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apsmunro.bsky.social
Alasdair Munro
@apsmunro.bsky.social
5.9K followers 350 following 690 posts
NIHR Academic Clinical Lecturer in Paediatric Immunology and Infectious Diseases University of Southampton and Southampton Children’s Hospital UK alasdairmunro.substack.com
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apsmunro.bsky.social
Alasdair Munro @apsmunro.bsky.social · Nov 29
My new post takes a look at the topic of “immunity debt”

What does this term mean, and why has it been so controversial?

What explains the weird reemergence of seasonal pathogens since the pandemic?

Is Covid-19 damaging immune systems?

Let’s find out! 💥

#MedSky #IDSky #PedSky 🧪
What is "immunity debt"?
A new study sheds further light on this seemingly controversial issue
open.substack.com
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Reposted by Alasdair Munro
apsmunro.bsky.social
Alasdair Munro @apsmunro.bsky.social · 28d
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...
Covid-19 sent the world mad
The pandemic polarised voters and undermined trust in institutions
www.economist.com
1 4
Reposted by Alasdair Munro
ejlim.bsky.social
Emma Lim @ejlim.bsky.social · 22d
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
Protecting infants with the maternal vaccine for RSV
Podcast Episode · The Paeds Round · 08/04/2025 · 28m
podcasts.apple.com
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Reposted by Alasdair Munro
damianroland.bsky.social
Prof. Damian Roland @damianroland.bsky.social · 25d
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)
Time for paediatrics to screen out sepsis “screening”
It is time to remove the term, “sepsis screen,” from the paediatric lexicon, argue these authors Despite the success of vaccinations against organisms such as Haemophilus influenza type B and Neisser...
www.bmj.com
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apsmunro.bsky.social
Alasdair Munro @apsmunro.bsky.social · 26d
Argh I hate how much I love this
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apsmunro.bsky.social
Alasdair Munro @apsmunro.bsky.social · 26d
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)
mazer.us
Benjamin Mazer @mazer.us · 26d
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...
Korea's reassuring vaccine data
Autopsy results reveal extremely rare sudden deaths
mazer.substack.com
2 8 22
Reposted by Alasdair Munro
mazer.us
Benjamin Mazer @mazer.us · 26d
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...
Korea's reassuring vaccine data
Autopsy results reveal extremely rare sudden deaths
mazer.substack.com
7 21
apsmunro.bsky.social
Alasdair Munro @apsmunro.bsky.social · 28d
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...
Covid-19 sent the world mad
The pandemic polarised voters and undermined trust in institutions
www.economist.com
1 4
apsmunro.bsky.social
Alasdair Munro @apsmunro.bsky.social · Sep 5
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
financialtimes.com
Financial Times @financialtimes.com · Sep 5
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
7
Reposted by Alasdair Munro
financialtimes.com
Financial Times @financialtimes.com · Sep 5
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
11 14 37
Reposted by Alasdair Munro
statsepi.bsky.social
Darren Dahly @statsepi.bsky.social · Aug 31
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.
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apsmunro.bsky.social
Alasdair Munro @apsmunro.bsky.social · Aug 22
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
4 3 4
apsmunro.bsky.social
Alasdair Munro @apsmunro.bsky.social · Aug 21
Reading that piece was like time travelling back to 2022

Although they cited our article, they don’t appear to have read it as it explained clearly all the mistakes they made

@tah-sci.com

academic.oup.com/cid/advance-...
Cycles of Susceptibility: Immunity Debt Explains Altered Infectious Disease Dynamics Post-Pandemic
The epidemiology of infectious disease re-emergence since the COVID-19 pandemic is consistent with reduced population immunity from infection, due to non-p
academic.oup.com
7
Reposted by Alasdair Munro
larshenningmd.bsky.social
Lars Henning @larshenningmd.bsky.social · Aug 1
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.
apsmunro.bsky.social
Alasdair Munro @apsmunro.bsky.social · Aug 1
You’ve missed the point

Not every seasonal vaccine requires an RCT (I don’t believe anyone is suggesting that currently)

The scenario for covid vaccines is unique as they were trialled on a background of ~zero population immunity

There is now substantial population immunity
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apsmunro.bsky.social
Alasdair Munro @apsmunro.bsky.social · Aug 1
This means an updated RCT for covid would be generalisable for future seasons

A flu RCT would not be very generalisable

Hence, a new RCT for covid vaccines in the modern immunity landscape is not an unreasonable suggestion (although personally I don’t feel is necessary)

Nothing disingenuous here
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apsmunro.bsky.social
Alasdair Munro @apsmunro.bsky.social · Aug 1
This is different to flu, where trials were conducted on a background of population immunity comparable to today

Also, there is large inter-seasonal variation in flu vaccine efficacy due to strain matching

There are much smaller, marginal differences for covid per vaccine/variant
1 2
apsmunro.bsky.social
Alasdair Munro @apsmunro.bsky.social · Aug 1
You’ve missed the point

Not every seasonal vaccine requires an RCT (I don’t believe anyone is suggesting that currently)

The scenario for covid vaccines is unique as they were trialled on a background of ~zero population immunity

There is now substantial population immunity
1 3
apsmunro.bsky.social
Alasdair Munro @apsmunro.bsky.social · Jul 31
They may reduce deaths to some extent, but current studies are observational and almost certainly heavily biased. That is why we don't license medicines on observational studies.

Whether the effect size in the current immunity landscape continues to justify use, and it what groups, is the question
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apsmunro.bsky.social
Alasdair Munro @apsmunro.bsky.social · Jul 31
More expensive if you spend $millions on therapies which don't significantly reduce them

I'm not personally convinced studies are needed, but I think there is absolutely room for valid disagreement
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apsmunro.bsky.social
Alasdair Munro @apsmunro.bsky.social · Jul 31
Congratulations, and, condolences 🙂
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apsmunro.bsky.social
Alasdair Munro @apsmunro.bsky.social · Jul 31
Indeed, and I think this is a space where there is room for legitimate disagreement

I do not think it is wholly unreasonable to suggest that, in the modern immunity landscape for Covid, an unbiased assessment of the relative benefits of vaccination is warranted to see if it justifies the costs
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apsmunro.bsky.social
Alasdair Munro @apsmunro.bsky.social · Jul 31
Yes, but the ratio of older people vs younger with comorbidities who received the vaccine was almost 9:1, making this overwhelmingly older people for whom no serious safety concerns exist
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apsmunro.bsky.social
Alasdair Munro @apsmunro.bsky.social · Jul 31
This is almost exclusively adults aged 65y and older, which is not the category for which safety concerns exist
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Reposted by Alasdair Munro
debscohen.bsky.social
Deb Cohen @debscohen.bsky.social · Jul 30
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/...
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apsmunro.bsky.social
Alasdair Munro @apsmunro.bsky.social · Jul 29
I have seen data on this, and it doesn't seem to

Very unhelpfully, I cannot remember the source of the data, so this response is useless

However, it probably *shouldn't* reduce transmission much, as infants do not really mix apart from the people most likely to be their own source of infection
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apsmunro.bsky.social
Alasdair Munro @apsmunro.bsky.social · Jul 9
So long as the research is cheap, it is ethical even if it is wrong!
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