For New York musician Erica Mancini, COVID-19 made repeat performances.
March 2020. Last December. And again this May.
“I’m bummed to know that I might forever just get infected,” said the 31-year-old singer, who is vaccinated and boosted. “I don’t want to be getting sick every month or every two months.”
But medical experts warn that repeat infections are getting more likely as the pandemic drags on and the virus evolves – and some people are bound to get hit more than twice. Emerging research suggests that could put them at higher risk for health problems.
There’s no comprehensive data on people getting COVID-19 more than twice, although some states collect information on reinfections in general. New York, for example, reports around 277,000 reinfections out of 5.8 million total infections during the pandemic. Experts say actual numbers are much higher because so many home COVID-19 tests go unreported.
Several public figures have recently been reinfected. U.S. Health and Human Services Secretary Xavier Becerra and Canadian Prime Minister Justin Trudeau said they got COVID-19 for the second time, and U.S. Sen. Roger Wicker of Mississippi said he tested positive a third time. All reported being fully vaccinated, and Trudeau and Becerra said they’d gotten booster shots.
“Until recently, it was almost unheard of, but now it’s becoming more commonplace” to have COVID-19 two, three or even four times, said Dr. Eric Topol, head of Scripps Research Translational Institute. “If we don’t come up with better defenses, we’ll see much more of this.”
Why? Immunity from past infections and vaccination wanes over time, experts say, leaving people vulnerable.
Also, the virus has evolved to be more contagious. The risk of reinfection has been about seven times higher with omicron variants compared with when delta was most common, research out of the United Kingdom shows. Scientists believe the omicron mutants now causing the vast majority of U.S. cases are particularly adept at getting around immunity from vaccination or past infection, especially infection during the original omicron wave. U.S. health officials are mulling whether to modify boosters to better match recent changes in the coronavirus.
The first time Mancini got COVID-19, she and her fiance spiked fevers and were sick for two weeks. She couldn’t get tested at the time and but had an antibody test a couple months later that showed she had been infected.
“It was really scary because it was so new and we just knew that people were dying from it,” said Mancini. “We were really sick. I hadn’t been sick like that in a long time.”
She got vaccinated with Pfizer in the spring of 2021 and thought she was protected from another infection, especially since she was sick before. But though such “hybrid immunity” can provide strong protection, it doesn’t guarantee someone won’t get COVID-19 again.
Mancini’s second bout, which happened during the huge omicron wave, started with a sore throat. She tested negative at first, but still felt sick driving to a gig four hours away. So she ducked into a Walgreens and did a rapid test in her car. It was positive, she said, “so I just turned the car around and drove back to Manhattan.”
This bout proved milder, with “the worst sore throat of my life,” a stuffy nose, sneezing and coughing.
The most recent illness was milder still, causing sinus pressure, brain fog, a woozy feeling and fatigue. That one, positive on a home test and confirmed with a PCR test, hit despite her Moderna booster shot.
Mancini doesn’t have any known health conditions that could put her at risk for COVID. She takes COVID-19 precautions like masking in the grocery store and on the subway. But she usually doesn’t wear a mask on stage.
“I’m a singer, and I’m in these crowded bars and I’m in these little clubs, some of which don’t have a lot of ventilation, and I’m just around a lot of people,” said Mancini, who also plays accordion and percussion. “That’s the price that I’ve paid for doing a lot throughout these past few years. It’s how I make my living.”
Scientists don’t know exactly why some people get reinfected and others don’t, but believe several things may be at play: health and biology, exposure to particular variants, how much virus is spreading in a community, vaccination status and behavior. British researchers found people were more likely to be reinfected if they were unvaccinated, younger or had a mild infection the first time.
Scientists also aren’t sure how soon someone can get infected after a previous bout. And there’s no guarantee each infection will be milder than the last.
“I’ve seen it go both ways,” said Dr. Wesley, a pathologist at Houston Methodist. In general, though, breakthrough infections that happen after vaccination tend to be milder, he said.
Doctors said getting vaccinated and boosted is the best protection against severe COVID-19 and death, and there’s some evidence it also lessens the odds of reinfection.
At this point, there haven’t been enough documented cases of multiple reinfections “to really know what the long-term consequences are,” said Dr. Peter Hotez, dean of Baylor University’s tropical medicine school.
But a large, new study using data from the U.S. Department of Veterans Affairs, which hasn’t yet been reviewed by scientific peers, provides some insight, finding that reinfection increases the risk for serious outcomes and health problems such as lung issues, heart disorders and diabetes compared with a first infection. The risks were most pronounced when someone was ill with COVID-19, but persisted past the acute illness as well.
After Mancini’s last bout, she dealt with dizziness, headaches, insomnia and sinus issues, though she wondered if that was more due to her busy schedule. In a recent week, she had 16 shows and rehearsals – and has no room for another COVID-19 reprise.
“It was not fun,” she said. “I don’t want to have it again.”
Why it's important to tell people that monkeypox is predominantly affecting gay and bisexual men – Medical Xpress
For decades, several African countries have experienced ongoing outbreaks of MPXV, driven primarily by contact with animals and transmission within households. However, before last year, most people in Europe and North America had never even heard of the disease. That was until the current outbreak among gay, bisexual and other men who have sex with men.
Debates over the epidemiology of MPXV
Over the past several months, a controversy has raged about whether it’s OK to say that the current MPXV outbreak is primarily affecting gay and bisexual men, and that it is primarily being spread through close personal contact, such as sex.
As a social and behavioral epidemiologist working with marginalized populations, including gay and bisexual men, I believe it’s important that people know that sexual and gender minority men are the primary victims of this MPXV outbreak. I believe this knowledge will help us end the outbreak before it bridges into other communities.
For reference, more than 90% of cases in non-endemic countries have been transmitted through intimate sexual contact, and the vast majority of cases are among gay men. Very few cases are linked to community transmission.
While these statistics are undisputed, some have feared that identifying sexual behavior as the primary cause of current MPXV transmission would dampen the public health response. Others have warned that connecting MPXV to an already stigmatized community will worsen stigma towards gay sex.
Non-sexual transmission is possible, and a considerable threat
However, months into the current outbreak, we have not seen these routes emerge as important pathways of transmission. This may be due to changes in the fundamental transmission dynamic of MPXV or due to enhanced cleaning procedures implemented in response to COVID-19 in places such as gyms and restrooms.
Why it’s crucial to know MPXV affects gay and bisexual men
Informing the public about MPXV is important because public opinion plays an important role in shaping public health policies, such as who gets access to vaccines and what interventions are used to stop disease transmission.
A recent study conducted by my team aimed to demonstrate the importance of public health education by asking Canadians to participate in a discrete choice experiment.
We asked participants to choose between two hypothetical public health programs across eight head-to-head comparisons. Descriptions for each hypothetical program identified the number of years of life gained by patients, the health condition it addressed and the population it was tailored for.
From our analyses of this data, we learned a lot about how the public wants public health dollars to be spent and how their knowledge and bias shapes these preferences. There were five major takeaways:
- People preferred interventions that added more years to participants’ life expectancy. In fact, for one year of marginal life gained, there was a 15% increase in the odds that participants chose that program.
- We found that people tended to favor interventions that focused on treatment rather than prevention. While this approach is emotionally intuitive, large bodies of evidence suggest that it is more cost-effective to prevent disease than to treat it. As the old saying goes: An ounce of prevention is worth a pound of cure.
- People generally preferred interventions for common chronic diseases—such as heart disease, diabetes and cancer—and were less likely to favor interventions for behavior-related conditions, such as sexually transmitted infections.
- People generally preferred programs focused on the general population as opposed to those tailored for key marginalized populations. In fact, people were least likely to prefer interventions tailored for sexual and gender minorities.
- The bias against behavioral interventions and those tailored for key populations was overcome when the programs addressed a health condition that was widely understood to be linked to the population the program was tailored to. For example, people were more likely to support interventions for sexually transmitted infections when these interventions were tailored for people engaged in sex work or for gay and bisexual men.
This study highlights why it is important to educate the public about health inequities. People are smarter, more pragmatic, and more compassionate than we give them credit for. If we take the time to share evidence with them about the challenges that stigmatized communities face, they will be more willing to support policies and efforts to address these challenges.
Ending MPXV quickly is critical, especially since the virus has the potential to evolve in ways that could make the disease more infectious. Protecting gay and bisexual men first, protects everyone.
We should, of course, always be aware of the potential harms and the corrosive effects of stigma. However, in public health, honesty really is the best policy.
Why it’s important to tell people that monkeypox is predominantly affecting gay and bisexual men (2022, August 15)
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How Worried Should You Be About New Reports on Polio? – The Suburban Newspaper
MONDAY, Aug. 15, 2022 (HealthDay News) — Poliovirus detected in New York City wastewater last week put public health officials on high alert, as it indicates the potentially paralyzing virus is circulating widely in the area.
But infectious disease experts say there’s no need for families of fully vaccinated children to panic.
“The inactivated polio vaccine is part of the standard childhood immunization schedule, so for most families, it really shouldn’t be a concern,” said Dr. Gail Shust, a pediatric infectious diseases specialist at NYU Langone Hassenfeld Children’s Hospital in New York City. “It happens to be an extremely effective vaccine.”
At this point, there’s also no need to seek out a polio booster for a fully vaccinated child or adult, she added.
“For kids who’ve gone through the normal vaccination schedule in the United States, there is zero reason for them to get a booster,” Shust said.
Instead, concern should be focused on communities with clusters of unvaccinated children and adults, because those are the people at risk for polio, experts say.
A young man in Rockland County, N.Y. — about 45 minutes northwest of the Bronx — was diagnosed in late July with the first case of paralytic polio identified in the United States in nearly a decade.
Subsequently, poliovirus was detected in the sewage of both Rockland County and neighboring Orange County, indicating community transmission of the virus.
Polio can lead to permanent paralysis of the arms and legs. It also can be fatal if paralysis occurs in muscles used to breathe or swallow.
About 1 in 25 people infected with poliovirus will get viral meningitis, and about 1 in 200 become paralyzed.
“A lot of people who get infected with poliovirus, they’re asymptomatic,” Shust said. “It’s entirely possible there are other cases that haven’t been diagnosed and there are more people infected than we’re aware of.”
Children should receive at least three doses of polio vaccine by 18 months of age, with a fourth dose delivered between ages 4 and 6, according to the U.S. Centers for Disease Control and Prevention.
New York state health officials said they are particularly concerned by neighborhoods where fewer than 70% of children between 6 months and 5 years of age have received at least three doses of polio vaccine.
About 86% of New York City kids have gotten all three doses, but in Rockland County the rate is just over 60%, and in Orange County the rate is just under 59%, state health officials said.
Statewide, nearly 79% of children have received three doses by their second birthday, officials said.
Poliovirus also has been identified in London’s wastewater, and health officials in the United Kingdom have decided to offer polio vaccine boosters to children.
“They’re starting to do that in London. We haven’t said that that’s necessary,” said Dr. William Schaffner, medical director of the Bethesda, Md.-based National Foundation for Infectious Diseases.
“The only time we’ve given boosters in the past is when someone who was vaccinated as a child then decided to travel to some developing country where there was a lot of polio, and we said, OK, to be on the safe side, to be prudent, we’ll give you a booster before you go,” Schaffner said. “It wasn’t really thought to be necessary, but it was a prudent, extra, easy, safe thing to do.”
Poliovirus lives in the intestinal tract and can be transmitted through stool, so wastewater surveillance is a logical way to track it, said Vincent Racaniello, a professor of microbiology and immunology at Columbia University in New York City.
“These viruses have probably been in the sewage for years,” he said. “We’ve just never looked for them, and now we started to look because of this case. And I would say the more we look, we’re going to find it all over the U.S., especially in major cities.”
These strains of poliovirus likely entered the United States from people in other countries who have had the oral polio vaccine, Racaniello and Schaffner said.
The oral vaccine was the first developed and the easiest to administer, so it is still used as part of the World Health Organization‘s polio eradication efforts around the globe, the experts said. But, Racaniello said, it’s an infectious vaccine, meaning it contains a weakened version of the virus itself.
“It reproduces in your intestines, and you shed it — that’s the virus in the sewage,” he said. “That virus gets around very easily, and it can cause polio even though it’s a vaccine virus. After it passes through the human gut, it can reacquire the ability to cause polio.”
The United States stopped using the oral vaccine in 2000, after the U.S. Preventive Services Task Force decided that the risk of even a few incidental cases of polio was too great, Schaffner said.
“Each year we had about 4 million births and we had somewhere between six and 10 cases of vaccine-associated poliomyelitis,” he said. “We were giving a very small number of children and adults paralysis by using the oral vaccine.”
The U.S. now exclusively uses a four-dose inactivated polio vaccine.
“The virus is killed. There’s no possibility it can multiply. It cannot mutate. It cannot cause paralysis,” Schaffner said. “But as an inactivated viral vaccine, it has to be given by needle and syringe, which is more cumbersome and considerably more expensive and, of course, added to the number of inoculations little children were getting, which didn’t make moms too happy.”
Schaffner said it’s “notable” that vaccine-related poliovirus is circulating in the United States.
“We wouldn’t have expected it to be widely disseminated, so we’re just finding there’s even more intercontinental transmission of these oral polio vaccine viruses than we thought,” Schaffner said.
“If you had asked me before this case, I would have said that unless somebody has just gone abroad or had a visitor from abroad, you wouldn’t find it here because we’re not using [the oral vaccine] in the United States,” Schaffner added. “But we may be a smaller global community even than I thought.”
The only true protection is vaccination, and Racaniello hopes that wastewater surveillance data will help persuade the vaccine-hesitant to go ahead and get their jabs.
“Maybe they thought there was no poliovirus in the U.S., right? And so they say I don’t need to get vaccinated,” Racaniello said. “And so now we can show them that there is. In fact, I think we should do more surveillance of wastewater and show people, look, it’s in every major metropolitan city. You better get vaccinated.”
The U.S. Centers for Disease Control and Prevention has more about polio.
SOURCES: Gail Shust, MD, pediatric infectious diseases specialist, NYU Langone Hassenfeld Children’s Hospital, New York City; William Schaffner, MD, medical director, National Foundation for Infectious Diseases, Bethesda, Md.; Vincent Racaniello, PhD, Higgins Professor, Department of Microbiology and Immunology, Columbia University, New York City
Monkeypox outbreak 'shows signs of slowing' in Britain, health officials say – CBC News
British health officials say the monkeypox outbreak across the country “shows signs of slowing,” but that it’s still too soon to know if the decline will be maintained.
In a statement on Monday, the Health Security Agency said authorities are reporting about 29 new monkeypox infections every day, compared to about 52 cases a day during the last week in June. In July, officials estimated the outbreak was doubling in size about every two weeks. To date, the U.K. has recorded more than 3,000 cases of monkeypox, with more than 70 per cent of cases in London.
The agency also said more than 27,000 people have been immunized with a vaccine designed against smallpox, a related disease.
“These thousands of vaccines, administered by the [National Health Service] to those at highest risk of exposure, should have a significant impact on the transmission of the virus,” the agency said.
It said the vast majority of cases were in men who are gay, bisexual or have sex with other men and that vaccines were being prioritized for them and for their closest contacts and health workers.
Last month, Britain downgraded its assessment of the monkeypox outbreak after seeing no signs of sustained monkeypox transmission beyond the sexual networks of men who have sex with men; 99 per cent of infections in the U.K. are in men.
British authorities said they bought 150,000 doses of vaccine made by Bavarian Nordic, the world’s only supplier. The first 50,000 doses have already been rolled out or will be shared soon with clinics across the country, and the next 100,000 vaccines are expected to be delivered in September.
Canada will use wastewater testing to track disease
The Public Health Agency of Canada (PHAC) has repeatedly declined to provide the number of monkeypox vaccines Canada has in the national stockpile, citing security concerns, despite providing that number for other vaccines and other countries sharing that information.
Chief Public Health Officer Dr. Theresa Tam said during a news conference Friday that Canada has so far deployed 99,000 vaccines to provinces and territories.
She said that it was “too soon to tell” if cases were slowing in Canada, although there may be “some early signs” that they are not increasing at the same rate as during the beginning of the outbreak.
There are now 1,059 monkeypox cases across Canada, with the bulk of them in Ontario and Quebec, and Tam said Canada will soon move to testing wastewater in different regions of the country to better track the spread of the disease, building off the infrastructure developed to monitor COVID-19 during the pandemic.
Anyone can become infected with monkeypox through multiple forms of close, physical contact with an infected person’s lesions, including skin-to-skin contact such as touching or sex, as well as through respiratory droplets in a conversation, or even being exposed to contaminated clothes or bedding.
Most people recover without needing treatment, but the lesions can be extremely painful and more severe cases can result in complications including brain inflammation and death.
Globally, there have been more than 31,000 cases of monkeypox reported in nearly 90 countries. Last month, the World Health Organization declared the outbreak to be a global emergency and officials in the U.S. have classified the epidemic there as a national emergency, but Canada has not followed suit.
Outside of Africa, 98 per cent of cases are in men who have sex with men. With only a limited global supply of vaccines, authorities are racing to stop monkeypox before it becomes entrenched as a new disease.
Tam said more than 99 per cent of monkeypox cases in Canada are in men and the median age of those infected is 35. Late last month, PHAC urged gay and bisexual men to practise safe sex and limit the number of sexual partners, in an effort to slow the spread of the virus among sexual networks.
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