Health
Monkeypox Appears to Recede, but Risks and Uncertainties Linger
Almost 4 months after the primary report of monkeypox in america, the virus is displaying promising indicators of retreat, easing fears that it could spill over into populations of older adults, pregnant girls and younger kids.
Provides of the vaccine have improved, and federal well being officers have begun medical trials to realize a greater understanding of who advantages, and the way a lot, from each the vaccine and the drug used to deal with those that turn out to be contaminated.
That’s the excellent news. However unhappily, case numbers are accelerating in a number of states and jurisdictions, together with Indiana, Virginia and Massachusetts. Black and Hispanic males make up practically two-thirds of the contaminated, however solely about one-fourth of these vaccinated up to now.
“Our progress is extremely uneven,” stated David Harvey, the manager director of the Nationwide Coalition of STD Administrators.
“This outbreak is way from completed,” he added.
Current stories recommend {that a} single dose of the vaccine, Jynneos, might not be protecting sufficient, elevating recent considerations concerning the Biden administration’s plan to distribute fractional doses.
And federal well being officers have warned that the virus may turn out to be proof against tecovirimat, the one secure remedy for individuals who are contaminated.
“If you solely have one drug in your armamentarium, that may be considerably precarious,” stated Dr. Anthony S. Fauci, the Biden administration’s prime medical adviser. “However you’ve received to go together with what you might have similtaneously you attempt to develop extra medication.”
As of Friday, there have been practically 25,000 instances of monkeypox in all 50 states, the District of Columbia and Puerto Rico. The USA accounts for practically 40 p.c of the worldwide tally.
However new instances have been lowering steadily for weeks, to a every day common of 208 on Sept. 22 from greater than 500 in early August.
The Los Angeles Division of Public Well being not too long ago confirmed the nation’s first demise from monkeypox, in a severely immunocompromised particular person. Well being officers in Texas are investigating one other demise that could be associated to the an infection.
Two instances of encephalomyelitis — irritation within the mind and spinal twine — have been reported, each in beforehand wholesome homosexual males of their 30s.
Total, nonetheless, federal well being officers are optimistic that the epidemic is waning. Whereas testing and vaccines will proceed to be vital, officers envision a future wherein monkeypox shouldn’t be gone, however manageable with contact tracing, vaccination and early remedy.
“I feel it’s going to look a little bit bit extra like extra episodic instances, smaller clusters,” stated Dr. Demetre Daskalakis, the deputy coordinator of the White Home’s monkeypox response.
What to Know Concerning the Monkeypox Virus
What’s monkeypox? Monkeypox is a virus just like smallpox, however signs are much less extreme. It was found in 1958, after outbreaks occurred in monkeys saved for analysis. The virus was primarily present in components of Central and West Africa, however not too long ago it has unfold to dozens of nations and contaminated tens of 1000’s of individuals, overwhelmingly males who’ve intercourse with males.
The latest decline is most certainly the results of a mixture of vaccinations, immunity gained from an infection within the inhabitants most in danger, and a change in conduct on this group, Dr. Daskalakis stated.
In a survey carried out by the C.D.C. in August, roughly half of males who’ve intercourse with males stated they’d lowered the variety of their companions and one-time sexual encounters.
However falling case numbers might quickly lead these males to imagine that the menace has handed. “We will’t ask folks to vary their conduct endlessly,” Dr. Daskalakis stated. “That didn’t actually work with H.I.V., so it’s not going to work right here, both.”
Vaccination is more likely to be a more practical containment technique in the long run, he added.
As of Sept. 20, well being officers had administered practically 700,000 doses of Jynneos within the 48 jurisdictions for which information had been out there. Whereas that could be a substantial enchancment over the early weeks of the outbreak, it accounts for under 22 p.c of the doses wanted to guard the 1.6 million People estimated to be at excessive danger.
At the same time as infections decline, the proportion of instances amongst Black and Hispanic males has grown to 70 p.c in mid-September from 37 p.c in late Could. But Black males have obtained lower than 9 p.c of the doses administered up to now, and Hispanic males about 16 p.c.
Federal well being officers are intensifying efforts to achieve high-risk teams and have vaccinated at the very least 11,000 attendees at giant gatherings the place Black and Hispanic males congregate, reminiscent of Atlanta Black Pleasure.
The C.D.C. has introduced a brand new program that might make as much as 10,000 vials of vaccine — or 50,000 doses, below the brand new dose-sparing technique — out there to communities the place hesitancy, language obstacles, immigration standing or different obstacles forestall widespread vaccination.
Eligibility for the vaccine is scattershot by location, and the factors usually opaque, based on an evaluation by the Kaiser Household Basis. Some states, like Indiana and New Mexico, supply no info on-line about who qualifies. Laboratory and well being care employees who could also be uncovered to the virus are eligible in solely 18 states and cities.
Many males at excessive danger have opted for a single dose, which might not be sufficiently protecting. Though the proportion of second doses has elevated, up to now 77 p.c of administered doses are first doses.
A brand new research suggests that won’t be sufficient to stop an infection or extreme signs. Dutch researchers discovered that one full dose of Jynneos produces low ranges of antibodies to monkeypox.
Two full doses are higher however nonetheless “modest,” stated Dr. Marion Koopmans, the pinnacle of virology at Erasmus Medical Middle in Rotterdam, the Netherlands, who led the research.
“It does increase the query how good safety might be,” she stated. “Since we don’t know a complete lot about this, I do suppose we actually want to determine what’s happening.”
In a bid to stretch the vaccine provide, the Biden administration has embraced a dose-splitting technique, wherein one-fifth of an everyday dose is delivered into the pores and skin — a so-called intradermal technique — fairly than the fats beneath. This method has been tried in different cases of vaccine scarcity.
However activists and a few scientists have decried the administration’s reliance on fractional dosing, noting that federal officers moved slowly to make out there hundreds of thousands of Jynneos doses held by the producer in Denmark.
“What’s so weird about this complete factor is we should always have by no means gotten into the scenario,” stated James Krellenstein, a founding father of PrEP4All, a gaggle that promotes entry to H.I.V. care.
There may be minimal analysis to assist fractional doses as a substitute of the complete common doses, Mr. Krellenstein famous: “They might be equal, however there’s an actual good likelihood that they’re not.”
The Dutch staff didn’t take a look at how nicely a one-fifth dose of Jynneos protects in opposition to monkeypox. However in an earlier research, they examined a chook flu vaccine just like Jynneos and located that two fractional doses produced a lot decrease ranges of antibodies than two full doses.
Nonetheless, it’s potential {that a} mixture of 1 full dose and one fractional dose may go nicely, Dr. Koopmans stated.
Little is understood concerning the effectiveness of normal doses, not to mention fractional doses, as a result of Jynneos was authorised primarily on the premise of animal information. However the proof up to now means that two doses are higher than one, stated Dr. Peter Marks, the Meals and Drug Administration’s prime vaccine regulator.
“Having two doses of Jynneos was the right technique to go right here, and the truth that the intradermal route allowed us to have a ample variety of doses to maneuver ahead in that path, I feel, was a sensible concept,” he stated.
“We’re working in a public well being emergency,” he added. “I feel we’re doing our greatest with the info that we have now in hand, and the info that we belief, and the info because it emerges.”
There may be some proof {that a} third shot given a yr after the primary two doses provokes a vigorous immune response. If that seems to be true, a three-dose routine could also be best to handle monkeypox infections in the long run. Dr. Marks stated federal scientists are nonetheless debating whether or not to check third doses.
A brand new trial led by the Nationwide Institutes of Well being, which started earlier this month, will enroll 200 adults and examine the usual dose with intradermal supply of one-fifth and one-tenth doses.
If the fractional doses show to be comparably efficient, the dose-splitting method would drastically increase world provide, together with in international locations the place the vaccine is presently unavailable.
Researchers will accumulate info on antibody ranges within the immunized individuals. However they won’t be monitoring different immune cells that could be equally vital for defense from the virus, based on Dr. John Beigel, the N.I.H. researcher main the trial.
“This was a call for expediency,” he stated.
A separate N.I.H. trial goals will take a look at how nicely tecovirimat, additionally referred to as Tpoxx, works in 500 adults and youngsters contaminated with monkeypox.
Tecovirimat is the one drug used to deal with monkeypox in america, because the options can have poisonous unintended effects. The drug was authorised in 2018 on the premise of animal research, and has by no means been examined rigorously in folks.
Small medical research, in addition to latest anecdotal observations of sufferers, recommend that the drug works nicely. A small proportion of sufferers expertise minor unintended effects, reminiscent of headache and nausea.
Given the early information, the Biden administration has been sharply criticized for making it too tough for clinicians to prescribe the drug. And the C.D.C. has urged clinicians to order tecovirimat for sufferers who’re severely immunocompromised, pregnant or breastfeeding, or who’ve lesions in sure delicate areas, in addition to for youngsters below 8.
The choice to restrict entry is rooted within the concern that indiscriminate use may result in Tpoxx-resistant monkeypox, federal officers stated. A number of research recommend that even small genetic modifications may go away the virus resistant, based on the F.D.A.
The brand new trial ought to supply a clearer image of the chance. “We need to make it a lot simpler, and with rather more confidence, to make Tpoxx out there for people who find themselves contaminated,” Dr. Fauci stated.
Princess Catherine, wife of Prince William, reported on Tuesday that her cancer was in remission. But what does it mean to be in remission from cancer?
Doctors discovered her cancer unexpectedly last March when she had abdominal surgery. She has not revealed the type of cancer she has, nor how advanced it was when it was discovered.
But she did say she had chemotherapy, which she said had been completed in September. She told the British news agency PA Media that she had a port, a small device that is implanted under the skin and attached to a catheter that goes into a large vein. It allows medicines like chemotherapy drugs to be delivered directly to veins in the chest, avoiding needle sticks.
Catherine told PA Media that chemotherapy was “really tough.”
“It is a relief to now be in remission and I remain focused on recovery,” she wrote on Instagram.
Her announcement “certainly is good news and is reassuring,” said Dr. Kimmie Ng, associate chief of the division of gastrointestinal oncology at the Dana-Farber Cancer Institute in Boston.
But cancer experts like Dr. Ng say that the meaning of remission in a patient can vary.
In general, when doctors and patients talk about remission, they mean there is no evidence of cancer in blood tests or scans.
The problem is that a complete remission does not mean the cancer is gone. Even when a cancer is “cured” — defined as no evidence of cancer for five years — it may not be vanquished.
That makes life emotionally difficult for patients, who have to have frequent visits with oncologists for physical exams, blood tests and imaging.
“It’s really scary,” Dr. Ng said. “The amount of uncertainty is very very hard,” she added.
But that ongoing surveillance is necessary, despite the toll it takes on patients.
“Different cancers have different propensities of returning or not returning,” said Dr. Elena Ratner, a gynecologic oncologist at the Yale Cancer Center.
As many as 75 to 80 percent of ovarian cancers, she noted, can come back in an average of 14 to 16 months after a remission, depending on the stage the cancer had reached when it was found and on the cancer’s biology.
“Once the cancer returns, it becomes a chronic disease,” Dr. Ratner said. She tells her patients: “You will live with this cancer. You will be on and off chemotherapy for the rest of your life.”
Dr. Ratner’s gynecological cancer patients have to come back every three months for CT scans to keep an eye out for evidence that the cancer has returned.
“The women live CT scan to CT scan,” she said. “They say that for two and a half months, they have a wonderful life, but then, in time for the next CT scan, the fear returns.”
“It costs them — it costs them a lot,” she said.
“It’s awful, yet I am amazed every day by their strength,” she said of her patients.
Deaths from bombs and other traumatic injuries during the first nine months of the war in Gaza may have been underestimated by more than 40 percent, according to a new analysis published in The Lancet.
The peer-reviewed statistical analysis, led by epidemiologists at the London School of Hygiene and Tropical Medicine, used modeling in an effort to provide an objective third-party estimate of casualties. The United Nations has relied on the figure from the Hamas-led Ministry of Health, which it says has been largely accurate, but which Israel criticizes as inflated.
But the new analysis suggests the Hamas health ministry tally is a significant undercount. The researchers concluded that the death toll from Israel’s aerial bombardment and military ground operation in Gaza between October 2023 and the end of June 2024 was about 64,300, rather than the 37,900 reported by the Palestinian Ministry of Health.
The estimate in the analysis corresponds to 2.9 percent of Gaza’s prewar population having been killed by traumatic injury, or one in 35 inhabitants. The analysis did not account for other war-related casualties such as deaths from malnutrition, water-borne illness or the breakdown of the health system as the conflict progressed.
The study found that 59 percent of the dead were women, children and people over the age of 65. It did not establish what share of the reported dead were combatants.
Mike Spagat, an expert on calculating casualties of war who was not involved in this research, said the new analysis convinced him that Gaza casualties were underestimated.
“This is a good piece of evidence that the real number is higher, probably substantially higher, than the Ministry of Health’s official numbers, higher than I had been thinking over the last few months,” said Dr. Spagat, who is a professor at Royal Holloway College at the University of London.
But the presentation of precise figures, such as a 41 percent underreported mortality, is less useful, he said, since the analysis actually shows the real total could be less than, or substantially more. “Quantitatively, it’s a lot more uncertain than I think comes out in the paper,” Dr. Spagat said.
The researchers said their estimate of 64,260 deaths from traumatic injury has a “confidence interval” between 55,298 and 78,525, which means the actual number of casualties is likely in that range.
If the estimated level of underreporting of deaths through June 2024 is extrapolated out to October 2024, the total Gazan casualty figure in the first year of the war would exceed 70,000.
“There is an importance to war injury deaths, because it speaks to the question of whether the campaign is proportional, whether it is, in fact, the case that sufficient provisions are made to to avoid civilian casualties,” said Francesco Checchi, an epidemiologist with an expertise in conflict and humanitarian crises and a professor at the London School of Hygiene and Tropical Medicine who was an author on the study. “I do think memorializing is important. There is inherent value in just trying to come up with the right number.”
The analysis uses a statistical method called capture-recapture analysis, which has been used to estimate casualties in other conflicts, including civil wars in Colombia and Sudan.
For Gaza, the researchers drew on three lists: The first is a register maintained by the Palestinian Ministry of Health, which mainly comprises the dead in hospital morgues and estimates of the number of unrecovered people buried in rubble. The second is deaths reported by family or community members through an online survey form the ministry established on Jan. 1, 2024, when the prewar death registration system had broken down. It asked Palestinians inside and outside Gaza to provide names, ages, national ID number and location of death for casualties. The third source was obituaries of people who died from injuries that were published on social media, which may not include all of the same biographical details and which the researchers compiled by hand.
The researchers analyzed these sources to look for individuals who appear on multiple lists of those killed. A high level of overlap would have suggested that few deaths were uncounted; the low amount they found suggested the opposite. The researchers used models to calculate the probability of each individual appearing on any of the three lists.
“Models enable us to actually estimate the number of people who have not been listed at all,” Dr. Checchi said. That, combined with the listed number, gave the analysts their total.
Patrick Ball, director of research at the Human Rights Data Analysis Group, and a statistician who has conducted similar estimates of violent deaths in conflicts in other regions, said the study was strong and well reasoned. But he cautioned that the authors may have underestimated the amount of uncertainty caused by the ongoing conflict.
The authors used different variations of mathematical models in their calculations, but Dr. Ball said that rather than presenting a single figure — 64,260 deaths — as the estimate, it may have been more appropriate to present the number of deaths as a range from 47,457 to 88,332 deaths, a span that encompasses all of the estimates produced by modeling the overlap among the three lists.
“It’s really hard to do this kind of thing in the middle of a conflict,” Dr. Ball said. “It takes time, and it takes access. I think you could say the range is larger, and that would be plausible.”
While Gaza had a strong death registration process before the war, it now has only limited function after the destruction of much of the health system. Deaths are uncounted when whole families are killed simultaneously, leaving no one to report, or when an unknown number of people die in the collapse of a large building; Gazans are increasingly buried near their homes without passing through a morgue, Dr. Checchi said.
The authors of the study acknowledged that some of those assumed dead may in fact be missing, most likely taken as prisoners in Israel.
Roni Caryn Rabin and Lauren Leatherby contributed reporting.
Dementia cases in the U.S. are expected to double by 2060, with an estimated one million people diagnosed per year, according to a new study led by Johns Hopkins University and other institutions.
Researchers found that Americans’ risk of developing dementia after age 55 is 42%, double the risk that has been identified in prior studies, a press release stated.
For those who reach 75 years of age, the lifetime risk exceeds 50%, the study found.
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Women face a 48% average risk and men have a 35% risk, with the discrepancy attributed to women living longer than men.
Dementia cases in the U.S. are expected to double by 2060, with an estimated one million people diagnosed per year. (iStock)
The study, which was published in the journal Nature Medicine on Jan. 13, analyzed data from the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS), which has tracked the cognitive and vascular health of nearly 16,000 adults since 1987.
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“Our study results forecast a dramatic rise in the burden from dementia in the United States over the coming decades, with one in two Americans expected to experience cognitive difficulties after age 55,” said study senior investigator and epidemiologist Josef Coresh, MD, PhD, who serves as the founding director of the Optimal Aging Institute at NYU Langone, in the release.
Understanding risk factors
“One of the main reasons for the increase is that great medicine and tecnological advances are keeping us alive longer and age is a risk factor for dementia,” Dr. Marc Siegel, clinical professor of medicine at NYU Langone Health and Fox News senior medical analyst, told Fox News Digital.
“Obesity is associated with inflammation, diabetes and high blood pressure, which are all independent risk factors for dementia.”
In addition to aging, other risk factors include genetics, obesity, hypertension, diabetes, unhealthy diets of ultraprocessed foods, sedentary lifestyles and mental health disorders, the release said.
“We have an obesity epidemic with over 45% adults obese in the U.S.,” Siegel noted. “Obesity is associated with inflammation, diabetes and high blood pressure, which are all independent risk factors for dementia.”
“And as an unhealthy population, we also have more heart disease, and atrial fibrillation is a risk factor for cognitive decline,” he added.
Dementia risk was found to be higher among people who have a variant of the APOE4 gene, which has been linked to late-onset Alzheimer’s disease. Black adults also have a higher risk.
Researchers found that Americans’ risk of developing dementia after age 55 is 42%, double the risk that has been identified in prior studies. (iStock)
Research has shown that the same interventions used to prevent heart disease risk could also prevent or slow down dementia, the study suggested.
“The pending population boom in dementia cases poses significant challenges for health policymakers in particular, who must refocus their efforts on strategies to minimize the severity of dementia cases, as well as plans to provide more health care services for those with dementia,” said Coresh.
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What needs to change?
Professor Adrian Owen, PhD, neuroscientist and chief scientific officer at Creyos, a Canada-based company that specializes in cognitive assessment and brain health, referred to the increase in dementia cases as a “tidal wave.”
“This new study’s anticipated surge in dementia cases underscores the urgent need for early and accurate detection,” he told Fox News Digital.
“By catching issues early, we give people the power to make lifestyle adjustments, seek available treatments and plan their futures with clarity.”
“By identifying cognitive decline at its earliest stages, we have an opportunity to intervene before patients and families bear the full weight of the disease.”
Owen recommends conducting regular cognitive assessments as part of routine check-ups to proactively identify early signs of cognitive decline.
“By catching issues early, we give people the power to make lifestyle adjustments, seek available treatments and plan their futures with clarity,” he said.
“By identifying cognitive decline at its earliest stages, we have an opportunity to intervene before patients and families bear the full weight of the disease.” (iStock)
Maria C. Carrillo, PhD, chief science officer and medical affairs lead for the Alzheimer’s Association in Chicago, said there is an “urgent need” to address the global crisis of Alzheimer’s disease and dementia.
To help keep the aging brain healthy, the Alzheimer’s Association published its report 10 Healthy Habits for Your Brain. Some of the tips are listed below.
For more Health articles, visit www.foxnews.com/health
– Participate in regular physical activity.
– Learn new things throughout your life and engage your brain.
– Get proper nutrition — prioritize vegetables and leaner meats/proteins, along with foods that are less processed and lower in fat.
– Avoid head injury (protect your head).
– Have a healthy heart and cardiovascular system — control blood pressure, avoid diabetes or treat it if you have it, manage your weight and don’t smoke.
Research has shown that the same interventions used to prevent heart disease risk could also prevent or slow down dementia. (iStock)
The research was funded by the National Institutes of Health.
Fox News Digital reached out to the researchers for additional comment.
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