Lucas Castellani

Infectious diseases doc in #theSoo @saultareahosp @thenosm

[Brad Spellberg @BradSpellberg]

There have been a number of questions raised about my statement that GRADE should be abandoned as a basis for drafting clinical guidelines. It's a simple issue that can seem complex. And people have some preconceived ideas that I want to clarify in this string.
1/16

[Jake Scott, MD @jakescottMD]

I've been hearing a lot about this common concern: "Are kids getting too many vaccines?"

It's a fair question. I'm a parent too. And as an infectious diseases physician who directs an antibiotic stewardship program, a big part of my job is stopping unnecessary medications. I'm a minimalist by nature - both personally and professionally.

But here's what most people don't realize:

A shocking fact in vaccine science: Kids today are exposed to FEWER antigens from vaccines than children in 1900 - when there was literally ONE vaccine (smallpox).

In 1986, kids received about 10 shots protecting against 7 diseases. Those vaccines exposed them to over 3,000 antigens - the pieces of viruses or bacteria (like proteins or sugars) that teach the immune system to recognize and respond to real infections.

Today's schedule includes more injections - about 50 by age 18 - but the total number of antigens is just ~150. That's a 95% reduction in antigen exposure, thanks to modern acellular and conjugate vaccine designs.

The data over 18 years (Offit et al., Pediatrics 2002):

🔹1900: 1 vaccine (smallpox) = ~200 antigens
🔹1986: ~10 vaccines = 3,000+ antigens + 3mg aluminum
🔹2025: ~50 vaccines = ~150 antigens + 5-6mg aluminum

As for aluminum adjuvant - a compound added to help trigger a stronger immune response - children today receive about 5–6 mg total over the full vaccine schedule, up from ~3 mg in 1986. That's a modest increase over 18 years. For perspective, infants ingest ~7–10 mg of aluminum just in their first six months from breast milk or formula.

So yes, there are more shots. But the actual antigen exposure is dramatically lower than it was in 1986 - or even 1900. Modern vaccines stripped out thousands of extra proteins while adding protection against Hib meningitis, pneumococcal sepsis, chickenpox complications, liver cancer, HPV cancers, and more.

TL;DR: Modern vaccines do far more with less. That's progress. Let's not go backwards.
@BradSpellberg @mtosterholm @ReporterGoodman @HelenBranswell @thekibosch @ENirenberg @AliSMV7 @atrupar @alejodiaz81 @zacroBID @ThePharmFox @DhandAbhay

[Lucas Castellani @IDdocSSM]

@erastourticketz Would be forever grateful if my wife and daughter could go to their first eras show. They are swifties through and through. 🙏🏻

[Lucas Castellani @IDdocSSM]

@erastourticketz My daughter and wife have been dreaming of going. Canadian swifties and trying for tickets since the start of eras tour. 🙏🏻

[Lucas Castellani @IDdocSSM]

@erastourticketz My daughter’s favourite song is Shake it off. Would be grateful if her and her mom could go. Canadian swifties who haven’t gotten tickets yet. 🙏🏻

[Lucas Castellani @IDdocSSM]

@erastourticketz My wife and 5 year old daughter have been really wanting to go. Canadian Swifties. Would be forever grateful for tickets.

[Lucas Castellani @IDdocSSM]

@erastourticks @RogersCentre @taylorswift13 V. Interested. My wife who is a huge fan is sad she hasn’t been able to secure a ticket. Thanks for all you do.

[Lucas Castellani @IDdocSSM]

@DrToddLee We’ve seen the same thing. And oddly enough no obvious increase in certain serotypes.

[Lucas Castellani @IDdocSSM]

@IDJClub @IDPharmacometrx @mwupce @NM_IDSteward Lucas Castellani - ID doc lurker from @SaultAreaHosp @ no COIs

[Sault Area Hospital @SaultAreaHosp]

The meeting concluded with the much-anticipated presentation of the prestigious Dr. William Hutchinson Award. This award recognizes distinguished contributions to health care in Sault Ste. Marie and Algoma. The 2023 recipient was Dr. Ehsan Mohammadi.
https://t.co/4afmceJ5dM

[Lucas Castellani @IDdocSSM]

Cool!

[Lucas Castellani @IDdocSSM]

@Darcy_ID_doc @coccimiglioml

[Lucas Castellani @IDdocSSM]

@mashru_jai @BogochIsaac Congrats on this guys!

[IPAC Canada @IPACCanada]

Floor swabs at LTC homes early predictor of COVID outbreaks, study finds #COVID19 #LTC https://t.co/jZ2tKc2Bok

[Lucas Castellani @IDdocSSM]

Lucky to be able to work with the CUBE group @FralickMike @ReesKassen @LAHug_ @NishaOttawa

[NEJM Evidence @NEJMEvidence]

Original Article: “Detection of Covid-19 Outbreaks Using Built Environment Testing for SARS-CoV-2,” by @fralickmike et al. https://t.co/2Xv3HdoEad

#IDTwitter #ARDS #CriticalCare @ReesKassen @IDdocSSM @UofT_DoM @SinaiHealth @CircleofCareOnt @uOttawa @SaultAreaHosp @thenosm

[NEJM Evidence @NEJMEvidence]

Wastewater testing has proved to be a valuable tool for forecasting Covid-19 outbreaks. Fralick et al. now report that polymerase chain reaction (PCR) swabbing of surfaces may provide a similar benefit for predicting outbreaks in long-term care homes. https://t.co/2Xv3HdoEad

[Lucas Castellani @IDdocSSM]

@FralickMike Another great Soo locum!

[CATIE @CATIEinfo]

Today is #WorldAIDSDay and the start of Indigenous AIDS Awareness Week, #IAAW, a time to reflect on what we have achieved and what we still must achieve with the response to HIV. End Inequalities. End AIDS. End Pandemics.
#WAD #WAD2022

[Michael Fralick @FralickMike]

🚨New pre-print from CUBE team🚨 For this study we wanted to understand how COVID-19 in the environment surrounding a hospitalized patient changes over space and time 🧵1/6 @ReesKassen @NishaOttawa @IDdocSSM @dnagenotek @BurellaMadison @dguttman @LAHug_ https://t.co/kagKgqT1zL

[Lucas Castellani @IDdocSSM]

Great to see an RCT on medical masks vs N95s. As with most studies there are some limitations but overall important information @zchagla @NHBugBusterDoc @DocDominik

[Jon Otter @jonotter]

Finally, an RCT comparing N95s and medical masks to protect healthcare staff from #COVID19 https://t.co/bWYymZma43 PCR–confirmed COVID-19 occurred in 52 of 497 (10.46%) in the medial mask group versus 47 of 507 (9.27%) in the N95 group (hazard ratio, 1.14 [95% CI: 0.77 to 1.69])