following measles infection—or whether they are simply the result of a population of migrants who are estimated to have 25% or higher latent TB infection, and being warehoused together in incredibly crowded conditions. There are studies showing that deaths from other infectious diseases rise very significantly for a period of time following measles infection, and we can assume that will be the case around the world as the epidemic progresses. Measles is truly the gift that keeps on giving. Not to be outdone by measles or a Johnny-come-lately virus like SARS2-Cov19, TB is a scourge which has been with us in recorded history for over 3000 years, and documented in pathologic remains 9000 years old. Despite some ups and downs, TB kills about 1-1.3 million people every year like clockwork, and certainly is in the running for the pathogen with the highest cumulative human death toll.

Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality | Science

https://www.science.org/doi/10.1126/science.aaa3662

In my March 15th post I discussed the environmental risks associated with the 16,000 different chemicals contained in the plastics which we inundate the planet with. One of the group of so called “forever chemicals” are the PFAS, florinated alkyl compounds which have been linked to endocrine disruption, thyroid disease, cancer and liver disease. This week the EPA finally set a limit on the acceptable level of PFAS in drinking water at 4ppt. Four parts per trillion may not sound like much of anything to worry about, but these chemicals accumulate steadily overtime in the body. Some US public water supplies are dramatically above this level of contamination. My home state of Colorado announced that 29 municipal water supply districts are currently above that cutoff, but did not provide specific level information. Around the country there will be a slow process of adding filtration systems to remove PFAS over several years (using money which we already don’t have, but hey why worry when the government is already 36 trillion in debt). In the meantime you can look into your local water utility analysis report if available, and if there is significant PFAS contamination, then activated charcoal filtration will greatly reduce it. You can deduct the cost from your tax payment—go ahead and tell the government I said it was ok.

Those of you unfortunately old enough to remember a movie The Graduate may recall Mr. Maguire saying to Dustin Hoffman, “I have one word for you, Plastics”. So while we are on the subject I would like to point out that microplastics are found not only in aquatic species, but have been detected in multiple human tissues, including in the carotid atheroma of over 50% of people undergoing the surgical removal of plaque from the arteries; and their presence is associated with a 4.5 fold higher risk of subsequent, stroke, MI and cardiovascular death. That increased risk is presumably linked to the higher levels of inflammation found when these microplastics are present. A recent study looked at thrombi removed from the arteries and veins of patients with ischemic stroke, MI or lower extremity DVT, and found microplastics in 80% of the 30 patients examined. Current world production of plastics is 400 million tons per year and expected to double by 2040. 40% of microplastics are traced to single use items such as water bottles, so perhaps you want to reconsider those Evians and stick with a stylish refillable metal water bottle. I have one word for you….

https://t.co/byxF88vLvR

I had planned to finish today without once mentioning COVID, but old habits die hard. I want to draw your attention to the publication of a randomized study of Paxlovid verses placebo, published in the New England Journal of Medicine on April 3rd. The important finding was there was no difference between the two groups in time to resolution of symptoms. There was a numerical finding favoring a reduction in hospitalization, not reaching statistical significance, but that was not the question the study was designed to answer. We know from multiple prior studies that Paxlovid reduces the need for hospitalization in HIGH RISK people. This study validates what I have been telling folks for a long time: If you are not in a high risk category don’t bother taking Paxlovid. Now that you have to pay through the nose for this medication it’s good to have this validation. The study link follows.

Nirmatrelvir for Vaccinated or Unvaccinated Adult Outpatients with Covid-19 | New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMoa2309003

I can’t avoid mentioning the elephant in the room today—Iran’s massive attack on Israel. Of course the war between Israel and Iran really began on October 7th, but now it’s a matter of open record. 300 ballistic missiles, drones and cruise missiles and all the Shiite mullahs managed to do was severely wound an 8 year old Sunni girl. Karma is that B word. Of course beyond the humiliation of being completely thwarted, the Iranian religious dictators couldn’t care less about killing other Muslims; Shiites and Sunnis fanatics have been at it for years. Let’s hope cooler heads prevail, and while we are at it perhaps one of those heads will stop supplying Iran’s terrorism machine by returning to the enforcement of the Iran oil embargo. When Iran was reduced to 300,000 barrels of oil per day a few years ago, the regime was occupied with barely staying afloat and avoiding overthrow—now back at 4 million barrels a day they are whooping it up. Of course high gas prices are inconvenient around election time, but so too is a major mideast war. Appeasement is a strategy that is guaranteed failure with dictators, terrorists and fanatics—some of us are old enough to have learned that.

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