Category: Covid-19

This study revealed a mortality rate of about 11% in patients diagnosed with CAM. Factors contributing to increased odds of death included a history of cigarette smoking, ICU admission, higher CAM stage, specific treatment methods, and ocular involvement.

Although different studies elucidated various mortality rates among CAM patients (14%37%) [10, 20,21,22], the pooled prevalence of all-cause mortality was reported as 24% [23]. However, the mortality rate during hospitalization of the cases in our study was 10.9%. According to the literature, it could be said that the survival rate of patients with mucormycosis associated with Covid-19 is higher than that of patients with other concomitant diseases (oncohematological and uncontrolled diabetes mellitus) [24]. A study on 49 patients that followed them up for six months reported that 81.8% of the non-survivors, were older than 60years old, 90.9% had intracranial involvement, and all had HBA1C>8.0% [21]. In a similar pattern to our result, a retrospective casecontrol study on 73 CAM cases, which have been followed up for 30days at minimum, showed no significant differences in age, gender, vaccination status, DM presence, remdesivir, and tocilizumab use among survivors and non-survivors [25]. Patients with malignancies, hematological disorders, or poorly controlled diabetes may have a more compromised immune status, predisposing them to poorer outcomes with invasive fungal infections like mucormycosis.

In contrast, COVID-19 can lead to immune dysregulation and increase susceptibility to opportunistic infections like mucormycosis. However, the underlying immune deficit may be less severe or variable compared to conditions like advanced malignancies or long-standing uncontrolled diabetes. In opposition to some studies [25, 26], our study elucidated considerable differences in corticosteroid usage and treatment methods among patients discharged from hospitals and patients who expired. Although the univariate analysis in a systematic review and meta-analysis on 851 non-COVID-19 associated mucormycosis cases elucidated DM and corticosteroid use as substantial mortality-associated factors, those lost significance in multivariate analysis [27]. While glucocorticosteroids are a known risk factor for invasive mycoses, their role in the treatment of severe COVID-19 has been pivotal in managing the hyperinflammatory response associated with the disease. In our study, we observed that the history of systemic corticosteroid use during COVID-19 was significantly associated with reduced odds of mortality. However, it is important to note that we did not have data on the effect of steroids on survival as all patients had started steroid treatment before the study period. This finding contrasts with the established risk of corticosteroids contributing to the development of mucormycosis, suggesting that while steroids may mitigate the severe effects of COVID-19, their dosing and duration need careful consideration to avoid predisposing patients to invasive fungal infections like mucormycosis. Further research is necessary to delineate the balance between their therapeutic benefits and potential risks in this context.

COSMIC study [10] elucidated that mortality and disease progression were considerably higher in stage 3c or worse when compared to stage 3b or better. Likewise, the results of our study demonstrated that patients with higher ROCM stages had a significantly higher mortality ratio. A review study on CAM cases from 18 countries reported higher mortality rates in case of CNS involvement among ROCM patients [22]. A multicenter study on 287 CAM and non-COVID-19-associated mucormycosis patients showed that higher age, cerebral involvement, and ICU admission were associated with higher mortality odds ratios at six weeks [28]. Our results confirmed that expired patients had lower visual acuity at the time of CAM diagnosis than those discharged from hospitals. The multiple logistic regression suggested that higher stage of CAM, treatments in the setting of ocular involvement, bilateral ocular involvement, and history of cigarette smoking and ICU admission due to COVID-19 could be considered as possible mortality-associated factors. Our findings regarding the potential relationship between cigarette smoking, severity of COVID-19 illness, and mortality from mucormycosis aligns with existing evidence demonstrated that smoking is known to impair lung function and increase susceptibility to respiratory infections like COVID-19 [29]. Smokers have been reported to have higher rates of severe COVID-19 illness and mortality compared to non-smokers [30]. Therefore, it is plausible that in this study, cigarette smoking may have predisposed patients to more severe COVID-19 illness, requiring ICU admission, and consequently increased the risk of mortality from the subsequent mucormycosis infection.

Secondary outcomes findings revealed that diabetes mellitus emerged as the predominant underlying condition, reflecting the high prevalence of this comorbidity in the study population. The exploration of COVID-19 characteristics brought to light a substantial positive rate for SARS-CoV-2 RT-PCR, emphasizing the association between mucormycosis and recent COVID-19 infection. Noteworthy was the observation that most patients had not received vaccination against SARS-CoV-2. ROCM clinical presentations showcased facial pain, swelling, and nasal discharge as common complaints, while ocular signs such as ptosis and periorbital swelling were highly prevalent. Imaging findings demonstrated ethmoid sinus involvement as the most common, and cavernous sinus involvement was observed in a relatively low percentage of cases. The majority of patients were classified as Stage 3 ROCM. Ocular involvement was prevalent in 92.3% of patients, with only 6.7% experiencing binocular issues. The 72.8% exhibited extraocular movement restriction, and frozen eyes were observed. Relative afferent pupillary defect (RAPD) was present in 61.8% of evaluated eyes. Chemosis was the most common ocular finding in slit-lamp biomicroscopy. Fundoscopy revealed atrophic discs in 23.3% and optic disc swelling in 3.7% of affected eyes. Microvascular events (CRAO, CRVO, BRVO) occurred in a minority of cases.

On average, CAM patients in our study were in the sixth decade of life, similar to other studies [10]. However, male predominance in our study was less (54.7%) than in other studies (71 to 73%) [10, 22]. The latest meta-analysis on a total of 3718 CAM patients [23] revealed DM as the most frequent underlying disease among these patients (89%) and reported that the pooled prevalence of systemic corticosteroid use in the treatment setting of COVID-19 disease was 79%, which all are consistent with our results (82.8% and 73.7%, respectively). According to the literature on non-COVID-19-associated [24] and CAM, the mean age of the patients and the existence of DM and corticosteroid use are quite similar in both groups. Lately, a casecontrol study confirmed the role of DM and corticosteroid use in CAM infection [31]. The inflammatory state and reduced immune response during hyperglycemic status that is intensified via SARS-CoV-2, the increased expression of GRP-78 (glucose-regulated protein 78) on epithelial and endothelial cells in response to increased glucose concentration and ketone bodies, and the increased free iron level that is intensified by ketoacidosis in COVID-19 patients altogether lead to a suitable environment for angioinvasion, hematogenous spread, and proliferation of mucormycosis [1, 9, 22, 32, 33]. Also, utilizing systemic corticosteroids in the treatment strategy of COVID-19 infection results in hyperglycemic media and the cytokine storm through the inflammatory state, providing a suitable condition for the fungi [9]. Impairment of immune function against mucormycosis caused by corticosteroids could increase the infection risk [22].

[21, 34]. Although the mean duration from COVID-19 infection to the CAM diagnosis (about 25days) among the included patients is comparable with the data (25.6days) from a recent systematic review [35], some other studies reported lower intervals [10, 36]. Most patients had mild or moderate lung involvement due to COVID-19 infection; this may state that CAM occurs more frequently in patients with less COVID-19 severity, which is suggested by another study [22].

In concurrence with our study, the most common presenting symptoms reported by a cross-sectional study on 270 CA-ROCM patients and a prospective study on 49 CA-ROCM patients were facial/periorbital pain and swelling [21, 37]. A systematic review and meta-analysis on 2,312 proven CAM patients reported headache (54%), periorbital swelling/pain (53%), facial swelling/pain (43%), ophthalmoplegia (42%), proptosis (41%), and nasal discharge/congestion (36%), decreased or loss of vision (31%), ptosis (28%), dental pain or loosened teeth (25%), palatal discoloration or ulcers (22%) as common symptoms [38], which are almost consistent with our study.

Consistent with other studies, the most commonly involved paranasal sinuses among CAM patients were ethmoid and maxillary sinuses [39, 40]. Mucormycosis usually starts from the maxillary sinus, extends to the ethmoid or sphenoid, and can invade the orbit through ethmoid foramina or splitting lamina papyracea [9].

Orbital involvement among CAM patients in our study (92.3%) was higher compared to a meta-analysis conducted on 3718 patients (61%) [23]. Also, in a study on 2826 probable/ possible/ proven ROCM Indian patients, orbital involvement among the patients was reported at 72% [10]. Consistent with other studies [34, 37], ptosis, periorbital edema, periocular pain/tenderness, ophthalmoplegia, and proptosis are common ocular and periocular signs and symptoms among CAM patients. Of 35 involved eyes in a cross-sectional study, retinal artery occlusion and disc edema were observed in 23% and 11%, respectively [34]. In another study on 49 CAM patients [21], the observed keratopathy, CRAO, and CRVO rates were reported at 24.49%, 4.08%, and 2.04%, respectively.

In this study, the number of patients who expired was 30 (11%), while the number of patients who were discharged was 244 (89%). Unbalanced data in a relatively small sample size reduces the statistical power of the tests. Therefore, it is necessary to interpret the results with caution due to this limitation.

Continued here:

Risk Factors of COVID-19 associated mucormycosis in Iranian patients: a multicenter study - BMC Infectious Diseases

Demography

We aimed to evaluate for cognitive, structural, and functional alteration in patients recovering from COVID-19 and how this alteration depends on the clinical profile of the patients (see Figs.1 and 2). Two clinical factors were assessed: Anosmia (An, involving anosmia and hyposmia/microsmia, see below) during the acute episode as a potential marker for neurological involvement, and hospitalization (HR) during the acute episode to indicate the severity of respiratory symptoms. Using linear modeling, we observed variations in age and the time elapsed between diagnosis and the first session, which includes MRI, behavioral task and clinical anamnesis (see Methods), among patients exhibiting these factors. Concerning age, there were no significant differences observed between patients with and without COVID-19 (age in z-score, beta=0.05, se=0.2, t=0.2, p=0.8) or between patients with and without anosmia (beta=0.05, se=0.2, t=0.2, p=0.8). However, patients with COVID-19 who required hospitalization were older than those with COVID-19 who did not require hospitalization (beta=0.7, se=0.2, t=3.4, r=0.35 [0.15 0.55], p=0.0008). Additionally, patients with COVID-19 requiring hospitalization presented a longer time interval between diagnosis and the first session (time in z-score, beta=0.6, se=0.2, t=3.1, r=0.32 [0.12 0.52], p=0.002). We did not find a difference in educational level between groups (betas<0.2, ts<1, ps>0.3). Consequently, age and time between diagnosis and the first session were used as control regressors in all analyses comparing clinical factors, as indicated in Fig.2A.

Reversal learning task. (A) Timeline of a trial. (B) Earnings for the three phases of the task for the complete sample. (C) Trial means and standard errors of the evaluation of earnings during the three phases of the task for the complete sample.

Behavioral and functional results. (A) Model applied to behavioral and brain data. B-C. Behavioral data from Reversal Learning Task. (B) Regressor effects over the rate of option change after a negative outcome during shift periods. (C) Regressor effects over learning rate following a negative outcome. (D) BOLD activity during the Reversal Learning Task. The left panel shows the global effect of the task. The right panel indicates the negative effect of the Anosmia regressor. HR: Hospitalization required; An: Anosmia; CTD: cluster-threshold detection.

All patients were queried about persistent post-COVID symptoms during initial anamnesis in the first session (see Methods).24 Twenty-two patients diagnosed with COVID-19 reported experiencing some degree of attention and memory issues, which persisted at the time of cognitive assessment battery administered in the study (second sessions, see Methods). The frequency of these reported cognitive symptoms did not show modulation by clinical factors (linear model dof=93, Anosmia: beta=0.05, se=0.09, t=0.5, r=0.06 [0.17 0.29], p=0.6; Hospitalization required: beta=0.08, se=0.09, r=0.09 [0.13 0.32], t=0.8, p=0.4). Additionally, seven patients reported cephalea, and six reported fatigue. Only four patients reported persistent olfactory alteration post-acute episodes. Patients reported an average duration of 1.3months (range: 0.514months) for their olfactory dysfunction. Of these patients, 68% (n=29) experienced a complete loss of smell (anosmia), while 32% (n=14) experienced varying degrees of changes in their sense of smell (hyposmia/microsmia). For the following analysis, we pooled these categories as 'patients with anosmia.' Patients underwent screening for olfactory alterations associated with SARS-CoV-2 using the KOR test.25 In addition to self-reported olfactory alterations, 6 out of 43 patients with anosmia during the acute episode identified less than 5 odors, suggesting a persistent olfactory dysfunction (for details, see Methods). Despite this, when evaluating the KOR test scores with the model (Fig.2A), no group differences were observed (linear model dof=93, Anosmia: beta=0.39, se=0.24, t=1.6, r=0.19 [0.44 0.05], p=0.11; Hospitalization required: beta=0.14, se=0.24, t=0.5, r=0.07 [0.30 0.17], p=0.5). Functional capacity was also evaluated using 6MWT.26 We did not find differences in this score between groups (linear model dof=93, An beta=0.003, se=0.02, t=0.16, r=0.06 [0.17 0.29], p=0.8; HR beta=0.007, se=0.02, t=0.3, r=0.09 [0.13 0.32], p=0.7).

Patients were evaluated using cognitive and psychological assessment batteries. ACE-III evaluation showed that the sample had a mean score of 92 with no differences between groups (linear model, df=93, COVID-19 diagnosis beta=1.9, se=3.0, t=0.6, r=0.08 [0.33 0.17], p=0.5; Anosmia beta=3.2, se=2.6, t=1.1, r=0.15 [0.10 0.39], p=0.2; Hospitalization required beta=-3.0, se=2.7, t=1.0,r=0.13 [0.3 0.11], p=0.2). In the same way, IFS-Ch frontal screening evaluation showed a mean of 21.8 with no differences between groups (COVID-19 diagnosis beta=1.8, se=0.9, t=1.8, r=0.22 [0.02 0.46], p=0.06; Anosmia beta=0.4, se=0.8, t=0.4, r=0.05 [0.18 0.28], p=0.6; Hospitalization required beta=-0.37, se=0.8, t=0.4, r=0.05 [0.29 0.18], p=0.6). We found similar results when analyzing the PHQ-9 (COVID-19 diagnosis beta=2.0, se=1.4, t=1.4, r=0.18 [0.07 0.43], p=0.15; Anosmia beta=0.9, se=1.2, t=0.7, r=0.09 [0.34 0.15], p=0.4; Hospitalization required beta=-0.5, se=1.2, t=0.4, r=0.05 [0.29 0.19], p=0.6), and GAD-7 screenings (COVID-19 diagnosis beta=2.5, se=1.4, t=1.8, r=0.22 [0.02 0.47], p=0.07; Anosmia beta=0.2, se=1.2, t=0.1, r=0.02 [0.22 0.26], p=0.8; Hospitalization required beta=-0.07, se=1.2, t=0.06, r=0.007 [0.24 0.23], p=0.9).

Initially, we assessed whether participants adapted their behavior during the game (Fig.1). For this purpose, we analyzed three phases during the game: a phase we labeled as 'Shift,' which encompasses the five trials following the programmed probability change; a 'Pre-Shift' phase, comprising the last five trials of the initial stable phase of each game, and a final Post-Shift phase, representing the final five trials of each game (corresponding to the conclusion of the second stable phase, see Fig.1C).

All participants decreased their earnings during the Shift phase, but increased them in the Post-Shift phase, reflecting learning and adaptation (Friedman test, stat=44.8, df=2, Kendall W=0.22, p=2e10; mixed model over single trials, b=0.14, se=0.01, t=10.29, r=0.11 [0.130.09], p=2e16, Fig.1B). Subsequently, we investigated an indicator of the strategies individuals employ during transitions. To do so, we assessed the rate of alternative change following a negative outcome. An exceedingly low value in this indicator suggests a tendency for individuals to uphold the value of the chosen option after experiencing negative outcomes, a phenomenon known as perseverative decision-making27. Conversely, exceedingly high values in this indicator may signify impulsive shifts or the tendency to alter one's choice immediately following an error without updating the value. This indicator decreases in value during the Shift compared to the Pre-Shift phase, reflecting the tendency to accumulate more evidence before shifting from the previously advantageous option (linear model, averaged data: beta=0.04, se=0.01, t=2.6, r=0.11 [0.19 -0.03], p=0.008; mixed-effects logistic model over single trials: beta=0.24, se=0.05, t=4.4, r=0.11 [0.15 -0.06], p=9e-6). These initial analyses indicate that the entire sample exhibited the expected behavior in the task, adapting their decisions after a shift with a cost in the transition.

Next, we applied the strategy indicator during the Shift phase to investigate potential differences among groups using the model described in Fig.2A. We observed that the clinical characteristics of COVID-19 patients differentially influenced the strategy indicator. The diagnosis of COVID-19 did not significantly impact the indicator (linear model: beta=0.01, se=0.03, t=0.4, r=0.03 [0.13 0.20], p=0.6); however, patients requiring hospitalization exhibited a decrease in this parameter (linear model: beta=0.1, se=0.03, t=3.2, r=0.26 [0.43 -0.10], p=0.001, similar results from Bayesian estimation shown in Fig.2B). In contrast, patients presenting anosmia demonstrated an increase in this parameter (linear model: beta=0.09, se=0.03, t=2.9, r=0.25 [0.08 0.41], p=0.003, similar results from Bayesian estimation shown in Fig.2B). None of this modulation occurred in the other phase of the task (ps>0.1). This strategic modulation significantly impacted total earnings, leading to higher earnings among patients with anosmia (linear model, beta=0.02, se=0.01, t=2.43, r=0.10 [0.02 0.19], p=0.015).

Then, we test if this behavioral modulation is related to specific cognitive computation. We fitted a cognitive model of participants responses using prospect theory and a Rescorla-Wagner algorithm to estimate the individual learning of the probability of each desk. We used a different learning rate estimated following a win and a no-win. Based on the preceding results, we tested if the clinical condition of hospitalization and anosmia modulated the differences between the learning rates. We found a similar pattern to the prior results: COVID-19 diagnosis per se did not affect the learning rate (linear model df=90, b=0.1, se=0.2, t=0.6, r=0.1 [0.11 0.21], p=0.3), Hospitalization generated a decrease in the learning rate after negative outcome (b=0.44, se=0.16, t=2.7, r=0.21 [0.37 -0.06], p=0.007, similar results from Bayesian estimation shown in Fig.2C), and Anosmia presents an increased learning rate (b=0.4, se=0.15, t=2.5, r=0.2 [0.05 0.35], p=0.01, similar results from Bayesian estimation shown in Fig.2C).

In summary, participants adjusted to the changing probabilities, resulting in increased earnings following the decreases caused by the shift in probability. A behavioral indicator shows participants' ability to employ different strategies during reversals. Clinical characteristics of COVID-19-recovered patients influenced this indicator, with hospitalized patients decreasing and anosmic patients increasing, impacting total earnings. When testing specific cognitive computations, the modulation due to hospitalization affected the individual learning rate.

We evaluated the BOLD signal of the participants while they engaged in the Reversal Learning Task. Cognitive modeling was used to estimate the utility of the chosen option (see Materials and Methods). During the feedback period, we contrasted wins and no wins.

Initially, we assessed the consistent activity across the entire sample to identify the activity associated with value and feedback as classically described in this type of task. We found that during the decision-making process, the value of the chosen option correlated with an extensive frontal-parietal-striatal network, consistent with the literature, including ventromedial prefrontal, medial parietal, and striatal regions.28,29 Conversely, during feedback, we observed that the contrast between win and non-win revealed activity in the ventral striatum, consistent with prior research.29 Subsequently, we assessed the modulation of clinical parameters on BOLD activity. COVID-19 diagnosis and hospitalization required regressors did not show modulation in decision-related or feedback-related activity. However, the regressor associated with anosmia negatively modulated the BOLD signal during decision-making in a network that includes lateral prefrontal, medial frontal, and left temporoparietal regions.

The gray and white matter were segmented using T1w and T2w images. Cortical thickness was analyzed using the specified model in the methods (Fig.2A). We found that neither the COVID-19 diagnostic regressor nor the hospitalization requirement showed significant modulation in cortical thickness. However, the anosmia correlated with a thinning of the cortical thickness in parietal areas (Fig.3A).

Brain structural results. (A) The anosmia regressor effect over the cortical thickness. (B) The anosmia regressor effect over the fraction of anisotropy in a whole-brain analysis of white matter integrity. (C) Regressor effects over axial diffusivity measured in segmented white matter tracts. HR: hospitalization required, CTD: cluster-threshold detection, TFCE: threshold-free cluster enhancement.

The integrity of the white matter was assessed through diffusion images. First, we conducted a whole-brain analysis, evaluating changes in the fractional anisotropy (FA). Statistical modulations were calculated using the specified model outlined in the methods (Fig.2A), and cluster-based statistics were performed using TFCE. Anosmia was the only regressor with significant modulation, demonstrating decreased FA (Fig.3B). The main tracts involved in the affected areas were the corticospinal tract, arcuate fasciculus, inferior fronto-occipital fasciculus, thalamus-parietal fasciculus, thalamus-occipital fasciculus, and posterior corpus callosum.

Next, we conducted statistical analyses for individual tracts. Long and short fibers were segmented using deterministic tractography. Various diffusion measures were evaluated to assess the integrity of each tract (FA, radial diffusion, axial diffusion, and mean diffusion). Each tract was evaluated using the model specified in the methods. The analysis revealed that no modulation survived multiple comparisons (Bonferroni correction). However, when applying an uncorrected threshold (Z>3.1, commonly used for cluster detection in whole-brain functional and structural imaging studies), it was observed that frontal and parietal fascicles exhibited an increase in axial and mean diffusion, indicating a disruption in white matter integrity. This white matter integrity disruption correlated with the hospitalization requirement and COVID-19 diagnosis (Fig.3C).

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Patients recovering from COVID-19 who presented with anosmia during their acute episode have behavioral, functional, and structural brain alterations...

While the reprieve from soaring temperatures may make it seem like the season is coming to a close, the COVID-19 summer wave persists. In fact,

While summer COVID waves are nothing newweve experienced them nearly every year since the pandemic beganthis wave has been drawn out. With kids headed back to school, its only natural to wonder if this wave will stretch right into fall and winter, especially with the contagious KP.3.1.1. and LB.1 variants circulating.

Meet the experts: Thomas Russo, M.D., professor and chief of infectious disease at the University at Buffalo in New York; infectious disease expert Amesh A. Adalja, M.D., senior scholar at the Johns Hopkins Center for Health Security; Adriana Glenn, Ph.D., associate professor at the George Washington University School of Nursing.

So, whats the latest on the COVID summer wave 2024 and what does this mean for this winter? Heres what we know right now.

Theres a lot happening with COVID-19 in the U.S. right now. Percent positivitywhich is the percentage of all COVID-19 tests performed that are actually positivestands at a whopping 18.1% right now, according to data from the Centers for Disease Control and Prevention (CDC). Right now, 2.4% of people who head to the emergency room are diagnosed with COVID-19 and nearly 2% of all deaths in the country are due to the virus, per CDC data.

This is all being fueled by the so-called FLiRT variants, including KP.3. Currently variants KP.3.1.1, LB.1, and KP.2.3 are the most common ones circulating in the country, per the CDC.

Its hard to say for sure how long the COVID-19 summer wave will last, but we probably have a few more weeks to go, according to Thomas Russo, M.D., professor and chief of infectious disease at the University at Buffalo in New York.

The wave has been hitting different parts of the country at different times, he says. The South and West coast were hit first. In general, Dr. Russo says that the waves tend to rise over four to six weeks, plateau, and then decrease over six to eight weeks. Were still going to be in the middle of this for a few weeks, and certainly through Labor Day, he says.

Infectious disease expert Amesh A. Adalja, M.D., senior scholar at the Johns Hopkins Center for Health Security, agrees. COVID summer waves usually last into about September and then the virus diminishes its activity, he says. Cases tend to ramp up again when the weather gets colder, Dr. Adalja adds.

Hopefully well have a respite before we hit the Thanksgiving and religious holiday seasons, which is the start of the winter waves, Dr. Russo says.

The official symptoms of COVID-19 have not changed. According to the CDC, those include:

But many people with COVID-19 right now are experiencing what feels like a cold, says Adriana Glenn, Ph.D., associate professor at the George Washington University School of Nursing. The symptoms do remain very similar to those of upper respiratory viruses, she adds.

This cold-like experience is a reflection of the level of immunity in the population in the virus, causing more cold-like symptoms as a persons immune system is able to control it much better, Dr. Adalja explains.

Some people have a cough, but it tends to be more of a throat-clearing cough vs. something deep in the chest, Dr. Russo says. Theres a sense of not feeling well in the first few days. That tends to go away and leaves you with a head cold.

But Dr. Russo stresses that people who are at high risk for serious COVID-19 infections may have a different experience. Symptoms to watch out for include shortness of breath, chest pain, dizziness, and confusion, among others, Dr. Russo says. While high-risk patients are the most likely to experience these, he points out that anyone can become seriously ill with COVID-19.

Its not entirely clear at the moment. This virus does tend to increase in circulation in the winter, so we have to anticipate that, Dr. Adalja says. This has occurred despite summer increases every year the virus has been with us.

But if you happen to get infected with the virus now and the same variants are still circulating this winter, its possible youll have a reasonable degree of protection in the winter, Dr. Russo says. However, we know that immunity wanes over time, he continues. Protection against severe disease tends to last four to six months and protection against infections tends to last even less than that.

Its also entirely possible that a new variant will surface and cause a new wave of infections, Dr. Russo says. Glenn agrees. The viruses year-long presence provides more opportunities for mutation and when that happens there are new variants that emerge, she says.

So, what does this mean for you? Once the new COVID-19 vaccine is released, Dr. Russo recommends getting it. The new formulation should be available soon, he says. Were still seeing 400 to 500 deaths from COVID a week and theyre largely preventable. Im hoping we can do a little bit better with vaccination as we move forward into the fall.

Originally posted here:

The COVID Summer Wave Is Still HereWhat Doctors Say It May Mean for Winter - Prevention Magazine

PermiaCare talked about the effects of COVID-19 trauma they've noticed in children who lived through the pandemic.

ODESSA, Texas

For some kids, the COVID-19 lockdown was a complete shift in what was normal for them.

For others, they may not have even known what things were like before the lockdown.

However, both had the potential to experience COVID-19 trauma, according to PermiaCare.

After COVID happened, everything changed and what we're seeing now in kids is, we believe, a direct result of having lived through and experienced the chaos that was the lockdown, quarantine, illness, loss, anti-socialization kind of from a mandated perspective really, said Chandra Wiginton, LPC-A, NCC, MST program manager for PermiaCare.

While the immediate effects of COVID-19 trauma were noticeable at the time and even joked about by society to a degree, Wiginton said theyre beginning to notice the long-lasting effects and what it does to a childs development later in life.

One of the things that they miss out on is problem solving and conflict resolution," Wiginton said. "So, if you get into a disagreement with a friend at school now, you're face to face. Before it was behind a screen, and I think it's fair to say that we speak differently, and we interact differently when there's a screen between us."

Wiginton went on to say that, "We might say things we would never say to somebody's face, which is why we saw an increase in cyber bullying. And then how do we problem solve? How do we figure out what we need to do to be happy that's a healthy coping mechanism?

Even if it's years later, Wiginton said it's not too late for families to help their kids to catch up on their development. Wiginton said it is part of what she and her people at PermiaCare help families do.

So of course some of them are still going to be dealing with repercussions of kids' social development not matching their age, right? But that doesn't mean there's not hope," Wiginton said. "We would call it hope for recovery, right? They can recover and they can develop those social skills even now, even if they sat for four or five years and did nothing toward getting better, coping better, any of those things.

Excerpt from:

The long-lasting effects of 'COVID-19 trauma' in children and teens - NewsWest9.com

From barbecues to festivals and elder facilities to crowded airports, COVID has been infecting many people this summer. Cases are likely to keep rising this fall and winter. Photo: Getty Images.

The most dramatic evidence that COVID-19 cases have been spiking this summer came during the Paris Olympic Games when the Worlds Fastest Man collapsed on the track after one of his races.

U.S. sprinter Noah Lyles still managed to win a bronze medal in the 200-meter race that he was projected to win, but after the sprint, it became obvious that he was sick and struggling.

Lyles, who has coped with asthma since he was a child, later told NBC interviewers that he had tested positive for COVID-19 two days before the 200-meter final.

After finishing, Lyles remained splayed on the track until medical authorities came to help him. They insisted he ride in a wheelchair to get fluids and a checkup.

It was extremely hard to breathe. My chest started getting tight. It was hard to get up because I was so fatigued, Lyles told reporters from USA Today.

Earlier in the Games, Lyles dazzled crowds and was full of bravado before eking out a razor-thin win in the 100-meter, which earned him bragging rights as the speediest man on Earth.

After Lyles chose to compete following a positive COVID-19 test, viewers around the world could see he was sick. The spark had disappeared from his eyes, and some questioned whether Lyles should have compromised his own health or perhaps put others at risk by competing while sick.

But there were no strict COVID-19 protocols at the Olympics this year, and four years after the pandemic began, it has become obvious that COVID-19 is a party crasher that can strike in all seasons.

From barbecues to festivals and elder facilities to crowded airports, COVID-19 has been infecting many people this summer. COVID cases are likely to keep rising this fall and winter.

Experts at the World Health Organization recently declared that COVID-19 infections are surging around the world, with 84 countries from the Americas to Europe to the Western Pacific reporting summer spikes. While other respiratory illnesses like the flu typically hit people during the winter months, its now clear that COVID-19 infections can strike during any season, and Dr. Maria Van Kerkhove, a director of pandemic preparedness, warned that more severe variants may be on the horizon.

Many people who are sick with COVID-19 now either dont take a test or dont report test results to any government or medical authorities, so its difficult to say exactly how bad current COVID-19 spikes are. But both the U.S. Centers for Disease Control and Prevention (CDC) wastewater monitoring and anecdotal reports from doctors indicate that COVID-19 cases have been rising all summer, and the newest infections can hit people hard.

So, what symptoms are people experiencing? Whats different about COVID-19 infections now compared to the earliest days of the pandemic? How long are symptoms lasting? What are the protocols if you test positive? What should you do if youre traveling? And when can people get the newest vaccines? To answer your top questions, we consulted with Dr. Michelle Barron, UCHealths senior medical director of infection prevention and control.

Most people who have had COVID-19 this year will tell you that it really knocked them down, said Barron, who is also a professor at the University of Colorado School of Medicine on the Anschutz Medical Campus.

I know quite a few people who have gotten it recently, and they were very sick. Theyd tell me, I had a fever and I couldnt get out of bed, Barron said.

Barron said most people are describing common symptoms that are similar to a bad cold or a case of the flu.

Its primarily the same symptoms that weve seen all along like a sore throat, body aches, headaches, sinus pressure, runny nose, fatigue and a fever that goes away pretty quickly, Barron said.

The duration of illness seems to be shorter than COVID-19 infections were in the past, especially in the earliest days of the pandemic, Barron said.

People have been getting sick but not for long periods of time. They tend to spike fevers and feel really, really tired, like they have the flu, Barron said. But then they get better quickly, as early as Day 3.

Inspired by track and field events, Barron compared the current course of COVID-19 infections to Olympic sprinters like Lyles.

Its like your 100-meter-dash people where its intense, and in 10 seconds, its over, Barron said.

Some people get infections that last longer. But many people these days are getting an intense illness that passes relatively quickly.

It hits you hard, and then its done, Barron said.

It is unusual for respiratory viruses (other than Rhinovirus which causes the common cold) to surge in the summer, Barron said. But viruses are opportunistic. They spread when they can find new hosts, regardless of the season.

And the newest COVID-19 variants are clearly pros at infecting people.

The newest variants are much more efficient at transmitting themselves. Theyre faster at infecting people, and they get more people sick, Barron said.

Plus, many people have not been vaccinated recently, or their immunities from previous infections or booster shots have worn off.

Immunities are not permanent. Thats why people get colds every year. Viruses change slightly, and your immune system is like, Oh. Who are you? I havent seen you in a while. We need to retrain our bodies to respond. Thats why we need updated vaccines, Barron said.

This years summer wave of infections shows that the current variants are sneaky and talented.

People who get sick have a higher viral load. You have more virus out there, and it transmits much better, Barron said.

The current variants that are causing COVID-19 infections now are all descendants of the omicron variant. Experts name the omicron sub-variants alphabetically, and were now into the Ks. The KP.3 subvariants make up nearly 50% of the variants now circulating and causing infections, according to the CDCs Nowcast data tracker.

The newest vaccine, which is due out any day now, was supposed to target the newest variants, so Barron and other infectious disease experts hope it will be highly effective in preventing deaths, hospitalizations and serious illnesses this fall and winter.

We dont know yet where were going to land in fall or if theres going to be yet another variant, but COVID-19 is now behaving a lot like the flu, so we most certainly recommend that people get both their flu shots and their new COVID-19 shots this fall, Barron said.

Whether you dont like being sick yourself or if you have vulnerable people in your life who you want to protect, youll want to get vaccinated, Barron said. And people who like to travel should definitely get vaccinated so they dont acquire COVID-19 while theyre abroad.

People of all ages should get it, Barron said. I would prioritize anyone over age 65 and anyone with underlying immunologic issues like cancer or lung disease or any kind of chronic condition like diabetes or heart disease.

For everyone else, its a good idea to get the new vaccine, Barron said.

Learn all about the new COVID-19 vaccine that is coming this fall.

The new vaccine is due out within days. As of mid-August, UCHealth medical providers do not have the new COVID-19 vaccine yet.

Barron expects the new COVID-19 vaccines to be available for patients by September.

If youve had a recent case of COVID-19, you should have some natural immunities that will last about three months. You can get the new vaccine any time you are better but can wait up until about 90 days after you had a COVID-19 infection, Barron said.

Barron encourages people to go with convenience rather than worrying too much about precise timing for fall vaccines.

For older adults, especially, get your vaccines when its convenient, Barron said.

People who delay vaccines might not get them before the respiratory virus season hits hard. So, if youre going to your doctor for another reason, and the vaccines are available, Barron encourages people to go ahead and get them.

Others will want to be sure to get the newest vaccine before traveling or getting together with a lot of family and friends.

You might want to time your vaccines so youll be protected for the holidays. Just remember that it takes two weeks for vaccines to go fully into effect, Barron said.

Barron always jokes that she doesnt have a Magic 8 Ball that allows her to predict whats going to happen in the coming months with infectious diseases.

I expect my Magic 8 Ball would say, Ask me later, Barron said with a laugh.

In all seriousness, its typical to see an increase in cases of flu and COVID-19 during the fall and winter months. So, Barron and other infectious disease experts can make educated guesses and are preparing for spikes in infections and hospitalizations during the traditional respiratory virus season.

Last year, during the fall and winter, we saw COVID and flu without as many RSV cases. Were certainly prepared for that kind of perfect storm again, Barron said.

The conditions in the late fall and winter months make it easy for viruses to spread.

Kids will be in school, people are traveling, the temperatures start to change and more people are indoors, so I expect thats what well see, Barron said.

COVID-19 is now part of the repertoire of viruses we see every year in the fall and winter, and we should anticipate that were going to see it along with flu and other common viruses, Barron said.

The best preparation for respiratory virus season is to get updated vaccines.

We have very good, effective vaccines against flu and COVID that will keep you out of the hospital and keep you from getting a severe form of the disease, Barron said.

We dont know how severe the season will be until we know whats circulating, Barron said.

But its always wise to get your vaccine so you can enjoy the lovely fall and winter months and all the wonderful holidays we get to celebrate, she said. You wont want to be sick with the flu or COVID and have to stay home and miss out on the fun.

For older people, others who are immunocompromised or people who are trying to stay healthy to protect other high-risk family members or friends, its best to be cautious while you travel since the virus that causes COVID-19 is clearly spreading widely now.

If youre traveling soon and havent been able to get an updated vaccine, you can wear a mask in crowded indoor settings, like airports, Barron said.

If health insurance covers the older version of the vaccine, travelers could get the current shot now. Then, in about 90 days, they could get the updated 2024/2025 vaccine. Immunities from that shot would go into effect in time to protect people during the busy holiday season.

You could get an extra layer of protection, Barron said.

And I most certainly emphasize the benefits of masks. You dont have to wear them all the time. But in dense crowds, the mask might give you a little more protection. Theres certainly no harm from wearing one, Barron said.

The most crucial place to protect yourself is when youre in the airport because you cant control whos around you. Once youre on the plane, the air filtration system is actually quite good.

As long as the person sitting next to you isnt hacking on you, youd be fine taking your mask off on the plane, Barron said.

Anyone who wishes to get an extra dose of the 2023/2024 COVID-19 vaccine should check with their doctor and insurance provider to make sure the cost is covered.

The tried-and-true methods for staying healthy still hold true.

Wash your hands, cover your cough and wear a mask if youre in dense crowds, Barron said.

Plus, stay home and isolate yourself from loved ones if youre sick.

Whether youve got a cold, the flu, RSV or COVID-19, its kind not to share your germs with other people.

Barron said doctors encourage their patients to manage COVID-19 now just as they would if they got the flu.

Please stay home and isolate until youre feeling better and you dont have a fever.

You should not expose yourself to others until youve had no fever for at least 24 hours, and thats without taking acetaminophen or ibuprofen to bring a fever down. So you really have no fever, Barron said.

After that, you can probably interact with people, Barron said.

Wearing a mask as you recover is courteous.

Wed ask you to wear a mask for a total of five days, and in the hospital, we have stricter protocols because people are sick and we have people who are much more vulnerable, Barron said. We also have health care workers and we dont want to expose them, so they dont expose others.

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COVID-19 cases spike in summer months. What will happen in fall 2024? - UCHealth Today

A hospital corpsman processes biological samples during a U.S. Naval Medical Research Unit Indo Pacific study on natural- and vaccine-derived immunity of respiratory diseases in U.S. sailors and Marines in September 2023. (U.S. Navy)

TOKYO Four years after the first confirmed case of COVID-19 in the United States, a Navy research lab is recruiting active-duty volunteers at two bases in Japan for a follow-up study on vaccines.

Singapore-based U.S. Naval Medical Research Unit Indo Pacific will collect blood and saliva samples at Yokosuka Naval Base and Naval Air Facility Atsugi, both south of Tokyo, later this month.

The study is a follow-up to a similar one last year that showed the XBB.1.5 booster is likely to decrease the number of duty days a sailor might lose to COVID-19 by hindering the transmission of the virus behind the respiratory disease, according to a Navy Medicine news release from Dec. 18.

Although other elements in the U.S., including the Department of Defense, have done similar studies, as well as militaries outside of the U.S., Naval Medical Research Unit Indo Pacifics study is the largest and most in-depth that has been conducted, Capt. Andrew Letizia, the units science director, said in a statement emailed by Tommy Lamkin, spokesman for Naval Medical Research Command.

The commands COVID-19 research is focused on the active-duty population, with almost all participants in the range of 20 to 45 years old, Letizia said.

Each participant will provide 1.2 ounces of blood and 0.06 ounces of saliva, Lamkin said. They will also answer a questionnaire about past COVID-19 exposures, vaccination history and infections.

The collection will take place at Yokosuka from 9 a.m. to 4 p.m. Aug. 27 to Sept. 20 at the second-floor lab of the naval hospital, and at NAF Atsugi from 8 a.m. to noon Aug. 28 at the base health clinic, according to a news release Aug. 6 from the medical research unit.

Volunteers do not need to sign up beforehand and can show up to the respective labs during the hours listed, Lt. Huy Nguyen, a principal investigator for the study, said in an email Wednesday.

The samples will be processed within four hours at Yokosuka Naval Hospitals lab and then shipped to Navy Medicine Readiness and Training Command Diagnostics Surveillance Division and Walter Reed Army Institute of Research B Cell Biology, two DOD labs in Silver Spring, Md., for analysis.

Most other researchers in academia are not studying this demographic of young adults whose immune systems are much different than children or older Americans, Letizia said. Therefore, we cant rely on other researchers to answer this specific scientific question. Instead, we have designed the entire study around DoD members.

The command conducts infectious disease research and studies viruses, microbes and insects in the Indo-Pacific to protect the medical readiness and health of service members, their families and partner nations, according to the research units website.

The units first COVID-19 study, the Survey Immune Response to Coronavirus Disease, took place last year at Yokosuka Naval Base with support from 7th Fleet, Lamkin said.

SARS-CoV-2, the respiratory virus that causes COVID-19, will continue to mutate, producing new variants that are more transmissible, immune-evasive and possibly capable of causing a more severe disease, Nguyen said.

Also, immunity against infection, whether from a natural infection or a vaccination, usually decreases within three to four months, Nguyen said.

It is important to gather the most up-to-date immunologic data of our troops against the latest circulating variants to see where we stand to inform future booster recommendations, Nguyen said.

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Navy research unit seeks volunteers for COVID-19 study at Tokyo-area bases - Stars and Stripes

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Enhanced Treatment in Severe-Critical COVID-19 With Tocilizumab, Remdesivir, Dexamethasone: A Jordanian Cohort Study - Cureus

Two European observational studies estimate the vaccine effectiveness (VE) of the COVID-19 XBB.1.5 vaccine approved in fall 2023 against hospitalization, the first one finding 49% overall VE in adults, and one showing good protectionbut uneven uptakeamong pregnant women.

For the firststudy, published in Influenza and Other Respiratory Viruses, researchers with the European Hospital Vaccine Effectiveness Group conducted a test-negative case-control study on the VE against hospitalization of the XBB.1.5 COVID-19 vaccine in the first months of its rollout from October 2023 to January 2024.

The XBB.1.5-like+F456L variant was dominant in Europe from fall to mid-December 2023, when BA.2.86 supplanted it.

The participants were 622 adults hospitalized for COVID-19 and 3,457 control patients admitted for a different severe respiratory infection to 41 hospitals at 7 sites participating in the Vaccine Effectiveness, Burden and Impact Studies (VEBIS) study. In total, 27% of COVID-19 patients and 44% of controls had been vaccinated after fall 2023, most with the Pfizer/BioNTech vaccine.

The median time between vaccination and symptom onset was 58days for COVID-19 patients and 52days for controls.

The adapted COVID-19 XBB.1.5 vaccines provided protection against hospitalisation in the first 3.5months post vaccination, by reducing the risk of COVID-19 hospitalisation by approximately half among the vaccinated individuals.

Overall VE was 49% against hospitalization (range, 69% at 14 to 29 days to 40% at 60 to 105 days postvaccination), although confidence intervals overlapped for all estimates, indicating uncertainty. VE was over 70% in adults ages 65 years and older up to 1 month after vaccination. VE in patients ages 80 and older declined from 76% in the first 29 days to 39% after 60 days.

The study authors noted that their VE estimates are lower than those of three previous European studies but in line with a fourth, except for a greater decline in VE with increasing time since vaccination (TSV), proposing that the differences could be attributed to different TSVs bands.

"The findings of our study suggest that the adapted COVID-19 XBB.1.5 vaccines provided protection against hospitalisation in the first 3.5months post vaccination, by reducing the risk of COVID-19 hospitalisation by approximately half among the vaccinated individuals," they concluded.

The second case-controlstudy, published in Vaccine, included all 47,046 pregnancies ending from June 2021 to August 2022 among 39,213 women seen at Northwest London general practices. In 57% of pregnancies, the mother had received at least one dose of COVID-19 vaccine during their pregnancy, with 91% of them receiving a second dose.

Pregnant women, the study authors noted, are at higher risk of COVID-19 complications such as hospitalization, intensive care unit admission, invasive mechanical ventilation, and death.

"They are also at increased risk of pregnancy-related complications such as preeclampsia and emergency cesarean delivery, and their infants are at higher risk of being preterm or stillborn," they wrote, adding that uptake has been suboptimal.

Most pregnancies (80%) were among women aged 25 to 39years, those who were White (39%) or Asian (34%), and those living in areas in the second (35%) or third (29%) most deprived quintiles of socioeconomic deprivation. The most common of the five risk factors studied was asthma (9.9%), and chronic heart disease was the least common (0.68%).

A total of 180 women were hospitalized for COVID-19. Admission for COVID-19 was much less likely among vaccinated women than among the unvaccinated. A conditional logistic regression model suggested a five-fold decrease in the chances of COVID-19 hospitalization in vaccinated women, compared with their unvaccinated peers (odds ratio [OR], 0.22).

Future vaccination programmes should engage pregnant women earlier and communicate with them clearly and carefully.

Vaccine uptake was lowest in women ages 18 to 24 years (33%), Black women compared with White (37%; OR, 0.55), and those in socioeconomically deprived areas (50%). Coverage was higher among women with chronic conditions, with the greatest uptake among those with chronic heart disease (75% for first dose, 94% for second).

Among women with chronic conditions, women with asthma (OR, 1.20), chronic heart disease (OR, 2.34), diabetes (OR, 1.54), and morbid obesity (OR, 1.15) had significantly higher odds of receiving at least one vaccine dose during pregnancy, compared with those without the condition.

The probability of receiving a first dose of the vaccine was nearly six times higher in the 45- to 49-year) age group than in those ages 25 to 29, compared with 18- to 24-year-olds.

Second-dose patterns were similar. Hospitalized women were much less likely to have been vaccinated than those not hospitalized (22% vs 57%; OR, 0.22). "This association reinforces evidence on the real-world effectiveness of COVID-19 vaccines in preventing severe disease and consequent hospital admission among pregnant women," the researchers wrote.

"COVID-19 vaccine uptake among pregnant women is suboptimal, particularly in younger women, Black women, and women in more deprived areas," they added. "Interventions should focus on increasing uptake in these groups to improve health outcomes and reduce health inequalities. Future vaccination programmes should engage pregnant women earlier and communicate with them clearly and carefully."

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COVID vaccine efficacy against severe illness just under 50%, per early estimates from 2023 - University of Minnesota Twin Cities

As schools reopen for another year, they are focused on improving student attendance. Butback-to-schoolis hitting just as COVID-19 cases are increasing, raising the question: When is a child too sick for school?

School absences surgedduring the pandemic and have yet to recover. Nearly 1 in 4 students remains chronically absent, defined as missing 10% or more of the academic year, according to the latest data analyzed by The Associated Press.

One reason for continued high absences: After years of COVID-19 quarantines, parents are more cautious about sending children to school when they might be contagious with an illness.

When a child misses school, even for an excused absence like a sick day, its harder for them tostay on track academically. So schools and health experts are trying to change the culture around sick days.

Heres what they want parents to know.

During the pandemic, the Centers for Disease Control and Prevention urged people who tested positive for COVID-19 to isolate at home for a set number of days and to quarantine after exposure to the coronavirus. In some settings, people with any mild illness were urged to remain home until symptoms were clear.

Those standards, and the caution behind them,remained for yearsafter schools reopened to in-person instruction. That meant children often missed large portions of school after contracting or being exposed to COVID-19 or other illnesses.

This spring, COVID-19 guidance officially changed. Now, the CDC suggests peopletreat COVID-19 like other respiratory illnesses, such as the flu and RSV.

If a child has a fever, they should stay home, no matter the illness.

A child can return to school when their fever has been gone for 24 hours without fever-reducing medication. Other symptoms should be improving.

If a child doesnt have a fever, its OK to send them to classwith some signs of illness, including a runny nose, headache or cough, according to schools and theAmerican Academy of Pediatrics. If those symptoms arent improving or are severe, such as a hacking cough, call your childs doctor.

The guidance around vomiting and diarrhea varies across school districts. Generally, students should remain homeuntil symptoms stop, according to American Academy of Pediatrics guidelines. Older children may be able to managemild diarrheaat school.

Unless your student has a fever or threw up in the last 24 hours, you are coming to school. Thats what we want, said Abigail Arii, director of student support services in Oakland, California.

Guidance from the Los Angeles Unified School District says students can attend school with mild symptoms such as a runny nose or cold, but should stay home if they have vomiting, diarrhea, severe pain or a fever of 100 degrees Fahrenheit (37 degrees Celsius) or higher.

School districts across the U.S. have similar guidance, including inTexas,IllinoisandNew York.

The CDC says people shouldtake additional precautionsfor five days after returning to school or other normal activities.

Masks and social distancing are no longer mandated but are encouraged to prevent disease spread. Experts also recommend plenty of handwashing and taking steps for cleaner air, such as opening a window or running an air purifier.

School districts say parents should keep up-to-date on all health examinations and immunizations for students so they dont miss additional days of school.

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COVID guidelines have changed. Heres when a sick kid can return to school - Fortune

World Health Organization official says regardless of strain, mpox is not the new COVID, as authorities know how to control its spread.

The mpox outbreak is not another COVID-19, says the World Health Organization, because much is already known about the virus and the means to control it.

While more research is needed on the clade 1b strain which triggered the UN agency into declaring a public health emergency of international concern (PHEIC), the spread of mpox can be reined in, the WHOs European director Hans Kluge said onTuesday.

In July 2022, the WHO declared a PHEIC over the international outbreak of the less-severe clade 2b strain of mpox, which mostly affected gay and bisexual men. The alarm was lifted in May 2023.

Mpox is not the new COVID, Kluge insisted.

We know how to control mpox. And, in the European region, the steps needed to eliminate its transmission altogether, he told a media briefing in Geneva, via video-link.

Mpox, a viral infection that causes pus-filled lesions and flu-like symptoms, is usually mild but can kill.

The clade 1b variety of mpox has triggered global concern because it seems to spread more easily through routine close contact. A case of the variant was confirmed last week in Sweden and linked to a growing outbreak in Africa.

Kluge said that the focus on the new clade 1 strain gives Europe a chance to refocus on the less severe clade 2 variety, including better public health advice and surveillance.

About 100 new cases of the clade 2 mpox strain are now being reported in the European region every month, added Kluge.

Kluge said the predominant route of transmission remained close skin-to-skin contact.

But he said it was possible that someone in the acute phase of mpox infection, especially with blisters in the mouth, may transmit the virus to close contacts, by droplets, in circumstances such as in the home or hospitals.

The modes of transmission are still a bit unclear. More research is required.

WHO spokesperson Tarik Jasarevic said the WHO was not recommending the use of masks.

We are not recommending mass vaccination. We are recommending to use vaccines in outbreak settings for the groups who are most at risk, he added.

The WHO declared an international health emergency on August 14, concerned by the rise in cases of clade 1b in the Democratic Republic of Congo (DRC) and its spread to nearby countries.

The Africa Centres for Disease Control and Prevention (Africa CDC) on Tuesday said the DRC and other African countries could start vaccinating against mpox within days.

Africa CDC has been working with countries experiencing mpox outbreaks on logistics and communication strategies to roll out vaccine doses that are due to arrive following pledges by the European Union, vaccine maker Bavarian Nordic, the United States and Japan.

We didnt start vaccinations yet. Well start in a few days, if we are sure that everything is in place. End of next week vaccines will start to arrive in DRC and other countries, Africa CDC Director General Jean Kaseya told a briefing.

We need to make sure that the supply chain management, the logistics are readyto ensure that this vaccine will be safely stored and can be safely administered to people who need them.

He said studies on the efficacy of different vaccines would continue in Africa while shots are being administered, so countries better understand which shots are appropriate in their context.

African states reported more than 1,400 additional mpox cases over the past week, taking the total number of cases in the 12 African countries where mpox has been detected to almost 19,000 since the start of the 2024, an Africa CDC presentation showed.

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Mpox not the new COVID, says WHO - Al Jazeera English