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The Handover is back.
You didn’t think you’d leave us in 2025, did you?
Fret not! We’ve crawled out of the inbox abyss, returning to quench your insatiable thirst for medical news for another year.
I know you’ve missed us. We’ve missed you, too.
So, Happy New Year and…
👋 Happy Friday. Here’s what we got:
🐔 Too Chicken Til Now: UK Finally Vaccinates for Varicella
💉 The Cannula That Lingers… Dangers of the PIVC Line
🧠 QuickBits: Other Top Stories of The Week
If you want to read any previous editions of The Handover, you can on our website.
NATIONAL GUIDELINE UPDATE
🐔Too Chicken Til Now: UK Finally Vaccinates for Varicella
There are three things guaranteed in life: Death, taxes, and an update to the childhood vaccination schedule (No prizes for guessing the subject of this article)
Just as you’d finally committed those jabs to memory, along comes the new and improved MMRV!
V for Varicella!
Up until this point, the UK’s recipe for chickenpox success (the so-called Chickenpox Party) has been as follows:
Step 1: Source an afflicted child and invite other local children to hole up in a room with them.
Step 2: Let them cough, sneeze and itch all over the others until they, too, are poxed.
Step 3: Charge a small fee and rake in the dosh.
Hottest MLM East of the Atlantic🤑
But this elite UK tactic didn’t quite catch on. That’s because other countries just … vaccinated against varicella instead. …for the last 20+ years.
Why has it taken the UK this long to vaccinate?
TLDR: the UK decided not do anything too rash.
And that's because the Joint Committee on Vaccination and Immunisation (JCVI) were concerned about the ‘exogenous boosting hypothesis’:
They thought that childhood exposure to chickenpox would boost immunity and thus prevent reactivation as an adult.
Remove childhood chickenpox, and you remove the immune top-ups. So suddenly, adults everywhere might be developing shingles. Or so the theory went.
Add to that worries about disease burden shifting to adults (where chickenpox is much more severe) and early cost-effectiveness models that didn’t initially favour vaccination. The JCVI’s long-standing answer was a NO.
But other countries didn’t really give a shingle f**k.
The USA, Canada, Australia and many others have all been varicella vaccinating since the ‘90s🤘
So what changed?
Why did the UK suddenly switch sides in the big ‘26?
In a nutshell: time
Thanks to those countries and their established vaccination programmes, we’ve been able to keep a close eye and get real-world data about the effectiveness of the jab. Turns out, the number of chickenpox cases, severity of cases AND complication rates all plummeted. Shocker.
Plus:
Updated modelling suggests there might be a slight increase in shingles, but only temporarily and far less than previously thought.
And now we have an expanded shingles vaccine too!
Data suggests the jab is cost-effective, potentially even cost-saving.
The burden of disease of chickenpox is significant, between missed school/work, GP visits and admissions, it’s estimated financially at £24 million a year
So the JCVI has listened and changed its tune. And from 2026:
The new combined MMRV vaccine will be given at 12 and 18 months
Kids under 6 can also catch up with the doses
It’s great news for Gen Alpha (+ Beta … an unfortunately named successor). And ironically, the update comes just as the US announces plans to cut the childhood vaccination schedule across the pond.
So even if taxes still exist, and we suffer daily with memorising ever-changing guidelines, at least we can take comfort in the fact that we’re slightly better than the States.
That’s national pride, baby 🇬🇧
RESEARCH UPDATE
💉 The Cannula That Lingers… Dangers of The PIVC Line
Ginny looks pretty good today.
Looking good, Ginny!
Yesterday’s takeaway didn’t agree with her at all.
She’d caught a terrible bout of gastroenteritis and has been blasting uncontrollably ever since.
But today paints a very different picture.
She looks well. Hydrated. Pretty much ready to go home.
The team decides to keep her “just one more night.” You nod. She smiles.
All is calm in Bed 12.
Until the Karen from Infection Control pulls you aside.
Clipboard in hand. Serious tone. Furrowed brow.
“What’s wrong with the patient in Bed 12?”
You pause. “Nothing. She’s fine.”
“You really don’t see it?”
Your eyes scan the obs, the chart, the tray table stacked with puzzle books and half-eaten custard… and then you see it.
A single, lonely cannula.
Not connected. Not flushed. Not even pretending to be useful.
And suddenly you realise… half the ward looks like this. IVs maintained for no apparent reason.
Welcome to the most underappreciated infection control problem in the building: The Cannula That Lingers.
It is definitely convenient to have a cannula in situ. In the world of hospital medicine, it's not always obvious when a patient will deteriorate. But when a quarter of cannulas on the ward are just sitting there unused, and a third of those placed in ED are never used at all, you’ve got to wonder:
Do we keep it in or just take it out?
Published in The Journal of Hospital Medicine’s Things We Do For No Reason™ Series, this review investigated the value of an indolent cannula.
The review cited a variety of studies that showed that ultimately, maintenance of idle cannulas does more harm than good:
Infection Risk: Systematic reviews have shown local infection rates of 65 per 100,000 catheter-days and bloodstream infection rates of 4.4 per 100,000 catheter days. This may sound low, but with two billion cannulas used every year globally, the absolute burden is still pretty big.
Staph Aurus 🤝Cannulas: Peripherally inserted venous cannulas account for 20% of all S. aureus bacteremia.
It’s Pretty Uncomfortable: Pain and phlebitis occur in about 10-20% of patients
And more than anything else. Let’s say the opportunity arises for you to use this idle cannula. Another study found that more than one-third of cannulas fail before treatment completion anyway.
The author concludes with a clear message:
Unused cannulas aren’t completely harmless. Just as we regularly reassess the need for central lines or indwelling catheters, we should be just as critical of cannulas. In stable patients who can take meds orally, consider taking the cannula out.
They’ll thank you.
Their veins will thank you.
Karen in Infection Control will probably bake you a cake.
QUICKBIT: OTHER NEWS YOU SHOULD KNOW
Another day, another study showing GLP-1RAs are the miracle cure for pretty much everything.
This time, JAMA investigated obese teens. Obese teens with asthma. 1,070 of them are between 12-18 years old. This observational study monitored these teens for 12 months after initiating GLP-1 RAs. They found that acute asthma exacerbations were seen in 5.4% of those with GLP-1RA’s compared to 10.7% in the control.
Additionally, trips to the ED were also fewer in the GLP-1 RA group; 1.5% vs 3.6%.
Now, it is observational, so the usual "we need more research" caveat applies. But still, it’s a big boost for parents rich enough to get their teens on Ozempic instead of a gym membership.
Researchers from Stanford released a paper detailing an AI model named Sleep FM. An AI that takes sensory inputs from a single night's sleep to predict future disease with a 93% accuracy. Essentially, an AI palm reader. Oh, how we’ve strayed from the light of the Lord…
Published in Nature Magazine, the AI takes sensory inputs such as Resp Rate, Brainwave(EEG), Heart Activity(ECG) and more. It then compares inputs to its database, trained on 65,000 people and 585,000 sleep records, to predict 130 diseases. Including Parkinson’s (AUROC 0.93), Dementia (0.85), and, uh, all-cause mortality (0.84).
It does sound a little Elizabeth Holmes-coded…but for now, fret not. Sleep well knowing, it’ll be a while before it’s a Whoop or Apple Watch App.
A UCL conducted study has utilised the wonders of AI to discover two new subtypes of multiple sclerosis.
The two new subtypes are based on a blood biomarker for nerve cell injury called sNfL(neurofilament light chain):
Subtype A – early-sNfL – identifies high levels of the biomarker, associated with damage to the corpus callosum.
Subtype B – late-sNfL – saw damage to cortical and grey matter volumes.
What's the point of knowing this anyway? “It’s a step towards more personalised monitoring and treatment”, according to Dr Eshaghi, the study's lead author.
So much fun for neurologists, very little fun for med students(finals are fast approaching!)
Yes. The Weightloss drugs are evolving. Not just in strength like the triple agonist Orforglitrpon, but also in ease of application. Novo Nordisk announced last week that Wegovy is now available as an oral daily tablet.
Gone are the days of keeping the needle in the fridge and injection site rotation. This daily pill is available in the United States for as little as $149 per month, which is less than the price of two SoulCycle classes.
Over 1.5 million Brits in the UK are on weight loss drugs, and 12% of the US population has used them for weight loss. So don’t be surprised if Ozempic counselling shows up in your OSCEs before Methotrexate does.
One for the healthcare girlies(and guys)💅
A study in the Journal of Hospital Infection compared gel nail polish to unpolished and standard polish to see which carried the highest bacterial burden after 21 days. They kept the nails trim <2mm, then used agar plates to grow bacteria on days 1, 4, 7, 14 and 21.
460 nails were evaluated, and they found Gel nails were not associated with a higher bacterial burden. In fact, on Day 21, before hand hygiene, they had a lower bacterial count than both standard-polished and unpolished nails. Tell that to the Karens at Infection Control.
Out with the old and in with the new. The Mental Health Act 1983 has been completely refreshed. Previously being deemed as “unfit for purpose”, as it apparently disproportionally discriminates against Black people and autistic groups.
Worthy of a full article, coming next week. Click here to read if you're curious in the meantime
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Fun Fact: Anaphylaxis is a misnomer. Charles Richet, who described it first, wanted to name the opposite of protection, phylaxis, in Greek. The correct term would be aphylaxis. The prefix ana- means upwards or again. Richet was just bad at Greek.
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