POST 259. June, 2022. Monkeypox. ”If HIV and Covid-19 were wake-up calls for the government to prioritize public health, monkeypox shows the consequences of hitting the snooze button too many times. HIV showed the importance of creating an infrastructure of health care workers who can provide approachable, competent care for stigmatized infections. Covid-19 revealed the make-or-break nature of coordinated logistics and communications.”

for links to POSTS 1-259 in chronological order, highlight and click on

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‘The World Health Organization will reconvene an emergency committee on monkeypox due to the “evolving situation,” Director-General Dr. Tedros Adhanom Ghebreyesus said Wednesday—this after the organization declared Saturday that the virus wasn’t an international public health emergency “at present.”

The committee “advised that I should reconvene them quickly based on the evolving situation, which I will do,” Adhanom Ghebreyesus said at a press availability, adding that the virus is potentially poised to “move into high-risk groups including children, the immunocompromised, and pregnant women.”

“We are starting to see this with several children already infected,” he said.

The WHO did not immediately respond to an email inquiry regarding when the committee might meet.

Adhanom Ghebreyesus and the committee on Saturday acknowledged the situation should be “closely monitored,” and the decision not to declare an emergency be “reviewed after a few weeks,” noting the global outbreak’s “emergency nature” and the “intense response efforts” required to control it.

One or more of the following conditions should trigger a reassessment, they said:

Evidence of an increased growth rate in cases in the next three weeks.

Cases identified among sex workers.

An increase in cases in vulnerable groups like immunosuppressed individuals, those with poorly controlled HIV infection, pregnant women, and children.

An increase in morbidity or mortality and hospitalization rates.

Evidence of re-entry into the animal population.

Evidence of significant mutation affecting how the disease presents itself.

Evidence of clusters of cases of different clades with more significant virulence detected outside of West and Central Africa.

The news comes less than 24 hours after the White House announced the first phase of its national monkeypox vaccine strategy, saying it would release tens of thousands of doses “immediately” from the Strategic National Stockpile—with millions more on their way the coming weeks and months.”  (A)

BEFORE THIS WHO ANNOUNCEMENT TO RECONVENE THE EMERGENCY COMMITTEE ON MONKEYPOX 

“The World Health Organization on Saturday declined to declare the unprecedented monkeypox outbreak that has spread around the world a public health emergency as of now…

Despite the PHEIC decision, WHO Director-General Tedros Adhanom Ghebreyesus sought to underscore the seriousness of the threat, noting the convening an emergency committee in the first place was a sign of that. In a statement, Tedros noted that the outbreak “is clearly an evolving health threat” that “requires our collective attention and coordinated action now.” But he said that the committee that advised him on the issue decided that the outbreak did not yet constitute a PHEIC, and he agreed.

“What makes the current outbreak especially concerning is the rapid, continuing spread into new countries and regions and the risk of further, sustained transmission into vulnerable populations including people that are immunocompromised, pregnant women, and children,” Tedros said in the statement. “That is why it is urgent that all member states, communities and individuals take the recommendations of the committee for stepped-up surveillance, improved diagnostics community engagement and risk communication, and the appropriate use of therapeutics, vaccines, and public health measures including contact tracing and isolation.”

In a summary of the committee’s discussion, the WHO said the group acknowledged that facets of the outbreak are unusual and that the response clearly necessitated international efforts, but that “while a few members expressed differing views,” the committee reached a consensus that the outbreak did not amount to a PHEIC. The committee said it should reconsider the decision depending on whether cases accelerate in the next few weeks; more countries start reporting cases; if there are upticks in cases in other groups of people, including sex workers; and if there are any signs the virus is becoming more transmissible or starts causing more severe illness.

A PHEIC (pronounced like “fake”) describes an extraordinary or unusual health threat that poses risks to other places through international spread and requires a coordinated response. PHEICs are typically declared when urgent international action is needed…

In the past, monkeypox infections seen outside the countries where the virus is endemic have typically been imported cases or have involved limited household transmission. This is the first time the virus has started circulating more widely in other countries.

Gregg Gonsalves, an associate professor of epidemiology at Yale School of Public Health, disagreed with WHO’s decision, which he called a “punt.” He said he felt that the criteria had been met and that a PHEIC declaration could have pushed public health authorities to step up their response and coordinate better across countries.

Gonsalves served as an adviser to the emergency committee, but did not have a say in whether to recommend a PHEIC be declared.

“An expanding outbreak of this disease is not good for anyone,” he said, noting that African public health officials have been saying for years that monkeypox needs more global attention. “Right now, we are not on top of our game with monkeypox, at least in the United States,” he added, pointing to the patchy surveillance system and limited vaccine deployment.”  (B)

“The overall risk is assessed as moderate at global level considering this is the first time that cases and clusters are reported concurrently in five WHO Regions. At the regional level, the risk is considered to be high in the European Region due to its report of a geographically widespread outbreak involving several newly-affected countries, as well as a somewhat atypical clinical presentation of cases. In other WHO Regions, the risk is considered moderate with consideration for epidemiological patterns, possible risk of importation of cases and capacities to detect cases and respond to the outbreak.  In newly-affected countries, this is the first time that cases have mainly, but not exclusively, been confirmed among men who have had recent sexual contact with a new or multiple male* partners… 

The risk is also represented by the difficulties involved in widespread lack of availability of laboratory diagnostics, antivirals and vaccines and as well as in ensuring adequate biosafety and biosecurity in diagnostic, clinical and referral laboratories everywhere that cases have occurred.

A large part of the population is vulnerable to monkeypox virus, as smallpox vaccination, which is expected to provide some protection against monkeypox has been discontinued since the 1980s. Only a relatively small number of military, frontline health professionals and laboratory workers have been vaccinated against smallpox in recent years. A third-generation vaccine MVA received authorization of use by the European Medicines Agency for smallpox. The authorization of use provided by Health Canada and the United States Food and Drug Administration (FDA) includes an indication for the prevention of monkeypox. An antiviral agent, tecovirimat, has been approved by the European Medicines Agency, Health Canada, and the United States FDA for the treatment of smallpox. It is also approved for use in the European Union for the treatment of monkeypox.

WHO urges all Member States, health authorities at all levels, clinicians, health and social sector partners, and academic, research and commercial partners to respond quickly to contain local spread and, by extension, the multi-country outbreak of monkeypox. Rapid action must be taken before the virus can be allowed to establish itself as a human pathogen with efficient person-to-person transmission in areas that have previously reported monkeypox, as well as in newly affected areas.” (C) 

“The US Centers for Disease Control and Prevention announced on Tuesday the activation of its Emergency Operations Center (EOC) to respond to the US monkeypox outbreak.

The activation of the EOC “allows the agency to further increase operational support for the response to meet the outbreak’s evolving challenges,” the agency said in a news release.

This facility is currently activated for Covid-19 and is where experts monitor information on other public health emergencies, such as hurricanes, earthquakes and oil spills.

According to CDC’s webpage, the center works to outline a structure of response from the government and alongside non-government actors in emergency response.

Most recent data from the CDC show at least 244 probable or confirmed cases of monkeypox in the US.” (D)

“Nearly 60,000 doses of the Jynneos vaccine—the safer of two available—will be deployed from the stockpile, and nearly 250,000 additional doses will be made available in the coming weeks in an effort to slow spread of the disease. In the coming months, another 1.6 million doses will be released, federal health officials said on a Tuesday evening press call.

Individuals at high risk of contracting monkeypox and areas with the highest number of cases will be prioritized, officials added.

“While monkeypox poses minimal risk to most Americans, we are doing everything we can to offer vaccines to those at high-risk of contracting the virus,” U.S. Department of Health and Human Services Secretary Xavier Becerra said in a Tuesday evening news release. “This new strategy allows us to maximize the supply of currently available vaccines and reach those who are most vulnerable to the current outbreak.”” (A)

“Clinics nationwide will begin offering vaccinations against monkeypox to anyone who may have been exposed to the virus, federal health officials announced on Tuesday.

Until now, immunizations were offered only to people with a known exposure.

States will receive doses of a safer and newer monkeypox vaccine called Jynneos from the federal stockpile, based on the number of cases and the proportion of the state’s population at risk for severe disease, the officials said at a news briefing.

State health authorities may also request supplies of an older vaccine developed for smallpox, which is believed to protect against monkeypox, as well.

The Department of Health and Human services will provide 56,000 doses of the Jynneos vaccine immediately and an additional 240,000 doses in the coming weeks. Another 750,000 doses are expected to become available over the summer, and a total of 1.6 million doses by the end of this year.

“This vaccine currently has some limitations on supply, and for this reason the administration’s current vaccine strategy prioritizes making it available to those who need it most urgently,” Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said.

The older smallpox vaccine, called ACAM2000, is associated with harsh side effects, including death, in people who are immunocompromised, pregnant women and older adults.

The new vaccination plan drew quick criticism from experts, who said the campaign was too small and slow to make an impact. The longer it takes to contain the monkeypox outbreak, the greater the chances that the virus will become entrenched in the United States, particularly among men who have sex with men, researchers warned.

“Many of us are concerned that the window is closing for us to be able to eliminate monkeypox,” said Dr. Celine Gounder, an infectious disease expert and editor at large for public health at Kaiser Health News.

“If we don’t start vaccinating more quickly and broadly, we’re going to have a very difficult time containing this,” she said. Ideally, tests and vaccines for monkeypox could have been offered at L.G.B.T.Q. Pride events across the country in order to reach men at high risk of contracting the virus, Dr. Gounder added.

Some experts said the plan was also unfair to men at risk who will not have access to the Jynneos vaccine, especially those who have H.I.V. and cannot safely take the older smallpox vaccine.

“There won’t be enough to meet the need,” said Elizabeth Finley, director of communications for the National Coalition of STD Directors. “Plus, without better testing capacity, a strategy based on contacts with a positive case falls flat.”…

New York City, which had identified 55 cases of monkeypox as of Tuesday, had 1,000 doses of the Jynneos vaccine at hand. The city’s health department began administering the vaccines at a single clinic in Chelsea, where the clientele is largely affluent white men who have sex with men.

The city offered the first doses at noon on June 23. Less than two hours later, officials announced that the clinic could no longer accommodate walk-ins and had booked appointments through June 27. As of Tuesday, the city was still waiting for more vaccine doses to become available.”  (E)

“The Biden administration announced steps to beef up its response to monkeypox on Tuesday, detailing plans to offer more vaccines and more tests to people who are most at risk of getting it — including men who have sex with men and their partners.

The move comes after pressure from states, who have been pushing the administration to release more doses of monkeypox vaccine from the Strategic National Stockpile managed by the Office of the Assistant Secretary for Preparedness and Response at the Department of Health and Human Services. Critics have also charged that the United States is not offering enough testing to monitor the spread of the virus, which is thought to be more widespread than current case counts suggest.

The new plan tackles both. It will release more vaccines to areas with the highest case rates, and it will scale up testing, making tests available at five commercial laboratories in addition to an existing network of public health labs.

On Tuesday, HHS also activated the CDC’s Emergency Operations Center to give the agency more flexibility and manpower to manage the nation’s monkeypox response.

The new plan will allocate vaccine doses based on case rates in a state, focusing on men who have sex with men and their known partners, as well as anyone who thinks they might have been recently exposed to the virus as an anonymous partner.

“If you’re among those who have had a known exposure or in a group that is at higher risk for an exposure in the past two weeks, here’s what we’d like you to know,” said CDC Director Dr. Rochelle Walensky.

“Vaccination after exposure, or using vaccines for post-exposure prophylaxis, is meant to reduce your risk of becoming infected with a monkeypox virus and then become sick. Vaccination should occur within two weeks of a possible exposure, And the sooner you can get vaccinated after the exposure, the better.”

So far in the United States, there have been 306 cases of monkeypox identified across 28 jurisdictions. Globally, there have been more than 4,700 cases reported from 49 countries, she said.

Currently, 10 states would be considered to be in the first tier for priority in ordering vaccines.

The plan comes in the middle of Gay Pride, a month filled with parties celebrating gender and sexual diversity, and a season that many in public health have worried will only fuel the spread of the monkeypox virus, which is spread by close contact, including sex.

Currently, the only people who can get monkeypox vaccines are those with a known exposure, Walenksy said.

Given the large number of contacts and difficulty in identifying all contacts during the current outbreak, the new strategy will recommend vaccines for those who have a known exposure who are contacted by public health, as well as those who have been recently been exposed, but were not identified through contact tracing.

This includes those who had close physical contact with someone diagnosed with monkeypox, those who know their sexual partner was diagnosed with monkeypox, 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 vaccination plan may require the US to use two different types of vaccines.

The first is a newer, modern vaccine called Jynneos which is manufactured by the Danish company Bavarian Nordic. It was evaluated and developed to treat monkeypox infection. The US currently has 64,000 doses of this vaccine in the stockpile. The government will make 56,000 of those doses available to states in the first phase of the roll out.

The US has ordered more of this vaccine, and the government plans to make 1.25 million more doses of the Jynneos vaccine available through the summer and fall, the administration said. There are 300,000 doses that were being held by the manufacturer that are currently on the way.

But, the US doesn’t have enough doses of Jynneos to vaccinate all who might want it, so public health officials are also considering whether to use a second, older type of vaccine called ACAM. The ACAM vaccine was developed to treat smallpox. It’s given by using a two pronged needle that’s repeatedly dipped into the vaccine and used to prick the skin on the upper arm, causing a small sore or “pock” to form.

“It’s a very kind of like, old-school technology that basically I don’t know any clinicians that actually know how to do that. So it’s actually very difficult to roll out because you have to train people in a new vaccine methodology,” said Dr. Jay Varma, professor and director of the Cornell Center for Pandemic Prevention and Response in New York City.

The other complications is that the ACAM vaccine uses a live, but weakened version of a virus to inoculate a person.

“It’s presumed not to be safe to be able to be used in people with HIV,” Varma said. The primary risk group for monkeypox — men who have sex with men — also has high rates of HIV infection.

On Tuesday, Walensky said that as more Jynneos vaccine arrives in the US, the country will adjust its strategy to include more people.

“You know, as soon as we have more vaccines available, we will of course continue to expand from a post-exposure prophylaxis strategy, ideally to a pre-exposure prophylaxis strategy,” Walensky said.

On Tuesday public health experts said that expansion would be important.

“It’s critical that we get vaccine out to the at-risk population and approach, vaccine use much as we’ve approached the pre exposure prophylaxis for HIV,” said Dr. Michael Osterholm who directs the Center for Infectious Disease Research and Policy at the University of Minnesota.” (F)

“The U.S. is underreacting to the monkeypox outbreak. Given that a vaccine is available for the infection—and can be targeted toward the people most at risk—public-health authorities and health-care providers need to move more quickly and forcefully to change the outbreak’s trajectory…

When the coronavirus spread worldwide in early 2020, we lacked an effective vaccine, so governments required masks, distancing, ventilation, testing, and contact tracing to try to minimize transmission until the COVID-19 shots arrived. The world is not at the same disadvantage with monkeypox; we have a vaccine, and our current attempts to test and contact trace our way out of this epidemic are failing. A swift, targeted vaccination campaign—one that identifies Americans at risk and persuades them to get a shot—is far more likely to stop the monkeypox outbreak.

Different diseases require different responses. The coronavirus is becoming endemic because it spreads quickly and easily, and even high-quality vaccines that protect against severe disease do not prevent initial infection or reinfection. Smallpox, among the most deadly pathogens in history, could be eliminated because of four distinguishing features that most human pathogens do not have: Its symptoms—most notably, the skin rash it causes—are very characteristic, so doctors could easily identify patients who had it; its infectious period was short; new infections were preventable by a highly effective vaccine; and the virus had no animal reservoirs from which it could infect unvaccinated humans. As such, routine smallpox vaccinations for U.S. populations were stopped in 1972. Yet because of the cessation of mass vaccination programs for smallpox, humans have waning protection from monkeypox…

Many of the current cases are in MSM ages 30 to 55, at first linked to two large raves held in Spain and Belgium. Of note, sexual transmission of monkeypox has never previously been described. Although monkeypox has been reported in semen, the most likely route of spread during the current outbreak is the close skin-to-skin and respiratory contact during sexual activity. Moreover, transmission from prolonged face-to-face contact can put household members and other close contacts of active cases at greater risk.

That monkeypox is spreading among gay men has led to calls to postpone this month’s Pride celebrations, and the CDC has faced some criticism for recent messaging that offers tips on how to avoid the pathogen during sex. Yet the agencies are following the well-grounded concept of harm reduction—which calls for both minimizing the impact of a health threat while also recognizing the other needs of the individuals and society involved. People crave companionship and intimacy, and messages that ignore those needs and recommend complete abstinence are unlikely to succeed. Harm reduction is the basis of most current public-health messaging about reducing HIV risk, and is profoundly important in the field of addiction and substance use.

Health agencies deserve credit for trying to minimize stigma in their communication, even as they recognize that relevant communities need to be alerted to how this particular outbreak is being spread. (The WHO is also considering a change in the very name monkeypox to prevent stigma against the geographic areas originally connected with the disease and to banish associations with animals that appear to play little role in its spread.)”  (G)

“The monkeypox outbreak that health authorities first noticed in Europe back in May is getting worse. According to the World Health Organization’s latest report, there are over 2,100 confirmed cases, and at least one person has died.

Now geneticists finally have enough data to begin getting a handle on how exactly the outbreak started—and where it might be heading.

It’s not good news. Monkeypox, a viral disease that causes fever and a rash and can be fatal in a small percentage of cases, is endemic in Africa. And now it’s running amuck on every other permanently inhabited continent—and evolving quickly. While health officials have all the tools they need to contain it—primarily contact-tracing and vaccines—right now the virus is moving faster than we are, and adapting.

The current strain of monkeypox may have been circulating, undetected, months before we finally diagnosed the first case outside Africa. And because there are so many more copies of the virus than we first expected, each mutating separately, this new pox strain could evolve into dangerous new forms with disturbing speed.

The pox mostly spreads through close physical contact, especially sexual contact. It’s not a sexually transmitted disease, however. It just takes advantage of the skin-to-skin contact that accompanies sex. The virus can also travel short distances on spittle, although probably not far enough to qualify as “airborne.”

Monkeypox occasionally spreads to places where it’s not already endemic. In 2003, 47 people in the U.S. got sick with the West African strain after exposure to a shipment of pet rodents from Ghana to Texas. A rapid response by state and federal health officials—and a few doses of smallpox vaccine, which also works on monkeypox—prevented anyone dying and temporarily eliminated the virus in the U.S.

“Because there are so many more copies of the virus than we first expected, each mutating separately, this new pox strain could evolve into dangerous new forms with disturbing speed.”

Officials first noticed the current outbreak, also of the West African strain, after diagnosing a U.K. traveler returning from Nigeria in early May. Hitching a ride to Europe, the virus spread quickly through physical contact. David Heymann, who formerly headed the World Health Organization’s emergencies department, said that men attending raves in Spain and Belgium “amplified” the outbreak—apparently through close, sometimes sexual, contact with other men.

After that, the virus accompanied travelers on planes heading for countries far and wide. Doctors diagnosed the first U.S. case on May 27. As of Thursday, the U.S. Centers for Disease Control had tallied around 3,500 cases in 44 countries, including 172 in the U.S.

Just one person has died of the pox in the current outbreak—in Nigeria. But serious illness and death can lag an actual diagnosis by several weeks, so it’s possible many more deaths are coming.

Worse, on June 3 the CDC announced it had found genetic evidence of U.S. pox cases that predated the first cases in Europe from May. Doctors may not have noticed or reported these earlier cases, at first, owing to the similarity between pox symptoms and the symptoms of some common sexually-transmitted diseases such as herpes.

There was some speculation that the earlier U.S. cases were part of a totally separate outbreak that just happened to overlap with the May outbreak. Isidro and her team sequenced 15 samples taken from current pox patients and concluded that, no, there’s just one big outbreak. “All outbreak MPX strains sequenced so far tightly cluster together, suggesting that the ongoing outbreak has a single origin,” they wrote, using the scientific acronym for monkeypox…

One particularly disturbing possibility is that the pox is often or even usually circulating to some degree in non-endemic countries, but we rarely notice unless there’s a big surge in infections that compels doctors to look more closely at symptoms that could easily be mistaken for something else. Say, herpes. “When you start looking for something, you find it,” Michael Wiley, a public health expert at the University of Nebraska Medical Center who was not involved with the new study, told The Daily Beast.

In any event, undetected or overlapping transmission vectors are alarming—and not just because they could mean faster viral spread to more places before authorities finally, hopefully, contain an outbreak. No, the multiple introductions also represent an opportunity for a virus to mutate more, or more quickly, than usual.

When it comes to viral diseases, every infected person is a kind of living laboratory—a place where the virus can interact with the human immune system’s antibodies and T-cells and develop countermeasures. The more separate chains of transmission we hand the pox, the more likely the virus is to mutate along these vectors in some way that benefits it and hurts us. For example, developing resistance to our vaccines and antibodies…

Monkeypox may have been hiding in plain sight long before we finally noticed it two months ago. Maybe this strain of the virus got lucky and more than one traveler helped spread it outside Africa nearly simultaneously. Maybe it’s evolving faster because it’s getting cleverer. More likely, it’s changing at its current fast clip because there are so many more copies of the virus than we first expected, each mutating every chance it gets.” (H)

“Monkeypox cases continue to rise across the nation, with approximately 200 cases confirmed by the Centers for Disease Control and Prevention as of Monday afternoon.

Despite the rising number of cases, David J. Cennimo, an associate professor of medicine and pediatrics in the Division of Infectious Diseases at Rutgers New Jersey Medical School, said the overall caseload is still low.

“We’re finding cases, so I think that awareness of the disease is important because the more people are aware of monkeypox, especially if they are having symptoms, they’re going to seek medical care and that’s important for us to do good case finding,” he said.

Cennimo compared the current outbreak to one that occurred in 2003, which infected 47 people across six states after originating in Gambian pouched rats imported from Ghana.

He said that what worked to curb the virus two decades ago was alerting people who had come in contact with the pouched rats and advising them to avoid contact with others if they developed lesions, which is a symptom of monkeypox. Now, times have changed, he said, explaining that the current epidemiology indicates that the disease is being sexually transmitted.

Cennimo said that he has been advising patients to practice safe sex, especially those in heavily populated hotspots like the New York City metro area where people may have more than one sexual partner and thus increase their risk for infection.

This also means that public health officials should focus on messaging campaigns that emphasize how crucial it is to identify and report symptoms among at-risk patients without stigmatizing those who get infected.

“I’m hoping we can basically handle this the way we did in 2003 because what we definitely don’t want to see happen is monkeypox becoming another endemic virus,” he said. “If we can break the cycle of transmission now, take care of people who are already infected and not infect other people, in theory, we could do that.”

Another challenge facing public health officials, he said, is highlighting the dangers associated with monkeypox without causing a panic among the general public. Cennimo added that since the country is still dealing with the lingering effects of the COVID-19 pandemic, officials are faced with duelling priorities.” (I)

“As if dealing with continued waves of Covid-19 isn’t enough, the U.S. is facing a new outbreak — monkeypox — that highlights just how close the U.S. public health system is to its breaking point.

While monkeypox has not technically been categorized as a sexually transmitted infection (STI), it looks and acts like common STIs and shares the same barriers to detection and treatment, including stigma and access to knowledgeable providers.

For people like me who are working inside the broad national response to monkeypox, there are loud echoes of the earliest days of Covid-19 and, longer ago, of AIDS. But understanding the country’s capacity to contain monkeypox requires an examination of the STI epidemic that the nation has ignored for years, which is why these diseases continue to be out of control…

If HIV and Covid-19 were wake-up calls for the government to prioritize public health, monkeypox shows the consequences of hitting the snooze button too many times. HIV showed the importance of creating an infrastructure of health care workers who can provide approachable, competent care for stigmatized infections. Covid-19 revealed the make-or-break nature of coordinated logistics and communications.

The U.S. is at a crossroads regarding sexually transmitted infections. It can mount an effective monkeypox response and provide communities across the country with the infrastructure needed to promote health care for everyone. Or it can continue to play catchup in crisis after crisis and let common infections continue to rage in between.” (J)

“Some U.S. adults are a step closer to getting updated COVID-19 boosters this fall, as government advisers voted Tuesday that it’s time to tweak shots to better match the most recent virus variants.

The Food and Drug Administration will have to decide the exact recipe but expect a combination shot that adds protection against a version of the super-contagious omicron variant to the original vaccine.

Advisers to the FDA voted 19-2 that some version of omicron should be part a fall booster campaign, an effort to blunt an expected COVID-19 surge.

“We are going to be behind the eight-ball if we wait longer,” agreed Dr. Mark Sawyer of the University of California, San Diego.

Pfizer says its tweaked COVID-19 shots boost protection against the omicron variant…

Pfizer and Moderna tested shots updated to better match the omicron that surged over the winter, but that first mutant has disappeared — replaced by its genetically distinct relatives. The two newest omicron cousins, called BA.4 and BA.5, together now make up half of U.S. cases, according to the Centers for Disease Control and Prevention…

Both Moderna and Pfizer found what scientists call “bivalent” shots — a combination of the original vaccine plus omicron protection — substantially boosted levels of antibodies capable of fighting that variant, more than simply giving another regular dose. Many scientists favor the combination approach because it preserves the original vaccines’ proven benefits, which include some cross-protection against other mutants that have cropped up during the pandemic.

Both companies found the tweaked shots also boosted antibodies against BA.4 and BA.5 but not by nearly as many.” (K)

(A) WHO monkeypox emergency committee to reconvene due to ‘evolving situation’, ERIN PRATER,

(B) WHO: Monkeypox outbreak not yet a global public health emergency, by Andrew Joseph, https://www.statnews.com/2022/06/25/who-monkeypox-outbreak-not-yet-a-global-health-emergency/

(C)Multi-country monkeypox outbreak: situation update, https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON396

(D)CDC activates Emergency Operations Center for monkeypox, By Virginia Langmaid, https://www.cnn.com/2022/06/28/health/cdc-eoc-monkeypox/index.html

(E) As Monkeypox Spreads, U.S. Plans a Vaccination Campaign, By Apoorva Mandavilli, https://www.nytimes.com/2022/06/28/health/monkeypox-vaccinations-cdc.html?referringSource=articleShare

(F) US to offer monkeypox vaccines in states with high case rates, By Brenda Goodman, https://www.cnn.com/2022/06/28/health/monkeypox-vaccines-states-high-case-rates/index.html

(G)The U.S. Is Underreacting to Monkeypox, By Monica Gandhi, https://www.theatlantic.com/ideas/archive/2022/06/monkeypox-vaccine-gay-bisexual-men-us/661380/

(H)The Monkeypox Virus May Be Exhibiting ‘Accelerated Evolution’, by David Axe, https://www.thedailybeast.com/current-monkeypox-virus-may-be-showing-accelerated-evolution-as-more-new-cases-rise

(I) Infectious diseases expert says U.S. is ‘in flux’ amid monkeypox outbreak, by Jack O’Brien, https://www.mmm-online.com/home/channel/infectious-diseases-expert-says-u-s-is-in-flux-amid-monkeypox-outbreak/

(J) The next epidemic may be here. The U.S. isn’t ready for it, By David C. Harvey, https://www.statnews.com/2022/06/28/next-epidemic-monkeypox-may-be-here-us-isnt-ready-for-it/

(K) FDA advisers recommend updating COVID booster shots for the fall, https://www.npr.org/2022/06/28/1108400756/fda-advisers-recommend-covid-booster-omicron