Jason Andrews
@JasonAndrewsMD
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infectious diseases physician + Prof @Stanford
Stanford, CA
Joined June 2022
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Our leaders were more outraged by students camping out in tents than by refugees being bombed in them.
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In Jan, 2021, Jay Bhattacharya published an article claiming that most Indians have natural immunity and vaccination would be harmful. 3 months later, between April and June, 2021, an estimated 3 million people died of COVID in India.
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This is the "rigorous adherence to science" that Elon appreciates.
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In it, he claimed that vaccines provide "no benefit" to previously infected individuals and that it is "unethical to vaccinate them." Numerous studies including ours have shown that vaccines confer substantial protection to people with prior infection.
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I tend to avoid sharing personal news on this platform, but I owe a great deal of debt to many mentors, colleagues, postdocs & students for this milestone, whom I need to sincerely thank for years of support. Thanks
@NathanLo3579
for surprising me w/a temporary nameplate!
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Does BCG revaccination protect against TB infection? We nested a trial assessing QuantiFERON conversion (and sustained QFT conversion) among Brazilian healthcare workers in the BRACE RCT and did not find evidence of protection. 1/6
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Years ago (studying TB risk), we gave wearable, GPS-tracking CO2 sensors to students in Cape Town to quantify 'rebreathed air' across various locations. Schools were the highest risk sites. Here's a sample 24-hour trace. See the CO2 spikes and drops going into out of classrooms.
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A lot of excitement on twitter today about TRUNCATE-TB, for good reason. An intensified regimen of bedaquiline + linezolid + HZE for 8 weeks was non-inferior to 24w standard HRZE. Eager to hear more from TB community but some brief thoughts...
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Typhoid remains a major cause of illness and death in LMICs, and antimicrobial resistant strains are on the rise. Today, we published a pair of studies addressing this:
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Could detecting M. tuberculosis in air samples be useful for surveillance in congregate spaces or improve our understanding of transmission patterns? We've been working on this for years and recently released a pair of pilot studies. 1/3
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The WHO finally recommends systematic screening for TB in prisons, but most LMICs have not implemented it, as specific guidance is lacking. In a new paper, we review evidence for TB screening in prisons and provide recommendations about implementation. 1/5
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Congratulations to newly minted Dr. Sindiso Nyathi! Sindiso gave a brilliant defense of his thesis on phylogeography of Dengue. Watching him progress from his vision 5 years ago, navigating numerous challenges to create an elegant body of work was just awesome to behold.
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This is incredible, inexpensive, invaluable for monitoring risk for infectious disease transmission and broader health effects of air quality (CO2 and cognition, PM2.5 and cardiopulmonary health). California, let's get on this!
@AbraarKaran
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Easily the best part of the academic job is being the first to greet your student as doctor. Congrats Yiran
@loloyem
on a brilliant defense of your PhD! So amazed by all that you have accomplished!
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The 2023 WHO Global TB Report has a special section on TB in prisons! Indicates that WHO will work towards collecting & reporting notification data among PDL from all regions. Fantastic to see the attention brought to this important issue.
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How can environmental surveillance for Salmonella Typhi be performed at low cost & with minimal lab infrastructure? We found that detecting Typhi-specific phages in surface waters using a simple, inexpensive approach readily identified high-risk locations.
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New CDC report out on endemic fungi in U.S. California & Arizona account for 97% of cocci cases. Lower income and minority communities in the central valley are disproportionately affected. 1/5
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Should we look at the quantitative results of QuantiFERON (QFT) tests or just use the dichotomous result? This question frequently comes up clinically, so here are several reasons to look further than positive/negative: (1/7)
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What tools work for active case finding for TB in high-risk populations? We have been searching for solutions for mass TB screening prisons for years, and finally have a promising candidate: x-rays with automated interpretation. Our work just out: 🧵
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We are recruiting for a postdoc in infectious disease modeling at Stanford! Come work with a passionate international team evaluating new approaches to tackle the TB pandemic, with focus on underserved populations. Please share!
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Preventive treatment can be an effective tool for reducing TB burden, but remains underutilized in underserved populations. In this new piece, we argue for expanding provision of TPT for persons deprived of liberty as a crucial step to advancing equity:
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New postdoc opening in modeling of typhoid vaccine strategies with the amazing
@NathanLo3579
and me at
@StanfordMed
. Project is with wonderful collaborators at
@sabinvaccine
and
@AKUGlobal
. Please share!
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People who have never cared for patients or lost loved ones to pandemics can make flippant comments suggesting we choose to have them. Our ICUs weren't overwhelmed by choice. We didn't decide to lose millions of lives. To suggest otherwise demeans our care and our loss.
The start and end of pandemics are primarily political decisions. If the media and some badly mistaken scientists manage to convince the politicians that there is a pandemic, then we will have a pandemic.
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Upi hired me a decade ago, giving me the greatest opportunity of my life & supporting me more than I ever deserved. When starting in academia, we are plagued with self doubt & need mentors who believe in us. Upi sees the best in people and nurtures it. We will miss her immensely.
Upinder Singh, MD, has been named chair and department executive officer of the Department of Internal Medicine, effective Oct. 1. Dr. Singh is a professor and division chief of Infectious Diseases and Geographic Medicine at Stanford. Welcome, Dr. Singh!
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Spent a day at the Institute of Bioinformatics in Bangalore to see the new lab of our lab alum
@Renu__Verma
. She has already built a formidable group and has numerous exciting projects underway. Mtb, consider this a warning, the Verma lab is coming for you!
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Very exciting to see the results of the endTB clinical trial! Three regimens showed non inferiority (including one superior) to a rigorous standard of care. Such an important advance for patients.
@TheUnion_TBLH
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Congratulations Dr. Yiran Liu (
@loloyem
)! You bring brilliance, morality & compassion to everything you do. I cannot wait to see all of amazing things you do in the years to come. Thank you for letting our lab be part of your journey. h/t
@AbraarKaran
for the photos!
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I support our students' right to peaceful protest here at Stanford. The encampment (see agenda) is not violent or harmful. Police response on campuses across the country has been. I hope that our university leadership will not invite violence onto our campus.
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World TB Report 2022 is out. Tons of good info, but every year the first thing I do is search it for "prison", "jail", "incarceration" etc to see if WHO has started to give more attention to this problem. And every year the same result: no results found.
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Deforestation accelerated while science funding was slashed by 45% under Bolsonaro. From Nature:
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Paraguay's prisons have among the highest TB rates in the world. In the Ciudad del Este regional prison, ~6% of residents are diagnosed with Xpert+ active TB each year, despite no active case finding or on-site diagnostics. True burden likely twice as high. 1/3
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Scrub typhus is one of the most neglected infectious diseases, w/ high case fatality rate & wide geographic distribution. One of the reasons it remains neglected is lack of understanding of burden. Our latest seroepi approach to estimating incidence:
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"You can't improve if you don't measure." The first lesson I learned from
@TheIHI
. Remarkably, and dismayingly, global cases of TB in prisons aren't tracked and reported, and we haven't had measures of the global burden until now. 1/n
1/n Our new manuscript in
@TheLancetPH
is out describing the country, regional, and global burden of tuberculosis among individuals in prisons. We also calculated the case detection ratio (proportion of all cases that are diagnosed) of TB in prisons.
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Can we detect Mtb in the built environment and use this to study TB transmission? Our pilot work in hospital rooms and prisons showing Mtb can be readily detected using surface swabs and full-length genomes recovered via RNA bait capture-based sequencing.
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Hunting for Typhi bacteriophages with Shiva and Kesia in Kathmandu.
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"In the time between the two trials, approximately 9 million people will have died from TB." More than 5 years passed between the end of Phase 2 and start of Phase 3 trials for M72 b/c GSK decided it wasn't profitable. At last, this terrible tale is told
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Outstanding TB science session on tools and methods for understanding TB transmission with talks by
@ted_h_cohen
@rycktessman
Frank Cobelens and more
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@_Eric_Reinhart
Great piece Eric! Counters false narrative that physician burnout is due to overwork, which is contradicted by data showing average physician work hours have steadily declined for 2 decades. 'Demoralization' (perfectly loaded word) for reasons your describe hits nail on the head.
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As "lyme lab leak" nonsense circulates here🤦♂️, will take the opportunity to plug the outstanding work of lab alum
@katwalter7
showing that Borrelia burgdorferi is diverse and has been circulating for tens of thousands of years.
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Important study on duration of culturable BA.1 shedding out of MGH/Brigham. Median 5 days from 1st positive test, 8 days from symptom onset/pos test. Striking that a quarter of participants had shed culturable virus >10 days
Data from small longitudinal cohort show that SARS-CoV-2 omicron (BA.1) variant can be cultured a median of 8 days after symptom onset or initial positive test.
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Delightful to be back in Vellore with
@jebujohn
and colleagues to kick off a new project on new tools for measuring typhoid vaccine impact.
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Thoughts on new data () on Mtb 'resisters' (people who remain persistently TST/IGRA negative despite intense exposure):
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Was just instructed by an editor of a prestigious journal to "avoid use of the term 'disease'" and instead use "invasive symptomatic infection".
So I guess our specialty name needs to change now.
Also a few journals and government agencies will need to update their names.
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Important new paper on excess TB burden during economic recession in Brazil. 71% of excess cases among 20-39 year old men, likely driven by incarceration.
@Yunfei_J_Li
@ted_h_cohen
@PelissariDM
Nick Menzies
@EthelMaciel
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There's no one I'd rather respond to an inflight medical emergency over the Sahara desert with than you,
@BogochIsaac
(everything turned out fine, long night)
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Our latest with
@yemlooo
and
@juliocroda
on the continued scourge of infectious diseases in carceral settings:
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A delight to host Dr. Gustavo Velasquez for ID grand rounds on all-oral regimens for MDR/RR-TB, sharing results of the EndTB trials and intriguing data on linezolid dose reduction!
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First fatal case of Alaskapox, an orthopoxvirus, in an elderly immunocompromised man. Seventh case since identification in 2015
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Congrats to
@yemlooo
on passing her PhD quals! Yiran has done amazing work on multiple facets of incarceration & health. Also organized an engaging & impactful community advisory board including persons deprived of liberty to guide this effort. An incredible scientist & advocate
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Penal reform in Kazakhstan led to dramatic declines in incarceration and, with it, tuberculosis in prisons. Biomedical interventions can and should supplement these efforts but alone cannot achieve this degree of impact
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Thank you
@juliocroda
and your incredible team for an inspiring and productive week, reviewing latest data from our TB studies and planning the next phase of our efforts to
#EndTB
in prisons.
@yemlooo
@katwalter7
@ArgitaDSalindri
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My Brazilian postdocs insist that Brazil's World Cup matches are global public holidays and that I'm legally obligated to provide churrasco and cerveja. Something about 'direitos humanos' and 'Lula prometeu'. Is this true?
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We just launched a search for two new faculty members in the Division of Infectious Diseases and Geographic Medicine
@StanfordMed
. Please share!
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New study out in
@TheLancetPH
by
@ch272n
@KBibbinsDomingo
and colleagues on COVID-related excess mortality. Workers in agriculture, transportation, manufacturing, restaurants had the highest excess mortality risk.
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Typhoid conjugate vaccines likely to be not only highly cost-effective but cost-saving in Bangladesh. Our new analysis here:
@PreventTyphoid
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New paper on detecting Salmonella Typhi-specific bacteriophages to map typhoid risk using simple low-cost assays, with data from Nepal, led by Sneha Shrestha and Kesia da Silva:
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Sharing our new paper on development & validation of a Nanopore pharmacogenomic panel to guide TB drug dosing. >50% of patients receive suboptimal dosing, leading too excess toxicity risk (too high) or risk of failure/relapse (too low). 1/3
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Lab mini-retreat to the beautiful but chilly NoCal coast!
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This is fantastic news.
@kathleen_neuzil
is an incredible physician-scientist and leader, a perfect choice for leading Fogarty. She consistently places impact and equity at the center of her work and everything she engages with, will be a guiding light for the NIH
Fogarty is excited to welcome Dr. Kathleen Neuzil as our new director of this May!
In her new role, Dr. Neuzil will lead
@NIH
efforts in
#globalhealth
research.
Learn more:
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my phone autocorrected fungemia to dragons and i'm just gonna go with it
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Latest work on how correctional facilities can amplify infectious disease epidemics driving broader community transmission, with Chris Weyant,
@feralaes
, Jeremy Goldhaber-Fiebert & Serin Lee. 1/5
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Congrats
@katwalter7
who just started as new Asst Prof
@UUtah
! She uses her talents in genomic epi to advance health equity in vulnerable populations. Will miss her at Stanford but look fwd to working w/her on her K01 (👏) w/
@juliocroda
@ted_h_cohen
@CarolineColijn
@bmathema
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A pleasure to meet with Beto Ovelar, President of the Senate of Paraguay, to discuss the problem of TB in prisons and plans to respond to this. It is so impressive to see the political will built by
@guillesequera
@lalyestigarr
and
@Sarita13659917
for this work.
@juliocroda
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Nice study out of MGH/BWH found Paxlovid reduced hospitalization or death among vaccinated pts. Investigators mitigated immortal time bias by selecting pts not meeting endpoint 2 days from dx (which reduced event rate & made NNT appear larger than is).
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What is the spatial scale of typhoid spread in endemic communities? We investigated this in the context of phased vaccine introduction in Navi Mumbai, India, and our paper reporting this is out. 1/n
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Thank you
@StanfordCIGH
! Excited to work with
@ArgitaDSalindri
who is leading this important project
A new
#GlobalHealth
Seed Grant aims to address the high burden of
#TB
in low-resource prisons by implementing novel case-finding approaches and preventive measures in an Indonesian prison.
@stanforddeptmed
@jasonandrewsmd
#healthequity
#tuberculosis
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Oropouche is spreading in Brazil. A warning from an expert who has been tracking it closely that we will soon be seeing it across the continent and maybe beyond.
Casos autóctones na Bahia, no Piauí e agora em Santa Catarina. O vírus já está no país todo e em breve no continente. Oropouche pode se tornar o primeiro vírus originário do novo mundo a causar epidemias de escalas internacionais.
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This is where we need to be going, away (again) from vertical programs, a habit that's easy to fall back into. This is a nice piece, challenging us to rethink and reimagine our approaches.
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Great talk on typhoid incidence before & after vaccine introduction in Pakistan by
@TahirYousafzai8
. Incidence is down but remains too high, with extensively drug-resistant strains still comprising the majority. Vaccines are necessary but not sufficient to eliminate typhoid
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Nice review of climate change and waterborne diseases by Jan Semenza and Albert Ko. Highlights four pathogens that may pose increasing health threats as climate change progresses, implications for amplifying inequities.
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Shiva Naga gave an outstanding talk on data from Nepal demonstrating that serosurveys performed in schools provide unbiased estimates of typhoid seroincidence, at a fraction of the time/personnel/cost of household-based surveys. Making this approach scalable for closing data gaps
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Excellent Mtb genomic epi study out of Chiang Rai Province, Thailand, which found incarceration history strongly associated (aOR 4.5) with being in a large TB transmission cluster in community.
@megan_b_murray
h/t
@SheelaShenoi
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Wonderful to be here to see my friend
@juliocroda
open the 57th Congress of the Brazilian Society of Tropical Medicine in Belém! Inspiring the next generation of scientists!
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Mato Grosso do Sul state in Brazil officially declared "D-day on TB in prisons", commemorated annually on March 25.
@juliocroda
was instrumental in building political will for this all-too-rare commitment to the health and rights of persons deprived of liberty.
No dia 25 de maio de 2017, conseguimos instituir no dia 25/03 de março, o dia "D" de Combate à Tuberculose, no âmbito do Sistema Penitenciário do Estado de MS. Desde então, 23% a 32% dos novos casos de TB se concentram nessa população.
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We've been doing Mtb genomic surveillance in MS for years for research. Now, with leadership from Health Secretariat (esp. Crhistinne Gonçalves), State Public Health Lab & Fiocruz (
@juliocroda
), sequencing will now be done routinely at Lacen Campo Grande! First batch just out!
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Richard Horton dropping harsh truth on the celebrations around the UNHLM political declarations:
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Opening of the EUSAT Prisons and TB meeting in Asunción with talks this morning by
@guillesequera
@Sarita13659917
and Cecile Magis-Escurra.
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We are hiring for a Research Program Coordinator to help lead solutions-oriented projects in global infectious diseases. Please share!
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Outstanding reporting on the health, security and human rights conditions in Paraguay's prisons, with insightful comments from
@guillesequera
A Martín le agarraron entre cinco, le ataron los tobillos y le colgaron boca abajo. Enseguida, su propia sangre enrojeció más la cuerda roja que rasgaba su piel. Solo fue el comienzo.
(Va hilo 🧵sobre
#Tacumb
ú con fotos ⬇️).
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Impressive new data linkage study from the 100 Million Brazilian Cohort provides detailed insights into TB risk among household contacts. Will be helpful in targeting household support, case finding and prevention measures.
I am pleased to share the paper "Incidence and risk factors of tuberculosis among 420 854 household contacts of patients with tuberculosis in the 100 Million Brazilian Cohort (2004–18): a cohort study"
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The list of people to thank from around the world is too numerous to share here. I hope I can repay and pay forward their support. I came to
@StanfordMed
ten years ago next month, found lovely colleagues who encourage and help one another. It is an awesome place to be.
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>90 days after myocarditis following mRNA COVID vaccination, vast majority of patients had recovered: normal troponins, echos, stress tests. Quality of life scores no different than population mean.
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Sun has set on MedTrop Belém! Congress president
@juliocroda
led a fantastic program. So nice to see colleagues, hear about great research, and envision the future.
@otavio_ranzani
@EthelMaciel
@LeoMarti_EpiTB
@IzabelaMR
@lalyestigarr
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@juliocroda
gave a fantastic talk on automated interpretation of X-rays for TB screening in prisons. Barrier = lack of x-ray machines in most prisons. Ultra portable X-ray devices may be a transformational technology for expanding access to this critical screening approach
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@jakescottMD
Agree, and notably not by people with experience and expertise in managing these diseases.
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Great piece on coccidioidomycosis (valley fever), a growing health threat in the western states. It is one of these most difficult diseases we manage in infectious diseases and new tools are not coming quickly enough.
@JulieParsonnet
@katwalter7
I flew down to Arizona earlier this summer to learn about a desert fungus that’s easy to inhale, capable of wreaking havoc on the human body, and spreading thanks to climate change.
My deep dive on Valley Fever — and other emerging fungal threats:
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Prof Berg's lab created the first recombinant DNA, launching the field of genetic engineering. He then paused this work, called for a voluntary moratorium to establish safe guards for the nascent field. Then spent decades supporting the next generation of scientists.
The Stanford Medicine community mourns the passing of Nobel Prize winner and recombinant DNA pioneer Paul Berg. His work set in motion the field of genetic engineering, which has led to lifesaving drugs and opened new avenues of genetic research.
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“The dengue battle is multifactorial... We need to continue carrying out vector control, eventually with more effective tools associated with vaccination”
@juliocroda
on Brazil's launch of the Qdenga vaccine.
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@jlsalinas7
Agree, was always surprised by the high household SAR of norovirus and skeptical of the "aerosolized vomit" hypothesis as a driver, though there was an interesting study 2 years ago supporting it: air sample norovirus RNA positivity by hours post-vomit.
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Just read this marvelous essay on tuberculosis and the complexities & inadequacies of the phrase 'directly observed therapy' by
@padmasayee
. Can't recommend it highly enough.
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A case of vaccine-derived polio (Sabin type 2) reported in New York. OPV is a highly effective vaccine but poses risk of reversion to a virulent virus if circulates long enough. 1/5
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Loved this talk by
@kathleen_neuzil
, "Confronting the challenge of data inequity". Lack of typhoid burden data hinders efforts to introduce vaccines & other interventions, a cycle that perpetuates inequalities. 1/2
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Visited the women's state prison in Rio Pardo, Brasil today with
@LPossuelo
and saw this mural 😩
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Privately operated immigration (ICE) detention centers were more likely to have COVID outbreaks. Our analysis in AJPH:
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@guillesequera
,
@lalyestigarr
and Sarita Aguirre have a vision and commitment to achieve "Cero TB" in Paraguay's prisons.
@juliocroda
@agbasteiro
@katwalter7
and I spent time together with them past week to help develop the strategy. I came away so motivated. 2/3
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There are now two WHO prequalified typhoid conjugate vaccines, and Gavi is offering support for national introductions. Unfortunately, most at-risk countries lack population-based incidence data. Below is a map of data sources for 'global estimates'. Brief 🧵
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