Alasdair Munro

Huge developments this past week in the question over whether the old, live-attenuated shingles vaccine prevents dementia The messaging around this topic from much of the Sci-Com field has been atrocious What is the truth?

Does the shingles vaccine reduce the risk of developing dementia? The science isn't as solid as some claim, but private vaccinations are soaring. Was great to speak to @apsmunro.bsky.social to understand where we are at on the evidence: www.thetimes.com/article/f980...

Piperacillin/tazobactam (Tazocin, Zosyn etc) is ultimately a drug for Pseudomonas aeruginosa Are you worried about Pseudomonas? Pip/taz is a great choice Not worried about Pseudomonas? You don’t need pip/taz, there is almost certainly a better option

Wondering how to keep kids immune systems healthy as we enter the school year? We reviewed the evidence on diet, supplements and exercise for @pidjournal.bsky.social Tldr: the same things that makes kid healthy in general keep their immune system healthy too - no need for supplements

A calm and devastating critique

My piece on the new White House Executive Order on childhood vaccines The document is based on an inappropriate premise, flies in the face of existing science, and would achieve the opposite of its own stated aims It is a catastrophic failure at vaccine policy

Read the well-written opinion piece cited in this post; a brilliant example of logical thinking. Well done Alasdair.

Despite negative RCTs, I don’t think air filters are useless I think the magnitude of their likely effect was grossly oversold by many advocates - writing cheques the trials could not cash Misalignment of expectations has caused a lot of confusion

Given all the interest in air cleaning following the recent negative RCT… Here is an old post explaining why cleaning air is not comparable to cleaning water It’s a good thing to do, but we need to be realistic about what it can achieve

As usual @apsmunro.bsky.social is a model of good sense More Fuss About Filters open.substack.com/pub/alasdair...

Huge numbers of neonates get long courses of IV antibiotics for suspected early onset sepsis, despite an incidence of only 0.5-1% New evidence shows these courses can stop earlier and babies can go home sooner Practice needs to change ASAP #Peds #PedsID 🧪

Does the (live) shingles vaccine protect against dementia? Fergus Hamilton and colleagues provide important evidence in a new preprint using hospital data from the whole of England in a regression discontinuity design from which we *don't* show evidence of a meaningful protective effect /cont

The JCVI announced they are now recommending the MenB vaccination for adolescents in the UK, which many people (including me!) will be very pleased about How did this change come about? The story is fascinating, and perhaps not without controversy...

The JCVI announced they are now recommending the MenB vaccination for adolescents in the UK, which many people (including me!) will be very pleased about How did this change come about? The story is fascinating, and perhaps not without controversy...

ICYMI my latest post looks at a common cause of concern for parents - infection related rashes! Why do they happen and when should you worry? Join me to find out all this and more! #Peds #PedsID 🧪

My latest post looks at a common cause of concern for parents - infection related rashes! Why do they happen and when should you worry? Join me to find out all this and more!

My latest post looks at a common cause of concern for parents - infection related rashes! Why do they happen and when should you worry? Join me to find out all this and more!

Oh no you’re way behind Jack (Can’t believe you made me dig out ttespoof.pdf)

Five-year-old Isla is a star today on BBC South Today 📺🤩 She and mum, Jennifer, are taking part in a major new clinical trial, funded by @nihr.bsky.social and co-led by @uhsft.bsky.social, to improve care for children and young people with severe acute asthma. Watch BBC One in the South at 6.30pm

@apsmunro.bsky.social does actually discuss this study and its limitations in quite a bit of detail in this fascinating blog reviewing this question. An interesting issue with study design and more questions than answers I think alasdairmunro.substack.com/p/the-truth-...

Great article by @apsmunro.bsky.social on the dementia - shingles vaccine question. TLDR - The shingles vaccine is excellent at preventing shingles, but the evidence for a protective effect against dementia is pretty weak alasdairmunro.substack.com/p/the-truth-...

tl;dr Despite what you've likely seen on socials the old Shingles vax probably isn't protective against dementia. Still good for shingle tho..

"Then they looked at dementia, and found …. nothing. A complete null result, stable across sensitivity analyses, with no bias they could find to explain the gap with Wales."

Great post @apsmunro.bsky.social! Doing more is such a natural reaction. But even 'benign' interventions may likely be harmful when tested properly. I'm yet to know of a trial for sepsis where adding antibiotics has been beneficial (outside of TB where we do it to prevent emergence of resistance).

My new post looks at two antimicrobials which have been routinely used and even recommended in guidelines despite a lack of RCT evidence In the last few weeks they’ve both been shown to have no benefit, and worse, high probability of harm - killing patients A lesson we keep failing to learn

New Ebola situation report is out (there was none yesterday) and numbers are still rising shockingly fast: 782 confirmed cases now (+72 in the last 24 hours) That includes 181 confirmed deaths. Follow-up of contacts is back down to 56,5%. Not good. insp.cd/sitrep-n30-m...

OMG "This is a firm reminder that “we must do more for the sickest” is a human reflex, not an evidence base. The discipline of waiting for a trial, rather than acting on what feels right, is the thing that actually protects patients." "More to follow when both papers are out in full."

My new post looks at two antimicrobials which have been routinely used and even recommended in guidelines despite a lack of RCT evidence In the last few weeks they’ve both been shown to have no benefit, and worse, high probability of harm - killing patients A lesson we keep failing to learn

An AI-designed ‘universal’ coronavirus vaccine trialled at @uhsft.bsky.social @southamptoncrf.bsky.social could help protect against future viruses before they emerge 👇 Experts say this could potentially save millions of lives and avoid costly lockdowns. 🔗 research.uhs.nhs.uk/news/new-ai-...

The Ebola outbreak has been extremely fast moving, and the news has been mostly terrible News of potential trials of vaccines and therapeutics does lend some hope - but these are some way off Catch up on the latest developments with me and what it all means here

Indeed! Randomization + routinely collected data go back to Richard Peto's call for 'large and simple trials' that inspired the hugely succesfull RECOVERY trial in COVID-19. Nicely summarized important points.

2/ Emphasising the role of randomisation. Randomisation is entirely compatible with the use of routinely collected data. Importantly, the source of the data does not compensate for weaknesses in study design, and "real-world evidence" is no substitute for rigorous methodology...

"There have been reports of family members retrieving bodies from quarantine." -- all very normal, sadly. Same happened in 2014. The locals do a lot to make it worse, unfortunately :( Fingers crossed on getting it stopped ASAP & vaccine candidates

The Ebola outbreak has been extremely fast moving, and the news has been mostly terrible News of potential trials of vaccines and therapeutics does lend some hope - but these are some way off Catch up on the latest developments with me and what it all means here

New piece on arguments on the weight of evidence, following a post by @adamjkucharski.bsky.social We don't always need gold standard, sometimes aluminium standard is enough But when we disagree, it's not usually about the standard of evidence or science It's about decision thresholds and values

New piece on arguments on the weight of evidence, following a post by @adamjkucharski.bsky.social We don't always need gold standard, sometimes aluminium standard is enough But when we disagree, it's not usually about the standard of evidence or science It's about decision thresholds and values

"Funding cuts have left the region dangerously exposed," said Heather Reoch Kerr, Congo country director for the International Rescue Committee. www.reuters.com/business/hea...

The contrast between the number of media requests I got when rich people on a cruise were facing a deadly, but contained outbreak versus now that some of the poorest people in the world are facing a deadly and devastating epidemic is just so so stark and it just really annoys the hell out of me.

Very informative Ebola explainer by @apsmunro.bsky.social with an update on the current outbreak in the east of the Democratic Republic of the Congo: open.substack.com/pub/alasdair...

My new post looks at the latest in the Ebola outbreak We didn't need another VHF outbreak right now - and this one is much worse - Why is Ebola both interesting and terrifying? - What makes this outbreak different? - What does the future likely hold?

1/ We are living in an era of emerging zoonotic infections. While hantavirus is the focus today, preventing epidemics requires sustained investment in the tools needed to prevent, rapidly detect & respond to biological threats, whether natural, accidental, or deliberate.

Looking for something to read this weekend? I’m running a trial for a hantavirus vaccine Catch up on the outbreak with me, including: - timeline of events - what we’ve learnt so far - why this isn’t the next pandemic No ivermectin banter I’m afraid 🤷‍♂️

UK has published its guidelines by the way for people who were on the ship: "The ship is expected to dock in Tenerife on Sunday ... British Passengers and ship crew not displaying any symptoms of hantavirus will be escorted by UK Government staff to an airport and given free passage back to the UK."

Lots of posts using the 2020 NEJM superspreading event paper as estimate of typical hantavirus transmissibility. Reminder that superspreading events are by definition an outlier. If you want to estimate transmissibility you need to look at ALL infections, not just cherry pick tail of distribution.

And here is the Andes virus sequence from the Swiss patient who was a passenger on MV Hondius: 🧪 #hantavirus virological.org/t/complete-s...

My update on the hantavirus cruise ship outbreak The news has developed at pace, with significant case and genomic updates in the past few days What we know for sure: - This is not the next pandemic - Hantavirus is under researched - We need investment in public health agencies to keep us safe

Hantavirus is, thankfully rare - that means that most clinicians have never encountered a case or have much knowledge of the disease. Here’s a solid summary from an infectious disease expert actually working on hantavirus. If you’re curious, start here.