Lucas Castellani

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

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

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

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

**SELLING** 🩶(2) tickets for Vancouver @ BC Place on 12/6/2024; TOTAL: $39 CAD + PayPal G&S fee 🩶Please comment only if you are a Canadian Swiftie & this will be your first Eras show! 🩶Ticket(s) and price have been verified. *Please no DMs! 🫶🏻

@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. 🙏🏻

**SELLING** 🩶(2) tickets for Vancouver @ BC Place on 12/7/2024; TOTAL: $39 CAD + PayPal G&S fee 🩶Please comment with your favorite song only if you are a Canadian Swiftie! 🩶Ticket(s) and price have been verified. *Please no DMs! 🫶🏻

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

**SELLING** 🩶(2) tickets for Vancouver @ BC Place on 12/8/2024; TOTAL: $39 CAD + PayPal G&S fee 🩶Please comment only if you are a Canadian Swiftie & this will be your first show! 🩶Ticket(s) and price have been verified. *Please no DMs! 🫶🏻

@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.

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

Friends, there be some bad invasive strep pneumoniae these days

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

Welcome to #IDJClub! Your moderator tonight is @IDPharmacometrx (ID Pharmacist @mwupce @NM_IDSteward, COI = senior author of international consensus recs for prolonged b-lactams) Please take a moment to introduce yourselves (lurkers too!) & declare relevant COIs

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. sah.on.ca/about/awards-r…

Cool!

@Darcy_ID_doc @coccimiglioml

An ID pharmacist is an ID attending's attending.

@mashru_jai @BogochIsaac Congrats on this guys!

Excited that I was able to work on this with @BogochIsaac and help bring it to fruition (although he did all the heavy lifting). Very interesting topic that will become more relevant as travel continues to rebound.

Floor swabs at LTC homes early predictor of COVID outbreaks, study finds #COVID19 #LTC ow.ly/MCF650NjfKZ

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

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. eviden.cc/3S3wrgy

@FralickMike Another great Soo locum!

Every time I’m on service I teach trainees about this paper by Derek MacFadden. This study was practice changing for me. It is a real shame he isn’t in Toronto! Prob the smartest & nicest guy out there! cmaj.ca/content/185/15…

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

🚨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_ medrxiv.org/content/10.110…

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