2019 Influenza Surveillance & Flu Vaccines

Here’s a quick rundown of the 2019 flu surveillance data. I do one of these each year to see if my family should get the vaccine and if so which one. My usual guidelines are: a) skip every other year if the subtypes are the same as last year’s vaccine, b) skip it if the vaccine is a total miss, and c) get it otherwise.

Last year, during the two peak weeks, influenza caused 7.7% of all deaths in the US. If you’re a Libraries-of-Congress units types of person, that’s roughly four 9/11 attacks every year attributed to this one family of viruses. Maybe that deserves some military funding, or just FDA approval for the broad-spectrum anti-flu agents already mired in years of testing. Right-to-try ought to be expanded to any disease with such a massive body count.

TL;DR – despite possible reduced effectiveness, get the regular vaccine this year. Here’s why:

The good news is the FDA has specified all regular-dose vaccines are to be quadravalent (4-strain) this year. This is excellent news as many people have died over the past several years because the FDA recommended trivalent vaccines at “free” clinics and buying a quadravalent vaccine took serious legwork. This was extreme malpractice in my opinion; after the first year the data was clear. Anyway, deciding between tri- and quad- was one of the main reasons I do this every year, and I am glad to not have to do that again. In fact, the ‘extra’ quad component this year is a home-run. More on that later.

Down to the dirty details, then. There are some interesting observations in the latest CDC technical report [2]. First, the number of gene sequenced viruses is up 5-10x over last year. This is great, and a huge jump. Next, among the circulating H1N1, nearly all have evolved to subclade 6B.1A, vs. last year’s much larger percentage of clade 6B.1. Similarly, the H3N2 subtype 3C.3a increased from 12% to 81% in just a year. Interestingly, among the B/Victoria strains, now more than 85% of circulating strains have either a 2 or 3 amino-acid deletion in the HA protein, which binds the virus to a cell membrane. Most likely this is one of those quick evolutions which helps evade the human immune system (and makes a cultured-virus vaccine so difficult to stay current).

A bit of great news is that the B/Yamagata (Y3) circulating flu strain was 100% susceptible to the vaccine (B/Yamagata B/Phuket/3073/2013), which is the same as last year’s vaccine. So, even healthy people who don’t get vaccinated this year should have good coverage if they got last year’s quadravalent. As I mentioned above, this is the strain that was non-standard last year (16% of 2017-2018 circulating virus) and only in the quad. Almost everybody gets it this year! This could potentially reduce total deaths by 16% with more sane policy.

Lastly, a full 62% of tested 3C.3a samples (representing 28% of the circulating strains) did not respond well to the vaccine antigen test. The cause appears to be an HA protein mutation related to the eggs they were cultured in. Here’s what I don’t know (please comment if you do): will the flu shots cultured in eggs be less effective because of it? Are there any cell-cultured vaccines available on the market and are they the standard “free flu shot”? The way I’m reading this, the H3N2 (3C.3a1) A/Singapore portion of the vaccine may have very low effectiveness. The only silver lining is that this is at 7% of the current strains. It could well become more dominant if it can run rampant even among vaccinated members of the population. This may lead to discontinuance of egg-cultured flu vaccines in the future, but I don’t think anybody was sounding the alarm bells about this possibility – it seems like quite a surprise, though entirely plausible in retrospect.

Besides the virology data, I also learned one more interesting factoid: apparently the CDC has a small army of ferrets, whose job it is to fight the flu for antigenic sensitivity testing. These ferrets are probably having quite a bad time, but the information they provide could very well save thousands of human lives. However, for people who take a principled stand against animal testing – you should probably not get the flu vaccine, as its composition is determined to a significant degree based on animal testing. I do implore you to let your kids make that decision for themselves when they turn eighteen, though.

Bonus section: Antivirals. Treating flu with antivirals depends on catching it super-early, and getting immediate treatment for maximum effectiveness. It’s probably a waste of money, otherwise, in most cases, but if my life depended on it, I’d ask for a cocktail of the endonuclease inhibitor baloxavir (Xofluza) and the neuraminidase inhibitor zanamivir.

Again in 2019, as of right now, New England is showing minimal activity but the Mid-Atlantic is picking up steam. Act accordingly.

Summarized Data Table based on CDC Technical Report as of 2019-w37

[1] https://www.cdc.gov/flu/season/faq-flu-season-2019-2020.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fflu%2Fseason%2Fflu-season-2019-2020.htm
[2] https://www.cdc.gov/mmwr/volumes/68/wr/mm6824a3.htm?s_cid=mm6824a3_w

Low-Carb Chocolate Pie

20160313_224522

Yes, it’s possible to have a low-carb Chocolate pie on Pi Day.

Crust:

1 c slivered blanched almonds

1 c coconut flour

1/2 c blended cocoa

1 t baking soda

1/4 c Kidsweet or other non-nutritive sweetener

1/2 c coconut oil

1 t vanilla extract

1/4 c water

2 eggs

  1. preheat oven to 350F.
  2. pulverize almonds in blender/food processor
  3. add other powders.  Mix.
  4. Add eggs, oil, and liquids and blend.
  5. Press evenly into 9″ pie dish.  Clean up top edge so it doesn’t burn on the edges.  Blind-bake for 20 minutes, then cool.

Chocolate:

4 oz, by weight, baking chocolate

3 oz, by weight, coconut oil

1 oz, by weight, Kidsweet

1 oz, by weight, water

  1. combine ingredients into bowl.  Microwave 2 minutes on high.  Stir to blend, then place in refrigerator to cool.  Stir occasionally.
  2. when the chocolate has cooled to 60 degrees, microwave again for 30 seconds.  Stir and set aside.

Filling:

1 12oz package soft silken tofu

1 batch chocolate, as above

1 T Kidsweet

1 t vanilla extract

1 t instant coffee

1/3 c water

  1. combine all ingredients in blender/food processor, for about 1 minute.
  2. pour into cooled pie crust.  Place in refrigerator to cool/set for 2 hours.
  3. Slice into eight pieces.  Try to believe it’s sugar-free and low-carb.

More-Healthy Energy Bars

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These are great energy bars, with a nice profile of protein, fat, and carbs to provide energy and satiety.  They’re only appropriate for a low-carb diet if you eat them during exercise.  They have better ingredients and better nutrition than most anything you’ll find in the store, since those need to be shelf-stable instead of being nutritious.  Best of all, these are fairly low in sugar while still being quite tasty and they should have a fairly nice glycemic profile for energy both now and later.

 

 

 

Ingredients:

1/4 c chia

1/2 c hemp seed hearts

1/4 c flax seeds

 

2 c “old-fashioned” oats

1/2 c coconut oil

 

1 c raisins

 

2 c pecans

1 c sunflower seeds (raw)

1 c pumpkin seeds (raw)

1 c cashews (raw)

1 c almonds (raw)

 

1 package silken tofu

2 T Kidsweet (or 4 T sugar)

3/4 t sea salt

1/2 t NuSalt

1/2 c honey

 

Method:

  1. In food processor, finely grind chia, hemp, and flax to a powder.  Set aside.
  2.  Toast all nuts and seeds in the oven at 350*F.   Pecans (usually not raw) take about 25 minutes, the rest about half an hour.  Allow to cool.
  3. Coarsely grind pumpkin and sunflower seeds, set aside.  Grind pecans, set aside.  Grind almonds and cashews.  (a large/powerful food processor might be able to handle them all at once).
  4. Drain tofu then mix it with the Kidsweet, honey, and salts.
  5.  Heat coconut oil in a pot, then add oats.  Stir until light brown and toasted.
  6.  Slowly combine all ingredients in food processor with one cup of water.  For a standard  power food processor, it’s probably two batches, with half of each step’s ingredients at a time.  For  a smoother texture bar, process longer.
  7.  Line a jelly roll pan with parchment and pour mixture (nearly a paste now) out onto parchment and spread evenly.  Bake at 350* for 40-50 minutes, until the top is becoming golden brown (the very edges will likely be dark).
  8.  Cool for a few minutes and cut into bars while still hot.  Remove parchment from pan and place directly on cooling rack.  Cool and package.

Yield: 20 bars.

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Keep bars refrigerated until the day you’re going to use them.   For easy transport, wrap like a gift in wax paper and close with a small piece of masking tape.

 

 

 

 

 

Nutrition data (via MyFitnessPal):

Calories: 561

Carbs: 30g

Fat: 46g

Protein: 16g

Sugars: 8g

Sodium: 75mg

 

Jocks are Smart

human-calculator

I’ve debated with others in the past about different types of intelligence. I’ve used the example of star athletes – a football quarterback for example – who can look at everybody on the field, judge their positions, velocities, and make a prediction such that he can lob a pass far down field with exactly the right angle and velocity so his wide receiver need only put up his hands and hold onto it.  I’ve held that this requires calculations that we can only simulate with calculus and supercomputers today. Others have held that this is “just instinct” and not really a sign of intelligence. It seemed like a fair point of disagreement given a lack of evidence to support one position or the other.

Imagine my surprise to find further data on the argument on a “History” Channel reality show that my eight-year-old son is enjoying. On the first episode of Stan Lee’s Superheros, they profile a man who is a “human calculator”. He can do any arbitrary arithmetic (including cube roots) in his head almost instantly, as if by instinct. The show adequately demonstrates the skill (using the UCSD Math Department as examiners), but then they put him into an fMRI to see what’s going on. What’s going on is that he’s doing math in the brain center that’s used for motion, not the typical brain center most people use for math.  Besides presaging the future of humanity, it effectively demonstrates just how marvelous the motion centers are at doing enormously complex mathematical computations.

Touchdown for “Jocks are Smart” (though I’m not yet claiming the field goal).

Leftover Turkey Tortilla Soup

1 large yellow onion, diced

1 oz minced Anaheim chili

1 oz minced jalapeno chilies

3 oz cooking oil

2 T sea salt

3 t garlic paste (~6 cloves)

1/2 t ground peppercorns

1 1/2 T oregano

2 T toasted cumin, ground

2 T coriander, ground

1 T paprika, ground

2 t thyme

2 lbs leftover dark meat turkey

28 oz diced tomatoes

2 c chicken stock

1 can hominy, drained

1 can black beans, drained

2 c frozen mixed vegetables (w/ corn)

1/2 t potassium salt (salt substitute)

2 cups tortilla chips, partly broken

2 c mexican-blend cheese (shredded)

  1. Coat pot with 2T cooking oil and start tomatoes cooking in pot on high.

  2. Saute onion and chilies in saute pan in 2T of cooking oil with 1 t salt until golden.

  3. Add garlic paste, pepper, oregano, 1T cumin, and paprika.  Cook for three minutes and add mixture to tomatoes.

  4. Place turkey in saute pan and cook over high heat with 2 t salt, thyme, remaining cumin, and 2T cooking oil.  Break up pieces and pan-fry on medium-high heat until browned and stringy.

  5. When tomato mixture begins to stick to bottom of pan, add chicken stock, vegetables, hominy, black beans, and salt substitute.  Bring to a boil.  Mix in turkey.  Check for salt.

  6. Stir in tortilla chips until thoroughly mixed.  Stir in cheese until evenly distributed.

  7. Add water to desired thickness.

Accessing my.scouting.org with Firefox 34

Since Firefox 34 landed, users of Mozilla’s Firefox have been unable to access my.scouting.org, due to the disabling of SSLv3 in Firefox 34 (it’s slightly more complicated than that but close enough).

Users will encounter an error like this:

myscouting-firefox-34

One workaround is to switch to Chrome, but for those who like Firefox, a short journey into the configuration editor will re-enable SSLv3 and allow you to access My.Scouting.

1) Type about:config in the location bar.

2) In the search bar that comes up, enter: security.tls.version.min . Double-click on the entry that comes up and change the value to ** (zero).

3) Do the same for security.tls.version.fallback-limit .

You should now be able to access the site again. It’s not great to leave these settings like this.  Hopefully the Office updates sooner or later to support more modern ciphers (propeller-heads: ECDHE suites) or Mozilla backs down from its overly-aggressive stance (too much, too soon, good long-term idea). If you’re doing this change, try to remember to come back in a year and undo it, for better long-term security.