Following the World Health Organisation declaring monkeypox a viral infection and public health emergency of international concern (PHEIC)-the highest level of warning-molecular virologist at Banaras Hindu University and director of B R Ambedkar Centre for Biomedical Research (ACBR) and Delhi School of Public Health (DSPH), Prof Sunit K Singh, said the situation is not as alarming as it was in the case of Covid-19. "It is high time to adopt a global approach to tackle the monkeypox outbreak by judiciously considering surveillance programs and testing at ports of entry, especially for those coming from countries affected by this outbreak. Govt of India is taking all necessary steps to handle any emergency situation. There are no cases reported in India so far, so there is no need to panic," he said. The common symptoms include fever, skin rashes, sore throat, muscle aches, and swollen lymph nodes. The modes of transmission from an infected person may occur through very close contact, kissing, sex, and respiratory droplets. Dr. Singh said that compared to Covid-19, we are in a far better position in terms of availability of monkeypox vaccines. "In the case of SARS-CoV-2 infection, we started developing Covid-19 vaccines while the disease was progressing, but for monkeypox, we have vaccine platforms and vaccines specifically designed against smallpox," he said. "The monkeypox viruses are closely related to the smallpox virus, which is why the smallpox vaccine is reported to be 85% effective in preventing monkeypox," he added. Thailand has confirmed its first case of the Mpox Clade 1b variant, marking the second time this strain has been identified outside Africa and the first one in Asia. According to Reuters, the patient is a 66-year-old European man who arrived in Thailand last week from an unspecified African country where the disease was prevalent. The Clade 1b variant has raised global concern due to its potential for rapid spread through close contact. Sweden reported a case of this variant last week, linking it to an ongoing outbreak in Africa, making it the first evidence of the strain's spread outside the continent. The World Health Organization has declared the recent outbreak a public health emergency of international concern after the identification of this new variant. Dr. Singh, however, said this is not the first instance of monkeypox virus infection reported outside endemic regions of Western and Central Africa. "In 2003, a monkeypox outbreak was reported in the USA," he said. In 1958, outbreaks of a pox-like disease occurred in colonies of monkeys kept for research purposes, hence the name 'monkeypox.' The first human case of monkeypox virus infection was reported in 1970 in the Democratic Republic of Congo.
Serum Institute of India on Tuesday said it is currently working to develop a vaccine for Monkeypox, with positive outcomes expected in a year's time. The World Health Organisation on August 14 declared the Mpox outbreak a public health emergency of international concern. The move came after a sudden increase in cases was recorded in parts of Africa.
In India, around 30 Mpox cases have been detected since 2022. The most recent case in the country was reported in March 2024.
The Union Health ministry has issued advisories highlighting that scrutiny at airports and seaports, especially at international entry points will increase.
The government has declared three hospitals -- Ram Manohar Lohia Hospital, Safdarjung Hospital, and Lady Hardinge Medical College -- as nodal centres for the isolation, management and treatment of patients.
5 min read Last Updated : Aug 22 2024 | 10:16 AM IST
Traveller, stay on watch. On August 14, the World Health Organisation (WHO) declared the recent upsurge in Mpox cases a global health emergency. The situation is raising alarms, particularly in Africa, where the disease could potentially spread further across the continent and beyond.
Since 2022, the WHO has reported 99,176 Mpox cases and 208 deaths across 116 countries. In India, a total of 30 cases have been detected since the 2022 declaration, with the most recent case reported in March 2024.
What is Mpox, and how does it spread?
Mpox, also known as monkeypox, is an infectious disease caused by the monkeypox virus. It manifests with a painful rash, swollen lymph nodes, and fever. The virus spreads through close contact with infected individuals or animals, with transmission possible via skin lesions, direct skin-to-skin contact, and proximity to an infected person.
What measures are countries taking to protect travellers?
The Indian government has directed airports, ports, and border authorities to stay vigilant in response to the global rise in Mpox cases. According to reports, central hospitals such as Safdarjung, Ram Manohar Lohia, and Lady Hardinge will have facilities for isolating suspected Mpox cases.
Democratic Republic of Congo (DRC)
The DRC is currently experiencing its worst Mpox outbreak, with a 160% increase in cases and a 19% rise in deaths compared to last year.
Indonesia
Indonesia's Health Ministry has introduced stringent health screening protocols for foreign visitors. Travellers must now complete forms disclosing their medical history and recent travel activities upon entry. To ensure early detection, the Ministry has designated 12 state laboratories nationwide to monitor and identify potential Mpox cases.
China
Chinese authorities have implemented strict travel restrictions for individuals showing Mpox symptoms. Enhanced airport surveillance measures have been introduced to isolate and test affected travellers. Those with symptoms such as fever, headache, muscle pain, or rash must report their condition upon entry. These measures will remain in force for six months.
South Africa
South Africa has launched a new airport screening initiative aimed at identifying and addressing potential Mpox cases among arriving travellers. This proactive measure is part of a broader strategy to enhance early detection and containment of the virus.
Kenya
Kenya has introduced testing procedures for travellers entering the country to identify Mpox cases and prevent their spread. Although only mild cases have been detected thus far, these measures are seen as crucial for monitoring and managing the outbreak.
Nigeria
Nigeria has implemented a mandatory declaration process for travellers heading to specific African regions. Travellers must complete a declaration form, either at the airport or online, to aid in tracking and controlling Mpox transmission.
Pakistan
Border Health Services in Pakistan have called for heightened monitoring and protective measures. Officials are closely monitoring travellers and implementing rigorous health checks to curb the spread of Mpox.
What should travellers do to avoid getting Mpox?
The Centres for Disease Control and Prevention (CDC) in the US has issued guidelines for travellers to protect themselves against Mpox infection:
1. If eligible, get vaccinated with two doses of the Mpox vaccine before travelling. Use the Mpox Vaccine Locator to find vaccination sites.
2. Avoid close, skin-to-skin contact with people who have a rash that looks like Mpox.
3. Do not touch the rash or scabs of an infected person.
4. Refrain from kissing, hugging, cuddling, or having sex with someone with Mpox.
5. Avoid contact with objects and materials used by an infected person.
6. Do not share eating utensils or cups with someone who has Mpox.
7. Do not handle or touch bedding, towels, clothing, or personal items of an infected person.
8. Wash your hands often with soap and water or use an alcohol-based hand sanitiser, especially before eating or touching your face.
What to do if you have Mpox symptoms or have been exposed?
If you have symptoms of Mpox or have been in close contact with someone who has it, speak to your healthcare provider about testing and treatment. The CDC recommends vaccination for those exposed to Mpox or at higher risk.
Do not travel if you have Mpox
If you are infected with Mpox, isolate at home until your symptoms are gone and your rash has healed completely. If travel is unavoidable, ensure you do not have a fever or respiratory symptoms and take additional steps to prevent spreading the virus.
Travellers who test positive for Mpox while abroad may be subject to local public health laws, including isolation requirements. Similarly, those exposed to Mpox may need to quarantine according to local regulations. It is advisable to consider travel health and medical evacuation insurance, as treatment options may be limited in some countries.
According to the European Centre for Disease Prevention and Control (ECDC), travellers planning to visit affected areas should consult their healthcare provider or travel health clinic regarding vaccination eligibility.
First Published: Aug 22 2024 | 10:16 AM IST
The World Health Organization (WHO) has declared a global public health emergency as the mpox virus ravages the African continent with cases having spiked by 160% this year. As Bavarian Nordic ramps up production of the only marketed mpox vaccine, a few clinical trials are underway to combat the outbreak.
The Danish biotechs vaccine, called Jynneos, was approved for emergency use by the U.S. Food and Drug Administration (FDA) in 2022, and is the only one that has widespread approval to target the virus. This was also the year that a previous mpox outbreak hit parts of the world, such as countries in Europe and North America, where the virus is not endemic.
The viral infection, formerly known as monkeypox, which can spread through close contact with an infected person, animal, or contaminated objects, results in rashes, fever, headache, muscle aches, back pain, low energy and swollen glands. While the severity can vary from person to person, extreme cases can cause death. But this time around, a new, deadlier strain of the mpox virus called clade 1 has been spotted in the Democratic Republic of Congo and has been spreading at an alarming rate, according to the Africa Centres for Disease Control and Prevention (CDC).
Now, Bavarian Nordic is scaling up production to ensure fair access and said that it will work along with the Africa CDC and the WHO to contain the spread. So far, this year, more than 500 deaths have been reported in Africa, crossing 2023 figures. The biotech aims to manufacture 10 million doses of Jynneos by the end of 2025 with plans to supply up to 2 million doses this year.
JYNNEOS is a live, non-replicating vaccine that elicits immune responses to a group of viruses known as orthopoxviruses. It contains a weakened form of the vaccinia virus, which is related to the monkeypox and smallpox viruses, and cannot copy itself in the human body.
However, as countries suffered Jynneos shortages in 2022, more trials are underway at present, to test investigational vaccines and drugs to tackle the epidemic.
A major concern among U.S. legislative leaders and government medical countermeasure operations is the sole dependence on a single non-U.S. supplier for supply of a critically needed medical countermeasure such as the mpox/smallpox vaccine.
There is only one authorized supplier of the MVA vaccine (Bavarian Nordic), which has insufficient production capacity to meet the existing and forecasted needs, said David Dodd, chief executive officer (CEO) of American biotech GeoVax. Health authorities in Africa recently stated that 10 million doses are needed, but only 200,000 doses are available. Unfortunately, Jynneos is produced in a manufacturing process that is constrained in the production yield and speed of production.
GeoVax expects to change this situation, initially as the first U.S.-based supplier of an Modified vaccinia Ankara (MVA) vaccine, and also implement an advanced manufacturing process that provides higher production yield faster at lower cost, added Dodd.
GeoVaxs GEO-MVA is very similar to Jynneos as they are both derived from the same initial MVA parental line. The MVA vaccine provides protective immunity against mpox and smallpox, which is why MVA is used worldwide as the protective vaccine against both mpox and stockpiled by the U.S. government as a medical countermeasure against a potential bioterrorism threat utilizing smallpox, explained Dodd. GEO-MVA and Jynneos are anticipated to provide similar protection against mpox and smallpox, and therefore, an expedited regulatory pathway is expected to be finalized soon.
Due to the current insufficient supply of MVA vaccines, especially with reports of infection outside of Africa, like Sweden, where a case of the new strain was confirmed, GeoVax is in talks with U.S. legislators and global regulators to authorize and boost MVA vaccine supply.
The basic need for manufacturing the mpox vaccine has been met, and we are ready to advance towards the vaccine product manufacturing process. The company is actively engaging with U.S. and global stakeholders to discuss how we can contribute to countermeasure activities, said Dodd.
Moreover, the biotech seeks to accelerate the production of MVA vaccines regardless of GEO-MVA or Jynneos. These vaccines typically use cells derived from specially sourced chickens, which is a lengthy process. The company has validated an advanced MVA manufacturing process that does not depend on these chickens to overcome the limitation of a slower, more complex manufacturing process, at a time when it is challenged to respond promptly to epidemics or pandemics. So instead, an avian cell line will be ten times more efficient, explained Dodd.
While currently the chicken embryonic fibroblasts (CEF)-based manufacturing process remains for GEO-MVA and Jynneos, GeoVax is transitioning to the advanced manufacturing process. The benefit will be to increase the supply of MVA vaccine more quickly, thereby expanding the global supply available, without being dependent upon stockpiling as the manner to develop mpox vaccine supply, said Dodd.
Meanwhile, mRNA giant Modernas vaccine the biotech famed for developing one of the COVID-19 vaccines is being trialed in the U.K. The National Institute for Health and Care Research (NIHR) in the U.K. is calling for healthy people aged between 18 and 49 to take part in the study.
However, it has been a let down on the treatment front. The antiviral pill tecovirimat, also known as TPOXX, has been in the clinic for a while now. It works by interfering with a protein that is present on the surface of the virus to hinder it from replicating, thereby slowing the spread of infection. But last weeks disappointing trial results found that the drug is no better than placebo.
Thus far, the majority of mpox cases has been in the Democratic Republic of the Congo and surrounding areas within that region. The Africa CDC, along with the DRC Ministry of Health and the WHO are leading the counter-effort, explained Dodd. And, smallpox vaccines like American biotech Emergent BioSolutions ACAM2000 will be used to dampen infection rates in the DRC as well as the other impacted countries of Burundi, Kenya, Rwanda, and Uganda. Around 50,000 doses will be sent to the affected regions. With the possibility of more than one MVA vaccine for rollout and expedited manufacture, hopes of controlling the spread of the deadly virus remain.
By Arthur Allen and Eliza Fawcett, Healthbeat and Rebecca Grapevine, Healthbeat August 26, 2024
The FDA has approved an updated covid shot for everyone 6 months old and up, which renews a now-annual quandary for Americans: Get the shot now, with the latest covid outbreak sweeping the country, or hold it in reserve for the winter wave?
The new vaccine should provide some protection to everyone. But many healthy people who have already been vaccinated or have immunity because theyve been exposed to covid enough times may want to wait a few months.
Covid has become commonplace. For some, its a minor illness with few symptoms. Others are laid up with fever, cough, and fatigue for days or weeks. A much smaller group mostly older or chronically ill people suffer hospitalization or death.
Its important for those in high-risk groups to get vaccinated, but vaccine protection wanes after a few months. Those who run to get the new vaccine may be more likely to fall ill this winter when the next wave hits, said William Schaffner, an infectious disease professor at Vanderbilt University School of Medicine and a spokesperson for the National Foundation for Infectious Diseases.
On the other hand, by late fall the major variants may have changed, rendering the vaccine less effective, said Peter Marks, the FDAs top vaccine official, at a briefing Aug. 23. He urged everyone eligible to get immunized, noting that the risk of long covid is greater in the un- and undervaccinated.
Of course, if last years covid vaccine rollout is any guide, few Americans will heed his advice, even though this summers surge has been unusually intense, with levels of the covid virus in wastewater suggesting infections are as widespread as they were in the winter.
The Centers for Disease Control and Prevention now looks to wastewater as fewer people are reporting test results to health authorities. The wastewater data shows the epidemic is worst in Western and Southern states. In New York, for example, levels are considered high compared with very high in Georgia.
Hospitalizations and deaths due to covid have trended up, too. But unlike infections, these rates are nowhere near those seen in winter surges, or in summers past. More than 2,000 people died of covid in July a high number but a small fraction of the at least 25,700 covid deaths in July 2020.
Partial immunity built up through vaccines and prior infections deserves credit for this relief. A new study suggests that current variants may be less virulent in the study, one of the recent variants did not kill mice exposed to it, unlike most earlier covid variants.
Public health officials note that even with more cases this summer, people seem to be managing their sickness at home. We did see a little rise in the number of cases, but it didnt have a significant impact in terms of hospitalizations and emergency room visits, said Manisha Juthani, public health commissioner of Connecticut, at a news briefing Aug. 21.
Unlike influenza or traditional cold viruses, covid seems to thrive outside the cold months, when germy schoolkids, dry air, and indoor activities are thought to enable the spread of air- and saliva-borne viruses. No one is exactly sure why.
Covid is still very transmissible, very new, and people congregate inside in air-conditioned rooms during the summer, said John Moore, a virologist and professor at Cornell Universitys Weill Cornell Medicine College.
Or maybe covid is more tolerant of humidity or other environmental conditions in the summer, said Caitlin Rivers, an epidemiologist at Johns Hopkins University.
Because viruses evolve as they infect people, the CDC has recommended updated covid vaccines each year. Last falls booster was designed to target the omicron variant circulating in 2023. This year, mRNA vaccines made by Moderna and Pfizer and the protein-based vaccine from Novavax which has yet to be approved by the FDA target a more recent omicron variant, JN.1.
The FDA determined that the mRNA vaccines strongly protected people from severe disease and death and would do so even though earlier variants of JN.1 are now being overtaken by others.
Public interest in covid vaccines has waned, with only 1 in 5 adults getting vaccinated since last September, compared with about 80% who got the first dose. New Yorkers have been slightly above the national vaccination rate, while in Georgia only about 17% got the latest shot.
Vaccine uptake is lower in states where the majority voted for Donald Trump in 2020 and among those who have less money and education, less health care access, or less time off from work. These groups are also more likely to be hospitalized or die of the disease, according to a 2023 study in The Lancet.
While the newly formulated vaccines are better targeted at the circulating covid variants, uninsured and underinsured Americans may have to rush if they hope to get one for free. A CDC program that provided boosters to 1.5 million people over the last year ran out of money and is ending Aug. 31.
The agency drummed up $62 million in unspent funds to pay state and local health departments to provide the new shots to those not covered by insurance. But that may not go very far if the vaccine costs the agency around $86 a dose, as it did last year, said Kelly Moore, CEO of Immunize.org, which advocates for vaccination.
People who pay out-of-pocket at pharmacies face higher prices: CVS plans to sell the updated vaccine for $201.99, said Amy Thibault, a spokesperson for the company.
Price can be a barrier, access can be a barrier to vaccination, said David Scales, an assistant professor of medicine at Weill Cornell Medical College.
Without an access program that provides vaccines to uninsured adults, well see disparities in health outcomes and disproportionate outbreaks in the working poor, who can ill afford to take off work, Kelly Moore said.
New York state has about $1 million to fill the gaps when the CDCs program ends, said Danielle De Souza, a spokesperson for the New York State Department of Health. That will buy around 12,500 doses for uninsured and underinsured adults, she said. There are roughly one million uninsured people in the state.
CDC and FDA experts last year decided to promote annual fall vaccination against covid and influenza along with a one-time respiratory syncytial virus shot for some groups.
It would be impractical for the vaccine-makers to change the covid vaccines recipe twice every year, and offering the three vaccines during one or two health care visits appears to be the best way to increase uptake of all of them, said Schaffner, who consults for the CDCs policy-setting Advisory Committee on Immunization Practices.
At its next meeting, in October, the committee is likely to urge vulnerable people to get a second dose of the same covid vaccine in the spring, for protection against the next summer wave, he said.
If youre in a vulnerable population and waiting to get vaccinated until closer to the holiday season, Schaffner said, it makes sense to wear a mask and avoid big crowds, and to get a test if you think you have covid. If positive, people in these groups should seek medical attention since the antiviral pill Paxlovid might ameliorate their symptoms and keep them out of the hospital.
As for conscientious others who feel they may be sick and dont want to spread the covid virus, the best advice is to get a single test and, if positive, try to isolate for a few days and then wear a mask for several days while avoiding crowded rooms. Repeat testing after a positive result is pointless, since viral particles in the nose may remain for days without signifying a risk of infecting others, Schaffner said.
The Health and Human Services Department is making four free covid tests available to anyone who requests them starting in late September through covidtest.gov, said Dawn OConnell, assistant secretary for preparedness and response, at the Aug. 23 briefing.
The government is focusing its fall vaccine advocacy campaign, which its calling Risk less, live more, on older people and nursing home residents, said HHS spokesperson Jeff Nesbit.
Not everyone may really need a fall covid booster, but its not wrong to give people options, John Moore said. The 20-year-old athlete is less at risk than the 70-year-old overweight dude. Its as simple as that.
KFF Health News correspondent Amy Maxmen contributed to this report.
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In a recent study published in JAMA Psychiatry, a team of scientists from the United Kingdom (U.K.) investigated whether coronavirus disease 2019 (COVID-19) was associated with mental health illnesses and whether the association was modified based on COVID-19 vaccination status among the general population, as well as among patients who were hospitalized due to the disease.
Study:COVID-19 and Mental Illnesses in Vaccinated and Unvaccinated People. Image Credit:Viacheslav Lopatin/Shutterstock.com
Numerous studies on hospitalized COVID-19 patients as well as non-hospitalized individuals who experienced milder forms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have shown that COVID-19 is associated with the subsequent development of mental health illnesses.
These include mental health impairments such as depression and anxiety, as well as more severe forms such as psychotic disorders.
While microvascular alterations and persistent inflammation due to SARS-CoV-2 infection are some of the potential physiological mechanisms linked to mental health illnesses after COVID-19, psychosocial causes such as anxiety about the disease and the outcomes post-COVID-19 have also been implicated.
Furthermore, although the rapid development of COVID-19 vaccines was instrumental in limiting the transmission and morbidity of SARS-CoV-2 infections, the long-term implications of these rapidly developed vaccines on other post-COVID-19 outcomes, including mental health issues, remain unclear.
In the present study, the researchers used electronic health records of over 18 million individuals in the U.K. to examine associations between COVID-19 diagnoses and the subsequent development of mental health illnesses before the availability of the vaccine and in vaccinated and unvaccinated individuals after COVID-19 vaccine rollouts.
The associations were also examined separately based on sex, age, disease severity, ethnicity, previous SARS-CoV-2 infections, and history of mental health illnesses.
The mental health illness outcomes examined in the study were depression, generalized anxiety disorders, addiction, eating disorders, self-harm, and post-traumatic stress disorder, as well as serious illnesses such as bipolar disorder, schizoaffective disorder, schizophrenia, and psychotic depression.
Covariates such as sex, age, ethnicity, smoking status, comorbidities, deprivation, employment in health care, and residence in a care home were included as potential cofounders. Three cohorts were included in the study, with the follow-up for the pre-vaccine cohort stretching from early January 2020 to mid-December 2021.
Since the vaccine became available for all adults on June 18th, 2021, the follow-up for the vaccinated cohort began around then, or two weeks after the second dose of the COVID-19 vaccine, and ended in mid-December 2021, which was the end of the study. For the unvaccinated cohort, the follow-up began 12 weeks after the vaccine became available.
COVID-19 diagnoses were confirmed based on laboratory tests, irrespective of the manifestation of symptoms.
The follow-up period for the pre-vaccine cohort overlapped with the period of circulation of the wild-type and Alpha variants of SARS-CoV-2, while the follow-ups for the vaccinated and unvaccinated cohorts were during the period of circulation of the Delta variant.
Confirmed diagnoses of COVID-19 were the exposure in the study, and the measured outcomes were comparisons of adjusted hazard ratios for the incidence of various mental health illnesses before and after the availability of the COVID-19 vaccine and between unvaccinated and vaccinated individuals.
The study found that the incidence of mental health illnesses was higher for close to a year after COVID-19 among individuals who were not vaccinated against SARS-CoV-2 infections.
The findings showed that the mental health illness incidence rates were significantly higher in the four weeks following the onset of the COVID-19 pandemic as compared to before the pandemic.
However, the incidence rates were relatively lower among the vaccinated cohort. Furthermore, the incidence rates for mental health illnesses remained higher for close to seven months in individuals who got COVID-19 before the vaccinations became available, especially among those hospitalized for acute SARS-CoV-2 infections.
The subgroup analyses showed that the association between COVID-19 and the incidence of mental health illnesses was stronger among men, older adults, and those with a history of mental health illnesses. However, the association did not vary significantly between ethnic groups.
While COVID-19 vaccines were found to mitigate the impact of SARS-CoV-2 infections on subsequent mental health status, the study showed that a history of mental health illnesses influenced vaccine uptake.
This finding highlighted the importance of actively encouraging individuals with existing mental health illnesses to get vaccinated.
The high incidence of mental health illnesses associated with COVID-19 before the availability of the vaccine also potentially reflects the greater levels of uncertainty and concern surrounding COVID-19 outcomes and the effectiveness of treatment options in the early stages of the pandemic.
Overall, the study found that the COVID-19 vaccine mitigated the incidence of mental health illnesses, and unvaccinated individuals were at a higher risk of developing mental health difficulties after COVID-19.
The association was stronger among men and older adults, as well as among people with a history of mental health issues, highlighting the need for encouraging vaccine uptake.
Journal reference:
Walker, V. M., Patalay, P., Ignacio, J., Denholm, R., Forbes, H., Stafford, J., Moltrecht, B., Palmer, T., Walker, A., Thompson, E. J., Taylor, K., Cezard, G., Elsie, Wei, Y., Arab, A., Knight, R., Fisher, L., Massey, J., Davy, S., & Mehrkar, A. (2024). COVID-19 and Mental Illnesses in Vaccinated and Unvaccinated People. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2024.2339. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2822342
Amid an unexpectedly large surge of summer COVID infections in the U.S., and with the fall/winter virus season around the corner, updated COVID vaccines have arrived.
COVID vaccines are one of the best and safest ways to protect against severe illness and hospitalization. Updated COVID vaccines are chosen to target the variants currently circulating and are recommended for everyone 6 months of age and older.
In this Q&A, Andy Pekosz, PhD, a professor in Molecular Microbiology and Immunology, discusses who the updated vaccine is recommended for, when to get yours, whether its safe to get it alongside other seasonal vaccines.
The updated mRNA COVID vaccines from Moderna and Pfizer are based on the KP.2 strain, one of the FLiRT variants that have been spreading since early spring. These variants and their sub-variants have caused the majority of infections during this summers COVID wave.
Everyone 6 months and older should get vaccinated against COVID, according to the CDCs recommendations.
For children ages 6 months to 4 years: Vaccination is recommended, but the number of vaccinations is based on which vaccine they receive, their age, and whether theyve received a previous COVID vaccine. Parents and guardians should refer to CDC guidance and check with their pediatrician to see whats recommended for their child.
For people ages 5 years and up: One dose of the updated COVID vaccine is recommended, regardless of whether theyve been vaccinated previously. If someone has received a COVID vaccine recently, they should wait at least two months before getting the updated one for this season.
According to updated CDC guidelines, individuals who are immunocompromised may receive additional doses with their health care providers guidance.
This summers surge has been larger and lasted longer than many experts anticipated, making it a little trickier than years past to determine the best time to get vaccinated.
People who have not had COVID in the past few months have a couple options:
People at higher risk of severe illness should consider getting an updated COVID vaccine as soon as possible. Everyone who is eligible should get an updated COVID vaccine by mid-October in order to build immunity ahead of holiday travel and gatherings. Remember, it takes about two weeks to build up immunity following a vaccine, so schedule your vaccination accordingly.
Broadly speaking, the COVID vaccine provides strong protection against infection for up to three months and protection against severe disease out to six months. That said, there are a lot of variables that can affect duration and strength of protection, including any new variants that may emerge and how different they are from the vaccine formulation.
If youve had COVID this summer, youll have strong infection-based immunity and can wait a few months after your infection before getting the vaccine. According to the CDC, you can wait three months since your symptoms began or, for asymptomatic cases, since you first tested positive.
Theres some evidence to support waiting as long as six months after a COVID infection to receive an updated vaccine. Waiting longer than the CDCs guidance of three months is not recommended for high-risk groups, but its something people can discuss with their doctor.
Between the two mRNA vaccines from Moderna and Pfizer, there is no reason to get one over the other. They target the same KP.2 variant, are similarly effective, and elicit similar side effects.
The COVID vaccine is free under most health insurance plans and Medicare.
If you dont have insurance to cover the cost of the COVID vaccine, look for vaccination clinics run by your local or state health department. Children under 18 may also be eligible to get a free COVID vaccine through the CDCs Vaccines for Children Program.
You can find local pharmacies offering COVID vaccines at Vaccines.gov or by contacting your health care provider or local health department.
The common side effects are the same as with previous COVID vaccines. Symptoms like soreness at the injection site, achiness or joint pain, fatigue, slight fever, chills, or nausea are normal and not cause for concern. These side effects are a sign that your body is mounting an immune responseexactly what its supposed to do following a vaccine. Side effects generally subside within a day or two.
If youve never been vaccinated against COVID, now is a great time to start. People 5 years of age and older are considered up to date on COVID vaccination once they receive one dose of an updated mRNA COVID vaccine.
The vaccine is a close match to variants currently circulating and provides good protection against severe disease, hospitalization, and death. While KP.2 is not causing a significant number of infections, the most prevalent variants circulating right now are very closely related to them. The vaccine will never be a perfect match to the circulating variants because it takes 2-4 months to make the vaccine, and during that time the virus continues to change as it infects people.
Vaccine-induced immunity is better because its safer. When you get infected with COVID, symptoms from the infection wreak havoc on your body. Whether or not youve been infected or vaccinated previously, the updated COVID vaccine is going to strengthen your immune responses to high levels and do so in a safe way.
People who are vaccinated can still get COVID, but it is much more likely they will experience mild symptoms. Vaccinated people are much less likely to experience severe illness or get so sick that they need to be hospitalized. Data continue to show that those who are hospitalized with COVID are largely people who have not received a COVID vaccine within the past 12 months.
Particularly for people at higher risk of severe COVID, vaccination is an essential tool for reducing COVID complications, hospitalization, and death.
Yes! In fact, studies have shown that people who decide to spread out their vaccines into separate appointments often dont follow through with getting both. Weve also seen that the immune response generated by each vaccine does not change based on whether they are administered at the same time or separately.
Its important to remember that many of the same populations at high risk of experiencing severe illness from COVID are also at high risk of severe influenza. Especially for these vulnerable populations, its a good idea to time your vaccines together.
Some vaccine manufacturers have been working on developing a combined vaccine for COVID and flu, but were not there yet. We certainly wont see a combined vaccine this year. Its possible one will be ready in time for fall 2025, but we wont know for sure until more clinical trial results are available.
Aliza Rosen is a digital content strategist in the Office of External Affairs at the Johns Hopkins Bloomberg School of Public Health.
When The Heritage Foundation releasedits comprehensive reporton the origins of the Covid-19 pandemic,headlines tended to focus on the cost to the U.S. Thats not surprising: At an eye-popping $18 trillion,its almost 10 times the projected 2024 budget deficit.
Arguably, however, the Commissions most infuriating conclusion was this: The global pandemic was totally preventable, in the words of Commissioner Dr. Robert Redfield, an experienced virologist who headed the CDC during the outbreak.
Had the Chinese government been more transparent and cooperative at the outset of the pandemic, millions of lives and trillions of dollars could have been spared. The pandemics proximal origin, the Commission found, was the Chinese governments aggressive opposition to honesty, transparency, and accountability along with its systemic cover up.
The Cover-Up
The Commissiona blue-ribbon team of experts led by former Director of National Intelligence John Ratcliffe and supported by data scientists, economists, and lawyersconcluded that the SARS-CoV-2 virus began circulating months before Beijing warned the world, likely in August-September 2019. The Chinese government then not only withheld key details, it engaged in an elaborate and deadly coverup.
Dr. Jamie Metzlone of the Commissions Democrats who served at the National Security Council, U.S. Senate, and State Departmentcondemned Beijing for having destroyed samples, hidden records, imprisoned Chinese citizen journalists, gagged Chinese scientists, blocked any meaningful international investigations, and cynically sandbagged the World Health Organization.
Ratcliffe described Chinas behavior during this period as frankly inexcusable.
Added Metzl: There can be, in our view, little doubt that Chinas government is primarily responsible for the COVID-19 pandemic. But for the unique pathologies of the Chinese state, there very likely would have beenno pandemic at all.
The Cost
Worldwide, the COVID-19 pandemic is considered one of the seven deadliest plagues in human history, with excess deaths topping 28 million, according to some estimates. The World Bank has characterized the economic upheaval caused by the pandemic as the largest global economic crisis in more than a century, with low-income countries hit the hardest.
The Commissions assessment that the pandemic cost the U.S. alone $18 trillion includes $8.6 trillion in excess deaths, $1.8 trillion in income lost, $6 trillion in chronic conditions like long COVID, $1.1 trillion in mental health costs, and $400 million in education losses.
The Origin
While the origin of the pandemic wasnt the focus of the Commission, notably all nine Commissioners concluded, without dissent, that the pandemic very likely stemmed from a research-related incident in Wuhan.
Indeed,evidence continues to emergefurther strengthening the lab leak theory and casting greater doubt on the natural spillover theory. The Wuhan Institute of Virology (WIV) was at the time conducting dangerous gain of function experiments to make coronaviruses more transmissible to humans, and it was doing so in alarmingly unsafe conditions.
The WIV experienced an unspecified incident in 2019, when several lab workers fell sick, the Chinese military abruptly assumed control of the lab, the lab mysteriously deleted its online database of over 10,000 bat virus samples at 2:00am, and ordered an expensive new air incinerator. A Chinese military scientist then produced a vaccine with logic-defying speed before suddenly going missing and being scrubbed from government records.
In recent months, new details have emerged about a 2018 grant proposal that sought funding to manipulate coronaviruses at the WIV in very specific waysways that exactly match the highly unusual features of the SARS-CoV-2 virus that have never been seen in nature.
At the event unveiling the Heritage report, Dr. Redfield contended SARS-CoV-2 shows clear signs of engineering and its origin had nothing to do with a natural spillover event at a Wuhan animal market. The full Commission report concludes that despite four years of extensive hypothesis testing, today there isno evidentiary basis for the theory of natural spillover. The handful of early pandemic academic papers advancing the natural spillover theory have since been hollowed out by fatal challenges to their underlying methods and conclusions.
Rather than a viral leap from animal to humans, Dr. Redfield contended that the pandemic was a direct consequence of scientific arrogance, with the scientists that were intentionally teaching this virus how to infect humans never recognizing something would ever go wrong. And, in fact, unfortunately this virus did escape.
Preventing Another Pandemic
To avoid a future pandemic and hold the Chinese government accountable, the Commission report concluded with several practical recommendations for the U.S. government:
The COVID-19 pandemic was almost certainly the deadliest and costliest event of the 21st century. Beijings ability to escape virtually any accountabilityand the global medias relative disinterest in the pandemics origins, cost, and Chinas culpabilityare equal parts confounding and infuriating.
Chinas response to SARS1 20 years ago was abysmal, Dr. Metzl argued at the Heritage event. Chinas response to SARS2, 20 years later despite all these international processes, was even worse. And the reasonis there was no accountability for all the obfuscation in the first case. With 28 million people dead as a result of COVID-19 and tens of trillions of dollars in damages it simply unacceptable, and franklyunimaginable, that every stone should not be overturned examining what went wrong.
SARS-CoV-2, the virus that causes COVID-19, may preferentially use a "back door" into cells to infect the brain, a new mouse study suggests.
The finding could partly explain why many people have neurological symptoms such as fatigue, dizziness, brain fog, or loss of smell or taste during or after a bout with the virus. Scientists think these symptoms may arise when SARS-CoV-2 enters the central nervous system, but how and why the virus moves from the respiratory tract to the brain wasn't clear until now.
In an article published Aug. 23 in the journal Nature Microbiology, researchers discovered mutations in the virus's spike protein, which it uses to enter human cells by binding to a molecule called ACE2 on the cells' surface.
"The SARS-CoV-2 spike protein coats the outside of the virus and allows it to enter a cell," study co-author Judd Hultquist, an assistant professor of infectious diseases at Northwestern University in Chicago, told Live Science in an email. "Normally, the virus can enter the cell in two ways: either at the cell surface (through the front door) or internally after it is taken up into the cell (through the back door)."
Part of the spike protein, called the furin cleavage site, helps the virus enter through the front door. If this site is mutated or removed, the virus can only use the backdoor route.
"Cells in the upper airways and lungs are highly susceptible to SARS-CoV-2, which can enter these cells through the front and back doors," Hultquist said. "To reach and replicate successfully in the brain, it seems like the virus has to enter through the back door. Deleting the furin cleavage site makes the virus more likely to use this pathway and more likely to infect brain cells."
To study this, the researchers used genetically engineered mice whose cells make human ACE2. After infecting these mice with SARS-CoV-2, they took virus samples from lung and brain tissue and sequenced the viral genomes.
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"We found that mice infected with normal SARS-CoV-2 had some infection in the brain but that there were a lot more infected cells when the virus had a mutation in the furin cleavage site," Hultquist said. Although it's not yet possible to say whether these infected cells are responsible for COVID-19's neurological symptoms, Hultquist and his colleagues saw high rates of infection in cells of the hippocampus and premotor cortex, which are associated with memory and movement, respectively.
However, the study was done only in mice, so more research is needed to find out whether SARS-CoV-2 has similar requirements for infecting the human brain.
"It is important to follow this study up with human sampling to see if the same mutations are found in humans as in mice," Matthew Frieman, a University of Maryland professor of microbiology and immunology who was not involved in the study, told Live Science. "As researchers target neuronal inflammation for therapy against long-COVID symptoms, understanding how the virus replicates there in the first place is of critical importance."
Hultquist also wants to know more about why furin cleavage site mutations make the virus more likely to enter the brain. "We show in the study that normal SARS-CoV-2 can replicate in the brain if it is directly injected, which suggests that loss of the furin cleavage site is important for travel to the brain," Hultquist said. "How exactly this works remains a mystery."
Even so, this research could lay the groundwork for treating the neurological effects of COVID-19.
"Knowing that the virus needs the back door to infect the brain provides unique opportunities to stop [it]," Hultquist said. "Small molecules that block this pathway may be particularly effective at preventing infection of the brain and the complications that arise. The next challenge will be to figure out not only which drugs may be best able to do this, but also which ones can get to the brain."
The Food and Drug Administration on Thursday approved the new Covid vaccines from Pfizer and Moderna.
Its the third time the vaccines have been updated to match circulating strains since the original series. The shots should be available within days. The agency hasn't yet approved a third vaccine, from drugmaker Novavax.
The timing of the new vaccines last year's rollout was in mid-September is significant, since most of the U.S. is still caught in the summer wave of Covid illness. As of Monday, the Centers for Disease Control and Prevention reported, the number of people testing positive for Covid keeps rising and emergency room visits for Covid have been increasing since mid-May. Hospitalizations are rising, too.
Heres what to know about the updated vaccines.
The new shots from Pfizer and Moderna are designed to target the KP.2 strain, a descendant of the highly contagious JN.1 variant that began circulating widely in the U.S. last winter. The drugmakers started making the new doses in June after the FDA advised them to freshen the formulas to match the version of the virus that was gaining ground in the U.S.
A third vaccine, from drugmaker Novavax, has been updated to target the JN.1 strain. JN.1 and KP.2 have largely faded from circulation, according to the CDC.
As of Saturday, a sister strain called KP.3.1.1 accounted for about 36% of all new Covid cases, while another sister strain, KP.3, accounted for about 17%.
Its unclear exactly how effective the vaccines will be against the newer strains, but experts expect that they will protect against severe illness.
A spokesperson from Pfizer told NBC News that data submitted to the FDA shows that its vaccine generates a substantially improved immune response against multiple currently circulating variants, including KP.3, compared to earlier versions of the vaccine.
There are very minor sequence differences between the variants, said John Moore, a professor of microbiology and immunology at Weill Cornell Medical College.
A paper published this month in the journal Infectious Diseases found that KP.3.1.1 shares similarities with JN.1 and KP.2, although it has a few additional mutations that may help it spread more easily.
All these changes are incremental. They do not change the overall big picture, Moore said. KP.3.1.1 is just another step in the road that the overall omicron lineage is taking towards greater transmissibility.
In an earlier interview, Dr. Ashish Jha, dean of the Brown University School of Public Health and a former White House Covid-19 response coordinator, said Covid is most likely endemic in the U.S., meaning the virus is following a relatively predictable pattern that will last a very long time.
That means well be getting a yearly updated Covid vaccine to protect against mutations and waning immunity, just like annual flu shots.
As of May 11, only 22.5% of adults got last years updated Covid vaccine, according to data from the CDC. Only 14.4% of children ages 6 months through 17 years got vaccinated.
For this fall, the CDC recommended that all Americans ages 6 months and older get the new shots.
But Dr. Isaac Bogoch, an infectious disease specialist at the University of Toronto, said its challenging to make a one-size-fits-all recommendation on who should get the vaccine, especially for healthy, young adults.
Its fair to say that the vaccines are still helpful, certainly at an individual level, and to some extent at a community level, he said.
Its critically important that people at the highest risk of a severe Covid infection including people over 65 or with weakened immune systems or underlying health conditions, such as heart disease or obesity get the vaccine, Bogoch said
The heavy lifting of the vaccine is really in protecting the most vulnerable people from severe outcomes, like hospitalization and death, he said.
Millions of people in the U.S. have had Covid within the last few weeks and months. An advantage of the summer wave is that people who have recently recovered have an immune boost to fight off future infections.
Because the vaccines will be available earlier this year than last, the question of timing for the most protection through the winter is more urgent. According to CDC guidance, if youve recently had Covid, you may consider delaying your vaccine dose by 3 months.
For people at high risk of severe illness, experts say get the vaccine when it becomes available. That's because infection may not provide as much protection as vaccination, said Dr. Ofer Levy, the director of the Precision Vaccines Program at Boston Childrens Hospital.
Protection from infection can vary based on the severity of infection, the strain, as well as a persons age and health.
For the young and healthy, it may not be as beneficial to get the vaccine so close to recovery from infection, said Akiko Iwasaki, professor of immunology at the Yale School of Medicine. High levels of antibodies present from recent infection may prevent the vaccine from stimulating new immune cells.
If theres a lot of antibodies already circulating, those antibodies are going to block the [vaccine] from doing its job, she said. Thats one reason why its not recommended to get the vaccine immediately after youve had Covid.
Dr. Paul Sax, clinical director of the division of infectious diseases at Brigham and Womens Hospital in Boston, said theres no harm in getting the vaccine now, although it may make more sense to wait since Covid cases tend to pick up around November.
Assuming thats the case again this year, I would say sometime in October when people get their flu shot would be perfect, Sax said.
Theres not a risk to getting it right away, but the initial protection from the vaccine may not last through an expected winter wave, Sax said.
The good thing is that all of us with our immunity from prior vaccines or getting Covid or both dont have as much of a risk of severe disease, he said. But if you want to really completely avoid getting infected its that antibody spike after the vaccine that happens one to three weeks after thats most protective.
Dr. Manisha Juthani, commissioner of the Connecticut Department of Public Health, said that people who recently had Covid can wait a few months before they get their updated vaccine.
Immunity does wane from having had Covid or getting the vaccine, Juthani said Wednesday during a media briefing with the Association of State and Territorial Health Officials ahead of the winter respiratory virus season. If you dont feel strongly about getting the vaccine right away, then waiting about three months from when you had Covid, and particularly, so that as were approaching the holidays, that you get that shot before the big holidays and when you may be gathering with people.
If you feel strongly that you really want to get the shot as soon as its available, even if you had Covid this summer, then of course you can get that, she added. Theres nothing to say that you cant in September or October.
Data from prior Covid vaccines suggests that the initial protection against infection peaks about a month after the shot and starts to wane over the next several months, even when the vaccine is well matched to the circulating strains.
Fortunately protection against severe disease remains robust for much longer, Iwasaki said.
Ultimately you never know when you may become infected with the virus, she said.
Its kind of a risky calculation because waves just means that there is a large number of infections in the population, but at the individual level you can get infected tomorrow, she said. So its very difficult to predict what is the best time to get it.
Iwasaki plans to get the vaccine herself sooner rather than later since she has not been infected or had a booster in some time.
Sax recommends that his patients wait two to three months after recovering before getting another shot.
The reality is, your infection gives you some boost of your own immunity, he said.
Like other versions of the Covid vaccines and similar to flu shots, the most common reaction is some pain at the injection site. Other side effects include:
The CDC says the side effects typically resolve after a few days. Serious side effects, such as the life-threatening allergic reaction called anaphylaxis, are rare.
Pfizer and Modernas vaccines have been associated with a small but increased risk of myocarditis, the inflammation of the heart muscle, mostly in young men. Most people make a full recovery.
Pfizer, Moderna and Novavax are charging up to $150 per dose for a Covid vaccine, according to data from the Centers for Medicare and Medicaid Services.
The vast majority of people with public and private health insurance should pay nothing out of pocket for the updated Covid vaccines as long as they stick with an in-network provider, said Jennifer Kates, director of the Global Health & HIV Policy Program.
Medicare and Medicaid require that the vaccines are free for patients. The Affordable Care Act, also known as Obamacare, requires private insurers to cover all vaccines that are recommended by the CDCs vaccine committee and director.
However, Kates added that the ACAs requirement does not apply to grandfathered plans plans that existed before the ACA was signed into law and short-term health plans.
People enrolled in these plans may face cost sharing for the Covid vaccine, or the vaccine may not be covered at all, she said.
Children without insurance can get free vaccines through the government-run Vaccines for Children Program.
For adults without health insurance, the situation is a bit different. The CDCs Bridge Access Program which has been paying for shots for uninsured adults is expected to shut down in August because of a lack of funding.
Once the funding runs out, uninsured individuals may be able to access free Covid vaccines through community health centers and other safety net providers that participate in the Section 317 vaccine program for adults, Kates said. Section 317 is a federal initiative that gives funding to states to provide vaccines for uninsured and underinsured adults.
Some state and local health departments may also have a limited supply for people without insurance, but any supply will be very limited, Kates said.
