Morning, Marco. Coffee, then sleep — here's the short version. Dengue turned up in a Florida county with no travel attached, which moves it onto your differential. The biggest Florida health story of the week is a rulemaking fight over school vaccines, and it's today's Debate. And the Mets lost on a walk-off with Senga on the mound, which is its own kind of genre.
A · Top Stories
Aug 24 · DOH-Citrus
Locally acquired dengue confirmed in Citrus County — no travel history required anymore
The Florida Department of Health in Citrus County issued a mosquito-borne illness alert yesterday after confirming a locally acquired case of dengue, and is coordinating surveillance with county mosquito control. CIDRAP flagged it the same day.
Citrus County is up on the Nature Coast, not Lee — but the word that matters is locally acquired. Once local transmission is documented anywhere in the state, "no recent travel" stops being a reason to drop dengue off the list for a febrile Floridian. The elderly presentation is the one that burns people: fever plus headache and myalgias looks like everything else, and the trouble arrives at defervescence, days 4–7, when plasma leak and thrombocytopenia show up. Warning signs are abdominal pain and tenderness, persistent vomiting, mucosal bleeding, a rising hematocrit with a falling platelet count, and lethargy. Practical traps: no NSAIDs and no aspirin, careful with anticoagulated patients, and NS1 antigen is the test that's useful early while IgM takes about five days to turn.
Worth doing: find out tonight whether your lab runs dengue NS1/IgM in-house or sends it to the state lab, and what the turnaround is. That's the question you don't want to be asking at 3 a.m. with a hypotensive 78-year-old and a platelet count of 40.
Lancet Infect Dis · covered Aug 24
The largest patient-level look at resistant hospital infections in Asia roughly doubles the modeled death toll — and finds almost no attributable mortality in high-income settings
ACORN-HAI, published in The Lancet Infectious Diseases, followed 9,496 patients across 41 hospitals in 19 Asian countries with ventilator-associated pneumonia or hospital-acquired bloodstream infection. Nearly three-quarters (73.7%) of infections involved drug-resistant bacteria, mostly gram-negatives, 62% of them multidrug-resistant. Crude 28-day mortality was 38% for resistant infections and 41% for MDR — 51% with carbapenem-resistant Acinetobacter, 49% with carbapenem-resistant Enterobacterales. Estimated deaths attributable to AMR in these two infection types: about 250,000, roughly twice the 2019 GRAM modeled figure.
The line buried in the results is the one for you: after adjustment, attributable mortality was 11% in low- and middle-income countries and essentially zero in high-income settings. Not because resistance is harmless, but because when the right drug is on the shelf and the lab turns around fast, resistance stops being the thing that kills the patient — access and diagnostics are. The authors are blunt that most carbapenem-resistant infections were treated with carbapenems or polymyxins because newer agents simply weren't available. That reframes the headline number as a supply-chain and lab-capacity finding, not an argument for broader empiric coverage in Cape Coral.
Worth doing: ask stewardship for your own unit's carbapenem-resistant Acinetobacter and CRE rates before this study's numbers set anyone's expectations. Your antibiogram, not Asia's, should be driving the 2 a.m. empiric choice.
Aug 24 · Becker's
Thirty health systems — including Tampa General and Tallahassee Memorial — are warning patients about a fake "MyChart Medicare Kit"
Becker's ran the running list yesterday: phishing emails and texts with subject lines like "Your MyChart Medicare Kit Awaits!" and offers of a free "2026 MyChart Senior Health Package," aimed at getting recipients to click a link or hand over identifiers. Cleveland Clinic, Mass General Brigham, Northwell, MD Anderson, Emory and two Florida systems are on the list. Epic says this is scammers borrowing the MyChart brand rather than any security failure, and that patients can keep using the portal normally.
The targeting is the point. "Medicare kit" and "senior wellness package" are aimed squarely at the population you admit, and your patients have been trained for a decade to trust anything that says MyChart. A confused 82-year-old who hands over a Medicare number doesn't come back to you as an IT ticket — she comes back as an identity-theft mess her daughter is trying to untangle while you're discharging her.
Worth doing: one sentence to families at discharge — "the hospital will never email you about a free Medicare kit." Cheapest intervention available to you this week.
B · The Debate
Should Florida drop hepatitis B, chickenpox, Hib and pneumococcal from its school entry requirements?
Surgeon General Joseph Ladapo signed the proposed rule on August 20, opening a 21-day public comment window. A public hearing in Panama City Beach last Friday put pediatricians and vaccine-mandate opponents in the same small room, and the story broke wide yesterday. The rule would also expand religious exemptions to cover "moral or ethical" belief and let families opt out of the state immunization registry.
The case FOR
Joseph Ladapo, Florida Surgeon General; Emma Spencer, Florida DOH — WUSF / News Service of Florida
A mandate is a different thing from a recommendation, and the state should only compel what schooling itself makes necessary. These four are the weakest fit for that test: hepatitis B is bloodborne and sexually transmitted, Hib and pneumococcal disease are mostly a risk to infants and toddlers well before kindergarten, and a vaccinated classroom does little to change any of their transmission math the way it does for measles. The department's framing, in Spencer's words, is "grounded in policy based on considerations that favor parental rights and medical freedom" — and Ladapo's version is blunter: "Who am I to tell you what your child should put in their body?"
There's a procedural argument too. Florida already grants religious and medical exemptions, so the mandate was never absolute; what the rule removes is a paperwork barrier that falls hardest on families least able to navigate it. And these four are the only ones the department can touch — the rest sit in statute.
The case AGAINST
Susan Kressly, MD, President, American Academy of Pediatrics; Frederick Southwick, MD and Paul Robinson, MD at Friday's hearing — NBC News
School entry requirements are the last reliable checkpoint in a child's immunization schedule, and removing one doesn't just change who gets the shot — it broadcasts that the shot is optional. Kressly's argument is about what schools actually are: "For many kids, the best part of school is being with friends — sharing space, playing on the playground and trading germs." Coverage rates track requirements closely, and Florida is proposing this while national kindergarten MMR coverage sits at 92.4% and the country is having its worst measles year since 1991.
The clinicians who testified made it concrete rather than statistical. Robinson described a two-year-old he treated for Hib who was left partially paralyzed, and recalled wards at Vanderbilt full of children with diseases now prevented. Southwick's objection was about the erosion underneath the rule: "I feel very sad to hear the distrust of physicians in the medical community."
Where it might land: the comment window closes around September 10, but the department told NBC a final decision isn't likely until next year — and the mandates that carry the most epidemiologic weight (MMR, polio, DTaP) are in statute, where no repeal bill has been filed in four sessions. A separate wrinkle landed yesterday: Florida's Catholic bishops told the attorney general there is no theological basis for religious exemption, which complicates the exemption expansion from an unexpected direction.
Sleep well, Marco. Nothing in here needs you before tonight.