iiinova — where your digital self keeps evolving

Jon Mosser @jonmosser.com · 24/12/2025

This one might be my favorite. I feel like they might be missing one key reason why the smallpox vaccine isn't given anymore... No more smallpox! (Thanks to #vaccines!)

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Jon Mosser @jonmosser.com · 24/12/2025

And then, ironically, there was a "natural foods" store distributing these pamphlets inside the market just across the street. Did you know that polio is caused by DDT? And here I was thinking it was caused by a virus this whole time!

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Jon Mosser @jonmosser.com · 24/12/2025

Found a #vaccine mural downtown in #YorkPA while home for the holidays. I believe that these murals are based on drawings by Lewis Miller, Pennsylvania Dutch folk artist from the early 19th century.

An old mural of a man in a blue coat labeled "Dr. Kennedy" and a child in a yellow dress looking up at him. Text reads: "1799. Dr. Kennedy he waxanate the children with matter A remedy to cure the smallpox."

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Jon Mosser @jonmosser.com · 05/12/2025

Timeliness is important everywhere, but may be particularly important in places with relatively high coverage, to make sure that children are protected by vaccines before they are exposed to vaccine-preventable diseases.

Comparison of improvements to coverage and improvements to timeliness. In countries with low immunisation coverage (A and B, solid line), improvements to coverage (A, dashed line) result in more child-months of protection during childhood (green shaded area) than improvements to timeliness (B, dashed line and green shaded area). In countries with high coverage (C and D), however, improvements to coverage (C) may result in fewer child-months of protection gained than improvements to timeliness (D).

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Jon Mosser @jonmosser.com · 11/04/2025

@who.int just released the results of a rapid pulse-taking survey on the impact of cuts to official development assistance (ODA). More than 40-50% of countries already reporting moderate-severe service disruptions to #HIV, #TB, #Malaria, #vaccine programs. #episky #idsky

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Jon Mosser @jonmosser.com · 26/03/2025

Here's the vaccine hesitancy language... "It is the policy of NIH not to prioritize research activities that focuses [sic] gaining scientific knowledge on why individuals are hesitant to be vaccinated and/or explore ways to improve vaccine interest and commitment."

Vaccine Hesitancy: It is the policy of NIH not to prioritize research activities that focuses gaining scientific knowledge on why individuals are hesitant to be vaccinated and/or explore ways to improve vaccine interest and commitment. NIH is obligated to carefully steward grant awards to ensure taxpayer dollars are used in ways that benefit the American people and improve their quality of life. Your project does not satisfy these criteria.

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Jon Mosser @jonmosser.com · 05/03/2025

#measles #vaccines have saved more than 93 million lives in the last 50 years, 68% of all the lives saved by vaccines around the world over that time. Responsible public health messaging right now would start and end with this: Measles vaccines save lives. doi.org/10.1016/S014...

Three plots showing the cumulative number of lives saved, life years gained, and years of full health gained due to vaccines between 1974 and 2024. Of the vaccines considered, measles has by far the largest impact over this time in the plots.

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Jon Mosser @jonmosser.com · 20/02/2025

This tool shows us that the #ACIP recommendations page on the #CDC website has had the definition of "Persons at Risk" scrubbed from the #mpox #vaccine recommendations. This censorship harms patients and keeps providers from making informed recommendations. Unfortunately, expect more to come.

Side by side snapshots of the CDC ACIP recommendations website at different points in time. On the left side, the version of the website has the following text highlighted in yellow; the same text is missing from the right side, illustrating that the text has been erased from the CDC site.

"Persons at risk:

Gay, bisexual, and other men who have sex with men, transgender or nonbinary people who in the past 6 months have had one of the following:
- A new diagnosis of ≥1 sexually transmitted disease
- More than one sex partner
- Sex at a commercial sex venue
- Sex in association with a large public event in a geographic area where mpox transmission is occurring
- Sexual partners of persons with the risks described in above
- Persons who anticipate experiencing any of the above"

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Jon Mosser @jonmosser.com · 28/01/2025

By phone: You can call the U.S. Capitol Switchboard at (202) 224-3121 or your senators' official .gov websites will have their DC office phone numbers. The AAP has provided these sample talking points to get you started:

Screenshot of text:

Hello. I am a pediatrician from {city, state}.
As confirmation hearings for the Secretary of Health and Human Services take place in the coming days, I am urging {Senator's name} to support children's access to vaccines.
Vaccines are vital to keeping children, families and communities healthy and preventing the spread of diseases.
Access to immunizations in our state helps ensure children can grow up healthy and strong.
It is one of our country's greatest scientific achievements that we have vaccines that equip our immune systems to resist so many diseases.
I urge {Senator's name} to consider the importance of lifesaving vaccines and support federal leaders who do the same throughout the confirmation process.
Thank you for your time.

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Jon Mosser @jonmosser.com · 28/01/2025

1) Go to federaladvocacy.aap.org and send a letter. I did this today. It's incredibly easy. Log in with your AAP username; the senators are pre-selected for you and an email with talking points is pre-populated for you to personalize.

A screenshot of a website with an image of the Capitol building and text: Protect Child Health and Support Access to Vaccines Tell your U.S. senators to protect child health and support access to vaccines. TAKE ACTION

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Jon Mosser @jonmosser.com · 08/01/2025

Come join our team at #IHME at the University of Washington! We've just posted three new job openings; all will focus on disease burden estimation for #NTDs. More details in each of the job descriptions linked below. #Episky #IDsky #globalhealth

A group of people with laptops open sitting around a conference room table and smiling

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Jon Mosser @jonmosser.com · 17/12/2024

For more than three millennia, #smallpox caused untold human suffering. This photo shows a young girl with smallpox in 1973 in Bangladesh. Only 7 years later, in 1980, WHO declared that smallpox had been eradicated. No one has to experience this ever again. All thanks to #vaccines. #idsky

Photo of a young girl with smallpox (CDC / public domain). From the CDC public health images library: "This image was captured in 1973, in the country of Bangladesh, and depicts a closer view of this child’s face, as she was being held by her father (see PHIL 3251). This girl who’d been infected with smallpox, displayed a classic, though severe maculopapular rash over her entire body." https://phil.cdc.gov/details.aspx?pid=3265

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Jon Mosser @jonmosser.com · 14/12/2024

Last, we can look at the % change in the number of positions offered, # of positions filled, and # of applicants preferring each subspecialty between 2022 and 2024! Good news for #PedsIDSky here: we have a pretty large % increase in the absolute # of applicants preferring ID! (caveat: small #s)

Percent change in # of positions filled between 2022-2024, by peds subspecialty. Plot showing % change between 2022-2024 on the X axis, peds subspecialty on the Y axis, color of each bar representing % change.

Percent change in # of positions offered between 2022-2024, by peds subspecialty. Plot showing % change between 2022-2024 on the X axis, peds subspecialty on the Y axis, color of each bar representing % change.

Percent change in # of applicants preferring each specialty between 2022-2024, by peds subspecialty. Plot showing % change between 2022-2024 on the X axis, peds subspecialty on the Y axis, color of each bar representing % change.

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Jon Mosser @jonmosser.com · 14/12/2024

As @inditrehan.bsky.social had pointed out, though, this is due to changes in both the # of positions available and # of applicants matching. For ID, for instance, both # of positions filled & # of positions available are up. For several others, ⬆️positions and ⬇️applicants are playing a role.

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Jon Mosser @jonmosser.com · 14/12/2024

Going back to the #Pediatric subspecialty match data for a bit of a deeper dive: I pulled data from 2022-2024, which is all that I could readily find on the NRMP website. Here are the trends in the % of positions filled, by year and pediatric subspecialty. ID is pretty flat! #Pedsky #PedsIDSky

A series of small plots showing the % of available positions filled on the Y axis and the year on the X axis, by pediatric subspecialty

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Jon Mosser @jonmosser.com · 13/12/2024

The President-elect of the United States of America is apparently considering vaccine bans for children based on the nonsense conspiracy theory that MMR causes autism. It's hard to overstate what a public health catastrophe this would be. #pedsky #pedsidsky #idsky

Screenshot of a news article reading: "On vaccines, Mr. Trump said he plans to listen to the arguments made by Robert F. Kennedy Jr., a longtime vaccine skeptic who is Mr. Trump’s choice to lead the Department of Health and Human Services. Both men have promoted the debunked theory that vaccines cause autism.

“We’re going to have a big discussion. The autism rate is at a level that nobody ever believed possible. If you look at things that are happening, there’s something causing it,” Mr. Trump said in the interview.

The president-elect said that the discussion could lead to some childhood vaccinations being banned.

“It could if I think it’s dangerous, if I think they are not beneficial, but I don’t think it’s going to be very controversial in the end,” he said."

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Jon Mosser @jonmosser.com · 11/12/2024

This is not a typical randomized controlled trial, but rather a cluster-randomized stepped wedge design. That means that early in the study, more wards would be in the no-screening group, and later in the study, more wards would be in the screening group.

A picture of text that reads: One inherent complexity of this design is confounding with time.27 As a result, the overall treatment effect could only be assessed by adjusted rather than crude analysis. As the COVID-19 pandemic started after trial launch, the baseline mortality increased in later periods corresponding with COVID-19 waves, resulting in 2-fold more COVID-19 cases and higher-risk patients in the screening group compared with the no screening group (eFigure in Supplement 2). This confounding may bias the results toward the null, underestimating the treatment effect. This confounding was accounted for by adjusting for periods and COVID-19 status. Interestingly, subgroup analysis demonstrated that screening was similarly effective in patients without or with COVID-19 and across study periods.

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Jon Mosser @jonmosser.com · 04/12/2024

More recently, Freed and Wickham looked at these net present value calculations and how they differ for #pediatric subspecialties by data source (AAAP vs AAMC). While the numbers and rankings are a bit different, it's hard not to see a persistent relationship with these match results. tiny.cc/k44zzz

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Jon Mosser @jonmosser.com · 04/12/2024

Catenaccio, Rochlin, and Simon looked at the correlation between fellowship fill rates (2014-2018) and lifetime net present value (2018-2019), by pediatric subspecialty. pmc.ncbi.nlm.nih.gov/articles/PMC...

Scatter plot of the lifetime net present value (X axis, in thousands of dollars) vs the percentage of fellowship positions filled (Y axis). Each point represents a pediatric subspecialty. A linear regression line is showing with 95% confidence intervals. In general, as the lifetime net present value increases, the proportion of fellowship positions filled also increases.

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Jon Mosser @jonmosser.com · 02/12/2024

16 measles outbreaks in 2024 so far, with 280 cases. Higher than recent years, but not as high as 2019, which was a particularly bad year for measles in the USA and around the world. www.cdc.gov/measles/data...

A column plot showing the number of measles cases per year in the USA, 2000-2024. Number of cases gradually grows with year-to-year fluctuation from 2000-2019, then a large spike in 2019 with 1,274 cases. Decreases during the COVID pandemic years, but a higher number of cases in 2024 compared to 2020-2023.

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Jon Mosser @jonmosser.com · 02/12/2024

In 14/50 health jurisdictions, there were enough exemptions in 2023-2024 to make it impossible to achieve 95% coverage with the #MMR #vaccine, even if every child without an exemption were vaccinated. This number has been on the rise over the last few years. #IDsky #PedsIDSky #Episky #Pedsky

A plot showing the number of jurisdictions for which it would be impossible to achieve 95% coverage with MMR vaccine amongst kindergartners because of the number of exemptions, by year. After reaching a low of 2 in 2020-2021, the number of jurisdictions has increased to 14 in 2023-2024.

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Jon Mosser @jonmosser.com · 02/12/2024

This isn't even the worst of it. #Vaccine exemption rates for kindergarteners increased in 41 of 50 jurisdictions with data last year - mostly nonmedical. In Idaho, **14.3%** of kindergarten students had exemptions (!) tiny.cc/dcjyzz

A horizontal bar plot showing the percent of incoming kindergarteners with vaccine exemption, by state, 2023-2024 school year.

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Jon Mosser @jonmosser.com · 28/11/2024

One last "fun" fact: the first #anti-vax movements started essentially immediately after the discovery of #vaccination. In this 1802 cartoon, the vaccine turns people into bovine abominations, with cows growing out of their heads. (This cartoon was largely a parody of extreme #anti-vaccine views).

An early 19th century cartoon. From the Morgan Museum's description: "The setting has been identified as London’s Smallpox and Inoculation Hospital at St. Pancras. A figure probably intended to represent Jenner himself is shown presiding over the scene as he makes an incision in the arm of a young woman who shrinks away in fear as he prepares to inoculate the small wound with infectious lymph from a bucket labeled “Vaccine Pock hot from ye Cow.” A picture depicting the worship of the golden calf adorns the wall behind them. The doctor appears blandly indifferent to the plight of the newly vaccinated, who panic as miniature cows burst forth from their bodies and one unfortunate man sprouts a pair of horns."

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Jon Mosser @jonmosser.com · 28/11/2024

From those beginnings came humanity's greatest public health accomplishment: the eradication of smallpox by 1980, thanks to the power of #vaccines.

A magazine cover for "World Health", a magazine of the World Health Organization, from May 1980. A globe is superimposed on a blue background with a diagonal yellow banner declaring "Smallpox is Dead".

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Jon Mosser @jonmosser.com · 28/11/2024

It wasn't until 20 years later that Edward Jenner began his experiments with #smallpox #vaccination, culminating in the vaccination of 8-year-old James Phipps, the son of his gardener in 1796. He then exposed Phipps to smallpox material to test the immunity. (This is why we have IRBs).

A painting of Edward Jenner, seated, inoculating eight year old James Phipps while his mother stands behind him.

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Jon Mosser @jonmosser.com · 28/11/2024

People then started to experiment with the use of cowpox. There were likely five or six different examples of these first #vaccinations, throughout Europe. Perhaps most well known is Benjamin Jesty, who infected his wife and kids (!) with cowpox in 1774 amidst a smallpox outbreak.

A painting of Benjamin Jesty sitting in a chair, a rotund, balding man in late 18th century clothes holding a cane.

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Jon Mosser @jonmosser.com · 28/11/2024

In southwest England, amongst the dairy farming communities, people had noticed that dairymaids who contracted cowpox seemed to be immune to smallpox. In 1765, John Fewster brought this folk knowledge to the medical establishment, presenting a paper to the Medical Society of London on the topic.

An engraving showing the lesions of cowpox. Top: umbilicated vesicles on cow udders. Bottom: similar lesions on human arms.

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Jon Mosser @jonmosser.com · 28/11/2024

The practice of variolation was then introduced to England by Lady Mary Wortley Montagu, who witnessed it in Turkey. Her brother had died of smallpox in 1713, and she survived the disease in 1715.

A painting of Lady Mary Wortley Montagu, a young woman standing in a beam of light, holding fabric over her left arm, with a shadowy figure in the background in a red coat.

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Jon Mosser @jonmosser.com · 28/11/2024

And here's the figure that shows data from three linkage studies looking at the incidence of #cervicalcancer by #vaccination status. For cohorts vaccinated early (i.e. prior to HPV infection) the reductions are really massive.

A scientific figure showing "Cumulative incidence of cervical cancer stratified by human papillomavirus vaccination status and age at vaccination (see legend), observed in linkage studies conducted in Sweden (14), Denmark (15), and Scotland (1), joining individual patient data from vaccination and cancer registries. The X-axis in the two plots on top expresses the years at follow-up, whereas the plot at the bottom expresses the years since start of screening invitation". "The green curves involving the youngest participants at vaccination are consistently located near the bottom of the plots, reflecting a very high effectiveness"

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Jon Mosser @jonmosser.com · 28/11/2024

Thanks! That article has a great overview of the history as well for anyone unfamiliar: #HPV #vaccines were licensed based on effectiveness against HPV infection and precancerous lesions (CIN) because the lag time between infection and cancer is so long. Some argued that this wasn't sufficient.

A text snippet from a scientific article that reads: Reduction of the burden of invasive cervical cancer, although the main purpose of HPV vaccination, was not an endpoint of the randomized HPV vaccination trials that led to their licensing and introduction of HPV vaccines in many countries. Having cancer as an outcome would have required very costly and lengthy observation periods and postpone the availability of vaccines for decades. Therefore, the World Health Organization (WHO) had recommended reduction of cervical intraepithelial neoplasia (CIN) of grade 2 or CIN3 or worse, associated with the HPV types targeted by the vaccine, as the first trial outcome (2)

A text snippet from a scientific article that reads:Conservative epidemiologists have criticized surrogate evidence based on protection against precursors, arguing that HPV infection and cervical precancerous lesions usually clear spontaneously and that by treating screen-detected lesions, progression to cancer can be avoided (5,13).

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Jon Mosser @jonmosser.com · 27/11/2024

🔥🔥🔥from the Greiner Dairy Company in 1931. "no progressive community, fully informed as to the facts, will permit the distribution of non-Pasteurized Milk. The health of the community is too precious to take a chance on anything but the best." tiny.cc/j9nxzz

An ad from 1931 showing a bottle of milk and text that reads:

PASTEURIZATION HAS COME TO STAY

because no progressive community, fully informed as to the facts, will permit the dis tribution of non-Pasteurized Milk.

The health of the community is too precious to take a chance on anything but the best.

The Greiner Dairy Co.

SOLD AT ALL FIRST CLASS INDEPENDENT DEALERS

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Jon Mosser @jonmosser.com · 27/11/2024

The South Jersey Milk Company had it right in *1930*. tiny.cc/59nxzz

An ad from the early 20th century for Abbot's Milk with one child handing another a glass of milk at the top. Text reads: What is "Pasteurized Milk?" Even though cows are healthy, barns clean and airy, utensils and cans clean and sterile, this is not enough to assure complete healthfulness of the milk. Pasteurization is an essential measure of safety-it assures the healthfulness of the milk-but in no way affects its taste, food value or cream line. You want pasteurized milk for your children. We sell that kind.

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Jon Mosser @jonmosser.com · 27/11/2024

Be like Right Baby, not like Left Baby! We figured this out more than 💯 years ago. 🥛♨️👍 #IDSky #PedsIDSky

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Jon Mosser @jonmosser.com · 24/11/2024

This... is one heck of a take. www.nytimes.com/2024/11/23/h... #MedSky #IDSky #PedsSky #PedsIDSky

Screenshot of a New York Times article that reads:

"We are playing with fire with the shake-ups and choices, but at this point change is needed,” said Dr. Michael Mina, an epidemiologist and former Harvard professor. He said the agencies were often too slow and bureaucratic, and their leaders too unwilling to engage with the public’s concerns. “At least there’s a better chance of positive change compared to complacency and more of the same,” he said.

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Jon Mosser @jonmosser.com · 23/11/2024

Over the last 50 years, #vaccines prevented 146 million deaths among children < 5, and 101 million among children < 1. 40% of the overall reduction in child mortality was attributable to #vaccination. A child living in 2024 is 40% more likely to survive to their next birthday because of #vaccines.

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Jon Mosser @jonmosser.com · 23/11/2024

Now seems like a good time to remember that #vaccines are the greatest #publichealth intervention in history, saving 154 million lives in the 50 years since the start of the Expanded Programme on Immunization in 1974. #EpiSky #IDSky #PedsIDSky doi.org/10.1016/S014...

A three-panel figure from an academic paper. Panel A shows changes in infant mortality from 1974 to 2024, with 40% of the reduction attributed to vaccination. Panel B shows cumulative infant deaths over the same time period, again with 40% of the reduction attributed to vaccination. Panel C shows coverage of routine childhood vaccines over time, with increases across all vaccines but some plateauing in later years and decreases in coverage for multiple vaccines since 2020.

A three panel figure from an academic paper. Panel A shows cumulative total deaths averted over time between 1974 and 2024 by vaccine (total 154 million). Panel B shows cumulative life years gained over the same time period (9 billion). Panel C shows total years of full health gained (10.2 billion). The measles vaccine has the largest contribution across all metrics.

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Jon Mosser @jonmosser.com · 21/11/2024

While the numbers are smaller, #IDSky is growing like crazy too! 📈🦠💊

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Jon Mosser @jonmosser.com · 21/11/2024

It's not your imagination: #MedSky's growth has been through the roof 📈 🚀 over the last few weeks! Here's to more in the months & years to come. (Made with R, ggplot, and the excellent atrrr package: buff.ly/40X0qxb )

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Jon Mosser @jonmosser.com · 20/11/2024

Washington State's #pertussis outbreak continues, with 1303 cases reported statewide so far in 2024 (24x higher than by this point in 2023 📈). See the full report from @wadepthealth.bsky.social here! 🔗 buff.ly/48X12Vy #medsky #idsky #pedsidsky

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Jon Mosser @jonmosser.com · 19/11/2024

The methods underpinning this tool are described in this publication from the Lancet (Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050. Lancet. 2024 Sep 28;404(10459):1199-1226.) 📄🔗 buff.ly/48WmE4w

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Jon Mosser @jonmosser.com · 19/11/2024

Explore the estimates by pathogen🦠 , infectious syndrome🩺 , and resistance status💊 ; drill down by country, year, or age. Super-useful for getting a picture of trends over time 📈 or exploring global patterns for a particular pathogen of interest🌍 .

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Jon Mosser @jonmosser.com · 19/11/2024

In 2021, between 1.14 million and 4.71 million people died because of bacterial antimicrobial resistance 🦠💊. Check out the MICROBE tool (Measuring Infectious Causes and Resistance Outcomes for Burden Estimation) from colleagues @ #IHME and #Oxford buff.ly/3UXziKA #IDSky #PedsIDSky #Medsky

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Jon Mosser @jonmosser.com · 19/11/2024

Reminds me of this slide from my noon conference lectures to peds residents on FUO: a place of diagnostic mystery, from which few return...

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Jon Mosser @jonmosser.com · 19/11/2024

While #measles is a real [& growing] problem, it's worth remembering that we live in a dramatically different world due to the save & effective measles #vaccine - which saves millions of lives every year, as this graph from buff.ly/48TExAZ shows

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Jon Mosser @jonmosser.com · 19/11/2024

All of our models are designed to fit together in an internally consistent way - so that our local estimates of #vaccine coverage add up to our district-level estimates; the district-level estimates add up to the state-level estimates, state-level to national, and national to global.

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Jon Mosser @jonmosser.com · 19/11/2024

For more information about the #geospatial #modeling methods that we use to estimate local patterns of #vaccine coverage, see buff.ly/40UaHdB and buff.ly/493UyEr

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Jon Mosser @jonmosser.com · 19/11/2024

At the local level, we estimate #vaccine coverage at a 5x5km resolution using #geostatistical #models fit to survey data. We use these to make estimates at first and second administrative levels (i.e. states and districts).

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Jon Mosser @jonmosser.com · 19/11/2024

At the national and global level, we estimate routine #immunization coverage for 11 vaccine-dose combinations, along with uncertainty in those estimates. If you want to learn more about the models that we've developed, see buff.ly/4ezQSvh

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Jon Mosser @jonmosser.com · 19/11/2024

Check out our team's estimates of #global, national, and local #vaccine coverage - all freely available on the IHME website! Just enter your email address to browse & download: buff.ly/4fxc06D. #vaccineswork #immunization #globalhealth

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