Everything seems to be on the rise

From RSV to Strep A, there appears to be an ever increasing number of infections occurring. A few thoughts on these upticks, and some words of caution.

Strep A. Measles, RSV, the flu. As we enter the holiday season there appears to be a bombardment of reports on the uptick in many ailments.

Right now the UK has recorded 15 children deaths attributed to Group A strep bacteria as noted by The Guardian. Usually this infection may be considered relatively mild and easy to treat with antibiotics, so it’s rather strange to see such an uptick in deaths. Some reports suggest shortages in penicillin with families having to scour different pharmacies for prescriptions, although members of UK’s government such as the recently inducted Prime Minister Rishi Sunak have rebutted these claims in stating that there aren’t a current shortage of drugs to treat these infections, as noted in a recent House of Commons debate.

Irrespective of the government’s declarations, there appears to be a discrepancy in supply and demand. It’s hard to tell a family looking for antibiotics that there is a sufficient supply if they must search for said supplies.

There also appears to be a measles outbreak occurring in Ohio with up to 63 cases being reported in yesterday’s report from ABC News. This outbreak seems to be attributed, as suggested by the news article, to low MMR vaccination rates in children:

Three of the 63 children have received one dose of the measles, mumps and rubella (MMR) vaccine, a highly effective vaccine that protects against the three diseases. The remaining 60 children are unvaccinated. The majority of the children are under 5 years old.

Irrespective of our thoughts on childhood vaccination, it’s rather shocking to see an uptick in measles occurring.

All of this comes on the heels of the supposedly looming “tripledemic”, which suggests waves of RSV, flu, and COVID all intermingling in the near future. Many of these remarks are speculative, and some of the current statements, such as the ones from CDC Director Rochelle Walensky from Monday, suggest that the RSV peak may have already occurred and that there appears to be a decline in RSV infection across the country. I wonder if this occurred at the same time that she “encouraged” people to start masking again over fears of all of these respiratory infections…

With everything seemingly on the rise one is left to speculate as to why this could be occurring.

Of course, the immediate concern by Team Skeptic would be in considering what effect the COVID vaccines could have in these upticks. Could the COVID vaccines have an effect on immunosuppression to cause these issues?

I’m generally leery of this hypothesis because we have no way of knowing to what extent we should be seeing a drastic rise in other infections if a large portion of the world is considered to be immunocompromised.

Exactly how many rises in infection should be considered adequate to implicate the vaccines? Instead, we tend to see upticks of illnesses and allude to the fact that the vaccines may play a role.

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We saw this with the monkeypox issues and the strange upsurge of monkeypox cases both mild and severe. However, as I have noted, recent reports from the CDC suggest that most severe cases of monkeypox occurred in those with HIV/AIDS, and with a good portion of these individuals not being on anti-retroviral medications. So it could very well have been behavioral factors that dictated a lot of what went on with the monkeypox issue, with many cases serious illness stemming from prior immunocompromised status of these individuals. Interestingly, as of now recent reports suggest that the US will end the monkeypox health emergency in January.

All this to say that there was a verifiable explanation for the monkeypox issue that may not have been known at the time, and also didn’t have rely on speculations of COVID vaccine immunosuppression to justify this phenomenon. Again, to what degree should the monkeypox outbreak have run rampant if the entire world was dealing with widespread immunosuppression?

The measles outbreak may not be tied to COVID vaccines if we consider that a majority of the children did not receive the MMR vaccine. We’re doing some speculating here, but I’d be hard pressed to believe that children who didn’t receive the MMR vaccine would receive the novel, highly contentious and worrisome COVID vaccines. More evidence would be needed in seeing why these outbreaks are occurring, even if this may be tied predominately to lack of MMR vaccination (although other factors are likely at play).

As to Strep A, we once again have to deal with exactly why this outbreak is occurring now compared to other times.

In trying to rationalize this issue in relation to COVID vaccine immunosuppression, I thought about the masking study from Japan I covered a few months back.

Masking, Bacteria, and Fungus

Although most of the bacteria found on masks weren’t pathogenic, several of them are considered to be pathobionts:

However, just because these bacteria are part of our microbiome doesn’t necessarily mean that we are fully protected from infections. For example, Staphylococcus epidermidis and Staphylococcus aureus are classified as pathobionts (symbiotic bacteria that may become pathogenic under certain circumstances). These bacteria are part of our microbiome and generally kept in check. However, if levels of these bacteria increase above normal levels they can lead to various skin conditions2.

That is to say, should we expect a combination of both masking and vaccination (if vaccination were to lead to immunosuppression) to lead to an uptick of infections from these pathobionts or other synergistic bacteria?

This doesn’t appear to be the case, although such a speculation would require that we understand what exactly to look out for with these bacteria in particular. Some evidence suggests that gut bacteria are pathobionts, and may lead to inflammatory bowels and other gut-related diseases in times of immune dysfunction¹.

So looking for gut issues may be a better tell, although we don’t have evidence of upticks in GI issues (as far as I am aware).

It’s also worth noting that COVID vaccination in children appears to be fairly low relative to older groups.

One CNN article notes the following in an article from mid-November:

And Covid-19 vaccination rates among children have long lagged behind those for adults. Just 32% of children ages 5 to 11 and 61% of those ages 12 to 17 have competed their initial series of Covid-19 vaccination, compared with 78% of adults.

Altogether, the fact that Strep A deaths are at levels higher than previous years is extremely concerning, but to the degree that COVID vaccines play a role is again, another highly speculative argument.

Again, what exactly should be looked out for if we are to assume widespread immunosuppression?

But broadening to other vaccines, Igor Chudov raised an interesting question a few days ago about the flu vaccine and increased risk of bacterial infection.

There’s a lot of nuance in this discussion, but on the surface this does appear to be the case that flu vaccination may be associated with increased risk, as noted in the study provided by Igor².

HOWEVER, note that this effect has actually been seen with flu infections in general. It appears that the association between flu infection and subsequent bacterial infection is actually known. In fact, this was the foundation for the researchers in the study cited by Igor (Mina, et al.):

Following infection with an influenza virus, infected or recently recovered individuals become transiently susceptible to excess bacterial infections, particularly Streptococcus pneumoniae and Staphylococcus aureus. Indeed, in the absence of preexisting comorbidities, bacterial infections are a leading cause of severe disease during influenza epidemics. While this synergy has been known and is well studied, what has not been explored is the natural extension of these interactions to live attenuated influenza vaccines (LAIVs). Here we show, in mice, that vaccination with LAIV primes the upper respiratory tract for increased bacterial growth and persistence of bacterial carriage, in a manner nearly identical to that seen following wild-type influenza virus infections. Importantly, LAIV, unlike wild-type virus, did not increase severe bacterial disease of the lower respiratory tract. These findings may have consequences for individual bacterial disease processes within the upper respiratory tract, as well as bacterial transmission dynamics within LAIV-vaccinated populations.

And this shouldn’t come as too much of a surprise, as many viral infections are also associated with bacterial infections. It’s likely that many bacteria may find a niche in the viral/host dynamics to take hold.

Interestingly, part of this may be owed to gut dysbiosis during a viral infection.

A study by Sencio, et al.³ examined the effects of flu infection on the gut microbiome of mice. With infection from H3N2 and H1N1 there was an apparent shift in the gut flora of mice by 7 days post infection.

There was also an apparent truncation of short-chain fatty acids produced by these altered gut flora as noted by acetate production at 7 days post infection (dpi) for the mice relative to the control mice:

From Sencio, et al. Figure 1. The top two charts show the differences in bacteria in fecal (A) and cecal (beginning of the large intestine, B) in control mice and mice 7 days and 14 days post infection. C and D show the levels of short-chain fatty acids at these timepoints, which show a drastic reduction in these molecules.

It is suggested by the researchers that the change in the gut microbiome, leading to the alteration in SCFA production, is actually what reduces the antibacterial properties of the gut that may make one susceptible to bacterial infection.

Interestingly, lack of food intake may alter the gut microbiota and therefore may be part of the reason for downstream bacterial susceptibility.

The researchers note this in their Discussion:

Food intake and diet composition can rapidly shape the structure and function of the gut microbiota (David et al., 2014; Desai et al., 2016; Maslowski et al., 2009). Moreover, previous studies have revealed that fasting and feeding rhythms significantly alter the gut microbiota (Thaiss et al., 2016). Loss of appetite is a feature of influenza (Monto et al., 2000). In view of our present results, we suggest that decreased food intake during influenza infection, and thus reduced amounts of ingested complex carbohydrates, from 4 dpi onward is at least partly responsible for perturbation of the microbiota.

The study from Mina, et al. uses an attenuated flu virus, and so the capabilities of replication and mild viral infection may still be enough to simulate a flu infection, leading to the downstream alterations in gut flora, alteration in SCFA production, and therefore increased susceptibility to other bacterial infections.

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I bring this point up because several commenters have remarked about the gut microbiome in regards to overall health. There’s a lot that is still unknown with both viruses and our glut flora, but we may find that things are far more connected than they appear.

Flu vaccination doesn’t appear to be at the levels they were prior to COVID, likely owed to vaccination fatigue that has led people to not receive the recent COVID boosters as well as the flu vaccine. Apparently pregnant women are not receiving flu vaccines at the same level as prior years.

And so maybe flu vaccination wouldn’t account for the uptick in these bacterial infections. We would also have to know what type of vaccine people are getting as well in order to draw connections between the vaccines and the bacterial infection.

However, it may be that gut dysbiosis caused by the actions over the path 3 years, in which many people did not go outdoors, lived in sterile environments, did not see one another, and had poor eating/sleeping habits all may make us more susceptible to infections of all sorts.

To be clear, we may find out at some point that the massive COVID vaccination campaign may have caused permanent damage to the immune system.

However, for the time being there are other possible explanations for what we are seeing. It’s likely that all of these factors have culminated and made us all the worse off, leading to the uptick in these infections and other morbidities.

At the same time we are seeing an uptick in these infections, we are also seeing an uptick in fear porn and other shock-value reportings which may amplify histrionics over what’s going on.

It’s important to remember to keep a level-head and not jump to conclusions. Look for alternatives, and see if there could be other reasons for the things we are seeing.

Remember that we are still finding out the ramifications of the lockdowns on our overall health, among all of the other things going on.

Image from Getty Images.

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1. Chow, J., Tang, H., & Mazmanian, S. K. (2011). Pathobionts of the gastrointestinal microbiota and inflammatory disease. Current opinion in immunology, 23(4), 473–480. https://doi.org/10.1016/j.coi.2011.07.010

2. Mina, M. J., McCullers, J. A., & Klugman, K. P. (2014). Live attenuated influenza vaccine enhances colonization of Streptococcus pneumoniae and Staphylococcus aureus in mice. mBio, 5(1), e01040-13. https://doi.org/10.1128/mBio.01040-13

3. Sencio, V., Barthelemy, A., Tavares, L. P., Machado, M. G., Soulard, D., Cuinat, C., Queiroz-Junior, C. M., Noordine, M. L., Salomé-Desnoulez, S., Deryuter, L., Foligné, B., Wahl, C., Frisch, B., Vieira, A. T., Paget, C., Milligan, G., Ulven, T., Wolowczuk, I., Faveeuw, C., Le Goffic, R., … Trottein, F. (2020). Gut Dysbiosis during Influenza Contributes to Pulmonary Pneumococcal Superinfection through Altered Short-Chain Fatty Acid Production. Cell reports, 30(9), 2934–2947.e6. https://doi.org/10.1016/j.celrep.2020.02.013