I must admit that I've been quite shocked by your blog posts on herpes viruses. I was unaware of how easy transmission was, and I was treating them more like an "avoidable" disease (ala HIV) rather than one you get through just leading a "normal" life (ala certain HPVs).
I am curious though, if it's something you're even willing to discuss:
1. How good do you think the evidence of prevalence in young demographics is? As in, for all herpesviruses, it seems to increase almost linearly with age... which makes little sense prima-facia. If you haven't gotten it by the age of 30-40 (when most people marry and stabilize their friend groups, thus severely reducing the number of infection vectors), it seems reasonable to assume the chances of you getting it are low. Would you entertain a hypothesis where most (60-80%) of people are carriers of most HVs since birth or a young age, but only end up shedding the virus in detectable amounts, or getting an infection serious enough to get an immune-adaptive response at an older age?
2. If one was convinced to try and test themselves for various HVs (in order to assess risk to sexual partners and close friends/family. How indicative (if at all) would you think IgG levels are? And what methods of measuring IgG have the specificity to identify a latent infection? (I tried looking this up and it seems impossible from a layman-y perspective to get anything close to an obvious or consensus answer)
3. (maybe a bit personal) do you actually consider the impact of HVs to be enough to warrant lifestyle changes ? (i.e. not engaging with untested sexual partners, severely reducing the amount of food and drink that you share, prophylaxis after being in contact with possible infection vectors, etc). Does it seem reasonable to assume that anti-viral therapies would progress enough in the case of these viruses to adopt a "don't care" approach?
Ultimately , if you don't really have answers or feel comfortable giving them, no worries. I get that the level you're communicating this too is probably "medical researcher and policy maker" and I'm asking dumb clinical~ish questions that aren't your job. But I think you're answers would be interesting.
Fair enough, I meant that more as a "you should totally write more because your biology articles have been very insightful", I'd honestly love to read anything you come up with next.
>1. How good do you think the evidence of prevalence in young demographics is? As in, for all herpesviruses, it seems to increase almost linearly with age... which makes little sense prima-facia. If you haven't gotten it by the age of 30-40 (when most people marry and stabilize their friend groups, thus severely reducing the number of infection vectors), it seems reasonable to assume the chances of you getting it are low.
The evidence of prevalence (in both young and old demographics) is quite solid, the tests (mainly IgG serology) are quite reliable. Now, there may be different explanations for the rate of increase over time. The first explanation is that people are exposed throughout their lives. However, it could also be possible that historically there was more exposure than now. E.g. someone who's 70 years old was infected 65 years ago at age 5.
2. In general IgG testing for herpesviruses is quite reliable, even more so than for testing for other viruses, because the chronic infection leads to a long-lasting IgG response. The usual way of measuring IgG is ELISA. For example: "the clinical sensitivity of the CMV IgG ELISA Test Kit is 98.0%, and the clinical specificity is 98.3%." http://atlas-medical.com/upload/productFiles/209002/PPI1653A01%20CMV%20IgG%20ELISA%20Rev%20A.pdf
3. The lifestyle changes required to avoid infection may not be worth it, depending on what you value. If you really like kissing people, you might be OK with losing 1.1 years of life expectancy. For vulnerable people (especially women of childbearing age) this is more important, though.
Personally, CMV is just another reason to not share bodily fluids with anyone except my girlfriend.
Hm, fair enough, I might have gotten the wrong impression about IgG tests. I'm considering getting some for HSV1+2, EBV and CMV and potentially adjusting my behaviour based on the results, especially since I live in areas and interact with demographics with low prevalence.
Though I must admit I do fall squarely on the side of "kissing loads of people is probably worth the QALY drop", but I may reconsider, I guess a problem here is path dependence, payback of avoidance (for both HSVs and HPVs) gets lower the less you've avoided them in the past.
But even if I don't adjust my lifestyle personally, it's still a fascinating read, and has certainly made me question the common memes being spread around sexual education and hygiene norms.
This herpes virus series is very interesting. I have given birth to five children and I have heard a lot about toxoplasmosis and listeria and the smoked salmon and cheese and cats to avoid, but I never heard of CMV and the kisses to avoid.
Calling women of childbearing age "vulnerable people" implies a challenge to hook-up culture. It is not necessarily wrong, just very radical in current Western society.
I have to admit this new knowledge makes me a bit nervous when I take care of my two months old baby: can I sing to him at a close range? Or will those droplets of saliva we now all know are there when people sing give him cytolomegavirus? Age-old human social behaviour gets questioned with this kind of new knowledge.
I must admit that I've been quite shocked by your blog posts on herpes viruses. I was unaware of how easy transmission was, and I was treating them more like an "avoidable" disease (ala HIV) rather than one you get through just leading a "normal" life (ala certain HPVs).
I am curious though, if it's something you're even willing to discuss:
1. How good do you think the evidence of prevalence in young demographics is? As in, for all herpesviruses, it seems to increase almost linearly with age... which makes little sense prima-facia. If you haven't gotten it by the age of 30-40 (when most people marry and stabilize their friend groups, thus severely reducing the number of infection vectors), it seems reasonable to assume the chances of you getting it are low. Would you entertain a hypothesis where most (60-80%) of people are carriers of most HVs since birth or a young age, but only end up shedding the virus in detectable amounts, or getting an infection serious enough to get an immune-adaptive response at an older age?
2. If one was convinced to try and test themselves for various HVs (in order to assess risk to sexual partners and close friends/family. How indicative (if at all) would you think IgG levels are? And what methods of measuring IgG have the specificity to identify a latent infection? (I tried looking this up and it seems impossible from a layman-y perspective to get anything close to an obvious or consensus answer)
3. (maybe a bit personal) do you actually consider the impact of HVs to be enough to warrant lifestyle changes ? (i.e. not engaging with untested sexual partners, severely reducing the amount of food and drink that you share, prophylaxis after being in contact with possible infection vectors, etc). Does it seem reasonable to assume that anti-viral therapies would progress enough in the case of these viruses to adopt a "don't care" approach?
Ultimately , if you don't really have answers or feel comfortable giving them, no worries. I get that the level you're communicating this too is probably "medical researcher and policy maker" and I'm asking dumb clinical~ish questions that aren't your job. But I think you're answers would be interesting.
Also... have you considered doing HPV next?
About HPV: maybe I'll do it someday. However, I want to blog about something besides viruses next.
Fair enough, I meant that more as a "you should totally write more because your biology articles have been very insightful", I'd honestly love to read anything you come up with next.
>1. How good do you think the evidence of prevalence in young demographics is? As in, for all herpesviruses, it seems to increase almost linearly with age... which makes little sense prima-facia. If you haven't gotten it by the age of 30-40 (when most people marry and stabilize their friend groups, thus severely reducing the number of infection vectors), it seems reasonable to assume the chances of you getting it are low.
The evidence of prevalence (in both young and old demographics) is quite solid, the tests (mainly IgG serology) are quite reliable. Now, there may be different explanations for the rate of increase over time. The first explanation is that people are exposed throughout their lives. However, it could also be possible that historically there was more exposure than now. E.g. someone who's 70 years old was infected 65 years ago at age 5.
2. In general IgG testing for herpesviruses is quite reliable, even more so than for testing for other viruses, because the chronic infection leads to a long-lasting IgG response. The usual way of measuring IgG is ELISA. For example: "the clinical sensitivity of the CMV IgG ELISA Test Kit is 98.0%, and the clinical specificity is 98.3%." http://atlas-medical.com/upload/productFiles/209002/PPI1653A01%20CMV%20IgG%20ELISA%20Rev%20A.pdf
3. The lifestyle changes required to avoid infection may not be worth it, depending on what you value. If you really like kissing people, you might be OK with losing 1.1 years of life expectancy. For vulnerable people (especially women of childbearing age) this is more important, though.
Personally, CMV is just another reason to not share bodily fluids with anyone except my girlfriend.
Hm, fair enough, I might have gotten the wrong impression about IgG tests. I'm considering getting some for HSV1+2, EBV and CMV and potentially adjusting my behaviour based on the results, especially since I live in areas and interact with demographics with low prevalence.
Though I must admit I do fall squarely on the side of "kissing loads of people is probably worth the QALY drop", but I may reconsider, I guess a problem here is path dependence, payback of avoidance (for both HSVs and HPVs) gets lower the less you've avoided them in the past.
But even if I don't adjust my lifestyle personally, it's still a fascinating read, and has certainly made me question the common memes being spread around sexual education and hygiene norms.
This herpes virus series is very interesting. I have given birth to five children and I have heard a lot about toxoplasmosis and listeria and the smoked salmon and cheese and cats to avoid, but I never heard of CMV and the kisses to avoid.
Calling women of childbearing age "vulnerable people" implies a challenge to hook-up culture. It is not necessarily wrong, just very radical in current Western society.
I have to admit this new knowledge makes me a bit nervous when I take care of my two months old baby: can I sing to him at a close range? Or will those droplets of saliva we now all know are there when people sing give him cytolomegavirus? Age-old human social behaviour gets questioned with this kind of new knowledge.
Does Substack have a button to report spam? Because you've got some from "Sheryl".