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Tag: Baylor College of Medicine

  • Prime Season For Mosquito Bites: Houston Residents Have More to Worry About Than Just West Nile

    Prime Season For Mosquito Bites: Houston Residents Have More to Worry About Than Just West Nile

    Mosquitoes, the tiny pests that Houston residents are more than accustomed to buzzing around and being micro-sized nuisances, are packing a heavier punch this summer season.

    According to Harris County Public Health, West Nile — a virus transmitted by Culex mosquitoes — is rising. There have been 74 confirmed cases of the arbovirus detected in Harris County, two dozen more cases this year than the total number of cases reported in 2023.

    Dr. Peter Hotez, co-director of the Texas Children’s Hospital Center for Vaccine Development and dean of the National School of Tropical Medicine at Baylor College of Medicine, said mosquito-borne illnesses may not be the only threat to those wanting to enjoy the outdoors this summer.

    Hotez noted that other arboviruses — infections caused by certain arthropods — such as tick-borne illnesses, could also increase in number over the summer months because of environmental conditions.

    Hotez is also closely monitoring the potential rise of other mosquito-borne illnesses, such as Zika, Chikungunya and Dengue. All of these are transmitted by Aedes mosquitoes, which are different from the mosquitoes carrying West Nile.

    “With the much warmer summers that we’ve been having and all the rainfall, I’m kind of holding my breath,” Hotez said.

    “We seem to be better prepared to do mosquito control for [West Nile] as opposed to the Aedes mosquitoes where you have to go into individual homes and turn over containers containing water,” Hotez added. “It’s much more intrusive and not as well received. So, it tends to be more problematic using conventional control methods.

    Culex mosquitoes—West Nile carriers—can be effectively managed by trucks that spray insecticide in the evening hours. This practice occurs in most cities and counties where the virus is detected.

    As Hotez mentioned, Aedes mosquitoes are more difficult to ward off. However, he noted that there are new technologies, such as using genetically modified mosquitoes or Wolbachia technology — a type of bacteria that lives in a mosquito and is a biological control agent that reduces a mosquito’s fitness for transmitting viruses.

    Hotez said Houston is a hotbed for arboviruses, and the factors that drive these illnesses to spread include warming temperatures, increased rainfall patterns, urbanization and poverty.

    He advised residents to use bug spray with DEET, a common ingredient in insect repellent, and avoid going outdoors for prolonged periods in the evening.

    Protection against these viruses is important as West Nile can produce severe encephalitis — inflammation of the brain —  in adults and children, chronic renal illness and symptoms akin to long COVID in terms of depression and long-term neurocognitive symptoms.

    Unfortunately, Hotez noted that with the increasingly higher temperatures, the spread of West Nile and potentially other arboviruses is expected to get worse in July and August before it gets better.

    Faith Bugenhagen

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  • COVID-19 On Steep Decline, But Physicians Advise Public To Continue Vaccines

    COVID-19 On Steep Decline, But Physicians Advise Public To Continue Vaccines

    Texas is entering into the spring season in a good spot in terms of the number of cases, emergency room visits, hospital admissions and deaths due to COVID-19, which are all steadily declining to some of the lowest numbers reported since the start of the pandemic over four years ago.

    The statewide numbers reflect national trends shown in the U.S. Centers for Disease Control and Prevention’s most recent data for the first week of April, which shows the country recorded the lowest number of deaths within a week in years: 266.

    “We expect it to continue to be like this for a few months,” said Dr. Luis Ostrosky, chief of infectious diseases and epidemiology at UTHealth Houston. “We have traditionally seen an uptick in probably late summer or early fall after everybody’s starting to come back from vacation and everything.”

    Ostrosky said people have built up immunity from COVID-19 vaccines and previous infections to the current variant in circulation, JN.1, a relative of BA.2.86 and an omicron subvariant.

    Currently, two kinds of immunizations are available: an mRNA vaccine by Pfizer-BioNTech and Moderna and a protein subunit vaccine by Novavax. The primary difference between the two is that mRNA vaccines teach the body to create proteins needed to fend off the virus, while protein subunit vaccines already contain pieces of the virus.

    However, the formula for all these vaccines was updated in September to a monovalent one based on XBB.1.5, another subvariant of the omicron family.

    “We started to recommend these particular vaccines in September. I hope that most of the high-risk people would’ve gotten one [then],” Ostrosky said. “Then we heard recommendations from the CDC to consider a second dose if it had been at least four months since your vaccine, so that has already come and gone as well.”

    According to Dr. Hana El Sahly, professor of Molecular Virology & Microbiology at Baylor College of Medicine, uptake for these updated COVID-19 vaccines is slow among the general population but higher in older populations and others that need it the most.

    The CDC recommends that people over 65 receive two doses of the updated vaccines, and those five years and older receive at least one dose. However, due to their vaccination history, this can vary per person.

    Ostrosky said medical professionals are not hearing any more recommendations for an additional dose before fall but that this is subject to change.

    Ostrosky added that the U.S. Food and Drug Administration and its advisers usually meet in May to determine what is in circulation in the Southern Hemisphere and use this information to formulate the flu vaccine for the next season.

    They will use the same system to decide whether to modify the makeup of the COVID-19 vaccination. However, Ostrosky said it does not look like they will be making any changes to the current vaccine formula.

    This is primarily because there are no emerging dominant variants. El Sahly noted that cases caused by JN.1’s subvariants, JN.1.13 and JN.1.18, have been slowly increasing over the past few weeks.

    “We’ve learned to watch very closely what’s happening in South Africa and Europe,” Ostrosky said. When we start seeing activity there, or when we start seeing a particular variant emerging and taking over there, that’s our queue to prepare.”

    “But, surveillance here in the United States has not shown any variant that’s predominantly taking over currently aside from JN.1,” Ostrosky added. “We’re in good shape as long as we don’t see the emergence of dramatically new variants.”

    Those behind on getting their updated COVID-19 vaccine should be able to find it at their local CVS or Walgreens, depending on location and availability. These immunizations should be free for individuals enrolled in private insurance, Medicaid, Medicare Part B and Medicare Advantage Plans.

    They should also be provided at these retail pharmacies at no cost to the uninsured or underinsured through the CDC’s Bridge Access Program. Although COVID-19 vaccines are supposed to come free of charge, administrative fees, such as appointment costs, are sometimes included.

    Mostly, the same coverage guidelines apply outside of CVS and Walgreens. Medicaid will continue to cover the costs of COVID-19 vaccinations and treatments — such as Paxlovid — through September 30, 2024. After this, coverage may vary per state.

    Depending on a person’s insurance, out-of-pocket expenses can add up for Paxlovid or other COVID-19 treatments like Molnupiravir, an antiviral medication used to treat early infection and prevent more severe symptoms of the virus.

    If an individual’s health care insurance does not cover COVID-19 vaccines and they are unable to access these immunizations through a low- or no-cost service, they could pay more than $115 for one dose of these vaccines.

    Ostrosky suggested strategically masking in crowded spaces as schools get out and early summer travel begins.

    Another newer preventative measure is Pemgarda, a medication taken to prevent COVID-19. It is the only preventative medication currently available that blocks virus infection.

    But, it is exclusively used for a small population of those at severe risk of illness from COVID-19, such as cancer patients or those who underwent a recent organ transplant.

    “It is already FDA approved. Many health care systems in Houston are figuring out how to get it and where to use it,” Ostrosky added.

    Faith Bugenhagen

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  • Daylight Saving Time Should Be a Thing Of The Past, Many Doctors Say

    Daylight Saving Time Should Be a Thing Of The Past, Many Doctors Say

    A switch to Daylight Saving Time is not good for us.

    That’s what an increasing number of medical doctors are saying, basing this on what they say is scientific evidence that the annual switch in hours extracts a heavy toll on the human body.  Of course, many of us already knew that.

    “Quite honestly, there is no benefit,” said Dr. Jairo Hernando Barrantes Perez, assistant professor of Pulmonary and Sleep Medicine at Baylor College of Medicine. “It is better for your body to keep the same circadian rhythm year round.”

    Many people say just pick one or the other — standard time or Daylight Saving Time — and stick to that year round. But sleep researchers disagree.

    Perez said those in the field of study support a permanent change to standard time because it aligns more with humans’ circadian rhythm. He’s a member of The American Academy of Sleep Medicine which has adopted this stance alongside other organizations, such as the Society for Research on Biological Rhythms.

    Dr. Kristin Eckel-Mahan, sleep researcher with UTHealth Houston, said the switch is particularly detrimental to those with a later chronotype, usually night owls who prefer staying up into the late night hours.

    Adolescents typically fall into the category of having a natural inclination to go to bed later, more than middle or elementary school-aged children, she said. However, those with this chronotype can vary in age from individual to individual.

    “For night owls who are already sort of habitually staying up late looking at tablets, TV or some type of stimulation that involves blue light, melatonin [sleep hormone] is already not secreting normally,” Eckel-Mahan said. “It’s delayed substantially—an hour more than it used to be—and they have a really hard time getting up in the morning because it’s even darker.”

    Since 2007, residents in the United States have set their clocks an hour ahead in mid-March and prepared to lose an hour of sleep — marking the annual switch to daylight saving time.

    This transition from standard time in the fall has existed for many years despite debate on when and for how long. However, in recent years, there’s been a growing push by lawmakers to abolish it altogether and adopt daylight saving time year round, permanently.

    In 2022, The U.S. Senate passed the Sunshine Protection Act, which would have ended the biannual switch and implemented perennial daylight saving time. The legislation stalled, but it was reintroduced the following year.

    Texas, along with 47 other states, abides by the transition. Arizona—excluding the Navajo Nation—and Hawaii do not participate in the switch. Individual states cannot choose to adopt permanent daylight saving time, but they can opt to eliminate any clock change. According to reports, nearly a dozen states have considered such legislation.

    According to Perez, the initial reason to implement daylight saving time in the U.S. was to save on electrical energy. But now, this energy is widely accessible, and research has shown that energy expenditures in most countries that switch clocks do not change significantly.

    “Unfortunately, this has been a political and economic issue for years,” Perez said. “It might’ve been better for the part of the country where the morning is too dark and too dangerous to be outside.”

    “Now, multiple arguments go back and forth, but if you look at how much energy or how much money you’re saving, it’s not doing much,” he added. “If you take into account the costs of taking care of the health complications and the extra police that are deployed [some studies indicate crime and motor vehicle accidents rise during the switch], the benefit gets voided.”

    The biannual switch can disrupt individuals’ sleep patterns, increase symptoms related to anxiety and depression, and affect moods and hormone production. Research indicates that the transition in the spring particularly increases the risks for heart attacks and strokes.

    Although it typically takes one to two weeks for someone to adjust, Eckel-Mahan added that evidence when evaluating individuals’ cortisol levels—a hormone related to stress that assists with getting up and remaining awake—indicates that some people never fully adjust to daylight saving time because their internal body clock is misaligned with the solar clock.

    “Some people adjust better than others, that is true,” Eckel-Mahan said. “But, not everybody is capable.”

    According to Eckel-Mahan, studies have also shown that humans have a slightly longer circadian period than 24 hours, but the solar clock keeps individuals on a 24-hour schedule. This means that the phase delay in the fall aligns more with the body’s natural rhythms.

    She said that those struggling with the transition can adhere to the solar clock, limit their exposure to blue light late at night, soak up as much sunlight during the daylight hours and avoid eating and exercising close to bedtime to help ease the change.

    According to Perez, those most affected by the transition include women of reproductive ages and children. He pointed out that the research evaluating the uptick in heart attacks in the days after switching to daylight saving time showcases that they are occurring in women more than they are men.

    Perez said researchers have seen that kids are very sensitive to the change and may sleep through the first few hours of school, disrupting their academic and social performance. He added that it is common for people to experience circadian misalignment and “social jet lag.” According to the National Institutes of Health, circadian misalignment is the inappropriate timing of sleeping, waking and feeding patterns or other central and peripheral rhythms.

    Perez cautioned those who are sleep-deprived and want to overcompensate by over-caffeinating that an increase in the consumption of coffee or energy drinks could lead to experiencing high blood pressure, higher cortisol levels or a heightened risk of cardiovascular problems.

    He also advised people who may opt to take melatonin to be aware and not overdose on the hormone, “I have patients that come to me, and they’re taking 20 milligrams. That’s way too much.”

    Instead, Perez recommends one to three milligrams, five milligrams maximum and the lowest dosages for children as their brains are not prepared for anything higher.

    Perez has been a part of the Public Safety Committee of the American Academy of Sleep Medicine for three years. He says despite advocating against the transition to year-long daylight saving time since joining, support for this stance hasn’t garnered traction.

    “Unfortunately, it hasn’t taken off or gained enough weight in Congress to pass a law to abolish it,” Perez said. “We were close a couple years ago, and we are trying to move forward this year again to do it, but people have to be aware that the benefit that was present 200 years ago is not present any longer.”

    “We weren’t aware of circadian rhythm then. We didn’t have as much information as we do nowadays,” he added. “We weren’t aware because we were not keeping statistics as close as we are nowadays. So now, we have evidence that it doesn’t help as much. It’s just a lack of knowledge from the general public.”

    Faith Bugenhagen

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