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As Monkeypox Spreads, Here's Who Should Get A Vaccine—And How – Forbes

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Monkeypox vaccines will be offered to anyone in the U.S. who thinks they have been been exposed to the virus and groups most at risk of catching it, including men who have sex with men, measures officials hope will contain the growing outbreak as they work to bolster limited supplies.

Key Facts

The new strategy recommends anyone with a confirmed or suspected exposure to monkeypox get vaccinated, expanding earlier rules limiting the shots to those with known exposures only.

This includes people who have had close physical contact with someone diagnosed with monkeypox, people who know their sexual partner was diagnosed and “men who have sex with men who have recently had multiple sex partners in a venue where there was known to be monkeypox or in an area where monkeypox is spreading,” the Department of Health and Human Services (HHS) said.

HHS said it will make 56,000 doses of the Jynneos monkeypox vaccine immediately available to states from the national stockpile and will provide an additional 240,000 doses in the coming weeks.

Jynneos, produced by Danish biotech Bavarian Nordic, is given in two doses delivered 28 days apart and is the safer of two vaccines used against monkeypox.

Supplies are limited and officials said states with the highest rates of monkeypox and that have more people vulnerable to severe disease will be prioritized, with Hawaii, Massachusetts, Utah, Illinois, New York, Rhode Island, California, Colorado and Florida and Washington, D.C., slated to be in the first tier of vaccine recipients, according to a draft of the plans seen by the Washington Post.

States may also request supplies of ACAM2000, an older vaccine developed for smallpox that is also believed to protect against monkeypox and is in much greater supply, though it is associated with serious side effects and its design makes it unsuitable for immunocompromised and pregnant people.

Key Background

Monkeypox is a well-understood entity that has flared up in parts of Central and Western Africa for decades. For decades, too, monkeypox has mostly been ignored by the global community who, before this year’s outbreak, rarely encountered the disease and these instances were almost always linked to travel. It does not spread easily and is primarily transmitted through close contact with an infected animal or person or contaminated objects like towels, clothes or bedding, though it can also spread via respiratory droplets produced when people breathe, cough, talk or sneeze. Monkeypox typically causes symptoms that include fever and a characteristic rash. The infection is usually relatively mild and will go away on its own within a month or so. It can kill and cause serious illness, however, and infection is particularly risky for children and pregnant people. The virus is a close relative of smallpox, unarguably one of the deadliest diseases to plague humanity and the only human disease to have ever been eradicated. This proximity means treatments and vaccines are available for monkeypox, even if not designed for it.

News Peg

In May, the near-simultaneous emergence of monkeypox in countries where it does not usually spread in Europe and North America alarmed experts and public health authorities. Some of these experts have long warned that the complete cessation of smallpox vaccination would leave the world vulnerable to monkeypox outbreaks and the way cases cropped up suggests it may have been quietly circulating for some time. Data from the Centers for Disease Control and Prevention show there have been 351 confirmed cases of monkeypox in the U.S. as of June 29, with large clusters in California (80), New York (72), Illinois (46) and Florida (35). The official count is likely to be a severe underestimate and could be painting an overly rosy picture of the disease’s spread. Experts warn that inadequate and underwhelming testing for the virus has left the nation ignorant as to the true extent of the outbreak. Globally, the CDC said there have been more than 5,000 cases confirmed across 51 different countries by laboratory testing during the 2022 outbreak. The bulk of these have been recorded in European countries like the U.K. (1,076), Germany (874), Spain (800), France (440), Portugal (391) and the Netherlands (257). A notable cluster has also been documented in Canada (276). Many more cases are suspected, but not confirmed, and official tallies likely underestimate the number of cases, particularly in areas with poor testing infrastructure. This data also does not capture the extent of the much longer monkeypox outbreak that has been ongoing in some African countries, notably Nigeria, from earlier this year and as an endemic disease for decades. Despite seeing more infections over a much longer time period, these countries have not received any monkeypox vaccines.

Big Number

1.6 million. That’s how many doses of the Jynneos vaccine the federal government will make available this year, HHS said, including the nearly 300,000 doses already released or expected in coming weeks. HHS said it expects an additional 750,000 doses will be made available over summer and another 500,000 throughout fall. As of late June, HHS said it had already distributed more than 9,000 doses of vaccine.

What To Watch For

Vaccine supplies and changing eligibility. There is not nearly enough of the Jynneos vaccine available in the federal stockpile for everyone who might want it. There have already been supply issues in areas that launched their own initiatives ahead of the national campaign. In Washington, D.C., and New York City, for example, vaccine supplies reportedly ran out less than a day after they kick started their immunization drives. The issue could intensify if eligibility guidelines expand or the outbreak grows. Officials have acknowledged the limited supply of vaccines and suggested the national strategy may change once supplies are on firmer footing. A stronger vaccine supply chain could mean a shift to vaccinating people before they have been exposed to monkeypox, CDC director Dr. Rochelle Walensky said at a press briefing.

Tangent

While the Jynneos vaccine may be in short supply, HHS officials told Forbes there is enough smallpox vaccine in federal stockpiles to immunize the entire U.S. population. The precise breakdown is not clear, but a significant portion consists of the ACAM vaccine. There is also a third shot, the Aventis Pasteur Smallpox Vaccine (APSV), which has similar setbacks to ACAM and has not been cleared for use. The nature of the ACAM vaccine poses some unique challenges if Jynneos supplies are insufficient. Aside from the noted risk of potentially serious side effects, the vaccine uses a related virus, vaccinia, to induce a sore or pock in the recipient, usually on the upper arm. On rare occasions, this can spread elsewhere on the body or even to other people and can leave a distinctive scar. The use of live virus limits who it can be given to, notably excluding people with compromised immune systems, those in close contact with such people and pregnant people. As monkeypox cases have been reported disproportionately among men who have sex with men, this poses a potentially significant problem, as rates of people living with HIV are higher in that community. An additional issue arises with how the ACAM shot is used. It relies on an old form of immunization featuring a distinct technique and special bifurcated needle, which most practicing clinicians are unlikely to have much, if any, experience using.

Further Reading

LGBTQ Pride events offer a make-or-break moment for monkeypox (NBC News)

What To Know About How Monkeypox Spreads—And Whether You Should Wear A Mask (Forbes)

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Health Canada approves updated Moderna COVID-19 vaccine

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TORONTO – Health Canada has authorized Moderna’s updated COVID-19 vaccine that protects against currently circulating variants of the virus.

The mRNA vaccine, called Spikevax, has been reformulated to target the KP.2 subvariant of Omicron.

It will replace the previous version of the vaccine that was released a year ago, which targeted the XBB.1.5 subvariant of Omicron.

Health Canada recently asked provinces and territories to get rid of their older COVID-19 vaccines to ensure the most current vaccine will be used during this fall’s respiratory virus season.

Health Canada is also reviewing two other updated COVID-19 vaccines but has not yet authorized them.

They are Pfizer’s Comirnaty, which is also an mRNA vaccine, as well as Novavax’s protein-based vaccine.

This report by The Canadian Press was first published Sept. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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These people say they got listeria after drinking recalled plant-based milks

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TORONTO – Sanniah Jabeen holds a sonogram of the unborn baby she lost after contracting listeria last December. Beneath, it says “love at first sight.”

Jabeen says she believes she and her baby were poisoned by a listeria outbreak linked to some plant-based milks and wants answers. An investigation continues into the recall declared July 8 of several Silk and Great Value plant-based beverages.

“I don’t even have the words. I’m still processing that,” Jabeen says of her loss. She was 18 weeks pregnant when she went into preterm labour.

The first infection linked to the recall was traced back to August 2023. One year later on Aug. 12, 2024, the Public Health Agency of Canada said three people had died and 20 were infected.

The number of cases is likely much higher, says Lawrence Goodridge, Canada Research Chair in foodborne pathogen dynamics at the University of Guelph: “For every person known, generally speaking, there’s typically 20 to 25 or maybe 30 people that are unknown.”

The case count has remained unchanged over the last month, but the Public Health Agency of Canada says it won’t declare the outbreak over until early October because of listeria’s 70-day incubation period and the reporting delays that accompany it.

Danone Canada’s head of communications said in an email Wednesday that the company is still investigating the “root cause” of the outbreak, which has been linked to a production line at a Pickering, Ont., packaging facility.

Pregnant people, adults over 60, and those with weakened immune systems are most at risk of becoming sick with severe listeriosis. If the infection spreads to an unborn baby, Health Canada says it can cause miscarriage, stillbirth, premature birth or life-threatening illness in a newborn.

The Canadian Press spoke to 10 people, from the parents of a toddler to an 89-year-old senior, who say they became sick with listeria after drinking from cartons of plant-based milk stamped with the recalled product code. Here’s a look at some of their experiences.

Sanniah Jabeen, 32, Toronto

Jabeen says she regularly drank Silk oat and almond milk in smoothies while pregnant, and began vomiting seven times a day and shivering at night in December 2023. She had “the worst headache of (her) life” when she went to the emergency room on Dec. 15.

“I just wasn’t functioning like a normal human being,” Jabeen says.

Told she was dehydrated, Jabeen was given fluids and a blood test and sent home. Four days later, she returned to hospital.

“They told me that since you’re 18 weeks, there’s nothing you can do to save your baby,” says Jabeen, who moved to Toronto from Pakistan five years ago.

Jabeen later learned she had listeriosis and an autopsy revealed her baby was infected, too.

“It broke my heart to read that report because I was just imagining my baby drinking poisoned amniotic fluid inside of me. The womb is a place where your baby is supposed to be the safest,” Jabeen said.

Jabeen’s case is likely not included in PHAC’s count. Jabeen says she was called by Health Canada and asked what dairy and fresh produce she ate – foods more commonly associated with listeria – but not asked about plant-based beverages.

She’s pregnant again, and is due in several months. At first, she was scared to eat, not knowing what caused the infection during her last pregnancy.

“Ever since I learned about the almond, oat milk situation, I’ve been feeling a bit better knowing that it wasn’t something that I did. It was something else that caused it. It wasn’t my fault,” Jabeen said.

She’s since joined a proposed class action lawsuit launched by LPC Avocates against the manufacturers and sellers of Silk and Great Value plant-based beverages. The lawsuit has not yet been certified by a judge.

Natalie Grant and her seven year-old daughter, Bowmanville, Ont.

Natalie Grant says she was in a hospital waiting room when she saw a television news report about the recall. She wondered if the dark chocolate almond milk her daughter drank daily was contaminated.

She had brought the girl to hospital because she was vomiting every half hour, constantly on the toilet with diarrhea, and had severe pain in her abdomen.

“I’m definitely thinking that this is a pretty solid chance that she’s got listeria at this point because I knew she had all the symptoms,” Grant says of seeing the news report.

Once her daughter could hold fluids, they went home and Grant cross-checked the recalled product code – 7825 – with the one on her carton. They matched.

“I called the emerg and I said I’m pretty confident she’s been exposed,” Grant said. She was told to return to the hospital if her daughter’s symptoms worsened. An hour and a half later, her fever spiked, the vomiting returned, her face flushed and her energy plummeted.

Grant says they were sent to a hospital in Ajax, Ont. and stayed two weeks while her daughter received antibiotics four times a day until she was discharged July 23.

“Knowing that my little one was just so affected and how it affected us as a family alone, there’s a bitterness left behind,” Grant said. She’s also joined the proposed class action.

Thelma Feldman, 89, Toronto

Thelma Feldman says she regularly taught yoga to friends in her condo building before getting sickened by listeria on July 2. Now, she has a walker and her body aches. She has headaches and digestive problems.

“I’m kind of depressed,” she says.

“It’s caused me a lot of physical and emotional pain.”

Much of the early days of her illness are a blur. She knows she boarded an ambulance with profuse diarrhea on July 2 and spent five days at North York General Hospital. Afterwards, she remembers Health Canada officials entering her apartment and removing Silk almond milk from her fridge, and volunteers from a community organization giving her sponge baths.

“At my age, 89, I’m not a kid anymore and healing takes longer,” Feldman says.

“I don’t even feel like being with people. I just sit at home.”

Jasmine Jiles and three-year-old Max, Kahnawake Mohawk Territory, Que.

Jasmine Jiles says her three-year-old son Max came down with flu-like symptoms and cradled his ears in what she interpreted as a sign of pain, like the one pounding in her own head, around early July.

When Jiles heard about the recall soon after, she called Danone Canada, the plant-based milk manufacturer, to find out if their Silk coconut milk was in the contaminated batch. It was, she says.

“My son is very small, he’s very young, so I asked what we do in terms of overall monitoring and she said someone from the company would get in touch within 24 to 48 hours,” Jiles says from a First Nations reserve near Montreal.

“I never got a call back. I never got an email”

At home, her son’s fever broke after three days, but gas pains stuck with him, she says. It took a couple weeks for him to get back to normal.

“In hindsight, I should have taken him (to the hospital) but we just tried to see if we could nurse him at home because wait times are pretty extreme,” Jiles says, “and I don’t have child care at the moment.”

Joseph Desmond, 50, Sydney, N.S.

Joseph Desmond says he suffered a seizure and fell off his sofa on July 9. He went to the emergency room, where they ran an electroencephalogram (EEG) test, and then returned home. Within hours, he had a second seizure and went back to hospital.

His third seizure happened the next morning while walking to the nurse’s station.

In severe cases of listeriosis, bacteria can spread to the central nervous system and cause seizures, according to Health Canada.

“The last two months have really been a nightmare,” says Desmond, who has joined the proposed lawsuit.

When he returned home from the hospital, his daughter took a carton of Silk dark chocolate almond milk out of the fridge and asked if he had heard about the recall. By that point, Desmond says he was on his second two-litre carton after finishing the first in June.

“It was pretty scary. Terrifying. I honestly thought I was going to die.”

Cheryl McCombe, 63, Haliburton, Ont.

The morning after suffering a second episode of vomiting, feverish sweats and diarrhea in the middle of the night in early July, Cheryl McCombe scrolled through the news on her phone and came across the recall.

A few years earlier, McCombe says she started drinking plant-based milks because it seemed like a healthier choice to splash in her morning coffee. On June 30, she bought two cartons of Silk cashew almond milk.

“It was on the (recall) list. I thought, ‘Oh my God, I got listeria,’” McCombe says. She called her doctor’s office and visited an urgent care clinic hoping to get tested and confirm her suspicion, but she says, “I was basically shut down at the door.”

Public Health Ontario does not recommend listeria testing for infected individuals with mild symptoms unless they are at risk of developing severe illness, such as people who are immunocompromised, elderly, pregnant or newborn.

“No wonder they couldn’t connect the dots,” she adds, referencing that it took close to a year for public health officials to find the source of the outbreak.

“I am a woman in my 60s and sometimes these signs are of, you know, when you’re vomiting and things like that, it can be a sign in women of a bigger issue,” McCombe says. She was seeking confirmation that wasn’t the case.

Disappointed, with her stomach still feeling off, she says she decided to boost her gut health with probiotics. After a couple weeks she started to feel like herself.

But since then, McCombe says, “I’m back on Kawartha Dairy cream in my coffee.”

This report by The Canadian Press was first published Sept. 16, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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B.C. mayors seek ‘immediate action’ from federal government on mental health crisis

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VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.

Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.

In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.

The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.

Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”

Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”

This report by The Canadian Press was first published Sept. 16, 2024

The Canadian Press. All rights reserved.

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