It’s that time of year again. You know RSV is coming! But it could all be different with RSV vaccination. Listen to the brilliant Dr Simon Drysdale for hear the latest @ox.ac.uk @voices4vaccines.bsky.social #RCPCH #paedsround @apsmunro.bsky.social @mariekeemonts.bsky.social

On #WorldSepsisDay highlighting editorial (with @apsmunro.bsky.social ) "Time for paediatrics to screen out sepsis “screening” www.bmj.com/content/381/... (For example screening, by definition, requires patient to be asymptomatic. But many patients receiving a “sepsis screen” are symptomatic)

This equates to 0.5 micromorts for each person receiving a vaccination course (usually several vaccines) That is less than the mortality risk for a single day of skiing (0.7 micromorts)

Covid vaccine deaths: the best data came out of Korea, which did autopsies on all post-vaccination sudden deaths. The country identified 21 deaths out of 44 million vaccinees. Yes people can die from the vaccine, but it’s incredibly rare. mazer.substack.com/p/koreas-rea...

Everything spoken about here is pretty widely accepted now These are really important things for institutions to be demonstrating they accept, and have learnt from if we want to build back trust from the public That includes us as health professionals www.economist.com/culture/2025...

This reminds me that contrary to some thinking, social media doesn’t reduce exposure to alternative viewpoints (eg “bubble effect”) It increases exposure - but only to the worst and most extreme versions of them, further convincing you that you’re right and “the others” are terrible idiots

Whereas traditional media caters to a range of views, with moderate positions well-represented, extreme views — of both left and right — are heavily over-represented on social media. on.ft.com/3HNwX1M

We didn't randomize, and there was no allocation concealment or blinding, and we can't really be sure what intervention they got or how the outcomes were measured, but we emulated a trial by drawing a DAG.

There are a lot of oral/enteral source infections where we add anaerobic cover to standard empirical antibiotics (usually cephalosporins - classic “cef and met” combo) Is there actually any empirical evidence this is beneficial? #IDSky

Instructive thread by Alasdair explaining difference in covid vaccination policy in UK & EU vs US and the difference to flu vaccination. Refreshing to see nuance and the need for thinking in trade-offs which is a necessary element for building a sustainable and efficient public health policy.

The UK’s flagship health research programme promises breakthroughs, but beneath an NHS branded facade, critics are asking who really benefits from this vast database, heavily backed by industry and government. @mgtmccartney.bsky.social and I investigate www.bmj.com/content/390/...

"What’s it like to have lived through both HIV and COVID as an ID doctor?" A new intern asked me that last week. I didn’t answer it fully then -- but I did here. #IDSky blogs.jwatch.org/hiv-id-obser...

Had my first attempt today at teaching junior researchers about statistical tests with the, “everything is just a linear model” approach Was an interesting session and am intrigued (and a bit scared) to receive the feedback…

Our latest data shows an increase in the number of pregnant women getting vaccinated against #WhoopingCough. Vaccination rates in England climbed from 59% in May 2024 to nearly 73% in March this year. Find out more: www.gov.uk/government/n... #EpiSki #MedSky

This is a travesty & a nightmare. The US was a founder of @gavi.org. It lowers global vaccine costs, has vaccinated 1B children, & averted 19M deaths. This pull out will cost 100s of thousands of children's lives a year - and RFK Jr will be personally responsible. www.politico.com/news/2025/06...

Now acute flaccid myelitis (AFM) and EV-D68 Since the pandemic, epidemic spikes in EV-D68 with respiratory cases seems to have been decoupled from cases of AFM - but why…?!

Finally made it to IIC Oxford (stupid trains) Managed to catch the end of John Carapetis talking about Group A Strep - and the exciting prospect of vaccines! Why has it not happened yet? Likely to get GBS vaccines before GAS... Fear over the MANY possible immune sequelae probably a factor

Looking forward to being in Oxford for the next few days at the Hot Topics in Infection and Immunity in Children course Speaking about the SNAP trial with Anna Goodman on Tuesday Might be at a loose end tomorrow evening if anyone fancies a Nando’s…

The head of HHS said he’d preserve ACIP. Then he fired the entire committee. Now a new panel -- with mostly unclear expertise in clinical trials, vaccines, and ID -- is in place. Time for high alert for changes that could seriously affect public health. #IDSky blogs.jwatch.org/hiv-id-obser...

The main reason it's almost always fine to use a linear model is no model option give you the true answer anyway (arguably there isn't really a "true" answer) So all we're aiming for is an approximation which is useful, and linear models almost always do an unreasonably good job of it

In our June issue: 180-day efficacy of nirsevimab against hospitalisation for #RSV lower respiratory tract infections in infants (HARMONIE): a randomised, controlled, phase 3b trial 🔗 buff.ly/XYWxDNa #MedSky #PedSky #IDSky #RSV @apsmunro.bsky.social @southamptoncrf.bsky.social @ovg.ox.ac.uk

Origami remains the most interesting contribution I have to make to this platform Fawkes the Phoenix by Jo Nakashima, with a single square sheet of 24cm washi deluxe #origami

Me, an idiot: “I think I will just check on this result for a rare and unexpected condition at 4pm on a Friday afternoon…” “Oh no”

A classic of the genre

Things I am good at: - Doing science Things I am not good at: - Wading through the bureaucratic processes necessary to get the grants and approvals to actually do the science

I thought this was a great article outlining the changes to the Covid-19 vaccination program in the USA Bringing it more in line with current practice elsewhere in the world www.nejm.org/doi/full/10....

I know what editors do with my submissions

Having a one hour session to teach “critical appraisal” feels like having a one hour session to teach “medicine” Except we actually give people 5 years to learn medicine whilst simply expecting doctors to critically appraise complex research based on one hour teaching sessions and vibes

I don't want to cause alarm, but has anyone checked in with @statsepi.bsky.social recently? I am quite confident this is one of those "tweets to send when in distress" events and the relevant authorities need to be notified

Definitely one of my favourite models so far, and one I plan to come back to in future #origami Pegasus by Phạm Hoàng Tuấn

The new head of FDA’s CBER, Dr. Vinay Prasad, is undoubtedly brilliant. He'll oversee vaccines, gene Rx, monoclonal Abs, & blood products. Let's hope he can get along well enough with others to be an effective leader, as the stakes are pretty darn high! #IDSky blogs.jwatch.org/hiv-id-obser...

A reminder that every time you have produced a pie chart was, in fact, an opportunity to produce anything other than a pie chart

Question for people involved in clinical research: What are your favourite studies/trials to use as teaching examples, particularly for critical appraisal?

I should know better than to read papers because it just makes me sad. This was for a very highly cited open-label single-arm study that gave an experimental treatment to children. Risks were unclear enough that a medicines regulator insisted they only recruit older kids.

Remember everyone, if you've identified a serious problem, the answer is almost CERTAINLY to implement more mandatory online e-learning

The hill I will currently die on: If you are choosing to use an IV antibiotic for a patient, you need a specific justification for NOT using an oral alternative IV is more invasive, higher risk to the patient and almost always more expensive #IDSky #PedsID

Dr Demirjian is bringing a @ukhsa.bsky.social perspective to our #BPAIIGTrainingDays and sharing impressive numbers on healthcare-associated infections and #antimicrobialresistance in children and young people! @aliciad3.medsky.social

Finding it very difficult not to whoop and cheer loudly whenever I hear people promoting oral over IV antibiotics 🥰 Great talk from @aliciad3.medsky.social on AMS and healthcare associated infections in children at the @bpaiig.bsky.social training day

It’s been a long time - nice to get into a bit of #origami again A bit rusty, but pleased with how it’s turned out! Fiery dragon (Kade Chan)

RA Fisher on factorial trials. An ongoing missed opportunity in medical research. "No aphorism is more frequently repeated in connection with field trials, than that we must ask Nature few questions, or, ideally, one question at a time. The writer is convinced this view is wholly mistaken... (1/2)

Excited to share our newest paper from my PhD: a post-hoc analysis of the BALANCE trial where we explored heterogeneity of treatment effect (HTE) in duration of antibiotic treatment for patients with bloodstream infection. A thread: doi.org/10.1016/j.ec... #IDSky @eclinicalmed.bsky.social

In clinical research, the intersection of the Venn diagram between 'answers an important problem' and 'uses sufficiently robust methods' is almost entirely occupied by randomised controlled trials

This has been true for under-18s for around a year - more Americans children die each year from medically confirmed influenza than Covid-19. 2/

Influenza has passed Covid-19 as a cause of death in ages 18-64 in the US on a year-on-year basis. More Americans aged 18-64 died in the last year from medically confirmed influenza than from medically confirmed Covid-19. 1/

Delighted our study (7+ years in the making) is out today in Nature. In a nutshell, 48 hours of antibiotics in week 1 led to impaired vaccine responses up to 15 months later in infants. We show (in-vivo) a probiotic can fix it #microbiome #science #immunology www.nature.com/articles/s41...

So far my brain has largely been too scrambled to tweet One point of interest- lots of MAMS/platform trials utilising Bayesian methods to add flexibility, but I think everything so far just uses completely flat priors - seems a bit of a waste?

Excited to be at the #CCTM25 meeting with @statsci.bsky.social today in London Great program including adaptive and platform trials... and "real world evidence"....🔥 I may tweet intermittently when my brain is not being scrambled by clever methods stuff

🔥 PhD opportunity 🔥 Interested in a Moderna-funded PhD focused on deconvoluting the immunological mechanisms that protect against whooping cough to inform novel vaccine design with me, @afvallejo.bsky.social & @jaylaver.bsky.social? If so, apply before 18.06.25! www.findaphd.com/phds/project...

Happy Large Enough N day for those who observe