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On national television, Biden administration spokesperson John Kirby mounted a feeble attempt to explain the presidents COVID-19 vaccine mandate for the military.Kirby, a retired Navy admiral, had no acceptable answers when pressed about the administrations "folly" and the perilous impact the mandate is already having on our national security.
Remarkably, Kirby perpetuated the narrative that the militarys mandate must remain in place while admitting with a straight face that he was quarantined for 10 days due to his current bout with COVID-19, despite being vaccinated and double boosted.
The unrelenting push to remove thousands of religious service members from the military for their sincerely held objections to taking the COVID-19 vaccine should be classified as a clear dereliction of duty by the Biden administration. The president himself declared "the pandemic is over."
A U.S. Marine receives the Moderna coronavirus vaccine at Camp Foster on April 28, 2021, in Ginowan, Japan. (Carl Court/Getty Images)
As Kirby revealed on national television, COVID-19 vaccines are ineffective in preventing infection or the spread of the virus. According to the Centers for Disease Control, service members who were only vaccinated once last fall are still at risk of severe illness. And boosters are not mandated by the Department of Defense.
HOUSE REPUBLICANS DEMAND ANSWERS ON PENTAGON COVID VACCINE MANDATE AMID PUNISHMENTS FOR UNVAXXED SOLDIERS
At this point, there is no "compelling government interest" in vaccinating this small percentage of religious service members because there is no evidence that the COVID-19 vaccines promote the "health and safety" of our force.
John Kirby holds a news briefing at the Pentagon on March 9, 2022, in Arlington, Virginia. (Kevin Dietsch/Getty Images)
In April 2021, top military leaders admitted that "the U.S. military has successfully continued operations and kept our forces safe during the pandemic by implementing other force health protection guidelines." Despite this statement, on Aug. 9, 2021, Kirby had an unusual message regarding the mandate, "You can consider this memo not just a warning order to the services but to the troops themselves," with the chairman of the House Armed Services Committee commenting that, "Some may try and criticize the Secretarys decision, using anti-vax arguments that are not supported by facts or science to politicize the conversation. These desperate attention seekers must be ignored."
While service members of faith are being denied accommodations and are presently prevented from doing their jobs and maintaining their careers, the Air Force is willingly accommodating service members who are unvaccinated for COVID-19 for medical reasons.
To any reasonable person, the hypocrisy and unlawfulness is clear.
ARMY PENALIZING SOLDIERS SEEKING RELIGIOUS ACCOMMODATIONS TO VAX MANDATE: TECHNIQUE OF COERCION
In a recent decision in a lawsuit brought by United Airlines employees, U.S. Court of Appeals for the Fifth Circuit Judge James C. Ho provided the best explanation of what the real objective is with these mandates.
In his concurrence, Judge Ho stated that United Airlines placed its employees with religious objections to taking the COVID-19 vaccine on indefinite, unpaid leave "to coerce its employees into violating their religious beliefs and whats worse, to do so irrevocably and permanently."
Judge Ho rightly concluded that Uniteds business decision had nothing to do with safety, but rather "the real reason for the vaccine mandate and indefinite unpaid leave policy is virtue signaling and currying political favor."
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Its time for the Biden administration to put its false, damaging narrative to rest. As the Supreme Court urged this past fall, "even in a pandemic, the Constitution cannot be put away and forgotten." The Supreme Court has also held that where it is "only conduct motivated by religious conviction that bears the weight of the governmental restrictions," then there "can be no serious claim that those interests justify the [militarys COVID-19 vaccination mandate.]"
At this point, the Department of Defense should be more concerned with its own 100% compliance with the Constitution rather than 100% vaccination compliance. How will religious liberty ever be preserved if our own executive branch is permitted to overtly dishonor it?
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Danielle Runyan is counsel for First Liberty Institute, a nonprofit law firm exclusively dedicated to defending religious liberty for all Americans, and a plaintiff in the lawsuit, Spence v. Austin. Read more at FirstLiberty.org.
Alberta physicians are raising the alarm about a dangerous trend fuelled by misinformation that could cost lives.
Dr. Stephanie Cooper, an obstetrician specializing in high-risk birthsat Foothills Medical Centre, said a patient recently refused to consent to a blood transfusion if it came from a donor who had received the COVID-19 vaccine.
"I see people with severe hemorrhage due to childbirth on a regular basis. And for me, the idea that this is out there is somewhat mind-boggling."
It came up in a routine conversation while she was counselling the patient before a C-section. The patient did not end up needing a blood transfusion.
Shocked by what she'd encountered, Cooper shared her experience on Twitter and was inundated with responses, including from other health-care providers who reached out with similar stories.
"I'm quite concerned about it," she said, noting Canada's blood supply does not register the COVID vaccination status of donors.
"There isn't a choice to receive COVID vaccine-negative blood. So by declining blood, it means you will die."
This is not an isolated incident in Alberta.
"We're seeing it about once or twice a month, at this stage. And the worry is of course that these requests might increase," said Dr. Dave Sidhu,the southern Alberta medical lead fortransfusion and transplant medicine.
That includes parents of sick children.
"We do see a few, certainly in our bone marrow transplant patients in particular. You have to remember these kiddos are immuno-compromisedand there's always more sensitivity around these patients, and some of them can be quite frail," said Sidhu, who isalsoan associate professor in the Cumming School of Medicine at the University of Calgary.
"Any caution or questions around that, we encourage our parents to ask."
According to Sidhu,requests for so-called directed blood donations,taken from an unvaccinated parent or legal guardian, come with a number of risksand have not been accommodated.
So far, parents have agreed to proceed after he's talked with them, he said.
And while some adults have ultimately refused blood transfusions, doctors were able to treat them in other ways.
"The real worry is situations where blood is needed and it is life and limb," he said.
"There is currently no medical or scientific evidence to suggest that there are changes in people's genetic composition due to these mRNA vaccines or any other issues with safety around blood from either vaccinated or unvaccinated donors."
According to Timothy Caulfield, a Canada Research Chair in Health Law and Policy at the University of Alberta, these situations are becoming increasingly common.
"It's happening not just in Canada but really all over the world. This is a really good example of a behaviour of a request that is the direct result of the spread ofmisinformation," he said.
"This is based on the idea that either the blood is contaminated, the blood is going to give them COVID, that they believe the risks associated with the COVID vaccines are going to have some adverse impact on them. So basically they've embraced and internalized the misinformation associated with the COVID vaccines and fear the blood as a result of that."
Caulfield said competent adults have the right to refuse treatment even if the decision could harm them.
"This really highlights, I think, how powerful misinformation can be. It can really have an impact in a way that can be dangerous," he said.
"There is no evidence to support these concerns."
Canadian Blood Services, which has an entire page onits websitededicated to this issue, said the health of patients is its top priority.
"Health Canada has not recommended or imposed any restriction on the use of the approved COVID-19 vaccines and blood donation," a spokesperson said in a statement emailed to CBC News.
"This is because the blood of donors who have received non-live vaccines does not pose a risk to patients who receive a blood transfusion."
On its website, Canadian Blood Services explains non-live vaccines "do not contain infectious bacteria or virus or other pathogens that can replicate in the vaccine recipient or cause an infection."
Other such vaccines, including those protecting against tetanus,whooping coughand influenza, do not impact eligibility to donate blood.
It also addressesconcerns vaccine-generated spike proteins, in an immunized donor, could be harmful to those receiving their blood.
"These claims are unproven and not substantiated by the safety studies required for regulatory approval of these vaccines, or from ongoing Canadian and international vaccine and blood safety monitoring," the website states.
Meanwhile, David Evans, a professor in the department of medical microbiology and immunology at the University of Alberta, believes improving scientific literacymay be the best way,in the long run, to combat the wave of misinformationthat is leading to these potentially life-threatening decisions.
"The reality is these vaccines have an incredibly good safety record," he said.
"Maybe we should start looking at our biology curriculum and starting to ask, 'what are we teaching our kids, what do we want them to know by the time they get out of Grade 12 about the way our biology works?'Just enough to help you put into perspective what we're talking about when something like this comes along."
It is now well established that Covid-19 has widened the global health equity gaps that existed even before the pandemic, pushing the Sustainable Development Goals wildly off track. But although Covid-19 remains an ongoing concern, we were already off track before the pandemic. In terms of challenges to the SDGs, Covid-19 is more a taste of things to come, and just one of many global trends that now threaten to make it increasingly difficult to achieve global goals including Health For All by 2030. In the face of what will likely be an increasingly uphill struggle, it will now take unprecedented financing, political support and prioritisation to get back on track.
Consider the context. Even as Covid-19 continues to spread, research suggests that the probability of us experiencing another pandemic with the same kind of impact is increasing by 2% each year. Similarly, every year now climate change, migration, conflict and food insecurity continue to leave hundreds of millions more people displaced, vulnerable and at risk. The implications of all this for public health are dire, which is why it is so important now not only to reverse the backslides we have seen, but to also gain ground as quickly as possible. And one way, and perhaps the best way, to do this is to prioritise vaccine equity.
The ultimate vision of Health For All means reaching a point where every country is able to provide access to affordable, quality health care to every person, everywhere, regardless of their social and financial status. In practice, the biggest barrier to achieving universal health coverage by 2030 will be reaching those people who have been left behind, the vast majority of whom live in the most marginalised communities in middle- and low-income countries where resources are often already limited, even more so thanks to Covid-19. That will take domestic and international investment in public health across the board to ensure that everyone, everywhere has at the very least access to stronger and more resilient primary health care. And routine immunisation has by far the greatest potential to make sure this occurs where the impact is the greatest, namely among missed communities.
Thats because the challenge, as we have seen with Covid-19, is that the last to be reached are often the hardest to reach. These are also the communities with the most to gain, and routine immunisation can help because it is an enabler. As the most efficient and cost-effective healthcare intervention, with the greatest reach and secure health outcomes, immunisation is often a gateway to other vital health interventions, helping to strengthen primary health care and bring us closer to universal health coverage in the process.
If a child misses out on routine vaccines, then the chances are that that child, their family and community are also not getting access to other forms of primary health care. But once a community gets access to vaccinations, it brings with it an entire service delivery infrastructure, including supply chains, cold storage, trained healthcare workers, data systems and surveillance, all of which help to improve access to other critical health interventions, from nutritional supplements and deworming to malaria prevention and maternal care.
That is why Gavis mission to halve the number of zero-dose children those who do not receive even a single dose of a basic vaccine by 2030 is so critical to the success of the SDGs. These children are the face of extreme poverty and missed communities, too often with limited access to both health and non-health services such as education, water and sanitation.
By redoubling our efforts to reach more zero-dose children, we help protect the most vulnerable children in the world from infectious disease. Plus it serves as an opportunity to build stronger and more resilient primary health care, arguably where it counts the most. And in the process, it also helps to improve pandemic preparedness. Local communities often have a better understanding of what they need the most, and when empowered with better health, knowledge and support, they are best positioned to design and implement preparedness interventions that address their specific health needs and challenges.
However, given the enormous toll that Covid-19 has placed on immunisation services in low-income countries, increasing immunisation coverage will not be easy. In 2021, the percentage of children receiving routine immunisation in the 57 low-income countries that Gavi supports had fallen to 77%, a drop of five percentage points since before the pandemic. Similarly, the number of zero-dose children in these countries rose for the second consecutive year to 12.5 million. That is a lot of ground to make up, let alone improve upon.
For low-income countries, many of which have even more limited resources than before the pandemic and many competing priorities, the goal of attempting to provide all health services to everyone may simply be too much. However, by focusing resources and efforts on those solutions that are most cost-effective and most beneficial to the poorest and most vulnerable communities, even the most cash-strapped government can start to build on this to make other health services available too.
Routine immunisation is just such a solution. It is already the most widely available health intervention in the world, but through this approach, known as progressive universalism, it can help to improve and accelerate access to stronger, more resilient primary health services to the communities most in need, bringing us closer to universal health coverage and Health For All. And in the process, everyone benefits, because it also helps to build resilient societies.
So, while it remains imperative that we continue to work towards achieving equity with Covid-19 vaccines, we also urgently need to restore and expand routine immunisation. That does not mean it should be our only focus. There is also an urgent need for investment in the healthcare workforce in many of the worst affected countries, without which immunisation programmes cannot operate, not to mention disease surveillance and many other areas that need political support and funding. But with an increasingly challenging global health landscape, taking a progressive universalism approach, by prioritising zero-dose children, offers the fastest and most effective way to simultaneously make up lost ground and have the biggest impact, by making sure that no one is left behind.
This article was originally published in Health: A Political Choice Investing in Health For All
SCIENTISTS are working on a cancer vaccine which will be personalised for individual patients.
The new jab will be used to treat treat patients with high-risk melanoma - the deadliest form of skin cancer.
1
The game-changing vaccine, which could prevent thousands of deaths each year, is in the second of three trials.
Manufacturers Moderna and Merck have said results of the trial, which will determine whether it stops cancer coming back, are expected by the end of the year.
The experimental vaccine is based of of the same messenger RNA (mRNA) technology that was used to create the revolutionary Covid vaccines.
The cancer shot is tailored for each patient to generate T-cells - a key part of the body's immune response - based on the specific mutational signature of each tumour.
mRNA vaccines are usually cheaper to produce than traditional vaccines.
However, personalised vaccines are very expensive.
There are various forms ofskin cancerthat generally fall under non-melanoma and melanoma.
How to spot melanoma
The most common sign of melanoma is the appearance of a new mole or a change in an existing mole. Most experts recommend using the simple ABCDE rule to look for symptoms of melanoma skin cancer, which can appear anywhere on the body.
Most experts recommend using the simpleABCDE ruleto look for symptoms of melanoma skin cancer, which can appear anywhere on the body.
In women, the most common specific location for melanoma skin cancers in the UKis the legs.
Men are more likely to see melanomas in theirtrunk - the back or torso.
Non-melanoma skin cancers, diagnosed a combined 147,000 times a year in the UK, kill around 720 people a year in the UK.
Melanoma, meanwhile, is diagnosed 16,000 times a year, but is the most serious type that has a tendency to spread around the body.
The deadly cancer takes the lives of 2,340 people per year.
Conventional vaccines are produced using weakened forms of the virus, but mRNAs use only the virus's genetic code.
An mRNA vaccine is injected into the body where it enters cells and tells them to create antigens.
These antigens are recognised by the immune system and prepare it to fight the virus.
No virus is needed to create an mRNA vaccine.
This means the rate at which the vaccine can be produced is accelerated.
As a result, mRNA vaccines have been hailed as potentially offering a rapid solution to new outbreaks of infectious diseases.
They can also be modified reasonably quickly if, for example, a virus develops mutations and begins to change.
Ohio's 6-week abortion ban has forced women with cancer to seek out-of-state abortions so they can receive cancer treatment. In at least two cases, women were refused cancer treatment until they had abortions. (The 19th)
CT and MRI may miss some pancreatic tumors, reducing the potential for early detection and a chance at life-saving surgery, according to a study presented at United European Gastroenterology (UEG) Week 2022 in Vienna.
An oncologist reflects on being on "the other side" of grief. (JCO Art of Oncology)
Merck and Moderna announced a collaboration to develop a personalized cancer vaccine. The mRNA vaccine is currently being tested in combination with pembrolizumab (Keytruda) among patients with high-risk melanoma in a phase II trial.
Data from worldwide cancer registries suggest the emergence of a global epidemic of cancers in younger adults. (CNN)
Patients with inflammatory breast cancer, and particularly triple-negative breast cancer, face an increased risk for developing central nervous system metastases. (Cancer)
A phase II study of neoadjuvant atezolizumab (Tecentriq) for resectable non-small cell lung cancer showed a 20% rate of major pathologic response. (Journal of Thoracic and Cardiovascular Surgery)
Data on 33,000 patients with breast cancer provided new insights into the distinct clinical features of invasive lobular cancer versus invasive ductal cancer, further emphasizing the need for different types of management. (Journal of the National Cancer Institute)
Disparities in cancer mortality stratified by education level widened during the height of the COVID-19 pandemic. (American Journal of Preventive Medicine)
Using electronic health records to glean information about patient-reported outcomes was associated with significant improvement in clinical outcomes. (Journal of Clinical Oncology)
Charles Bankhead is senior editor for oncology and also covers urology, dermatology, and ophthalmology. He joined MedPage Today in 2007. Follow
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More and more people are getting vaccinated against monkeypox and becoming acquainted with the common side effect: a hard lump.
"I've had a lot of patients show me their lumps," Elsbet Servay, clinical director of immunizations at Callen-Lorde Community Health Center in New York City, told Insider. "It's a normal, expected reaction."
This swelling is one of the 13 most common side effects healthcare workers typically see after administering Jynneos (the two-dose smallpox vaccine that also protects against monkeypox).
It's nothing to worry about, Servay said: Lumps and aches are "a part of your immune system doing its job."
If you are part of the select at-risk group advised to get vaccinated against monkeypox, here's what you need to know.
The US is dishing outmonkeypox shots at a faster clip these days thanks to both increased vaccine production, and a new skin-deep dose-saving technique. Federal officialssaid Tuesdaythat there should be "enough" vaccine supply now to inoculate everyone "in the at-risk community."
Instead of injecting a full dose into the fatty area at the back of a person's arm (a "subcutaneous injection"), some healthcare workers are following CDC advice to inject a fifth of the dose just under the surface of the skin (an "intradermal injection") at a very tight 5 to 15-degree angle.
"The technique is a bit of a dying art," Servaytold Insider. "It's just a little trickier to administer, but we do expect it to offer protection."
Because the intradermal injection is delivered so shallowly, you can actually see the vaccine liquid appear immediately inside the body, just under the surface of the skin:
If the intradermal injection does not immediately result in this bubble of liquid under the skin (often referred to as a "bleb" or "wheal"), the injection has failed, and has to be re-done.
Callen-Lorde has trained eight nurses in intradermal vaccine technique for monkeypox, done with special needles that can measure "a very small amount of liquid" with "very fine syringes," Servay said.
But, aside from this fine-tuned procedure, the effects of the monkeypox vaccine, whether given intradermally or subcutaneously, should be quite similar.
"The most common vaccine side effects are pain, redness, swelling, hardness, itching at the injection site," Servay said. These side effects may be slightly more pronounced with intradermal injections than they were with subcutaneous shots, in large part because "under the skin there's a more evolved, richer immune system" than in arm fat.
"When you think of all the cuts and scrapes that people get in day to day life, it makes sense," Servay added.
According to a 2015 study of more than 350 vaccine recipients, side effects are more common among people who get Jynneos intradermally than those who receive the bigger, deeper subcutaneous shots. But, there is one side effect that is far more common among people who get the vaccine injected into their arm fat.
The tenderness and pain at the injection site after a subcutaneous shot into the back of the arm can be worse than the pain after an intradermal forearm injection, which tends to just be more itchy and red.
Dr. Graham Walker, an ER physician in San Francisco told Insider that his injection site was "definitely tender" for a while after his first subcutaneous shot a few weeks ago.
"One time I bumped the back of my arm on something and it hurt a LOT for a few seconds, like a stubbed toe," he said.
The most common shared complaint among people who've gotten the Jynneos vaccine whether their injection was administered intradermally or subcutaneously has been the presence of a "bump," "knot," or hard "lump" lingering for days or weeks afterwards. (That watery bleb, on the other hand, starts to dissipate almost immediately, and shouldn't be noticeable by the next day.)
One microbiology student described his first (subcutaneous) shot lump on Twitter as the size of a "nickel" but said his second (intradermal) injection resulted in a hump as big as an "egg."
Second dose side effects can often be more pronounced than first doses, because the immune system has already been primed to react. (Be aware that some health departments, including New York City's, are not scheduling second doses just yet.)
Servay said if there's one word of caution she would offer to people getting monkeypox vaccines, it's that the vaccine "doesn't work right away" and people "really don't have any" protection in the first days after their shot is administered.
"I have seen cases of monkeypox in people who probably acquired it slightly before or around the time they got their first dose," she said.
An immune response to monkeypox starts ramping up at about two weeks after a first shot, but "two weeks after that second dose is when you get maximum protection," Dr. Demetre Daskalakis, the US's deputy monkeypox response coordinator, said during the briefing Tuesday.
"That shot is not for today," he said, stressing there are "lots of other strategies" to reduce the spread of the virus in the meantime.
However, if you're one of the more than 18,900 people nationwide who've recently had monkeypox, there's no reason to rush out and get shots. Like smallpox, immunity from a prior monkeypox infection should last for a while, experts say.
Dr. Fauci explains why people are not protected from monkeypox
Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, talked to USA TODAY about protection against monkeypox.
Ariana Triggs and Becky Kellogg, USA TODAY
As the monkeypox outbreak continues to spreadworldwide, cases across theU.S.are climbing. And on Monday, Los Angeles County reported what is believed to be the first recorded U.S. death linked to the virus.
Confirmed cases of monkeypox have reached more than 59,600worldwide, according toWednesday numbers from the Centers for Disease Control and Prevention. The outbreak, first spotted in Europe in late April, has reached 103countries the vast majority in nations that hadn't previouslyhad significant caseloads of the rare, viral infection.
In addition to the California death, the CDC has confirmed that 18 people outside the U.S. have died of the disease in 2022. Still,the world's largest monkeypox outbreak belongs to the U.S.
The U.S. had reported 22,774 confirmed monkeypox/orthopoxvirus cases as of Wednesday, per the CDC. Highly-populated states are leading the numbers with 4,300confirmed cases in California, followed by 3,694confirmed cases in New York.
What is monkeypox?A look at symptoms, treatment and addressing the myths
Combatting misinformation and stigma: Monkeypox is spreading through sex, but it's not an STI. Why calling it one is a problem.
On Monday, Los Angles County health officials announced that a resident had died from monkeypox, with the cause of death confirmed by the autopsy.The patient was severely immunocompromised and had been hospitalized, officials said.
It's possible that this marks the first recorded U.S. death from monkeypox, but health officials are also investigating whether monkeypox contributed to the August death of a Texas adult. That patient was also severely immunocompromised, the Texas Department of State Health Services said.
California: First known monkeypox death in US confirmed by LA County health officials
Texas: Officials investigating whether monkeypox played role in death of immunocompromised adult
Many have criticized the Biden administration for not acting more quickly at the start of the outbreak, including aslow launch on testing and vaccine rollout to meet demand, but the White House said last week that it was optimistic about rising vaccinations.
In order to stretch the nation's limited supply, U.S. health officials authorized a plan onAug. 9to give people one-fifth of the usual doseof the Jynneos vaccine, citing research that suggests the reduced amount is about as effective. This came days after the Biden administration announceda nationwide public health emergency.
As of Sept. 8,more than 460,000 doses have been given,Dr. Demetre Daskalakis, the deputy coordinator of the White House national monkeypox response, said last week.
The administration has also promised to ramp up vaccination offerings at large LGBTQ events, like Pride festivals, around the country in the coming weeks.
Monkeypox is not a gay disease.But LGBTQ leaders say they need more help for gay men and everyone else
Repeating history: After repeating early COVID mistakes, US now has the worlds biggest monkeypox outbreak
Monkeypox does not usually cause serious illness however,it can result in hospitalization or death. The virus is spread through close, physical contact. The current outbreak is primarily affecting men who have sex with men (93%of U.S. cases), but health officials stressthat the viruscan infect anyone.
However, experts have also stressed concerns of worsening racial disparities in the reported cases.Latinoand Black peoplehave been disproportionately infected.
Racial disparities: Black, Hispanic people disproportionately suffer monkeypox but fewer are getting the vaccine, early data shows
Here's where confirmed cases stand across U.S. states and territories, according to CDC numbers from Wednesday, September 13:
Alabama: 90
Alaska: 3
Arizona: 399
Arkansas: 52
California: 4,300
Colorado: 235
Connecticut: 114
Delaware: 35
District of Columbia: 473
Florida: 2,301
Georgia: 1,614
Hawaii: 25
Idaho: 12
Illinois: 1,187
Indiana: 195
Iowa: 22
Kansas: 7
Kentucky: 39
Louisiana: 219
Maine: 7
Maryland: 598
Massachusetts: 356
Michigan: 237
Minnesota: 163
Mississippi: 55
Missouri: 70
Montana: 5
Nebraska: 28
Nevada: 204
New Hampshire: 27
New Jersey: 633
New Mexico: 33
New York: 3,694
North Carolina: 435
North Dakota: 5
Ohio: 236
Oklahoma: 31
Oregon: 183
Pennsylvania: 678
Puerto Rico: 155
Rhode Island: 61
South Carolina: 133
South Dakota: 2
Tennessee: 239
Texas: 2,017
Utah: 128
Vermont: 3
Virginia: 422
Washington: 535
West Virginia: 10
Wisconsin: 64
Wyoming: 2
What's everyone talking about?Sign up for our trending newsletter to get the latest news of the day
Contributing: Celina Tebor, Cady Stanton, Karen Weintraub, USA TODAY. The Associated Press.
After the first case of monkeypox was reported in the U.S. in May, case numbers quickly climbedand calls for vaccinations soon followed.
Vaccines were introduced in the summer and, so far, over 900,000 have been administered across the country. Yet their rollout hasnt been quite so straightforward.
Limited dosage supplies meant that only certain individuals were deemed eligible for the jab which created a scramble for vaccination appointments. In light of this, the Food and Drug Administration (FDA) authorized that a single dosage could be split into five to reach more peopleprompting concerns that protection levels may be compromised.
Meanwhile, some recipients are developing a red, painful mark at the injection site.
Some outlets including The Washington Post reported this prospect is deterring recipientsprimarily men who have sex with menfrom getting either their initial or follow-up dose, partly for fear of stigmatization.
Lets take a closer look at some issues that have been arising and what implications they have for those receiving the vaccination.
Before delving into concerns around smaller dosage amounts, its important to understand how most vaccines are delivered regardless of what disease they provide protection against. There are three types of injectable vaccines: intradermal, subcutaneous, and intramuscular.
Most vaccinations currently available, like SARS-CoV-2 or influenza vaccines, are intramuscular injections, Dr Michael Chang, a specialist in infectious diseases at UTHealth Houston and Memorial Hermann Hospital, explained to Healthline.
Common intramuscular injection sites include the upper arm or leg. Furthermore, he noted, for most authorized or fully approved vaccines, injecting deeper into the muscle maximizes the immune response against the vaccine, optimizing protection. [It also] minimizes the frequency of local injection site reactions.
In subcutaneous injections, the needle is inserted into a layer deeper than the skin, usually the fatty layer between the skin and the muscle, said Chang. The JYNNEOS monkeypox vaccine was initially approved for administration in this way.
However, the approach isnt used as much for vaccines, as the immune response in the skin may not be as vigorous, and you have more local site injection reactions, Chang revealed.
This leads us to intradermal injection, whereby the vaccination is delivered to the top layer of the skin. This is now the method being used for monkeypox vaccines. So why the switch?
Often, intradermal vaccines require a lower dose to receive efficacy, Dr.Sujal Mandavia, chief medical officer at Carbon Health, told Healthline.
This is because the immune system of the fine layers of our skin is well primed to receive foreign things, like vaccines, and tends to respond quite vigorously.
With vaccine shortages a challenge, the intradermal approach enables doses to be split into fifths. The result? We can stretch the current available supply and vaccinate more at-risk individuals, noted David M. Souleles, MPH, director of MPH Program and Practice at the University of California, Irvine.
However, Chang explained, it is recommended that those aged under 18 still receive the vaccination subcutaneously rather than intradermally.
If you only receive 20% of a typical monkeypox vaccine dose, you might think you wouldnt be protected against the disease.
However, this isnt the case according to the research.
The FDA made the decision to use a lower amount of vaccination and administer it intradermally based on this clinical study involving 524 patients, said Mandavia. [The study] demonstrated that, when injected [intradermally] into the skin, one-fifth of the JYNNEOS vaccine produces a similar immune response to a full dose of subcutaneous administration.
While the current vaccination certainly offers protection, more research is needed into the defense levels it affords over an extended period. The effect on long-term immunity and protection against monkeypox from the one-fifth intradermal dose remains unclear at this time, Chang added.
Fortunately, receiving one-fifth of a vaccination dose doesnt mean you need to have four follow-up injections to obtain optimum benefits.
With intradermal administration of the monkeypox vaccine, two doses of the vaccine given 28 days apart is considered fully vaccinated and provides protection, shared Souleles.
If youre under the age of 18 and receive your vaccination subcutaneously, your second dose should also come 28 days after the first.
Peak immunity is expected 14 days after the second dose of the JYNNEOS vaccine, added Chang. Unfortunately, second dose coverage is low per Centers for Disease Control (CDC) data.
A key reason individuals are skipping their second dose? The appearance of a sore, red mark at the site of their first injection. Yet, this side effect isnt limited to the monkeypox vaccine.
This is a common issue with any intradermal injection, and not only the JYNNEOS vaccine, Chang shared.
The reason this appears, Mandavia explained, is because the body recognizes the viral load as foreign and sends immune cells to react against it.
Think about the COVID-19 vaccine or flu vaccine, added Souleles. That can often result in a sore arm at the injection site for days after the injection.
While potentially unsightly and uncomfortable, the red welt that commonly develops with the monkeypox vaccine is benign and is not harmful, assured Mandavia.
For those concerned about developing another red mark in a visible area following the second dose, you have options. Chang explained it is possible to request the injection be given in a less visible intradermal site, such as the shoulder (over the deltoid) or the upper back over the shoulder blades (scapula).
Good news: Chang explained that the mark usually subsides within 72 hours to 1 week although, in rare instances, they can remain for three to four weeks.
If, at any point following injection, you develop worsening tenderness or swelling at the injection site, it is important to consult with a healthcare provider, urged Chang.
In the meantime, if you develop a red mark at the injection point, following a couple of simple steps may help reduce it.
Since this is typically related to skin irritation, gentle massage and applying a cold pack to the site can help relieve the symptoms faster, Chang revealed.
Any damage to the skin (including via vaccination) can potentially leave a mark or scar in the long term. But some individuals are believed to be at greater risk.
For instance, its thought that those with keloidsor a history of themare more likely to develop scarring following intradermal vaccination.
Keloids are excess growths of scar tissue that grow following trauma to the skin. They are most often seen in those with darker skin, who are pregnant, or under the age of 30.
As such, the CDC recommends that individuals with keloids, either currently or previously, be given the monkeypox vaccination subcutaneously.
Additionally, the New York City Department of Health mentioned in their monkeypox vaccination leaflet, that monkeypox infection has high potential for scarring and permanent skin changes.
Some people eligible for the monkeypox vaccine have brought up concerns about getting their second dose.
However, to obtain optimal protection against monkeypox, receiving the full vaccination is essential. This means two injections, 28 days apart.
Having a sore mark might be uncomfortable for a short time, stated Mandavia. However, it is a mild side effect of the vaccine that could save you from more serious illness with symptoms like a painful rash, fever, headache, muscle aches, backache, swollen lymph nodes, chills, and exhaustion.
If you have any concerns about the vaccine, side effects, or potential scarring, always speak with your healthcare or vaccination provider.
News Release
October 11, 2022
Toronto Public Health (TPH) has added approximately 25,000 appointments for monkeypox immunization and doubled the number of clinics offering the vaccine from today until Friday, October 31, following the expansion of second-dose eligibility by the provincial government.
Eligible individuals who received a first dose of the Imvamune vaccine may now receive a second dose 28 days after their first dose. More information is available on the Ministry of Healths website.
TPH continues to follow federal and provincial guidance on administering of Imvamune vaccines to protect at-risk populations against the monkeypox virus. Appointments are available for clients who meet the following criteria:
a) Two-spirit, non-binary, transgender, cisgender, intersex, or gender-queer individuals who self-identify or have partners who self-identify as belonging to the gay, bisexual, pansexual and other men who have sex with men (gbMSM) community and at least one of the following: Had a confirmed sexually transmitted infection (STI) within the last year.
b) Individuals who self-identify as engaging in sex work or are planning to, regardless of self-identified sex or gender.
c) Household and/or sexual contacts of people who are eligible for Pre-Exposure Vaccination listed in parts (a) or (b) above and who are moderately or severely immunocompromised (have a weak immune system) or are pregnant. These individuals may be at risk for severe illness from a monkeypox infection and may be considered for Pre-Exposure Vaccination, and should contact a healthcare provider or Toronto Public Health for more information.
d) Research laboratory employees working directly with replicating orthopoxviruses. This completed form must be provided.
Appointments are required for eligible individuals to get vaccinated and can be booked online using the TPH Appointment Booking System. Health card and identification are not required to receive a monkeypox vaccine or to book an appointment at a City-run immunization clinic.
Starting today, six City of Toronto-run immunization clinics are administering the Imvamune vaccine:
Monkeypox spreads from person to person through contact with infected lesions, skin blisters, body fluids or respiratory secretions. It can also be transmitted by contact with materials contaminated with the virus (e.g. clothing, bedding) and through bites or scratches from infected animals.
Monkeypox symptoms include fever, headache, muscle aches, exhaustion and swollen lymph nodes, followed by a rash or blisters on the skin. Most people recover from monkeypox on their own without treatment. Vaccination is being offered to protect against the monkeypox virus and can help reduce serious symptoms. Like most vaccines, the Imvamune vaccine can take up to two weeks for those vaccinated to be fully protected.
TPH asks residents with monkeypox symptoms to self-isolate immediately and contact a healthcare provider. People who have been in contact with a person who has monkeypox should self-monitor for symptoms for 21 days. If symptoms develop, they should self-isolate, seek care and get tested. Healthcare providers are reminded that suspected or confirmed cases of monkeypox must be reported to TPH. As with many other diseases spread through close contact, people can lower their risk by reducing the number of close contacts, cleaning their hands frequently and wearing a mask when possible. Common household disinfectants can kill the monkeypox virus on surfaces.
Public Health Ontario updates monkeypox data for Ontario twice monthly. As of October 4, there was 496 laboratory-confirmed cases of monkeypox reported in Toronto, with eight probable cases currently under investigation. More information is available on the Public Health Ontario website.
TPH continues to follow up with anyone thought to be exposed to monkeypox. TPH also continues to work closely with the Public Health Agency of Canada, Public Health Ontario, and the Ontario Ministry of Health. TPH has communicated with local physicians to provide information on symptoms, laboratory testing and diagnosis, infection control precautions, treatment and reporting requirements for monkeypox.
More information is available on the Citys monkeypox webpage.
Residents can also find information about monkeypox on the Public Health Agency of Canadas website or through TPHs Health Connections onlineor by calling 416 338-7600.
Additional information is available on the Gay Mens Sexual Health Alliance website.
Toronto is home to more than 2.9 million people whose diversity and experiences make this great city Canadas leading economic engine and one of the worlds most diverse and livable cities. As the fourth largest city in North America, Toronto is a global leader in technology, finance, film, music, culture and innovation, and consistently places at the top of international rankings due to investments championed by its government, residents and businesses. For more information visit the Citys website or follow us on Twitter, Instagram or Facebook.
The Health Service Executive intends on completing monkeypox vaccinations for high priority groups by the end of the year.
Representatives from the HSE told the Oireachtas Health Committee today that 11 designated vaccination centres will open across the country from Monday, 17 October.
Individuals will be asked to self-identify their risk and book a vaccine appointment.
The HSE estimates that between 6,000 and 13,000 people would benefit from a primary prevention monkeypox vaccine.
The roll-out to high priority groups is already under way, with almost 500 people vaccinated so far, however Monday will mark a significant expansion.
TDs and Senators were told this morning that the aim is to complete vaccinations for high priority groups between now and December.
However, some queried how such a target could be met when the international supply of Monkeypox vaccine is limited.
"That community of 13,000 people ... only a fraction of those will actually be offered a vaccine in the short to medium term", Sinn Fin's Health Spokesperson David Cullinane told the committee.
Dr Ciaran Bannan, Consultant in Infectious Diseases, St James's Hospital, accepted that there are currently not enough doses to meet the overall 13,000 people that would benefit from a vaccine. However, he told members that it was hoped that further supplies would soon be secured.
To date over 2,000 vials of monkeypox vaccination have been sourced.
In August, the European Medicines Agency also advised that the vaccine could be administered intra-dermally, meaning vaccine vials can go further and provide more doses.
According to the EMA, one vial can provide five doses. In practice, the committee was told that vaccine administrators usually get four doses per vial.
Two doses of monkeypox vaccine are administered at least 28 days apart.
Politicians also heard that 194 cases of the disease have been notified in Ireland, with 11 of those requiring hospitalisation.
Cases are predominately male, and the mean age is 35 years.
Deputy Neasa Hourigan expressed concern over the financial challenges that people may face, particularly those in precarious work, if required to self-isolate.
"We're not supporting people financially the way we did during Covid," she told the Committee.
In response, Professor Fiona Lyons, Clinical Lead for Sexual Health, said that the HSE had "raised that [issue] with the Department".
Read more:Monkeypox cases top 70,000, says WHO
