This month, both the Centers for Disease Control (CDC) and the Washington State Department of Health (DOH) updated their COVID-19 guidance and removed the five-day isolation requirement for people who test positive for the virus.
Under the updated guidance, people who test positive for the coronavirus should stay home and away from other people until their overall symptoms are improving and they are fever-free for at least 24 hours without the use of fever-reducing medication. After returning to normal activities, they should wear a well-fitting, high-quality mask for five days when they will be around other people indoors. This updated guidance brings a unified, comprehensive approach for managing COVID-19 and other common respiratory viral illnesses, such as the flu and RSV.
Thanks to COVID-19 vaccines and other precautions we took, said King County Executive Dow Constantine, we are now in a place where we can treat COVID-19 the way we treat other respiratory viral illnesses. As a result, King County is sunsetting the Temporary COVID-19 Personnel Policy, almost four years to the day of issuing the first iteration.
Our region was the first in the country to experience a COVID-19 outbreak. We acted quickly and based our decisions on science. We listened to the experts and followed their guidance, Executive Constantine said. And thanks to your collective efforts, we were able to limit the spread of the virus and save thousands of lives, while continuing to deliver vital services for the people of this region.
As part of their update, the CDC continues to recommend that everyone take steps to reduce their risk of getting these viruses and spreading them to others, including getting recommended vaccinations, wearing high-quality masks in crowded indoor settings, and improving indoor air quality. You can learn more about the updated guidance in Public Healths latest blog: Ask Public Health: What are the latest recommendations for staying at home when sick?
I want to thank Public Healths Health Officer Dr. Jeff Duchin, who is retiring July 1, for his 30 years of service. His expertise and leadership during the pandemic in conjunction with the efforts of the Countys public health professionals and partners helped us save countless lives, Executive Constantine stated. I also want to thank our front-line employees who ensured customers had access to essential in-person services throughout the pandemic, and all employees who quickly adjusted their work to advance our priorities for this region.
Anglers arent the only ones catching something out in Wisconsin waters. University of Wisconsin researchers have detected almost 20 viruses in wild sport fish, including a distant relative of coronavirus thats usually associated with birds.
Researchers at UW-Madison say the discovery is part of a first-of-its-kindstudyin North America to survey healthy wild fish for viruses. They analyzed 103 blood samples from five fish species that included brown trout, lake sturgeon, northern pike, bluegill and walleye. The results were recently published in the journalPathogens.
The findings revealed 19 viruses that included 17 unknown to science before researchers discovered them, according to Tony Goldberg, an epidemiology professor at the universitys School of Veterinary Medicine. He said the findings underscore that fish get sick, too.
Walleye in our study have a coronavirus that is a distant relative of the coronaviruses we all now knowfrom the pandemic, Goldberg said.
Goldberg said its the first coronavirus associated with fish. He noted a poultry disease called infectious bronchitis is caused by a relative of the coronavirus found in walleye. The virus was found in 11 out of 15 walleyes sampled by the Wisconsin Department of Natural Resources. The studys findings also revealed viruses that are distant relatives of rubella and Hepatitis B.
Even so, he stressed theres no threat to human health or anglers.
These are fish viruses, and there are no known viruses of fish that can affect people because were just too far from fish evolutionarily, Goldberg said. People dont have to worry about eating fish because they might be infected with one of these viruses.
The work builds on previousresearchconducted by Goldberg on the fish virus viral hemorrhagic septicemia, or VHS. The virus was introduced to fish in the Midwest during the early 2000s, which evolved into a strain that caused massive fish kills in Wisconsin. The DNR collected blood samples from fish across the state for that research, which were then analyzed for viruses in the latest study.
The findings could help the DNR and fishery managers who routinely test fish at hatcheries. Goldberg said it can be challenging to handle the discovery of a new virus in fish that are set to be released into state waterways.
Do you put the fish out there anyway, knowing that they have something? Do you hold them indefinitely for some researcher to come and figure out what the virus is? Do you kill them? Goldberg said. Its a common problem.
Among species tested, lake sturgeon had the highest rate of infection with nearly 97 percent of samples containing any virus. Around 71 percent of walleye had viruses, and brown trout had the lowest infection rate with around 6 percent of samples that contained viruses.
Goldberg said its tempting to think lake sturgeon a fish that firstappearedwhen dinosaurs walked the Earth have accumulated several viruses over time.As for brown trout, he noted such non-native species are known to gain a foothold and spread because they dont encounter many pathogens that can infect them. Even so, its unclear why certain species had higher or lower rates of infection.
The next step in their research is to sample a larger set of fish using tests designed by the U.S. Fish and Wildlife Service to detect the 17 new viruses.
Eric Leis, fish biologist with the agencys La Crosse Fish Health Center, said it developed a test thats essentially the same fast and inexpensivepolymerase chain reaction, or PCR, technique used to test for COVID-19.
We can use those (tests) to assess basically the intensity of the infection, as well as determine the overall prevalence in the state, Leis said.
The goal of the research is to collect baseline data to determine what effect, if any, the viruses may have on the health of fish. Leis said its important to know where viruses are found as part of recovery efforts for fish like lake sturgeon.
If theres a population that doesnt have any of these viruses, we would select from that population for restoration efforts, Leis said.
The detection of viruses among fish in certain areas may also be used to investigate the cause of any fish kills. However, some viruses that have been linked to fish kills have also been found in healthy fish throughout the state.
Even though theyre infected with a virus, it doesnt necessarily mean that it would cause disease either, Leis said. Theres some times where fish are simply carriers. Theyre not the actual hosts that develop disease.
Goldberg added its rare that viruses are the sole cause of fish kills.
Theres very strong evidence that stressful environments make fish unhealthy and make them susceptible to viruses, Goldberg said. I wouldnt be surprised if some of the viruses we found, or some we havent found yet, pop up in the future when things like climate change get worse or we have water quality declines for any reason.
MINNEAPOLIS Researchers have found a concerning association between COVID-19 infection and an increased risk of developing the rare disorder Guillain-Barr syndrome over the following six weeks. However, the study authors, working with the American Academy of Neurology, also note those who received the Pfizer-BioNTech mRNA vaccine showed a lower risk of developing Guillain-Barr syndrome in comparison to others who did not receive the vaccine.
Guillain-Barr syndrome is a rare autoimmune disorder that causes the immune system to attack nerve cells and portions of the peripheral nervous system. Symptoms usually begin with weakness in the hands and feet before eventually progressing to full-blown paralysis. While it can be life-threatening if left untreated, the majority of Guillain-Barr patients make a full recovery.
The exact cause of Guillain-Barr syndrome remains a mystery, but it often develops after gastrointestinal or respiratory infections. Researchers note the rare disorder develops in up to 20 out of every one million people annually, and cases following certain vaccinations are extremely rare.
These findings further highlight the benefits of ongoing vaccination programs with mRNA-based vaccines, says study author Anat Arbel, MD, of Lady Davis Carmel Medical Center in Haifa, Israel. The results have important clinical and public health implications, in a media release.
This project assessed over three million people living in Israel, all of whom had no previous history of Guillain-Barr. Researchers tracked participants starting from Jan. 1, 2021 until June 30, 2022. During that period, 76 individuals developed Guillain-Barr. The study authors then matched each Guillain-Barr patient to 10 people who did not have the syndrome (760 people in total).
Next, the research team assessed whether participants had a COVID infection or a COVID vaccine over the six weeks prior to being diagnosed with Guillain-Barr (or the same period among matched participants).
This approach led to the finding that those with a recent COVID infection were six times more likely to develop Guillain-Barr than others who had gone without an infection. In all, 12 percent of those with Guillain-Barr had a recent COVID infection, in comparison to just two percent of the people who did not have Guillain-Barr.
Additionally, 11 percent of Guillain-Barr patients had been recently vaccinated with an mRNA vaccine, in comparison to 18 percent of those who did not have Guillain-Barr. All in all, the study estimates people with a recent mRNA vaccination were over 50 percent less likely to develop Guillain-Barr than the unvaccinated.
While Guillain-Barr is extremely rare, people should be aware that having a COVID infection can increase their risk of developing the disorder and receiving an mRNA vaccine can decrease their risk, Dr. Arbel adds.
Its important to note not all participants had access to COVID-19 tests. Thus, it is possible some people may have had a COVID infection without realizing it. In conclusion, the study authors stress these findings merely show an association and do not prove that COVID infection increases the risk of Guillain-Barr or that mRNA vaccination decreases the risk.
The study is published in the journal Neurology.
Just over three years after he recovered from a case of COVID-19 that left him hooked to a breathing machine for more than a month, Nick Barakos says hell never be the same.
While he has regained the 60 pounds he lost while sick and there isnt any lingering damage to his lungs, kidneys or liver, the 59-year-old restaurant owner has noticed some changes of heart. After years of deferring what had been a long-held aspiration, he finally built a home in his native Greece. And in his day-to-day life, Barakos says hes become soft-hearted.
Recalling the kindness of nurses and doctors or the family and friends who supported him through his ordeal leaves Barakos fighting back tears. During a recent hourlong interview with LNP | LancasterOnline, he choked up four times.
Thats one thing COVID has left me. Im a lot more emotional now, said Barakos, who owns Kyma Seafood and Johnnys Bar & Steakhouse in East Cocalico Township. Im very lucky and sometimes I just cry. Ill be driving down the road listening to an emotional song and I start crying.
Four years ago on April 10, the United States became the country with the most reported COVID-19 deaths as widespread mask mandates had been enacted. Just as vaccines to combat the disease were finally rolling out nearly a year later, Barakos came excruciatingly close to becoming another of the nearly 2,200 Lancaster County residents that died from the disease. At one point he was given only a 30% chance of survival.
During parts of February and March of 2021, Barakos spent 36 days on a ventilator at Wellspan Ephrata Community Hospital, a record that still stands for any patient at the hospital.
Nick Barakos, owner of Kyma Seafood Grill and Johnnys Bar and Steakhouse, in Stevens, speaks about his near-death experience with Covid-19 in 2021, and what he went through on Wednesday, Feb. 28, 2024. Nick was on a ventilator for 36 days and lost 60 pounds. It took him close to one year to regain the weight and strength he lost prior to being sick. Learning to walk again was one of the difficulties he had to conquer.
Patients on a ventilator can develop such complications as muscle weakness, recurring infections, pressure ulcers, hyperactive delirium and post-traumatic stress syndrome, among others. An August 2022 study published in the Annals of the American Thoracic Society found that 61% of a group of 1,966 COVID-19 patents had died 28 days after being intubated.
The longer you go on a vent, even without COVID, you run into long-term problems, Dr. John Jack Joseph, a WellSpan pulmonologist and one of the doctors on the team that treated Barakos, told LNP | LancasterOnline in March 2022. Hes an outlier, theres no question about it.
While being grateful to have beaten the odds, Barakos said he sometimes feels guilty that he made it when so many others didnt
Most people dont survive near death experiences, he said. Why did I survive and all these others are people dying. Why me?
READ:Restaurateur survives COVID-19 after 5 weeks on ventilator
When Barakos left the hospital he was unrecognizable to his family. Rail thin and weak, he couldnt even raise a fork to eat.
Returning home, he slowly resumed his lifelong weightlifting at a home gym. Although at first he needed to use a walker and barely could lift any weights, he persevered through a recovery that is as remarkable as his initial survival.
Im a stubborn old Greek. Now Im old I used to be young. But Im stubborn, he said.
His recovery has become an inspiration to the hospital staff who saw him at his lowest points.
Nick Barakos is seen at WellSpan Ephrata Community Hospital in this undated photo. He was admitted to the hospital with COVID-19 on Feb. 21, 2021, and spent more than a month there. He spent 36 days on a ventilator.
Some days seemed so bleak, but I cant stress how wonderful it felt as a nurse to see my patients improve and get out of the hospital, said Gerri Harris, a nurse in the hospitals intensive care unit. Nick will always be remembered on our unit as, The One That Made it!
About six months after coming home, Barakos returned to work at Kyma Seafood and Johnnys Bar & Steakhouse. Remarkably, he said some of his own employees werent taking the disease seriously, even after what had happened to him.
Some of these young kids, you know, they think theyre invincible, he said.
Barakos said he didnt lecture employees or customers about the disease and the governments response to it since it became a divisive issue. He would, however, occasionally share his own experience, including a photo his brother-in-law took of him on his 30th day in ICU when he was attached to a large breath tube, unconscious.
A lot of people got the vaccine the ones were on the fence - after they heard about me being so sick. So that was a good thing, he said.
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Barakos was born in Greece but his parents emigrated to the United States when he was a child. He grew up in York County and helped his parents in the restaurants they owned.
In 1994, Barakos and his brother George took over what was then the Silk City Diner along Route 272, just east of the Reading/Lancaster exit of the Pennsylvania Turnpike. They operated Johnnys Bar & Steakhouse as a separate restaurant on the buildings lower level.
Nick Barakos, owner of Kyma Seafood Grill and Johnnys Bar and Steakhouse, in Stevens, speaks about his near-death experience with Covid-19 in 2021, and what he went through on Wednesday, Feb. 28, 2024. Nick was on a ventilator for 36 days and lost 60 pounds. It took him close to one year to regain the weight and strength he lost prior to being sick. Learning to walk again was one of the difficulties he had to conquer.
In 2009 the brothers overhauled the upstairs restaurant, changing it from a diner into Kyma Seafood Grill. Barakos said the shift from an all-day diner to a dinner spot proved successful while also improving his own work schedule.
Barakos eventually bought out his brother and has operated the restaurants on his own for the last 10 years. Barakos owns the property and described a conservative approach to the business that allowed him to save money for the unexpected.
When restrictions meant to slow the spread of COVID-19 forced restaurants to close in March 2020, Barakos said some of his reserves - along with government assistance programs designed for restaurants helped the business survive.
We just took things in stride, he said. We just had to deal with things that were thrown at us. We had no option, no choice. We had to listen to the government, you know, for those safety rules. We closed down when they told us to and we tried to follow the safety measures as much as possible.
While the business was weathering the pandemic as well as could be expected, a year after the first restaurant closures, Barakos found himself fighting for his own survival.
Around Valentines Day in 2021, Barakos and several employees got sick with COVID-19, forcing the restaurant to close for a week. The other employees recovered, but Barakos took a turn for the worse and then much worse as he needed to be put on a breathing machine.
We got a call in the middle of the night one night that they intubated him. And from then on it was just some of the worst weeks of our lives, said Nicks sister, Vickie Saltos Barakos. He was basically in a state. He didnt know anything. We were the ones who were aware every second what was going on.
At one point Nick was given only a 30% chance of survival. Barred from visiting him because of worries about spreading the virus, the family stayed in touch through frequent calls to the hospital. Saltos Barakos said she also made the nearly hourlong trip from their home near York just to sit in the hospital parking lot, just to be closer to him.
Wed drive all the way up and sit outside and just cry, Saltos Barakos said. We were desperate to be near him.
In addition to doing their best to look after Nick, Saltos Barakos and her husband, Chris, also helped look after his restaurant since they also have experience in the industry.
Barakos said he doesnt remember much about his time in the hospital, although he does recall many strange and vivid dreams. It was only after he got out that the full impact of his experience became apparent to him.
Barakos, who never married, recalls thinking that he was glad that it was him and not someone with a wife and children who got the disease, and might not have survived.
Im thinking, whos going to remember me if I die, he said. But I had a rude awakening. So many people contacted me friends, family and customers. I got over 250 cards from customers and friends saying, you know, we would have missed you and this and that.
READ:'A man of the people': First Black teacher at SDL, civil rights pioneer Frederick M. Reed dies at 88
A changed man
While Barakos said he still occasionally gets recognized from some of the initial news stories about his recovery, the attention has died down along with the focus on COVID-19, which continues to circulate, but with much less impact.
Even Barakos own second bout with COVID-19 in January proved little more than a bad cold that didnt really worry him.
I was confident, he said. I had all the vaccines, you know, I had all of them.
And while he wore a mask for a couple weeks after that, he most often goes without one.
But for Barakos, the impact of COVID-19 continues to be life-changing. A dual citizen of Greece and the United States, Barakos would regularly visit Greece and the home his parents have in Nafpaktos, a coastal town about two hours east of Athens.
Barakos has long dreamed of building a home of his own in Greece, saying for the last 10 years that next year would be when he would finally do it.
After this experience, I said. Theres no next year. I did it. I built my house last summer, he said.
For now, the house is just a vacation home, but Barakos said that when he eventually retires from the restaurant business, he plans to move to Greece full time. Yet he doesnt imagine just taking it easy he wants to continue to find ways to help others once he doesnt have the daily pressures of running a restaurant.
I got a second chance and Im not going to let it go, he said. I mean, very few people get second chances in life. Very few. And if you dont take advantage of that, then that doesnt change you. Then you have no heart.
Nicks sister has noticed the ways her brothers experience with COVID-19 changed him.
Hes a lot more sensitive, emotional, Saltos-Barakos said. Very emotional. We are an emotional family, we show our feelings, but he has become even more emotional.
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This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Contact a qualified medical professional before engaging in any physical activity, or making any changes to your diet, medication or lifestyle.
With spring and the end of flu season just around the corner, many Canadians are wondering whether or not they need an updated COVID-19 vaccine and what the future of the virus may look like.
In January, the National Advisory Committee on Immunization (NACI) released recommendations for administering a booster dose of COVID-19 vaccines in the spring, particularly targeting Canadians with a heightened vulnerability to severe illness caused by the virus. These are typically people aged 65 or older, or those who are immunocompromised.
But Dr. Horacio Bach, a researcher and clinical assistant professor at the University of British Columbia's faculty of medicine, noted everyone can benefit from a COVID-19 booster every six months, or six months from their last date of infection.
"Antibodies don't last. After six months, they start to fade," he told Yahoo Canada. "We've known that from the very beginning, even before the vaccine, even for people naturally infected."
Still, the NACI recommended it's crucial high-risk individuals get their extra dose of the latest vaccine first to better protect them against the current variants of the Omicron origin. People considered high-risk include:
As of right now, only Ontario residents identified as higher risk will be able to access spring booster shots starting in April. British Columbia is set to announce its own guidance soon, while people in Manitoba and Nova Scotia are already able to access their spring booster.
Some research shows COVID-19 could ultimately develop a seasonal pattern, but for now, it hasn't disappeared in the spring or summer like the flu does.
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"The flu is seasonal. That's the reason we get one shot in November. What we see in COVID-19 is not as seasonal due to the number of hospitalizations," Bach said. "It's not something that disappears in the spring or summer. We don't know the behaviour of these viruses; everything is changing."
It may seem like COVID-19 is following a seasonal pattern, but only because flu season is a convenient time to remind people to get vaccinated. While COVID-19 infection rates tend to lower in the warmer months, they still persist, not reaching the same low levels as the flu does in the warmer months.
According to the NACI, people aged 80 and older face the highest risk of severe illness from COVID-19. Nevertheless, the recommendation now includes those aged 65 and above, recognizing the risk of severe infection varies across older adult age groups.
This demographic tends to deal with ailments, like gastrointestinal problems, high blood pressure and other underlying diseases, that put them at greater risk. Some are taking medication for other illnesses that render them immunocompromised, too.
"We age and there are problems and that's reflected in the immune response," Bach said. Someone who's 60 to 80 may not be as strong as when they were 20 years old."
Getting a spring booster is especially important for this demographic if they didn't receive a booster last fall.
Despite masking and social distancing no longer being mandatory, the recommendations remain the same: Mask up, stay home when you're sick and wash your hands.
"[Masks] are highly protective as long as they have at least three layers because the virus gets trapped there," Bach shared.
While he recommended wearing K95 or KN95 masks, even surgical masks are better than nothing, "as long as you wear it properly." That means well-fitted to the face and no gaping holes on either side of the mask.
Though some people may feel COVID-19 is just like getting the flu, the real risk many don't consider is long COVID, Bach added. Long COVID symptoms can include tiredness or fatigue, difficulty breathing, cough, chest pain, sleep disturbances and more.
At least 65 million people worldwide are estimated to have long COVID, according to a study in Nature Communications. That's 10 per cent of all severe acute respiratory infections, which is a high percentage, according to Bach, even though it sounds small. It's also likely much higher due to undocumented cases.
"If you get long COVID, you'll be impaired for we don't know how long and we don't know how to treat it yet," Bach noted. "Everyone is different. It's better to protect [yourself] than get sick."
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Basic characteristics of the study participants and overall seroprevalence among the vaccinated community
The distribution of participants based on socio-demographic data and potential risk factors for SARS-CoV-2 infection is presented in Table 1. Out of the total, 10,669 blood samples were assessed (12% of participants refused to participate in the serological survey), comprising 7,380 women and 3,475 men, with a median age of 44years (ranging from 14 to 102years) (Table 1).
The serological survey encompassed 10,669 participants, with 8,602 having received two doses of BBIBP-CorV/Sinopharm (meanSEM of months after the second dose=8.110.08), 1,817 with ChAdOx1 nCoV-19 (COVISHIELD, Oxford/AstraZeneca; meanSEM of months after the second dose=9.820.15), 208 with BNT162b2 (Pfizer-BioNTech, Comirnaty, Pfizer, USA; meanSEM of months after the second dose=7.140.55), and 42 participants vaccinated with a single dose of JCovden/Johnson & Johnson's COVID-19 vaccine (meanSEM of months after the first dose=7.501.00). Adjusted overall seroprevalences did not show significant differences between vaccines (p=0.099).
We determined an adjusted seroprevalence rate of 96% (95% CI: 95.5% to 96.4%) among participants who received the BBIBP-CorV vaccine (Table 2). Logistic regression analysis revealed several variables associated with a higher risk of detecting anti-SRAS-CoV-2 antibodies (Table 3). Specifically, a higher prevalence of antibody positivity was linked to age. Additionally, the odds of being antibody-positive are 0.59 times lower for male participants than for females. A higher prevalence of antibody positivity was associated with hypertension, mask-wearing, and PCR-confirmed COVID-19 disease (Table 3). Furthermore, the analysis by chronic kidney disease revealed that participants with kidney disease had a significantly lower probability of being seropositive than participants without kidney disease (Table 3).
For participants vaccinated with ChAdOx1-nCov-19, the adjusted seroprevalence was 97% (95% CI: 9697.9) (Table 2). Logistic regression analysis assessing the association between SARS-CoV-2 seropositivity and demographic characteristics and chronic diseases between February and June 2022 is presented in Table 4. In univariable analysis, participants in the age groups of more than 1419years and those with a PCR-confirmed diagnosis (OR=2.65; 95% CI: 1.056.68; p=0.038) tended to be significantly more likely to be seropositive for anti-SARS-CoV-2 antibodies (Table 4). In contrast, in the multivariable analysis, only participants with a PCR-confirmed diagnosis were more likely to be seropositive for anti-RBD (OR=2.69; 95% CI: 1.177.78; p=0.036) (Table 4).
For participants vaccinated with BNT162b2, the overall adjusted prevalence of anti-SRAS-CoV-2 antibodies was 98.5% (95% CI: 95.0100.0) (Table 2). Logistic regression analysis showed that participants with hypertension who received BNT162b2 were more likely to be seronegative compared to female participants and those without hypertension (Table 5).
The adjusted seroprevalence among participants vaccinated with the Janssen/Johnson & Johnson's COVID-19 vaccine was 98% (95% CI: 85.2100.0). Owing to the small sample size (n=42), logistic regression analysis of the association between SARS-CoV-2 seropositivity and demographic characteristics and comorbid conditions was not conducted.
Subsequently, we evaluated the magnitude of the humoral response by measuring IgG antibodies to the RBD of the S1 subunit of the SARS-CoV-2 spike protein. The median RBD antibody concentrations were 2355 AU/mL, 3714 AU/mL, 5838 AU/mL, and 2495 AU/mL after two doses of BBIBP-CorV/Sinopharm, ChAdOx1 nCoV-19/Oxford/AstraZeneca, BNT162b2/Pfizer-BioNTech, and after one dose of JCovden/Johnson & Johnson's COVID-19 vaccine. Significant differences were observed among vaccine brands (p<0.0001). Notably, there was no significant difference between the JCovden vaccine and the BBIBP-CorV vaccine (p=0.691) (Fig.1).
Anti-SARS-CoV-2 antibody levels among four vaccine brands. Data are presented as median and interquartile range for IgG antibody. MannWhitney and KruskalWallis tests were used.
Stratifying participants who received the BBIBP-CorV vaccine revealed a significant difference in antibody concentration titers by gender (median=2428 vs. 2238 AU/mL for females and males, respectively) (p=0.004) (Fig.2A). An association was identified between age and anti-RBD IgG levels in BBIBP-CorV vaccine recipients (<0.0001), with the highest levels observed in those aged65years (median=5145.5 AU/mL) (Fig.2B).
Anti-RBD IgG antibody responses to BBIBP-CorV vaccine/Sinopharm in the general population. (A) Antibody levels subdivided by gender. (B) Anti-SARS-CoV-2 IgG levels by age. (C) SARS-CoV-2 antibody titer in participants with and without diabetes. (D) SARS-CoV-2 antibody titer in participants with and without chronic kidney disease. (E) SARS-CoV-2 antibody titer in participants with and without hypertension. (F) SARS-CoV-2 antibody titer in participants with and without cancer. (G) SARS-CoV-2 antibody titer in participants with and without mask-wearing. (H) Antibody levels by the history of coronavirus disease 2019 (COVID-19). Data are presented as median and interquartile range for IgG antibody titers. MannWhitney test was used for comparisons.
Unexpectedly, participants with comorbidities exhibited the highest levels of anti-RBD IgG (Fig.2CE), while for participants with cancer, antibody levels showed no significant difference between those with (median=2078 AU/mL) and without cancer (median=2358 AU/mL) (Fig.2F). Additionally, individuals reporting mask-wearing demonstrated higher anti-RBD antibody titers (median=2468 AU/mL) compared to those not wearing masks (median=2215 AU/mL) (p=0.0002) (Fig.2G).
Lastly, our data revealed that individuals with confirmed exposure to SARS-CoV-2 had elevated anti-RBD antibody titers (median=3019 AU/mL) compared with uninfected individuals (median=2222 AU/mL) (Fig.2H).
Stratifying participants who received the Covishield vaccine revealed no significant difference in the humoral response by gender (median=3698 vs. 3845 AU/mL for females and males, respectively) (p=0.681) (Fig.3A). In contrast, bivariate Spearman analysis revealed a positive correlation between age and anti-RBD IgG titers (r=0.240, 95% CI: 0.195 to 0.284, p<0.0001) (Fig.3B).
Antibody responses against RBD after two doses of ChAdOx1-nCoV-19/AstraZeneca. (A) Gender difference in antibody response. (B) Scatter plot of the distribution of antibody titers according to age. (C) SARS-CoV-2 antibody titer in participants with and without diabetes. (D) SARS-CoV-2 antibody titer in participants with and without chronic kidney disease. (E) SARS-CoV-2 antibody titer in participants with and without hypertension. (F) SARS-CoV-2 antibody titer in participants with and without cardiovascular disease. (G) SARS-CoV-2 antibody titer in participants with and without cancer. (H) SARS-CoV-2 antibody titer in participants with and without mask-wearing. (I) Antibody levels by the history of coronavirus disease 2019. Data are presented as median and interquartile range for IgG antibody titers. Spearman correlation and MannWhitney test were used for comparisons.
Comparison between participants according to medical comorbidities revealed elevated anti-RBD antibody concentrations in those with diabetes (median=4660.5 vs. 3461 AU/mL for with diabetes and without diabetes, respectively) (p=0.002) (Fig.3C), chronic hypertension (median=4416 vs. 3546 AU/mL for with chronic hypertension and without chronic hypertension, respectively) (p=0.015) (Fig.3D), and renal disease (median=10,933 vs. 3637 AU/mL for with renal disease and without renal disease, respectively) (p<0.0001) (Fig.3E). In contrast, there was no statistical difference in antibody titers between participants with cancer (median=6038 AU/mL) and those without cancer (median=3708.5 AU/mL) (p=0.525) (Fig.3F) and cardiovascular disease (median=4094 vs. 3701 AU/mL for with cardiovascular disease and without cardiovascular disease, respectively) (p=0.830) (Fig.3G). Additionally, wearing a mask did not affect the humoral response in Covishield-vaccinated participants (Fig.3H) (p=0.611). However, prior exposure to COVID-19 increased the level of anti-RBD IgG (median=4618 vs. 3508 AU/mL for individuals with confirmed exposure to SARS-CoV-2 and uninfected individuals, respectively) (p=0.003) (Fig.3I).
In fully vaccinated participants with BNT162b2/Pfizer, stratification by demographics, comorbidities, and history of COVID-19 showed no significant differences in anti-RBD antibody concentrations (Fig.4AD,F). In contrast, an elevated antibody level was observed in participants who reported wearing a mask (median=6753 AU/mL) compared with those who did not report wearing a mask (median=4909 AU/mL) (p=0.046) (Fig.4E).
Antibody responses against RBD following two doses of BioNTech162b2/Pfizer vaccine. (A) Distribution of antibody titers according to sex. (B) Correlation of age and anti-RBD IgG antibody levels. (C) SARS-CoV-2 antibody titer in participants with and without diabetes. (D) SARS-CoV-2 antibody titer in participants with and without hypertension. (E) SARS-CoV-2 antibody titer in participants with and without mask-wearing. (F) Antibody levels by the history of coronavirus disease 2019. Data are presented as box and whisker plots with the minimum and maximum range for IgG antibody titers. Spearman correlation and MannWhitney test were used for comparisons.
Stratification of participants vaccinated with JCovden/Johnson & Johnson's COVID-19 vaccine showed no association by gender (p=0.456), and no correlation between age and anti-RBD antibody levels was noted (p=0.362). However, stratification of participants by comorbidities was not performed due to the limited sample size (n=42).
The Ministry of Health has diagnosed three more men with Mpox, taking the total number of cases in Cambodia to 17 since December 2023 to April this year.
The Ministry announced on Saturday that they had detected three more cases of Mpox, more commonly called Monkey Pox, in the last 15 days, and the infected are men between the ages of 20 and 43, most of them are Phnom Penh residents.
Five patients are currently under treatment and receiving medical attention at a hospital, the Ministry added.
Koy Vanny, a spokesman for the Ministry, said no one was seriously ill, they have been put in isolation, however, they cannot divulge the hospital to maintain their privacy.
There have been no deaths from Mpox virus in Cambodia, most of the victims sought medical help and received confidential testing to confirm the presence of the virus, he added.
Compared to neighbouring countries or other countries in the region, cases of Mpox are low, as the Ministry had implemented specific measures to prevent the spread of the disease, he said.
If they suspect that they may have been infected with the Mpox virus, they should consult a doctor, as this disease can be treated, and the treatment takes only two to three weeks, he added.
Dr Quach Mengly, a public health expert, said that although Cambodia hasnt had any fatalities from the Mpox virus, special care should be taken to prevent the spread of the disease in the community.
There is a vaccine to fight Mpox, so if the disease spreads, the Ministry may announce a vaccination programme to prevent the spread of the virus, he added.
The Ministry has announced that the Mpox virus is transmitted from person to person through all forms of sexual contact or direct contact with wounds, body fluids, and airborne droplets, as well as clothes, mattresses and towels contaminated with the virus.
The virus is also transmitted from an infected mother to the embroy through the umbilical cord during pregnancy.
The Ministry also advises people to take care of their personal health, especially to practice safe sex by using a condom and to avoid having multiple sexual partners.
Ministry called on people to avoid direct contact with people with Mpox.
Special to Iredell Free News
RALEIGH The N.C. Department of Health and Human Services is reporting a statewide increase in mpox cases. Over the past six months, 45 cases have been reported in 12 counties across North Carolina.
The national mpox outbreak began in late May 2022 and peaked from July to August 2022. A total of 703 cases were reported in North Carolina that year, and only nine cases occurred in 2023.
The mpox virus, formerly known as monkeypox, is primarily spread by prolonged close contact, typically skin-to-skin, that occurs during sexual activity. It is the associated rash, scabs or body fluid which contain the virus. Although anyone can become infected with mpox, cases have predominantly occurred among gay, bisexual or other men who have sex with men.
Fortunately, a safe and effective vaccine is available that reduces the risk of mpox infection, hospitalization and death. Those who are already fully vaccinated with two doses do not need to receive additional mpox vaccine doses.
It is important people know how to protect themselves against mpox infection as we have seen cases increasing across North Carolina over recent months, said Dr. Erica Wilson, medical director for the medical consultation unit in the NCDHHS Division of Public Health. The JYNNEOS vaccine is an important tool and North Carolina has an ample supply of vaccine.
Vaccines are currently free and available throughout North Carolina, regardless of immigration status. The two-dose JYNNEOS vaccine series is recommended for anyone at risk for mpox and aged 18 years and older, which includes the following:
Anyone who has or may have multiple or anonymous sex partners; or Anyone whose sex partners are eligible per the criterion above; or People who know or suspect they have been exposed to mpox in the last 14 days; or Anyone else who considers themselves to be at risk for mpox through sex or other intimate contact.
The mpox vaccine locator can be used to find local vaccine providers.
Anyone who develops mpox symptoms should seek medical care. Symptoms include a rash on any part of the body, like the genitals, hands, feet, chest, face or mouth. The rash can initially look like pimples or blisters and may be painful or itchy. The rash will go through several stages, including scabs, before healing. Some people experience flu-like symptoms before the rash, while others get a rash first followed by other symptoms. In some cases, a rash is the only symptom experienced.
Other mpox symptoms can include fever, chills, swollen lymph nodes, exhaustion, muscle aches and backache, headache and respiratory symptoms (i.e. sore throat, nasal congestion or cough).
People with mpox are usually sick for about two to four weeks and can spread the virus from shortly before symptoms start until their rash is completely healed, meaning until the scabs fall off and new skin appears. Some patients may benefit from antiviral treatment, including those with severe illness or people with HIV that is not well controlled or other immune compromising conditions. Antiviral treatment may also help treat painful or severe mpox disease involving the eyes, mouth, throat, genitals and anus.
NCDHHS is working closely with local health departments and community partners to provide education about mpox, when to get tested and improve vaccine access for people at higher risk. These efforts to enhance communication, education and outreach include social media campaigns, distributing educational materials, the Mpox Equity Report, the Mpox Communications Toolkit and the Take Pride Now campaign.
LEARN MORE
More information about the virus, how to limit the risk of infection, and how to get vaccinated can be found on the North Carolina Mpox andCDC Mpoxwebsites.
COPENHAGEN, Denmark, April 2, 2024 Bavarian Nordic A/S (OMX: BAVA) announced today that JYNNEOS, the only FDA-approved mpox vaccine, is now commercially available in the U.S., marking a significant expansion for access to JYNNEOS by establishing additional pathways for vaccine procurement, distribution, and reimbursement by both public and private payers.
Since 2022, in response to the global mpox outbreak, JYNNEOS has been made available through public health channels for individuals at risk of mpox infection. This was made possible through Bavarian Nordics long-standing partnership with the U.S. government to supply the vaccine for the national stockpile and enabled by interim guidance from the Centers for Disease Control and Prevention (CDC), recommending pre- and post-exposure use of the vaccine for individuals at risk during the outbreak. These recommendations were updated in October 2023 by unanimous vote by the CDC's Advisory Committee on Immunization Practices (ACIP), and JYNNEOS is now recommended for routine use in individuals 18 years and older with certain risk factors1.
While mpox no longer constitutes a public health emergency, infections are still occurring throughout the U.S., with around 200 cases every month on average and transmission of the virus having been reported across most of the states in 2024 to-date2. Since the beginning of the outbreak in 2022, more than 32,000 cases have been reported in the U.S., representing a third of all cases reported globally3.
According to estimates from the CDC, two (2) million U.S. individuals are eligible for vaccination against mpox4. Recent data shows 60% of this population remains completely unvaccinated, and 15% have received only one dose of the vaccine5. Real-world data show that protection against mpox disease is superior in vaccinees who received the full schedule of two vaccinations as recommended by the CDC, compared to those who are unvaccinated or have only received one dose of the vaccine6.
Through its existing nationwide vaccine distribution structure, Bavarian Nordic is now making the mpox vaccine commercially available across the nation. As of April 1, health care providers can order JYNNEOS through their preferred wholesaler and distribution partners to make it available for at-risk individuals at local pharmacies and physician offices in addition to public health clinics.
Paul Chaplin, President and Chief Executive Officer of Bavarian Nordic, commented: From the beginning of the mpox outbreak, almost two years ago, the prompt availability of an approved vaccine combined with a strong public health response have helped to significantly reduce the impact of this debilitating disease, but unfortunately, mpox has not gone away completely. Building on the trust and reliability as a supplier of vaccines to the U.S. government for more than a decade, we are proud to extend our commitment to improving the nations public health by making our mpox vaccine widely available to at-risk individuals through the regular channels. We look forward to working with healthcare providers across the nation to increase awareness and availability of the mpox vaccine.
Brian Hujdich, Executive Director, National Coalition for LGBTQ Health, commented: The expanded availability of JYNNEOS is a vital step toward ensuring equitable access to healthcare for the LGBTQ+ community and marks a significant stride in preventing the spread of mpox. We must continue to advocate for equitable policies that protect and support the health and well-being of all individuals and encourage those at risk to consult with their healthcare providers regarding vaccination.
About mpox Visit the CDC website for comprehensive information about mpox: https://www.cdc.gov/poxvirus/mpox/about/index.html
About Bavarian Nordic Bavarian Nordic is a fully integrated vaccine company with a mission to protect and save lives through innovative vaccines. We are a global leader in travel vaccines and a preferred partner with governments on vaccines for public preparedness. For more information visit www.bavarian-nordic.com.
About JYNNEOS JYNNEOS (Smallpox and Monkeypox Vaccine, Live, Nonreplicating) is approved for the prevention of smallpox and mpox disease in adults 18 years of age and older determined to be at high risk for smallpox and mpox infection. The vaccine was developed in collaboration with the U.S. government originally to ensure supply of a smallpox vaccine for the entire population, including immunocompromised individuals who are not recommended vaccination with traditional replicating smallpox vaccines.
JYNNEOS was approved by the U.S. Food and Drug Administration (FDA) in 2019 and in 2021, ACIP voted to recommended JYNNEOS for pre-exposure vaccination of people at occupational risk for orthopoxvirus exposures. In 2022, the CDC issued interim guidance, enabling pre- and post-exposure use of JYNNEOS during the mpox outbreak and an Emergency Use Authorization (EUA) was issued allowing the use of JYNNEOS in people under 18 years. In October 2023, the CDC updated its guidance for use of JYNNEOS, and now recommends routine use of the vaccine for at risk individuals 18 years and older.
Important safety information Appropriate medical treatment must be available to manage possible anaphylactic reactions following administration of JYNNEOS. Anyone who has experienced a severe allergic reaction following a previous dose of JYNNEOS or following exposure to any component of JYNNEOS may be at increased risk for severe allergic reactions.
Syncope (fainting) has been reported following vaccination with JYNNEOS. Procedures should be in place to avoid injury from fainting.
Immunocompromised persons, including those receiving immunosuppressive therapy, may have a diminished immune response to JYNNEOS.
Vaccination with JYNNEOS may not protect all recipients.
In smallpox vaccine-nave healthy adults, the most common (>10%) solicited injection site reactions were pain (84.9%), redness (60.8%), swelling (51.6%), induration (45.4%), and itching (43.1%); the most common solicited systemic adverse reactions were muscle pain (42.8%), headache (34.8%), fatigue (30.4%), nausea (17.3%) and chills (10.4%).
In healthy adults previously vaccinated with a smallpox vaccine, the most common (>10%) solicited injection site reactions were redness (80.9%), pain (79.5%), induration (70.4%), swelling (67.2%), and itching (32.0%); the most common solicited systemic adverse reactions were fatigue (33.5%), headache (27.6%), and muscle pain (21.5%).
The frequencies of solicited local and systemic adverse reactions among adults with HIV infection and adults with atopic dermatitis were generally similar to those observed in healthy adults.
Across all studies, a causal relationship to JYNNEOS could not be excluded for 4 serious adverse events (SAEs), all non-fatal, which included Crohns disease, sarcoidosis, extraocular muscle paresis and throat tightness.
Cardiac adverse events of special interest (AESIs) considered causally related to study vaccination were reported in 0.08% of subjects who received JYNNEOS and included tachycardia, electrocardiogram T wave inversion, electrocardiogram abnormal, electrocardiogram ST segment elevation, electrocardiogram T wave abnormal, and palpitations. None of the cardiac AESIs considered causally related to study vaccination were considered serious.
To report SUSPECTED ADVERSE REACTIONS, contact Bavarian Nordic at 1-844-4BAVARIAN or the US Department of Health and Human Services by either visiting www.vaers.hhs.gov/reportevent.html or calling 1-800-822-7967.
Please see full Prescribing Information
Contacts investors Rolf Sass Srensen, Vice President Investor Relations, Tel: +45 61 77 47 43 Graham Morrell, Paddock Circle Advisors (US), graham@paddockcircle.com, Tel: +1 781 686 9600
Contact media Michelle Trasatti, michelle.trasatti@syneoshealth.com, Tel: +1 443-528-7427
Media are also encouraged to visit https://www.bavarian-nordic.com/media/mpox for additional background information and media kit, including photos and b-roll.
References1 Persons at risk include gay, bisexual, and other men who have sex with men, transgender or nonbinary people who in the past 6 months have had one of the following: A new diagnosis of 1 sexually transmitted disease; More than one sex partner; Sex at a commercial sex venue; Sex in association with a large public event in a geographic area where mpox transmission is occurring, sexual partners of persons with the aforementioned risks, and persons who anticipate experiencing any of the aforementioned.
2 CDC, weekly data. Accessed April 1, 2024. https://wonder.cdc.gov/nndss/static/2024/12/2024-12-table968-H.pdf .
3 CDC. Ongoing 2022 Global Outbreak Cases and Data. Accessed April 1, 2024. https://www.cdc.gov/poxvirus/mpox/response/2022/index.html.
4 CDC. JYNNEOS Vaccine Coverage by Jurisdiction as of September 26, 2023. https://www.cdc.gov/poxvirus/mpox/cases-data/mpx-jynneos-vaccine-coverage.html
5 https://www.cdc.gov/poxvirus/mpox/response/2022/vaccines_data.html
6 CDC. 2022/2023 Mpox outbreak: situational awareness and updates (October 25, 2023, ACIP meeting presentation). Accessed April 1, 2024. https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2023-10-25-26/02-MPOX-Minhaj-508.pdf
Spanish Influenza was a widespread pandemic from 1918 to 1919. The highly infectious and fatal virus took millions of lives across the globe. Its death toll was enhanced by modern transportation but mitigated by modern medicine. Also known as the Spanish Flu, responses to this outbreak drew on centuries of public health measures. Analyzing its impacts unearths an infectious question: Was Spanish Influenza the first modern or global pandemic?
Over the course of two years, Spanish Influenza infected roughly 500 million people, one-third of the global population. Death toll estimates vary from twenty-one to one hundred million, with modern scholarship proposing a total greater than fifty million. At the time, many people lived in densely populated, unclean environments, especially the militaries fighting the First World War. Doctors often accompanied the armies, creating shortages of medical professionals on the homefront.
Spanish Flu was caused by a type A form of the H1N1 virus. Influenza types A and B cause annual flu epidemics, but type A is the only variety to spur global contagions. Flu viruses undergo frequent mutations, which are slight enough that immunity from past infections will provide protection. But roughly every forty years, a significant change in the viruss makeup ignites a pandemic. Major influenza outbreaks have occurred since at least 1500, perhaps much earlier.
Aquatic birds are carriers of influenza A viruses and may be the source of their presence in humans. Spanish Flu is theorized to have begun in birds before transmitting to mammals. This could have occurred through mutation or from pigs. Pig cells have receptors vulnerable to both bird and human flu viruses. Respiratory disease in American pig herds coincided with Spanish Influenza but could just as likely have been passed to pigs by humans.
Spain was neutral during World War I and did not have strict controls on its press as wartime nations did. These belligerent countries suppressed reports of the outbreak, not wishing to alert their adversaries to their losses. Spanish publications documented cases freely, so other countries called the disease Spanish Influenza, or Spanish Flu.
There are several theories on the origin point of Spanish Influenza. The speed of transmission pushed the limits of contemporary transit to the extent that some suggest the virus arose as early as 1916, spreading quietly and gradually. Outbreaks at two British Army camps in France in 1916 and 1917 exhibited comparable symptoms and rates of infection and death. Influenza outbreaks in China in early 1918 have also been proposed as the source.
The United States had one of the first recorded cases at Fort Riley, Kansas on March 11, 1918. Unlike suggestions of an earlier patient zero, transmission can be traced from this individual across the globe. The cramped nature of the military outpost caused the disease to spread rapidly. In a short time, additional cases struck military personnel on both coasts. Initially, the American public had little exposure to the virus, and the military largely ignored its spread, which was overshadowed by the war effort. Spanish Influenza fizzled out in the United States in May 1918, but by August, it returned after planting its roots virtually everywhere else.
Spanish Influenza killed 100,000 soldiers, but whether it affected the outcome of the war is debatable. Naval blockades and unrestricted submarine warfare threatened and substantially reduced commercial shipping and oceanic travel during the conflict. The end of the war brought a hasty return of troops, often welcomed back to their homes with celebratory events.
Mechanized transportation and the growing interconnectedness of the world allowed the virus to traverse rapidly across great distances. The flu struck India and North Africa by May, China by June, and Australia by July. A second, more fatal wave of the virus began in August, transmitting to the rest of Africa, Central and South America, and Europe. In December, countries began to recover and loosen restrictions before a third wave hit, ending for most in May 1919 and dissipating almost completely in 1920.
With most flu viruses, young children and the elderly are the most susceptible, but Spanish Flu was also extremely dangerous to healthy adults. In a reversal of course from every other influenza virus, half of all fatalities were from those aged 20-40, and 99% of victims were less than sixty-five years old. The death rate of 2.5% far exceeded the 0.1% of most influenza viruses.
Symptoms included a high fever, fatigue, dry cough, aches, and chills. Red spots formed on the cheeks before a blue hue took over ones face from lack of oxygen. The disease ravaged the patients respiratory tract within hours. In time, the lungs filled with fluid, in which victims drowned. It was not uncommon for victims to perish the same day symptoms appeared. Complications such as pneumonia often killed patients if the virus did not claim their lives first.
Medicine in 1918 was closer to modern practices than to the pre-industrial era. Notions of health, sanitation, and disease prevention were relatively adequate. However, no viral test could detect the Spanish Flu, and there were no effective medicines to treat infection. Medical professionals used technology such as X-rays and basic diagnostic methods to identify infection.
Drug manufacturers attempted to create a vaccine but were far off from a successful product. The first step, isolating the virus, may have been completed by scientists in Japan and Tunisia, but they could not preserve the specimen. Blood transfusions from recovering patients showed promise in treating the illness and saw experimental administration in flu epidemics since, although their effectiveness is unclear.
Easing symptoms proved to be the most reliable and accessible means of treatment. Nurses, mostly women with little to no previous experience, provided active care in medical facilities and in the community. The nursing profession expanded during the First World War, and their continued service for the pandemic proved essential.
Governments mobilized to initiate measures aimed at mitigating the spread of the virus and its effects. Responses varied at the national, regional, and local levels. Municipalities prohibited public functions, sometimes even extending the bans to schools and churches. Law enforcement officers were empowered to fine people for spitting or to arrest people for sneezing or coughing outside.
Public health organizations issued guidance and dictated policy. War news and propaganda made citizens accustomed to reading informational posters and newspapers. The Red Cross campaigned for every person to wear a mask in public. Individuals donned face coverings of varying styles and efficacy to guard against airborne contagion, although many resisted recommendations and mandates.
The Plague of Justinian spread across trading routes as far as Western Europe, Britain, Africa, and Central Asia from 541 to 590. Estimates state it wiped out 40% of the Byzantine Empires population, or 25 to 100 million worldwide. Citizens of Constantinople ran out of room to bury bodies, so they placed the dead in guard towers, covering corpses in quicklime to hasten decay.
The Black Death, the most notorious historical pandemic, claimed 100 to 150 million lives. The plague originated in China in 1334, traveling along the Silk Road to reach Europe by 1347. By 1352, it spread to Russia and the Middle East. Those fearing the Bubonic Plague practiced self-quarantine and avoided public gatherings, as no treatments were effective against the contagion. The Black Death affected localities differently, sometimes sparing sparsely settled agrarian regions while killing fifty to sixty percent of a citys population. Ports barred entry to ships, and militaries closed off roadways. Despite the high death tolls, the absence of contact with the Western Hemisphere bars them from being considered global pandemics.
An influenza pandemic in 1557 spread across Asia, turning west to Constantinople and Europe. Its presence may have been recorded in Central America, presumably ferried aboard Spanish ships. The flu ravaged the entirety of Spain almost simultaneously, making transmission plausible, but documentation of its presence in Spains colonies is lacking. Another outbreak in 1580 is more widely accepted to have spread across the entire known world. Slow transportation methods still hindered the transmission of these influenza contagions.
Cholera is a bacterial illness that inhabits the digestive system, contributing to an expulsion of fluids that causes dehydration and death. Seven distinct cholera pandemics have transpired since 1817. The disease spread first from India to neighboring regions, then to other continents and the Americas. As with the Black Death, official quarantines were imposed upon visitors from areas with known cholera infections.
The seventh iteration continues today in the Pacific, Caribbean, Middle East, and Africa. Cholera receives comparatively less attention than other infectious diseases, although it continues to take 21,000 to 143,000 lives each year. The bacteria cannot be eliminated because they thrive in water sources, but illness can be prevented with access to clean water and sanitation. As the first outbreak to spread to every inhabited continent in recent history, it is fair to call cholera the first modern global pandemic.
Worldwide populations that were still reeling from historys deadliest war to that point were punished by historys second deadliest pandemic. Most communities experienced the illness as a time of rapid death and panic, which mercifully ended within a short time. The Great War contributed to developments in transportation and mobilization, which spread the disease, as well as media and medicine, by which officials could attempt to contain and treat it.
Death rates dropped dramatically throughout the next decade as people gained immunity from past infections. The H1N1 family continued to circulate until 1957, when it was replaced by H2N2, reemerging in 1977 and continuing to the present. Spanish Influenza may not be the first global or the first modern pandemic, but it served as a period of coordinated action across society that continues to mold public health and pandemic response to this day.
