As 10-year-old Aaditya Goswami holed up in his home during the COVID-19 pandemic, with an altered routine and decreased physical activity, he started gaining weight, soon turning obese. About a year ago, his father, Poorna, noticed that the boy, who before the pandemic enjoyed playing outdoors, was increasingly lethargic. He stayed glued to his screens and became irritable.
Poorna, a lawyer in the north Indian city of Mathura, consulted a pediatrician and realized that his son's changed behavior was due to his pandemic-induced obesity. Blood tests revealed that the child was prediabetic owing to his weight gain.
"He was 9 at the time, and we were very worried when we learned that he was at risk for developing diabetes," says Poorna, adding that the boy's ideal weight is 40 kilograms (88 pounds) but had increased to 57 kilograms (125 pounds) during the pandemic. "COVID made all the difference," Poorna says. "It changed the habits and lifestyles of kids. Go to the playground and check. There are no kids there anymore."
In the past few years,severalstudieshave established a link between the COVID-19 pandemic and the global surge in childhood obesity. A July 2023 studyinvolving two Indiana schools found a 9% increase in the prevalence of obesity among children, especially those ages 5 to 11, from 2019 to 2021. Similar observations were made in Australia,China,Sweden,Turkey, the United Kingdom, and other nations, which attributed the alarming rise in childhood obesity to several pandemic-related factors, including school closures, routine changes, sedentary lifestyles, excessive eating, irregular sleep, physical inactivity, and increased screen time among children.
Although the impact of the pandemic on childhood obesity is well established, little is known about the long-term consequences of this alarming rise
Although the impact of the pandemic on childhood obesity is well established, little is known about the long-term consequences of this alarming rise, which have now started manifesting as serious ailments among children in India. Vaishakhi Rustagi, a New Delhibased pediatric and adolescent endocrinologist, tells Think Global Health that before the COVID-19 pandemic, she hardly treated one case of type 2 diabetes resulting from obesity among children. After the pandemic, she says, the incidence has "increased dramatically," with at least 18 to 20 such cases in the last two years. Her patients include a 6-year-old girl, who weighs 80 kilograms (176 pounds), and a 12-year-old boy, who weighs more than 100 kilograms (220 pounds).
"Because there was muscle disuse for almost two years during the pandemic, kids are experiencing muscle wasting and bone problems now. Hence, they cannot do much physical activity, furtherincreasing the weight they gained during the pandemic," says Rustagi, "Now, in addition totheweight gain, they alsohave other ailments associated with obesity, such as type 2 diabetes, dyslipidemia, high cholesterol, and fatty liver."
Ahmed Sert, a pediatric specialist and one of the researchers behind a 2023 study in Turkey, which also concluded a direct relationship between the pandemic and childhood obesity, says that the condition has several long-term impacts on the physical as well as psychological health of children. Such children, he says, are at a higher risk of developing chronic diseases such as type 2 diabetes, cardiovascular diseases, asthma, hypertension, certain types of cancer, and orthopedic ailments such as arthritis and joint pain. Furthermore, childhood obesity can also lead to poor self-esteem, depression, and social isolation due to stigma and bullying.
"Childhood obesity is a global issue and its effects are not limited to specific regions," emails Sert, who specializes in pediatric allergy and immunology. He adds that only the rates of childhood obesity and its consequences may vary across regions "depending on factors such as socioeconomic status, access to health care, cultural norms, and dietary habits."
Think Global Health spoke with five doctors across India, all of whom report an alarming increase in pandemic-induced childhood obesity and its related comorbidities. Shiv Kumawat, a pediatrician in the north Indian city of Jaipur, says that following the pandemic, at least 1 in every 4 of his patients are now either overweight or obeseas opposed to 1 in about 20 children before the pandemic. Most of these overweight and obese children are now reporting obesity-associated complications, including constipation, sleep apnea, breathing difficulties, asthma, allergy rhinitis, and dermatitis.
"At least 15 to 20% of these overweight and obese kids are already asthmatic," says Kumawat, "Although I havent seen many cases of type 2 diabetes and heart diseases yet, all these kids are at the risk of developing such diseases."
Children watch online lectures on mobile phones inside a digital mobile education library, amid the spread of COVID-19, in Mumbai, India, on October 16, 2020. REUTERS/Francis Mascarenhas
Similar trends have also been reported in the eastern Indian city of Kolkata, where, according to pediatrician Parichaya Bera, such cases have "more than doubled" in the recent past. Bera cites the case of a 13-year-old boy who became obese during the pandemic and now weighs around 85 kilograms (187 pounds). A few months ago, the boy's family approached the doctor after the adolescent developed an intestine infection. Bera, suspecting high sugar levels, had the boy undergo some tests, which revealed that he was diabetic.
"Type 2 diabetes is usually seen in adults over 35 years of age, but after the surge in childhood obesity during the pandemic, we are getting such cases much earlier now," says Bera.
Alok Sardesai, a Mumbai-based pediatric endocrinologist, has also noticed a substantial increase in complications such as type 2 diabetes resulting from pandemic-induced obesity among children. Diving into the cultural influences of weight gain, Sardesai says that childhood obesity thrives in India because families do not recognize it as a disease. He attributes this to India's history of child malnutrition, which, he says, lingered until two decades ago and made weight gain desirable. The same thought, he adds, persists today, and to ensure healthier children, the outlook toward obesity needs to change.
"People fail to distinguish normal weight gain with abnormal weight gain, and it is still appreciated when the child starts getting overweight and obese," says Sardesai.
A study published in the UK in January 2024 found "steep increases" in overweight and obesity prevalence among children during the pandemic in England. One of its researchers, Keith Godfrey, a professor of epidemiology and human development at the University of Southampton, tells Think Global Health that the economic impact of this rise in the UK would result in more than 8.7 billion British pounds in additional national health care as well as broadened economic and social costs. This, he says, is "hugely concerning" because health-care systems are ill equipped to handle the consequent burden of pandemic-induced childhood obesity.
"Mitigating the long-term effects of obesity in children likely requires a 'whole-systems' approach that addresses obesity at multiple levels simultaneously, including individual, family, community, environmental, and policy levels," Godfrey said in an email interview.
Health-care systems are ill equipped to handle the consequent burden of pandemic-induced childhood obesity
Rustagi, the pediatric and adolescent endocrinologist from Delhi, says that althoughthe long-term impacts of childhoodobesityhave already started manifesting among children in India, perpetrating enduring complications, most parents continue to remain unconcerned with their children's weight gain and are irregular with their follow-ups. She cites the case of a teenage girl who attempted suicide due to obesity-related depression but did not continue with her medical treatment, adding that in India, awareness among families is the key to mitigating the long-term impacts of childhood obesity.
"Everyone talks about obesity in adults, but these children, who are our future, are going to become a real load on the country after a few years," says Rustagi.
The problem, however, goes beyond childhood obesity, says Smrithi Bhagirathi, a pediatrician in the south Indian city of Bengaluru, who reports a 30% increase in the incidence of childhood obesity since the pandemic. She says that the pandemic has led to a fall in the general health of children, both physical and emotionaland that the "general trend is towards unhealthier physical and developmental health among kids." The doctor, however, is optimistic about the future.
"Children are easily adaptable," she says, "So anything which has caused havoc can be reversed by improving their diet and encouraging them to play."
The same is also true in the case of 10-year-old Aaditya, who, with regular exercise and dietary modifications, has lost five of his 17 excess kilograms, bringing him closer to his ideal weight and a healthier future. "Slowly, he's getting better," says his father.
Students play during recess at a school, in Ahmedabad, India, on February 25, 2022. REUTERS/Amit Dave
Puja Changoiwala is an award-winning journalist and author based in Mumbai.
The COVID-19 response illustrates steps officials should take to ensure the effectiveness of vaccine mandates.
The COVID-19 pandemic was the worst public health emergency of the last century. Despite aggressive attempts to contain the virus by social isolation, masking, and medical management, over 1.1 million Americans died between January 31, 2020, when the U.S. Department of Health and Human Services (HHS) declared COVID-19 a public health emergency, and March 11, 2023, when HHS declared the public health emergency over. Of those that perished, there was a particularly tremendous loss among the elderly, immunocompromised, and those in nursing homes.
In December 2020, the U.S. Food and Drug Administration issued emergency use authorizations for the Pfizer-BioNTech and Moderna COVID-19 vaccines. Despite the widespread availability of the vaccines at no cost, their adoption varied considerably. For this reason, physicians and public health officials soon called for a COVID-19 vaccine mandate.
In August 2021, President Joseph R. Biden directed the Centers for Medicare and Medicaid Services (CMS) to require nursing homes to ensure their workers were fully vaccinated against COVID-19 as a condition of participating in the Medicare and Medicaid programs. The Social Security Act provides that facilities participating in Medicare must meet certain requirements and that the HHS Secretary may impose additional requirements deemed necessary to protect the health and safety of patients in hospitals, nursing homes, and other CMS-certified facilities.
HHSs emergency declarations authorized its component agencies, such as CMS, to issue new health and safety regulations. In addition, outside of public health emergencies, CMS has the authority to oversee healthcare delivery systems. CMS issued its vaccine mandate based on substantial evidence demonstrating that the prevalence of nursing home COVID-19 cases was related to low levels of vaccination among care staff. Furthermore, evidence that many nursing homes were not implementing standard infection control practices accelerated vaccine mandate drafting and execution.
The Administrative Procedure Act requires that agencies that wish to forgo notice-and-comment rulemaking during a public health emergency must demonstrate that undergoing notice-and-comment would be impracticable, unnecessary, or contrary to the public interest. The Biden Administration concluded on this basis that it could create an emergency regulation to require vaccines in nursing homes. Nevertheless, as CMS was developing its emergency regulation, nursing homes expressed concern that the mandate could trigger widespread staff shortages because workers would refuse to receive the vaccine. The industry feared that a staffing shortage could lead to worse health outcomes for residents.
While developing the vaccine mandate, the CMS Center for Clinical Standards and Quality convened several listening sessions from all corners of the healthcare industry. During this feedback period, several states issued their own vaccine mandates in both nursing homes and hospitals, and individual nursing home chains and hospital systems also proposed vaccine mandates. This patchwork approach further complicated efforts to limit the spread of COVID-19.
Hospitals and nursing homes were concerned that the variation between states rules could lead staff to move to different states to avoid a vaccine mandate. Several providers pushed for a national mandate. A marked increase in the proportion of nurses who sought employment through traveling services during the public health emergency validated this concern. Several national leaders suggested that a national mandate would be useful to manage interstate variability.
Because of these concerns, CMS and HHS began to explore the medical benefits of a national mandate for all healthcare facilities that receive Medicare funding. Data from the National Healthcare Safety Network demonstrated that COVID-19 rates among long-term care facilities were higher in facilities with lower vaccination coverage among staff. The agencies also explored the legal basis for a mandate. Critically, they determined that systems for documenting medical and religious exemptions to the vaccine mandate would be needed.
Ultimately, CMS issued its regulation in November 2021. Shortly thereafter, 14 states challenged the regulation and argued that CMS had exceeded its statutory authority under the Social Security Act. In January 2022, the U.S. Supreme Court, in a 54 decision, upheld the mandate, explaining that:
The Secretary of Health and Human Services determined that a COVID-19 vaccine mandate will substantially reduce the likelihood that healthcare workers will contract the virus and transmit it to their patients. He accordingly concluded that a vaccine mandate is necessary to promote and protect patient health and safety in the face of the ongoing pandemic. The rule thus fits neatly within the language of the statute.
Importantly, the Court found that the HHS Secretary had examined sufficient evidence justifying the decision to (1) impose the vaccine mandate instead of a testing mandate; (2) require vaccination of employees with natural immunity from prior COVID-19 illness; and (3) depart from the agencys prior approach of merely encouraging vaccination.
After the Biden Administration declared the public health emergency over in March 2023, CMS ended its vaccine mandate in August. In the end, the mandate did not substantially disrupt the healthcare ecosystem, and staff resignations due to the mandate did not produce national adverse health outcomes.
It is difficult to analyze the precise effects of the vaccine mandate because there were many states and local facilities that had already mandated the vaccine. Nonetheless, there are at least three important lessons public health officials can learn for the future from CMSs experience in imposing a COVID-19 vaccine mandate.
First, it will be important to address the non-uniform manner in which states and local healthcare facilities adopt a mandatory vaccination policy during any future pandemic. There should be a national vaccine for healthcare facilities as soon as a safe and effective vaccine is approved. Early adoption can ensure national uniformity, which can in turn help prevent localized staffing shortages. The federal government should also monitor and evaluate the impact of any such mandate and adjust the manner of implementation as needed.
Second, public health officials should proactively collect evidence to demonstrate the health and safety implications of unvaccinated staff in Medicare-certified facilities to justify the need to forgo notice and comment rulemaking. This evidence can also help justify a national vaccine mandate if challenged in the courts.
Finally, public health officials should develop and implement rigorous standards for determining who is exempt from the vaccine mandate by balancing civil rights with healthcare concerns. Rigorous standards will help ensure vaccines succeed in cutting community transmission.
The political debate around vaccination continues to this day but these three lessons can help public health officials prepare for future public health emergencies.
COVID-19 breakthrough infections in vaccinated individuals may offer an unexpected benefit: heightened immunity against future SARS-CoV-2 infections.
Research from La Jolla Institute for Immunology (LJI) reveals that those who experience breakthrough infections develop a more robust immune response, particularly through improved T cell recognition and targeting of the virus.
The LJI scientists analyzed blood samples from vaccinated volunteers who had breakthrough infections.
The team discovered that these individuals developed T cells capable of recognizing multiple parts of the SARS-CoV-2 virus, including its variants like Omicron and Delta. This enhanced ability is referred to as an immunity wall.
The virus evolves, but, importantly, so does the immune system. T cells do not sit idle. Instead, they learn to recognize the parts of the virus that mutate, explained Professor Alessandro Sette, who co-led the study.
Vaccination against SARS-CoV-2 provides significant protection against severe disease. LJI studies show that this protection is long-lasting and effective against new viral variants.
The researchers focused on how breakthrough infections impact T and B cells by tracking a group of vaccinated volunteers who later contracted COVID-19.
With this study volunteer cohort, we were in a unique position to see how the immune system looked before and after a breakthrough infection, noted Professor Alba Grifoni.
Breakthrough infections prompted T cells to expand their repertoires, meaning they could recognize multiple features of SARS-CoV-2. This broadening was due to the combination of vaccination and infection.
Vaccines taught T cells to recognize the spike protein, while infections helped them recognize additional viral proteins. As a result, T cells could target SARS-CoV-2 even if it mutated.
Breakthrough infections also stimulated B cells to produce diverse antibodies targeting common epitopes between the vaccine and the infecting variant. These new antibodies were effective against both the vaccines antigens and the viral variants.
New B cell responses that are only specific to the infecting variant, but not the vaccine, are very rare, said study co-author Parham Ramezani-Rad.
Another significant finding was the location of immune cell development. COVID-19 vaccines are typically administered in the upper arm, while SARS-CoV-2 infects the upper respiratory tract. This discrepancy can delay the immune response. A breakthrough infection can add an extra layer of protection by initiating immune cells closer to the infection site.
The experts identified markers of previous SARS-CoV-2 infection in about 30% of volunteers who never showed symptoms, suggesting they had asymptomatic infections.
Our study suggests most people who never thought they got a breakthrough infection actually did, explained Professor Grifoni. The majority of the population appears to be affected by a combination of vaccination and one or more breakthrough infections.
The research also dispels concerns about T cell exhaustion from repeated vaccinations and infections. Instead, breakthrough infections prompted T cells to produce more cytokines, enhancing their infection-fighting capabilities.
After the breakthrough infection, the same cells produce multiple types of cytokines, making them more efficacious, noted Professor Grifoni. Not only are our T cells not exhausted, but they are actually improving their capabilities.
However, the immunity wall has its limits. Following an asymptomatic breakthrough infection, T cell abilities were found to plateau with subsequent symptomatic infections, although B cells continued producing neutralizing antibodies.
Despite the benefits of breakthrough infections, the researchers emphasize the importance of following current CDC guidelines for booster vaccines. SARS-CoV-2 continues to evolve, and COVID-19 can still cause serious illness, especially in immunocompromised individuals.
This research provides crucial insights for developing new vaccines against future SARS-CoV-2 variants and other potential pandemic viruses. Researchers are keen to explore how future variants or new vaccine designs might further enhance the immune response.
Studies of local B cell responses in the upper airway where the infection occurs will also be informative on how B cells responses are induced, particularly after breakthrough infection, said Ramezani-Rad.
The ultimate goal is to train T cells to recognize multiple types of coronaviruses simultaneously, potentially leading to a pan-coronavirus vaccine. This breakthrough study marks a significant step in understanding how to protect against viral infections and future pandemics.
Were very interested to see if this phenomenon could be exploited in general to prepare against other potential pandemic threats, said Sette. This is a step in a journey to help us protect against viral infections and potential pandemics.
The study is published in the journal Cell Reports Medicine.
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There were two updates on avian influenza over the long weekend. USDA detected bird flu in beef for the first time, but the meat was not allowed to enter the nation's food supply. And media reports said U.S and European officials were stepping up development of vaccines that could prevent avian influenza from becoming a pandemic.
USDAs Food Safety and Inspection Service (FSIS), which has been monitoring beef tissue from 96 culled and condemned dairy cows, said viral particles were detected in tissue samples, including muscle, from one cow.
Meat from condemned cows [presumably ones that show signs of any disease] is prohibited from entering the food supply No meat from these dairy cattle entered the food supply.
The 96 dairy cows were diverted from the supply because federal inspectors noticed signs of illness during routine inspections of carcasses at meat processing plants. Bird flu was found in only one of those cows.
The agency also has been testing ground beef for bird flu at retail stores, but it has yet to find any sign of the virus. Even if it were to get through, the Agriculture Dept. says cooking beef to an internal temperature of 165 degrees will kill it just as cooking kills E. coli and other viruses.
Back to the vaccine: Reuters reported U.S officials were moving bulk vaccine from CSL Seqirus that closely matches the current virus into finished shots that could provide 4.8 million doses of vaccine.
European health officials told Reuters they also were in talks to acquire CSL's prepandemic vaccine. Canadian health officials said they have met with GSK, maker of Canada's seasonal flu shots, to discuss acquiring and manufacturing a prepandemic bird flu vaccine once its seasonal flu production capacity is freed up. Other countries, including the UK, are discussing how to proceed on prepandemic vaccines.
AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts inmedicineon COVID-19, medical education, advocacy issues, burnout, vaccines and more.
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What are the symptoms of Mpox? Who is high risk for monkeypox? Is raw milk illegal? When is Hajj 2024? Are there long term effects of meningococcal disease?
Our guest is AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH. AMA Chief Experience Officer Todd Unger hosts.
Unger: Hello and welcome to the AMA Update video and podcast. Today, we have our weekly look at the headlines with the AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia. I'm Todd Unger, AMA's chief experience officer. Andrea, welcome back.
Garcia: Thanks, Todd. It's great to be here.
Unger: We're going to start out with headlines about Mpox. When we talked about this a couple of weeks ago. We were seeing an outbreak in the Democratic Republic of Congo, driven by a deadlier version of the virus. Andrea, what's the latest news there?
Garcia: Well, that outbreak in the DRC continues to get worse. And in response on Thursday, the CDC urged people at risk in the U.S. to be vaccinated as soon as possible. Although no cases of this particular subtype have been identified outside of Africa so far, experts have said that the escalating epidemic in the DRC does pose a global threat, just as infections in Nigeria set off that 2022 outbreak that struck tens of thousands of people here in the U.S. and abroad. According to a New York Times article, as the outbreak in the DRC worsens, that less deadly type of the virus that caused that 2022 outbreak is also regaining strength.
Just as a quick reminder, there are two main types of Mpox. Clade 1that's the type that is dominant in the DRC right now, which is more deadlyand then clade 2, which is the type that caused the 2022 global outbreak. With Pride events scheduled all over the world in the coming weeks, U.S. officials expect that it's only a matter of time before we see a resurgence here.
Unger: Andrea, were many of those who are at high risk now already vaccinated in 2022?
Garcia: Well, Todd, we did contain that outbreak through behavioral change and vaccination, but there are still many people who are at high risk who have not been immunized or who haven't received two doses, because as you remember, there were supply shortages during that 2022 outbreak. We know that two doses of the vaccine are better than one with an effectiveness of up to 90%.
And even when the vaccine didn't prevent infection, it lessened the severity and duration of the illness. Fewer than one in four Americans who are at risk have received two doses. This is a problem because vaccination is really the key to controlling this long-term. Given this, CDC is now working with advocacy groups and social media influencers to help get the message out to those in the U.S. who are at the highest risk in hopes that they'll get vaccinated before the virus resurges. In December, the agency also urged physicians to remain alert for possible cases and travelers from the DRC, and that is going to be especially important now.
Unger: Well, speaking of getting prepared, Andrea, what symptoms do physicians and patients need to watch for?
Garcia: Well, people with Mpox may have fever, intense headache and back pain, followed by a rash. Many patients also develop painful sores, often at the site of infection. We know that people who have weakened immune system, including those living with HIV, are at highest risk of becoming severely ill and dying. Compounding the issue is many countries have limited access to tests, vaccines and treatment, which means a vast majority of cases are being diagnosed solely based on symptoms.
Here in the U.S., there is an FDA-approved test that detects all versions of Mpox. The challenge is it can't distinguish between them, so a positive result on that test would need to be followed by a more specific test that can identify the clade. The good news so far is that the available vaccines and antiviral drugs are expected to be effective against all forms of the virus.
Unger: All right. Thank you, Andrea. And we're going to certainly continue to watch and track the issues around Mpox. Andrea, something else that we've been trackingbird flu. That continues to make headlines. What's the latest news this week?
Garcia: Well, according to the latest data, USDA is now reporting that 51 dairy cattle herds in nine states. Nine states have confirmed cases of H5N1. There have still been no additional human cases detected since that one case from Texas was reported on April 1, and recent wastewater surveillance data, which the CDC posted for the first time last week, shows no indicators of unusual flu activity in people, including avian influenza viruses, which is good news.
While influenza testing typically declines over the summer, the CDC is working on a plan for enhanced nationwide summer monitoring to help ensure that even rare cases of H5N1 in the community are detected. This plan includes increasing the number of influenza virus specimens that are tested and then subtyped in public health laboratories that can detect H5N1, and we should be hearing more about that plan in the coming weeks.
Unger: All right. Thank you. Andrea, I know a big concern of people out there is about the milk supply. Has there been any additional news about that?
Garcia: Well, we did see the CDC issue recommendations for physicians to support consumption of only pasteurized milk and dairy products made from pasteurized milk. And most of the nutritional benefits of drinking milk are available from pasteurized milk. Physicians are being asked to educate patients on the risks of consuming unpasteurized milk or products made from unpasteurized milk, particularly emphasizing that unpasteurized milk can contain bacteria or viruses, including the H5N1 virus.
I think physicians should also remind patients that unpasteurized or raw milk and any products made from raw milk, which can include cheese and ice cream or yogurt, can be contaminated with germs that can cause serious illness, hospitalization or death. Anyone, even healthy adults, can get sick from drinking raw milk. And it's important that anyone who consumes raw milk and gets sick seek medical attention immediately.
Unger: Andrea, it just makes you wonder. Is selling raw milk even legal?
Garcia: Well, federal law prevents the sale of raw milk for human consumption in its final packaged form across state lines. But each state makes its own laws about selling raw milk within its borders. Just because raw milk may be legal to obtain in a particular state obviously does not mean that it is safe to drink.
Unger: That's a very good reminder. Andrea, earlier this week, the CDC also issued a new health alert. Tell us more about that.
Garcia: Well, on Monday, the CDC issued a health alert, or HAN, to alert physicians to cases of meningococcal disease linked to Umrah travel to the Kingdom of Saudi Arabia, or KSA. Umrah is an Islamic pilgrimage to Mecca in the Kingdom of Saudi Arabia that can be performed any time of the year, and the Hajj is an annual Islamic pilgrimage. This year, that's taking place June 14 through 19. Since April of 2024, there have been 12 cases of meningococcal disease linked to KSA travel for Umrah, and they've been reported to national public health agencies. Five of those were here in the U.S., four in France and three were in the UK.
Unger: And Andrea, I think that can be potentially very devastating. Tell us more about that.
Garcia: Well, meningococcal disease is a rare but severe illness with a case fatality rate of 10% to 15%, even with appropriate antibiotic treatment. Initial symptoms may be nonspecific, but they can worsen rapidly and can become life-threatening within hours. Survivors may experience long-term effects, such as deafness or amputation of extremities. Immediate antibiotic treatment for meningococcal disease is critical.
Unger: So what do physicians need to know, in this case?
Garcia: Here in the United States, quadrivalent meningococcal conjugate vaccination is routinely recommended for adolescents, and it's also recommended for travelers to countries where meningococcal disease is hyperendemic or epidemic. In addition, all Hajj or Umrah pilgrims age one year or older are required by KSA to receive quadrivalent meningococcal vaccine.
Physicians should be working with their patients who are considering travel to perform Hajj or Umrah to ensure that those aged one year or older have received a meningococcal conjugate vaccine within the last five years and administered at least 10 days prior to arrival in KSA. Physicians should also maintain increased suspicion for meningococcal disease in anyone presenting with symptoms after recent travel to KSA for Hajj or pilgrimage. U.S. health departments and physicians should also preferentially consider treating close contacts as well.
Unger: Andrea, that's great to know, and something we're going to continue to keep an eye on. That's it for today's episode. Thanks so much for being here and keeping us informed.
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Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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Two doses of Bavarian Nordics Jynneos vaccine offer almost complete protection against mpox, according to a new report published today in Morbidity and Mortality Weekly Report. Also today, MMWR published an update on clade II mpox cases in the United States, showing cases have been consistent since October 2023, with most cases occurring in unvaccinated people.
In the first study, on Jynneos, the authors say that despite perceptions that now, 2 years after the global mpox outbreak began (primarily among men who have sex with men [MSM]), cases are rising among the previously vaccinated, there is actually evidence that persistent vaccine-derived immunologic response among persons who received the 2-dose vaccine series exists.
In May 2023, a cluster of mpox cases of occurred among vaccinated MSM, leading people to think vaccine efficacy was waning.
"Public perception of an increase in monkeypox virus (MPXV) infections among fully vaccinated persons during 2024 has further fueled concerns about the 2-dose series, the authors said.
The authors examined health records for 32,819 probable or confirmed US mpox cases reported to the Centers for Disease Control and Prevention from May 11, 2022, to May 1, 2024, and found a total of 24,507 (75%) occurred in unvaccinated persons. There were 271 cases (0.8%) among persons who were fully vaccinated.
Of those 271 cases, only 51 (19%) occurred during 2024. Mpox cases among fully vaccinated persons occurred a median of 266 days after receipt of the second vaccine dose, the authors said.
Overall, fully vaccinated persons had a 0.1% infection rate.
The number of breakthrough infections did not comprise a significant proportion of infections, including during 2024.
The number of breakthrough infections did not comprise a significant proportion of infections, including during 2024, the authors said. With only one in four eligible U.S. persons fully vaccinated, clinicians and public health authorities should continue to focus efforts on increasing vaccine coverage.
In another report, researchers show that from October 1, 2023, through April 30, 2024, the United States has averaged 59 cases of mpox each week, mostly among unvaccinated people.
The weekly average is down significantly from a peak of 3,000 cases per week in summer 2022.
Current cases are mostly reported among males (94%), 90% of whom identify as gay or bisexual. The average age of new case-patients is 34 years, and 34% identify as Hispanic, 32% as White, 25% as Black, 3% as Asian, 2% as multiracial, and 4% as another race.
Since October 2023, five US patients with mpox have died, the authors said.
"The current average of 59 reported cases per week represents a fifty-five-fold reduction, compared with the peak of 3,274 cases reported during the week beginning July 31, 2022 (the peak outbreak week); levels have remained stable since October 2023," the authors concluded.
Dr Bidyut Sarkar
A cure for cancer which issecond only to cardiovascular diseasesin its contribution to the global burden of disease has long been a dream.
While no magic bullet is yet in sight, three vaccines for particular skin and lung cancer types have advanced to the last stage of clinical trials in recent months.
If successful, these vaccines should be available to patients in the next three to 11 years. Unlike vaccines which prevent diseases, these aim to cure them or prevent relapses.
Cancer in every person is different because the cells in every cancerous tumour have different sets of genetic mutations. Recognising this, two of the vaccines are personalised and tailor-made for each patient. Oncologists working with pharmaceutical companies have developed these individualised neoantigen therapies.
A vaccine typically works by training the immune cells of our body to recognise antigens proteins from pathogens, such as viruses against future attacks by the pathogen.
In cancer, however, there is no external pathogen. The cells of a cancerous tumour undergo continuous mutations, some of which help them to grow much faster than normal cells while some others help them evade the bodys natural immune system. The mutated proteins in cancerous cells are called neoantigens.
In individualised neoantigen therapy, the gene sequence of the tumour and normal blood cells are compared to identify neoantigens from each patient, and then a subset of neoantigens are chosen that are most likely to induce an immune response. The vaccine for an individual patient targets this chosen subset of neoantigens.
These vaccines, jointly developed by pharma giants Moderna and Merck, have been shown in trials conducted so far to be significantly more effective in combination with immunotherapy than immunotherapy alone in preventing both the relapse of melanoma a type of skin cancer and non-small cell lung cancer after the tumours had been surgically removed.
Following these promising results in phase II clinical trials, the vaccines are now being tested on a larger group of patients in phase III trials. The studies are expected to be complete by 2030 formelanomaand 2035 forlung cancer.
The Moderna-Merck cancer vaccine may not be the first to reach the market. The French company OSE Immunotherapeuticspublished positive resultslast September from phase III clinical trials of a vaccine using a different approach for advanced non-small cell lung cancer. Its vaccine, Tedopi, is scheduled to startconfirmatory trials which are the last step before regulatory approval later this year and may be available by 2027.
Vaccines for pancreatic cancer being developed by BioNTech and Genentech, and for colon cancer by Gritstone, are also showing promising results in the early phases of clinical trials. Like the vaccines being developed by Moderna and Merck, these too are individualised neoantigen therapies based on messenger RNA (mRNA).
There is another kind of RNA therapy also under development that uses small interfering RNA (siRNA) and microRNA (miRNA). Since 2018, six siRNA-based therapies have been approved by the US Food and Drug Administration for the treatment of neural, skin, heart and renal diseases. Several more siRNA drugs are at various clinical trial stages for different types of cancer and a diverse range of other diseases.
Within cells, there are two kinds of nucleic acid molecules that contain coded information vital to life: DNA and RNA. While DNA contains genetic information, mRNA one among the different types of RNA carries the codes for the proteins. In addition, there are also non-coding RNA, some of which are functionally important. siRNA and miRNA are examples of such non-coding RNA.
The RNA vaccine for an individualised neoantigen therapy is a cocktail of mRNA carrying the codes for neoantigens the mutated fingerprint proteins in cancerous cells. For theModerna-Merck study, scientists identified 34 neoantigens per patient. They delivered the corresponding mRNA vaccine cocktail packed in lipid nanoparticles, just like the mRNA vaccines for COVID-19 developed by Moderna and Pfizer-BioNTech.
When the vaccine is delivered after removing the tumour, it trains the immune system to recognise neoantigens and fight back against the cancer returning. Usually, the bodys natural immune system corrects mutations and prevents us from having cancers. However, in some cases this natural immune response is insufficient, leading to tumour growth. In individualised neoantigen therapy, these mutations in the tumour cells are used for vaccine development and for training the immune system to fight back against relapse after removal of the tumour.
Recent advances in artificial intelligence are helping identify potential neoantigens and manage personalised therapies. Firstly, gene sequencing of tumours and normal blood cells of a patient and their comparison produces a huge amount of data. AI is used to find the genetic mutations of the patients cancer in such big data. Moreover, individualised therapy requires timely production and delivery of vaccines that are different for each patient. AI is also useful in the management of such data.
The individualised nature of the treatment is probably why it has beenmore effective in trialsthan previous, unsuccessful RNA vaccine candidates. However, this personalisation is also likely to raise challenges for the timely and cost-effective delivery of treatment to populations around the world.
The siRNA and miRNA treatments work in a way opposite to mRNA. While each mRNA in a vaccine carries the code for producing a protein from a pathogen (antigen) or tumour (neoantigen) to train our immune systems against future attacks by the pathogen or tumour, siRNA directly targets the mRNA of the antigen or neoantigen and terminates the production of the protein it codes. Thus, the effect of a siRNA is more direct and immediate (like a drug), rather than a protection against future attacks (like a vaccine).
Discovered at the turn of this millennium, siRNA-based therapeutics attracted immediate attention, but their initial success was limited due to their inherent low stability, difficulties in delivering them to desired locations, and rapid clearance from the bloodstream. However, in recent years, siRNA therapies have been boosted through chemical modifications that have increased their stability and ability to be delivered to specific locations such as tumours, and improved delivery systems such as lipid nanoparticle encasings.
These improvements led to recent successes in FDA approvals of siRNA-based therapies and furtherpromising reports of advancesin the treatment of diseases including a type of liver cancer.
Research scientistDr Bidyut Sarkaris the DBT-Wellcome Trust India Alliance Intermediate Fellow in the Department of Chemistry at Shiv Nadar Institute of Eminence, Delhi NCR, India.
Originally published underCreative Commonsby360info.
Measles is on the rise in the United States. So far this year, the number of cases is about 17 times what it was, on average, during the same period in each of the four years before, according to the Centers for Disease Control and Prevention. Half of the people infected mainly children have been hospitalized.
It's going to get worse, largely because a growing number of parents are deciding not to get their children vaccinated against measles as well as diseases like polio and pertussis. Unvaccinated people, or those whose immunization status is unknown, account for 80% of the measles cases this year. Many parents have been influenced by a flood of misinformation spouted by politicians, podcast hosts, and influential figures on television and social media. These personalities repeat decades-old notions that erode confidence in the established science backing routine childhood vaccines. KFF Health News examined the rhetoric and explains why it's misguided
A common distortion is that vaccines aren't necessary because the diseases they prevent are not very dangerous, or too rare to be of concern. Cynics accuse public health officials and the media of fear-mongering about measles even as 19 states report cases.
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For example, an article posted on the website of the National Vaccine Information Center a regular source of vaccine misinformation argued that a resurgence in concern about the disease "is 'sky is falling' hype." It went on to call measles, mumps, chicken pox and influenza "politically incorrect to get."
Measles kills roughly 2 of every 1,000 children infected, according to the CDC. If that seems like a bearable risk, it's worth pointing out that a far larger portion of children with measles will require hospitalization for pneumonia and other serious complications. For every 10 measles cases, one child with the disease develops an ear infection that can lead to permanent hearing loss. Another strange effect is that the measles virus can destroy a person's existing immunity, meaning they'll have a harder time recovering from influenza and other common ailments.
Measles vaccines have averted the deaths of about 94 million people, mainly children, over the past 50 years, according to an April analysis led by the World Health Organization. Together with immunizations against polio and other diseases, vaccines have saved an estimated 154 million lives globally.
Some skeptics argue that vaccine-preventable diseases are no longer a threat because they've become relatively rare in the U.S. (True due to vaccination.) This reasoning led Florida's surgeon general, Joseph Ladapo, to tell parents that they could send their unvaccinated children to school amid a measles outbreak in February. "You look at the headlines and you'd think the sky was falling," Ladapo said on a News Nation newscast. "There's a lot of immunity."
As this lax attitude persuades parents to decline vaccination, the protective group immunity will drop, and outbreaks will grow larger and faster. A rapid measles outbreak hit an undervaccinated population in Samoa in 2019, killing 83 people within four months. A chronic lack of measles vaccination in the Democratic Republic of the Congo led to more than 5,600 people dying from the disease in massive outbreaks last year.
Since the earliest days of vaccines, a contingent of the public has considered them bad because they're unnatural, as compared with nature's bounty of infections and plagues. "Bad" has been redefined over the decades. In the 1800s, vaccine skeptics claimed that smallpox vaccines caused people to sprout horns and behave like beasts. More recently, they blame vaccines for ailments ranging from attention-deficit/hyperactivity disorder to autism to immune system disruption. Studies don't back the assertions. However, skeptics argue that their claims remain valid because vaccines haven't been adequately tested.
In fact, vaccines are among the most studied medical interventions. Over the past century, massive studies and clinical trials have tested vaccines during their development and after their widespread use. More than 12,000 people took part in clinical trials of the most recent vaccine approved to prevent measles, mumps and rubella. Such large numbers allow researchers to detect rare risks, which are a major concern because vaccines are given to millions of healthy people.
To assess long-term risks, researchers sift through reams of data for signals of harm. For example, a Danish group analyzed a database of more than 657,000 children and found that those who had been vaccinated against measles as babies were no more likely to later be diagnosed with autism than those who were not vaccinated. In another study, researchers analyzed records from 805,000 children born from 1990 through 2001 and found no evidence to back a concern that multiple vaccinations might impair children's immune systems.
Nonetheless, people who push vaccine misinformation, like candidate Robert F. Kennedy Jr., dismiss massive, scientifically vetted studies. For example, Kennedy argues that clinical trials of new vaccines are unreliable because vaccinated kids aren't compared with a placebo group that gets saline solution or another substance with no effect. Instead, many modern trials compare updated vaccines with older ones. That's because it's unethical to endanger children by giving them a sham vaccine when the protective effect of immunization is known. In a 1950s clinical trial of polio vaccines, 16 children in the placebo group died of polio and 34 were paralyzed, said Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia and author of a book on the first polio vaccine.
Several bestselling vaccine books on Amazon promote the risky idea that parents should skip or delay their children's vaccines. "All vaccines on the CDC's schedule may not be right for all children at all times," writes Paul Thomas in his bestselling book "The Vaccine-Friendly Plan." He backs up this conviction by saying that children who have followed "my protocol are among the healthiest in the world."
Since the book was published, Thomas' medical license was temporarily suspended in Oregon and Washington. The Oregon Medical Board documented how Thomas persuaded parents to skip vaccines recommended by the CDC, and reported that he "reduced to tears" a mother who disagreed. Several children in his care came down with pertussis and rotavirus, diseases easily prevented by vaccines, wrote the board. Thomas recommended fish oil supplements and homeopathy to an unvaccinated child with a deep scalp laceration, rather than an emergency tetanus vaccine. The boy developed severe tetanus, landing in the hospital for nearly two months, where he required intubation, a tracheotomy and a feeding tube to survive.
The vaccination schedule recommended by the CDC has been tailored to protect children at their most vulnerable points in life and minimize side effects. The combination measles, mumps, and rubella vaccine isn't given for the first year of a baby's life because antibodies temporarily passed on from their mother can interfere with the immune response. And because some babies don't generate a strong response to that first dose, the CDC recommends a second one around the time a child enters kindergarten because measles and other viruses spread rapidly in group settings.
Delaying MMR doses much longer may be unwise because data suggests that children vaccinated at 10 or older have a higher chance of adverse reactions, such as a seizure or fatigue.
Around a dozen other vaccines have discrete timelines, with overlapping windows for the best response. Studies have shown that MMR vaccines may be given safely and effectively in combination with other vaccines.
Kennedy compares the Florida surgeon general to Galileo in the introduction to Ladapo's new book on transcending fear in public health. Just as the Roman Catholic inquisition punished the renowned astronomer for promoting theories about the universe, Kennedy suggests that scientific institutions oppress dissenting voices on vaccines for nefarious reasons.
"The persecution of scientists and doctors who dare to challenge contemporary orthodoxies is not a new phenomenon," Kennedy writes. His running mate, lawyer Nicole Shanahan, has campaigned on the idea that conversations about vaccine harms are censored and the CDC and other federal agencies hide data due to corporate influence.
Claims like "they don't want you to know" aren't new among the anti-vaccine set, even though the movement has long had an outsize voice. The most listened-to podcast in the U.S., "The Joe Rogan Experience," regularly features guests who cast doubt on scientific consensus. Last year on the show, Kennedy repeated the debunked claim that vaccines cause autism.
Far from ignoring that concern, epidemiologists have taken it seriously. They have conducted more than a dozen studies searching for a link between vaccines and autism, and repeatedly found none. "We have conclusively disproven the theory that vaccines are connected to autism," said Gideon Meyerowitz-Katz, an epidemiologist at the University of Wollongong in Australia. "So, the public health establishment tends to shut those conversations down quickly."
Federal agencies are transparent about seizures, arm pain and other reactions that vaccines can cause. And the government has a program to compensate individuals whose injuries are scientifically determined to result from them. Around 1 to 3.5 out of every million doses of the measles, mumps and rubella vaccine can cause a life-threatening allergic reaction; a person's lifetime risk of death by lightning is estimated to be as much as four times as high.
"The most convincing thing I can say is that my daughter has all her vaccines and that every pediatrician and public health person I know has vaccinated their kids," Meyerowitz-Katz said. "No one would do that if they thought there were serious risks."
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF the independent source for health policy research, polling and journalism.
Austin (Precision Vaccinations News)
The global gene editing marketis forecast to reach around $29billion by 2032, with the goal of targeting underserved diseases, such asherpes simplexvirus (HSV).
Researchers recently announced thatthey found an experimental gene therapy for genital and oral HSVthat removed 90% or more of the infection.
They developed a potentially curative approach against HSV infection based on gene editing using HSV-specific meganucleases delivered by adeno-associated virus (AAV) vectors.
Additionally, researchers at Fred Hutch Cancer Center located in Seattle, WA,stated that this pre-clinical therapy suppressed the amount of virus thatcan be released from an infected individual, which suggests that the therapy would also reduce the spread of the herpes virus.
Published in the journal Nature Communications on May 13, 2024, thisexperimental therapy involves injecting a mixture of gene-editing molecules into the blood to locate the herpes virus in the body.
The mixture includes laboratory-modified viruses called a vector commonly used in gene therapies plus enzymes that work like molecular scissors.
Once the vector reaches the clusters of nerves where the herpes virus hangs out, the molecular scissors snip away at its genes to damage them or remove the virus entirely.
"Herpes is very sneaky. It hides out among nerve cells and then reawakens and causes painful skin blisters," saidKeith Jerome, MD, PhD, professor in the Vaccine and Infectious Disease Division at Fred Hutch, in a press release.
"Our aim is to cure people of this infection so that they don't have to live with the worry of outbreaks or transmitting it to another person."
The study's abstractsays the gene editing performed with two anti-HSV-1 meganucleases delivered by a combination of AAV9, AAV-Dj/8, and AAV-Rh10 can eliminate 90% or more of latent HSV DNA in mouse models of orofacial infection, and up to 97% of latent HSV DNA in mouse models of genital infection.
Using a pharmacological approach to reactivate latent HSV-1, we demonstrate that ganglionic viral load reduction leads to a significant decrease in viral shedding in treated female mice.
While therapy is well tolerated, in some instances, we observe hepatotoxicity at high doses and subtle histological evidence of neuronal injury without observable neurological signs or deficits.
Simplifying the regimen through a single serotype (AAV9) delivering single meganuclease targeting a duplicated region of the HSV genome, dose reduction, and use of a neuron-specific promoter each results in improved tolerability while retaining efficacy.
These Fed Hutch researchers concluded these results reinforce the curative potential of gene editing for HSV disease.
Herpes simplex virus1 and 2 are among the most common viral infections in the U.S., with up to 80% of people between the ages of 14 and 49 infected with HSV-1 and more than 10% infected with HSV-2, says the U.S. NIH.
To advance research to understand and address HSV infection, the NIH has established the Strategic Plan for Herpes Simplex Virus Research. This plan aligns with ongoing national efforts, including the Sexually Transmitted Infections National Strategic Plan, and provides the framework for HSV research.
To date, no HSV vaccines have been approved by the U.S. FDA.
While herpes clinical trials advances have resulted in several therapeutics, the effectiveness of these treatments in reducing HSV symptoms and viral transmission varies widely.
New research suggests the HPV vaccine is preventing cancer in men, as well as in women, but fewer boys than girls are getting the shots in the United States.
The HPV vaccine was developed to prevent cervical cancer in women and experts give it credit, along with screening, forlowering cervical cancer rates.Evidence that the shots are preventing HPV-related cancers in men has been slower to emerge, but the new research suggests vaccinated men have fewer cancers of themouth and throatcompared to those who didn't get the shots. These cancers are more than twice as common in men than in women.
For the study, researchers compared 3.4 million people of similar ages half vaccinated versus half unvaccinated in a large health care dataset.
As expected, vaccinated women had a lower risk of developing cervical cancer within at least five years of getting the shots. For men, there were benefits too. Vaccinated men had a lower risk of developing any HPV-related cancer, such as cancers of the anus, penis and mouth and throat.
These cancers take years to develop so the numbers were low: There were 57 HPV-related cancers among the unvaccinated men mostly head and neck cancers compared to 26 among the men who had the HPV vaccine.
We think the maximum benefit from the vaccine will actually happen in the next two or three decades," said study co-author Dr. Joseph Curry, a head and neck surgeon at the Sidney Kimmel Cancer Center in Philadelphia. What were showing here is an early wave of effect.
Results of the study and a second were released Thursday by the American Society of Clinical Oncology and will be discussed next month at its annual meeting in Chicago. The second study shows vaccination rates rising but males lag behind females in getting the HPV shots.
HPV, or human papillomavirus, is very common and is spread through sex. Most HPV infections cause no symptoms and clear up without treatment. Others develop into cancer, about 37,000 cases a year, according to the Centers for Disease Control and Prevention.
In the U.S., the HPV vaccine has been recommended since 2006 for girls at age 11 or 12, and since 2011 for boys the same age. Catch-up shots are recommended for anyone through age 26 who hasnt been vaccinated.
In the second study, researchers looked at self- and parent-reported HPV vaccination rates in preteens and young adults in a large government survey. From 2011 to 2020, vaccination rates rose from 38% to 49% among females, and among males from 8% to 36%.
HPV vaccine uptake among young males increased by more than fourfold over the last decade, though vaccination rates among young males still fall behind females, said study co-author Dr. Danh Nguyen at the University of Texas Southwestern Medical Center in Dallas.
Parents of boys, as well as girls, should know that HPV vaccines lower cancer risk, said Jasmin Tiro of the University of Chicago Medicine Comprehensive Cancer Center who was not involved in the research. And young men who haven't been vaccinated can still get the shots.
It's really important that teenagers get exposed to the vaccine before theyre exposed to the virus, she said.
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