A lawsuit against Confluence Health over its COVID-19 vaccination policy now has seven fewer plaintiffs.
The suit was brought by 91 former Confluence Healthemployees who filed a class action against their employer over wrongful termination for not taking the COVID-19 vaccine.
The group says their religious rights were violated when Confluence required them to be vaccinated in 2121.
But Douglas County Superior Court Judge Brian Huber dismissed seven of the plaintiffs from the case last week, saying they never asked for a religious exemption from the vaccine requirement.
Huber sided with a motion to dismiss filed by Confluence Health.
The plaintiffs who are no longer part of the lawsuit are Annette Aguigui, Sue Sinclair, May Tussey, Chris Tussey, Bryce Tussey, Genevieve Wilson and Jeremiah Voss.
Judge Huber denied another motion from Confluence Health, which asked for the entire lawsuit to be dismissed.
Confluence Health argued the Superior Court lost jurisdiction over the case when the original lawsuit went to an appeals court.
Judge Huber dismissed the original case in April of 2023, saying Plaintiffs failed to identify which employees had requested a religious exemption, and failed to identify which religious beliefs they were claiming.
Plaintiff Attorney Steve Lacy, a former East Wenatchee mayor, filed then a second class action lawsuit against Confluence Health.
The day before filing a new case, the Washington State Court of Appeals accepted the plaintiff's request for appeal.
The appeals court will hear oral arguments in the original case on Jan. 24 while the second lawsuit is ongoing in Douglas County.
Plaintiffs are using the same argument from their previous class action suit, claiming that Confluence failed to uphold employees religious/medical exemptions.
They are also asking for all past and future damages, reimbursement of legal fees, and to go back to their previous positions with Confluence Health.
Vaccinations for COVID-19 began being administered in the U.S. on Dec. 14, 2020. The quick rollout came a little more than a year after the virus was first identified in November 2019. The impressive speed with which vaccines were developed has also left a lot of people with a lot of questions. The questions range from the practicalhow will I get vaccinated?to the scientifichow do these vaccines even work?
Keep reading to discover answers to 25 common COVID-19 vaccine questions.
Gallery Credit: Stephanie Parker
image:
RS2sequence conservation and protectiveefficacy
Top panel:Sequence conservation mapped onto a model of the RS2 molecule
Bottom Panel:Lung tissue sections from micedemonstrate superior protection conferred by RS2 against viral challenge.
Credit: Nidhi Mittal
Since the beginning of the COVID-19 pandemic, Raghavan Varadarajan, Professor at the Molecular Biophysics Unit (MBU), Indian Institute of Science (IISc), and collaborators have been working on developing a heat-tolerant vaccine that can offer protection against different strains of SARS-CoV-2 both current and future variants.
In a study published innpj Vaccines,they report the design of a synthetic antigen that can be manufactured as a potential COVID-19 vaccine candidate. They show that their vaccine candidate is effective against all current strains of SARS-CoV-2 and can be quickly adapted for future variants as well.
While current vaccines are proven to be effective against most SARS-CoV-2 strains, their efficacy has declined due to the virus rapid mutation. After analysing various proteins found in the virus, the researchers selected two parts of SARS-CoV-2's spike protein the S2 subunit and the Receptor Binding Domain (RBD) for designing their vaccine candidate. The S2 subunit is highly conserved it mutates much less than the S1 subunit, which is the target of most current vaccines. Scientists have also known that the RBD can provoke a strong immune response in the host. Therefore, the team created a hybrid protein called RS2 by combining these two components.
The researchers used mammalian cell lines to study the expression of the hybrid protein. The protein showed very high levels of expression, and I [initially] thought that the experiment was not working properly, says Nidhi Mittal, PhD student at MBU and first author of the study. This means, she explains, it can potentially be produced in large quantities.
The team then tested the effects of the protein in both mice and hamster models. They found that the hybrid protein triggered a strong immune response and provided better protection when compared to vaccines containing the whole spike protein.
The RS2 antigen can also be stored at room temperature for a month without the need for cold storage, unlike many vaccines on the market which require mandatory cold storage. This would make the distribution and storage of these vaccine candidates much more economical.
Varadarajan explains that his team began working on the vaccine even before the pandemic became widespread in India. At that time, the Bill and Melinda Gates Foundation provided us funding and support, he adds. Since 2000, Varadarajans team has been working on designing several viral vaccines, including those against AIDS and influenza. They have leveraged this expertise to design their current RS2-based COVID-19 vaccine candidate in collaboration with the startup Mynvax, that was, until recently, incubated at IISc.
According to the team, the vaccine candidate can be tailored to incorporate the RBD region of any new variant of SARS-CoV-2 that might emerge. Its high levels of expression and stability at room temperature can greatly reduce production and distribution costs, making it well suited for combating COVID-19.
Enhanced protective efficacy of a thermostable RBD-S2 vaccine formulation against SARS-CoV-2 and its variants
25-Oct-2023
Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.
An audit report has revealed that Covid vaccines valued at 28.1 billion Ugandan shillings ($7.3 million; 5.8 million) are set to be withdrawn from health facilities and subsequently destroyed.
The report shows that over 5.6 million doses of COVID-19 vaccines, acquired through a World Bank loan by the Ugandan government, have expired.
Moses Kamabare, the head of Ugandas drug procurement agency, expressed the challenging scenario, stating,
Diana Atwine, the Permanent Secretary in the Ministry of Health, explained in the report that the procurement of COVID-19 vaccines was based on speculation as the pandemic persisted.
The government committed conditional grants from the World Bank to manufacturers to produce and deliver vaccines, making halting the process impractical.
News continues after this ad
Atwine also disclosed that funds from GAVI, the Vaccine Alliance, have been secured to manage the recovery and destruction of all expired COVID-19 vaccines.
Auditor General Muwanga emphasised the need for prudent planning in emergencies and urged the government to prioritise recovery actions while advising the National Medical Stores to align the budget with demand to prevent drug stocking and ensure timely distribution to health facilities.
Nektaria Stamouli, the deputy editor in chief of Kathimerinis English Edition and Politicos Eastern Mediterranean correspondent, joins Thanos Davelis to discuss this latest move by the government to scrap all the fines imposed on the elderly who never got vaccinated against Covid-19, look at the reactions it has sparked, and break down how a new wave of infections is impacting the country.
FDA Finds No Definitive Link Between Diabetes, Obesity Drugs and Suicidal Thoughts
A preliminary review by the FDA did not find a conclusive link between popular drugs used to treat diabetes and obesity, such as semaglutide, the medication in Ozempic and Wegovy, and suicidal thoughts or actions, according to The Associated Press. However, the FDA also stated that although no definitive evidence has been uncovered, it cannot definitively rule out a small risk and will continue investigating reports. The review follows a federally funded study that found a lower risk of suicidal thoughts with semaglutide compared with other drugs used for obesity and diabetes, which was prompted by European regulators investigating anecdotal reports of self-harm thoughts among semaglutide users.
Congress Urged to Increase Funding for Vital Nutrition Program
Biden administration officials are calling on a divided Congress to increase spending on the Special Supplemental Nutrition Program for Women, Infants, and Children to avert a potential crisis, according to Reuters. The proposed $1 billion in additional funding is crucial for preventing as many as 2 million people from being turned away due to a shortfall caused by rising food costs and increasing program participation. The program, providing vital support to about 6.7 million low-income individuals, faces the risk of reduced services and longer waitlists if Congress does not act promptly.
Low COVID-19, Flu Vaccination Rates Strain Global Health Care
Public health officials are raising concerns about low vaccination rates against the latest versions of COVID-19 and influenza, putting significant pressure on health care systems globally, according to Reuters. Despite recommendations and efforts to communicate the risks, vaccination rates remain "incredibly low," with only 19.4% of US adults receiving the current season's COVID-19 vaccine, and nearly half of US adults getting a flu shot. Furthermore, the World Health Organization emphasizes the importance of increasing vaccine coverage to prevent severe illness and mitigate the impact on health care systems.
As many as 40 children and teenagers, including five babies younger than 5 months old, have died from the flu so far this season, as the virus continues to spread at high levels across most of the United States.
For the first time in months, the Centers for Disease Control and Prevention reported Friday a slight dip in how many people are getting the flu or being hospitalized from it, although experts warn that the virus isn't done yet.
The latest numbers are from the first week in January, and may simply reflect that schools were closed and that people tend to be less likely to see their doctor over the holidays.
"A lot of times after a one- or two-week decrease around the holidays, we see a pickup in activity again," said Alicia Budd, head of the CDC's domestic influenza surveillance team. That occurred during the 2019-2020 season, when the flu dropped around the same time, but then spiked two more times, in February and March.
"It is too early to know whether activity has peaked for the season," Budd said.
As of Friday, the CDC estimates that the flu has sickened 14 million people so far, with 150,000 flu-related hospitalizations and 9,400 deaths.
There were at least 13 pediatric deaths from the flu reported last week. Based on prior CDC reports, the number of children who have died so far this season is likely an undercount.
While the elderly are most likely to be hospitalized with the flu, Dr. Dhaval Desai, director of Hospital Medicine at Emory Saint Josephs Hospital in Atlanta, said hes seeing severe cases among all ages.
"It's not always necessarily the geriatric, older patients, he said. Ive had quite a few younger patients in their 20s to 40s admitted with flu.
Dehydration, wheezing, severe head and muscle aches and "high fevers that are staying high, above 104," are the main symptoms driving people to the hospital, Desai said.
Shortness of breath sent Quenten Thomas of Marysville, Tennessee, to the hospital last week. The normally energetic, outgoing 27-year-old was unable to get enough air into his lungs.
"It hurt when he coughed," his father, Robert Thomas, said. "He was having trouble catching his breath.
Quenten Thomas, a father of three young children, had to be put on a ventilator but his condition deteriorated quickly. He died from flu complications Jan. 6. He had not received the flu shot this year.
"I'm still in shock," Robert Thomas said, urging people to take the flu more seriously. "I know I will for the rest of my life."
"The biggest thing we're seeing right now is fevers," said Dr. Rachael Lee, an associate professor in the division of infectious diseases at the University of Alabama, Birmingham, "as well as fatigue and significant body aches."
Some have reported unusually severe symptoms, even if they've been vaccinated. Desai said he caught the flu in early November, a full month after his flu shot.
He had a high fever, sweats, cough, sore throat and crushing fatigue. He became so dehydrated that he ended up in the emergency room.
Those intense symptoms are hallmarks of how the flu can cause widespread inflammation in the body, putting the whole body in a stress state, Desai said.
Fevers of at least 103 degrees that carry on for several days, as well as signs of severe dehydration, also require medical attention, doctors said.
"If you're having difficulty breathing, that would be an indication to seek emergency care," said Dr. Andi Shane, head of pediatric infectious diseases at Childrens Healthcare of Atlanta.
A sign of dangerous dehydration is feeling "dizzy when you stand up and so weak that you can't walk from one side of the room to the other," Desai said.
People may also develop an intense headache.
Anyone ages 6 months and older can still get vaccinated. While it typically takes two weeks after vaccination to build strong immunity, the flu season can last until spring.
"Even if we have peaked, we still have half the season to go," CDC's Budd said.
The shot, she said, seems to be a good match to the circulating flu strains.
On Thursday, researchers in Canada reported that the shot is 61% effective in protecting against the predominant strain: H1N1. Among children ages 9 and younger, effectiveness rose to 74%.
Unfortunately, the number of people getting vaccinated this year is down, including pregnant women who are highly vulnerable to serious illness and children, based on early data.
An estimated 10 million fewer people including children and adults got their flu shots so far compared to the same time last year, according to the CDC.
"There is some degree of vaccination fatigue in the community," Desai said.
The majority of his patients hospitalized with flu this season, he said, have not had the flu shot.
While the vaccine does not necessarily prevent a person from getting infected with the flu, experts maintain that it can reduce the severity and length of the illness.
"The flu vaccine is not a particularly good vaccine at preventing flu," said Dr. Bruce Farber, chief of public health and epidemiology at Northwell Health in New York. "But it's a very good vaccine for preventing people from winding up in a hospital or being ill or dying of flu."
While the flu has been spreading rapidly over the last few weeks, Shane said, the new numbers are generally in line with previous, typical flu seasons.
I think that we are returning to the pre-pandemic flu season, she said. If we look and compare what happened last season compared with this season, we do seem to be trending towards our more normal seasonality.
Erika Edwards is a health and medical news writer and reporter for NBC News and "TODAY."
Vaccine-specific changes in the 2024 immunization schedule for adults aged 19 years include new and updated recommendations for respiratory syncytial virus vaccines (RSV) (3), influenza vaccines (4), COVID-19 vaccines (5), inactivated poliovirus vaccine (IPV) (6), Mpox vaccine (Mpox) (https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2023-10-25-26/04-MPOX-Rao-508.pdf), and meningococcal serogroups A, B, C, W, Y pentavalent vaccine (MenACWY-TT/MenB-FHbp) (https://www.cdc.gov/vaccines/acip/recommendations.html). Any reference to meningococcal serogroups A, C, W, Y polysaccharide diphtheria toxoid conjugate vaccine (MenACWY-D [Menactra]) was removed from the schedule because this product is no longer distributed in the United States. Other changes include clarification of the recommendations for hepatitis A vaccine (HepA), hepatitis B vaccine (HepB), human papillomavirus vaccine (HPV), measles, mumps, and rubella vaccine (MMR), pneumococcal vaccines, and tetanus, diphtheria, and pertussis vaccine (Tdap).
A fifth step in the How to Use the Adult Immunization Schedule box was added directing health care providers to review the new addendum section that lists new or updated ACIP recommendations that occur before the next annual update to the adult immunization schedule.
Information on injury claims, travel vaccine recommendations and a hyperlink to the 2024 child and adolescent immunization schedule was removed from the Cover Page and moved to a new Additional Information section on the first page of the Notes. This was done to harmonize presentation of this information with the 2024 child and adolescent immunization schedule.
Mpox (Jynneos), pentavalent meningococcal vaccine (MenACWY-TT/MenB-FHbp [Penbraya]), and RSV vaccines (Abrysvo [Pfizer Inc.] and Arexvy [GSK]) were added to the table of vaccine abbreviations and trade names.
MenACWY-D (Menactra) was removed from the table of vaccine abbreviations and trade names because it is no longer distributed in the United States, and any remaining doses of this product expired in October 2023.
The bivalent mRNA COVID-19 vaccines were removed from the table of vaccine abbreviations and trade names because current mRNA COVID-19 vaccines are all monovalent, and the bivalent mRNA COVID-19 vaccines used in the United States during 20222023 are no longer recommended.
COVID-19 row: The text overlay was revised to reflect updated vaccination recommendations. This text overlay now states, 1 or more doses of updated (20232024 Formula) vaccine.
RSV row: The RSV vaccination is a new addition to this table. The color of this row is purple for adults aged 1949 years, with overlaying text seasonal administration during pregnancy, reflecting the recommendation for the use of Abrysvo (Pfizer Inc.) during 3236 weeks gestation. The row is light blue for adults aged 60 years, indicating that the recommendation for RSV vaccination with either Abrysvo (Pfizer Inc.) or Arexvy (GSK) among adults aged 60 years is based on shared clinical decision-making.
Mpox row: A new row was added for Jynneos, with a purple bar across all ages reflecting the risk-based recommendation for Mpox vaccination.
A header sentence was added to Table 2 stating that medical conditions or indications are often not mutually exclusive and advising health care providers to review all relevant columns in the table if multiple conditions or indications are present.
Legend: The definitions of the yellow, purple, and gray colors in the legend were revised. The new definitions of these colors are intended to be more focused and narrower, such that the recommendation for vaccination based on that medical indication is more readily apparent. In addition, brown was introduced as a new legend color, indicating that additional doses of vaccine might be necessary based on medical condition or other indication. To account for these revised color definitions, many of the vaccine rows in Table 2 were recolored.
HepB row: Under the diabetes column, a blue bar was added to indicate that the recommendation for vaccination for persons aged 60 years with diabetes is based on shared clinical decision-making.
RSV row: The RSV vaccination is a new addition to this table. For use during pregnancy, the color is yellow with overlaying text of seasonal administration to indicate that the use of Abrysvo (Pfizer Inc.) in pregnancy is based on RSV seasonality. For the rest of the medical indications listed, the color is light blue reflecting that the recommendation for vaccination among adults aged 60 years is based on shared clinical decision-making.
Mpox row: A new row was added for Jynneos. Across all medical indications listed, the entire row is purple reflecting the risk-based recommendation for Mpox vaccination. In the pregnancy column, an overlaying text See Notes was added to encourage health care providers to review the pregnancy bullet in the Mpox vaccination notes.
The notes for each vaccine are presented in alphabetical order. Edits have been made throughout the Notes section to harmonize language, to the greatest extent possible, with that in the child and adolescent schedule.
A new Additional Information section now begins the Notes section of the 2024 adult immunization schedule. This section mirrors the Additional Information section in the Notes section of the 2024 child and adolescent immunization schedule and contains similar information. Bullets that were previously on the Cover Page (such as injury claims and travel vaccine recommendations, etc.) have now been incorporated into the new Additional Information section of the Notes section. The text for vaccine injury compensation was revised to add Mpox and RSV to the list of vaccines not covered by the National Vaccine Injury Compensation Program. Mpox is covered by the Countermeasures Injury Compensation Program.
COVID-19: All adults are now recommended to receive at least 1 dose of an updated (20232024 Formula) COVID-19 vaccine. The number of doses needed and intervals between doses might vary based on a patients previous vaccination history, immunocompromise status, and the vaccine product used. In addition, the COVID-19 notes section is divided into a Routine vaccination section that describes the vaccination recommendations for the general population and a Special situations section that describes the vaccine recommendations for persons who are moderately or severely immunocompromised.
HepA: To better align the language with ACIP policy, the bullet in the Routine vaccination section was revised to, Any person who is not fully vaccinated and requests vaccination. The HepA vaccine regimen is described in detail later in that bullet.
HepB: In the Routine vaccination section, additional context and details were added to the bullets describing the risk-based vaccination recommendation for persons aged 60 years. In addition, a note was added at the end of the Routine vaccination section describing the shared clinical decision-making recommendation for persons aged 60 years with diabetes.
HPV: In the Routine vaccination section, the guidance on interrupted schedules was removed because that information is presented on the Cover Page. Age ranges were reordered to be in chronological order. In addition, to improve clarity, the words of any valency were added to the bullet, No additional dose recommended when any HPV vaccine series of any valency has been completed using the recommended dosing intervals. Lastly, a link to a resource was added to assist health care providers with shared clinical decision-making recommendations for HPV vaccination.
Influenza: A hyperlink to the 202324 influenza recommendations and a bullet regarding the 202425 influenza recommendations were added. In the Special situations section, all bullets that discuss history of egg allergy were removed, and a note was added at the end of the Special situations section stating that persons with a history of egg allergy can be vaccinated with any influenza vaccine indicated for the recipients age and health status (4). Finally, the bullet describing Guillain-Barr syndrome was removed because this information is presented in the Appendix section on contradictions and precautions.
MMR: Minor changes were made to the Routine vaccination section to improve language clarity.
Meningococcal: All references to Menactra were removed because this product is no longer distributed in the United States. A link to a resource was added to assist health care providers with shared clinical decision-making recommendations for MenB vaccination. Lastly, information about the use of the newly licensed pentavalent meningococcal vaccine (Penbraya) is provided at the end of the meningococcal notes section.
Mpox: Mpox vaccination is a new addition to the Notes section of the adult immunization schedule. Risk factors that warrant routine Jynneos vaccination are listed. Bullets about the use of Jynneos among health care providers and in pregnant persons are provided at the end of the Mpox notes section.
Pneumococcal: Minor edits were made throughout the Routine vaccination and Special situations sections to provide clarity on the guidance and minimum intervals between doses of pneumococcal vaccines.
Poliovirus: Additional context was added to the Routine vaccination section. This section now calls for adults who are known or suspected to be unvaccinated or incompletely vaccinated to complete the 3-dose IPV primary vaccination series. A statement was added stating that most adults who were born and raised in the United States can assume that they were vaccinated against polio as children. The Special situations section describes administering a one-time, lifetime IPV booster dose to adults who have completed the primary series and who are at increased risk for exposure to poliovirus.
RSV: A new RSV notes section was added this year. The section begins with a Routine vaccination section that describes the use of Abrysvo (Pfizer Inc.) in pregnant persons during 3236 weeks gestation from September through January in most of the continental United States. In addition, a sub-bullet was added stating that either maternal RSV vaccination or infant immunization with nirsevimab (RSV monoclonal antibody) is recommended to prevent respiratory syncytial virus lower respiratory tract infection in infants. A note was added at the end of the RSV notes section to acknowledge that certain jurisdictions might have RSV seasonality that differs from most of the continental United States, and that providers should follow guidance from public health authorities regarding the timing of maternal RSV vaccine administration, based on local RSV seasonality. The Special situations section describes the shared clinical decision-making recommendation for vaccination of persons aged 60 years; either Abrysvo (Pfizer Inc) or Arexvy (GSK) may be used. In addition, a link to a resource was added to assist health care providers with shared clinical decision-making recommendations for RSV vaccination. Finally, a note was added that lists risk factors and medical conditions that health care providers should consider when thinking through a patients risk for severe RSV disease and potential benefit from vaccination.
Tdap: A note was added at the end of the Tdap section to clarify that a dose of Tdap received at age 10 years may be counted as the adolescent dose routinely recommended at age 1112 years.
The header sentence of the Appendix was revised to include all the sources used to create the Appendix.
COVID-19 row: Two new rows for COVID-19 vaccines were added describing the contraindications and precautions to COVID-19 vaccination. The first row lists the contraindications and precautions to mRNA vaccines (Pfizer-BioNTech and Moderna), and the second row lists the contraindications and precautions to the protein subunit vaccine (Novavax).
Hib row: In the Contraindicated or Not Recommended column, the bullet describing history of severe allergic reaction to dry natural latex was removed because vials of Hib products no longer contain latex.
Meningococcal rows: All references to Menactra were removed because this product is no longer distributed in the United States. Contraindications and precautions to vaccination with the new pentavalent meningococcal vaccine (MenACWY-TT/MenB-FHbp [Penbraya]) were added.
Mpox row: A new row for Mpox was added describing the contraindications and precautions to Mpox vaccination.
RSV row: A new row for RSV was added describing the contraindications and precautions to RSV vaccination.
A new addendum section was added to the adult immunization schedule to summarize new and updated ACIP recommendations that occur before the next annual update to the adult immunization schedule.
5-year-old boy sick with measles.
getty
A measles outbreak in Philadelphia has expanded to eight confirmed and three suspected cases with three patients hospitalized, city health officials said Monday. Vaccine-preventable diseases such as measles and polio remain a public health threat. And with childhood vaccine hesitancy on the rise, the problem could get worse.
Officials at the Philadelphia Department of Public Health are now warning the public about several known exposure sites across the city, including healthcare facilities and a daycare center.
Placed in a larger context, the current situation in Philadelphia speaks to a wider problem of the return of vaccine-preventable diseases as a result of the steady increase in vaccine hesitancy in recent years.
Measles was declared eliminated from the U.S. in 2000, which meant that at that time there was an absence of disease transmission for greater than 12 months. But that declaration turned out to be premature. While annual numbers of cases of measles in the 2000s were relatively small, they climbed to 1,274 confirmed cases in 31 states in 2019. This was by far the greatest number of cases reported in the U.S. since 1992. Notably, all cases in 2019 were linked to travel to countries with endemic measles. Upon returning to the U.S., those infected exposed at-risk populations (un- or under vaccinated), which in turn led to a large number of local epidemics.
In an outbreak in Ohio in 2022, 85 people contracted measles and 36 children were hospitalized. Of the 85 infected, 80 were unvaccinated, 24 of whom were too young to be vaccinated as they were under the age of 1 and hadnt yet begun their measles, mumps and rubella series of shots. Nevertheless, according to the health commissioner for Columbus Public Healththe jurisdiction where about 95% of the cases occurredvaccine hesitancy drove the upsurge.
Measles isnt the only vaccine-preventable disease that poses a public health threat. Others include polio, mumps, diphtheria, tetanus, whooping cough and hepatitis B. Data from the Centers for Disease Control and Prevention indicate that measles, mumps and rubella vaccination rates have fallen from 95% to 93% nationwide among kindergarteners since the outset of the Covid-19 pandemic. Furthermore, childhood vaccine exemptions, both medical (due to contraindications) and non-medical, are now at an all-time high. And while still only about 3% of children have non-medical exemptions on religious or philosophical grounds, the number is growing and is greater than 5% in 10 states.
The problem of vaccine hesitancy isnt limited to the U.S. A rise in incomplete vaccine coverage across the worlds population creates fertile ground for a measles rebound.
Based on estimates published in the journal Lancet, the global number of measles deaths in 2020 was 60,700, a 94% decrease from 1,072,800 deaths in 2000. The CDC estimated that worldwide during a period of roughly two decades beginning in 2000, measles inoculations prevented 57 million deaths.
However, from 2020 to 2022, measles fatalities more than doubled, reaching 136,000.
The most recent spike is attributed to a significant decrease in vaccinations globally during the Covid-19 pandemic, as immunization levels dropped to their lowest in 15 years.
This is worrisome. Some of it has to do with the pandemic itself, as routine healthcare services were halted. However, it appears that the decrease owes in part to a burgeoning anti-vaccination movement, triggered or simply reinforced by Covid-19 vaccine mandates, to which many people were opposed.
The more people forego childhood immunizations, the greater the chances diseases such as measles and polio stage a comeback. For measles in particular, such a resurgence is facilitated by the fact that the virus is incredibly infectious, with a reproduction number of 16. This means that in a susceptible population, on average a person with measles infects 16 others.
The disease causes an initial flu-like illness with symptoms that include a high fever of over 103 Fahrenheit (39.4 Celsius), copious congestion, red eyes and a rash that spreads around the entire body. Patients with measles can develop ear infections, severe gastrointestinal upset, pneumonia and brain swelling.
According to two studies published in 2019 in the journals Science and Science Immunology, measles can inflict more harm than just the acute infection. The virus can eliminate acquired immune memory by destroying the memory B, plasma and T cells, which in turn cause people to become much more susceptible to infections.
Before the advent of vaccines in the 1960s, an estimated 400 to 500 people in the U.S. died from measles annually while 48,000 were hospitalized and 1,000 suffered encephalitis (swelling of the brain) which can lead to lasting brain damage.
The CDC states that about one in five people in the U.S. who contract measles will be hospitalized; one out of every 1,000 patients will develop encephalitis; one out of every 1,000 patients will die.
High-risk groups for serious illness include young children, the elderly, pregnant women and people with weakened immune systems.
There is no known treatment for measles besides supportive care. Once infected, it is vital that individuals quarantine.
Medical experts are reminding the public that the disease can be prevented by being immunized. Specifically, the CDC recommends childhood vaccination with the measles, mumps and rubella vaccine, first at 12 to 15 months of age and then at 4 to 6 years of age.
I'm an independent healthcare analyst with more than 24 years of experience analyzing healthcare and pharmaceuticals. Specifically, I analyze the value (costs and benefits) of biologics and pharmaceuticals, patient access to prescription drugs, the regulatory framework for drug development and reimbursement, and ethics with respect to the distribution of healthcare resources. I have approximately 110 publications in peer-reviewed journals, in addition to hundreds of articles in newspapers and periodicals. I have also presented my work at numerous trade, industry, and academic conferences. From 1999 to 2017 I was a research associate professor at the Tufts Center for the Study of Drug Development. Prior to my Tufts appointment, I was a post-doctoral fellow at the University of Pennsylvania, and I completed my PhD in economics at the University of Amsterdam. Before pursuing my PhD I was a management consultant at Accenture in The Hague, Netherlands. Currently, and for the past 6 years, I work on a freelance basis on a variety of research, teaching, and writing projects.
The WHO has urged countries to continue to sequence COVID-19 samples to monitor variants.
The JN.1 COVID-19 variant is completing its global takeover, with the number of new cases having increased by 52% during the 28 days leading up to the end of the year, according to the World Health Organization (WHO).
In the United States, JN.1 accounts for more than 60% of COVID-19 cases, according to the Centers for Disease Control and Prevention and all of this on top of rising influenza and Respiratory Syncytial Virus (RSV) waves.
The pandemic is far from over, stressed American scientist Eric Topol in an opinion piece in the Los Angeles Times.
JN.1 is a derivative of the BA.2.86 Omicron subvariant of SARS-Cov-2 but with more than 30 mutations. Israeli variant trackers first discovered it in August. WHO first spoke about JN.1 at a press conference on 19 October press as a variant to keep a close eye on. Last month, it named JN.1 a variant of interest (VOI) but nit the more serious variant of concern (VOC).
According to Topol, by wastewater levels, JN.1 is now associated with the second-biggest wave of infections in the United States in the pandemic, after Omicron. He said the level indicates that around two million Americans are infected with JN.1 daily.
Although many people are carrying the virus and CDC data shows that US COVID-19 hospitalizations have continued to increase in the last two months, JN.1 has not caused the surge of hospitalizations seen in Omicron.
This is also the case in other countries, including Israel, where it was first discovered, according to Cyrille Cohen, the head of the field of life sciences and medicine for the Israel Science Foundation and a professor at Bar-Ilan University. He said the country is seeing 10 to 20 cases of severe COVID-19 disease in hospitals on any given day, compared to as many as 1,400 two years ago.
At the same time, studies are starting to show that the updated COVID-19 vaccines developed by Pfizer, Moderna and others are eliciting antibodies against JN.1 at least in vitro, according to Cohen.
For example, Kaiser Permanente recently released a report that showed a vaccine booster conferred approximately 60% protection against hospitalization for JN.1 and other recently identified variants.
However, Cohen cautioned that it can be challenging to determine the impact of COVID-19 vaccines today as people have had so many shots at different intervals and of different versions. Moreover, most people have either been exposed to or are sick with COVID-19.
The other issue is that vaccine uptake is deficient. CDC data as of 5 January showed that only 8% of eligible children and 19.4% of eligible adults had received the updated 2023-24 COVID-19 vaccine. The percentage jumped to around a third (38%) among adults over 65.
Many more people are opting to take the influenza vaccine: 44% of children and 45% of adults, including 70% of adults over 65.
Whenever there is a new variant, you need to ask three questions, explained Peter Chin-Hong, a professor of medicine and infectious disease at the University of California, San Francisco: Is it more transmissible? Do the vaccines work? Does it cause more severe disease?
Is it more transmissible?
Chin-Hong told Health Policy Watch that the data indicates JN.1 is more transmissible because it is rising to the top of the charts very quickly. He said that at the beginning of November 2023, JN.1 accounted for between 5% and 8% of all US cases, and today it is the most common variant.
Can it evade vaccines?
The answer here, Chin-Hong said, is generally no. He said the studies show that the vaccine works as long as people are newly inoculated. He recommended the vaccine for immuno-compromised people with pre-existing medical conditions and those over the age of 75. For these people, he said, just being infected a year ago and getting the first two shots will not be enough.
Does it cause more severe disease?
According to Chin-Hong, there is no evidence that JN.1 has caused more severe diseases so far and no evidence that it will. This is true in the countries currently experiencing a rise in the variant, and also from data in Singapore and other countries where JN.1 has been the predominant variant for longer, he said.
In those countries, the variant did not seem to cause more people to be hospitalized.
Moreover, he added that antiviral drugs such as Paxlovid and Remdesivir continue to work to curtail the severity of the virus.
Instead, he said his concern is that JN.1 will exploit the worlds COVID-19 complacency. The majority of countries have not kept up testing or vaccination, and given its high price tag, many low- and middle-income countries do not have access to drugs like Paxlovid.
Those are the vulnerabilities that JN.1 will exploit, Chin-Hong said.
But Cohen said he believes the world and COVID-19 are in another era since WHO ended the viruss official pandemic status in May 2023. He noted that COVID-19 is not the same threat as at the pandemics beginning or even during Delta.
With the Omicron era that started exactly two years ago, the infection decreased in intensity, Cohen said. Moreover, since most of us were exposed to COVID at least once in our lifetime, there is also some kind of protective [herd] immunity.
That does not mean, however, that the medical and scientific community should not be taking JN.1 or COVID seriously, Chin-Hong stressed. He said WHO should hurry to give the variant a Greek letter name, such as Pi, to allow governments and people to mobilize and fight the virus.
Right now, people are fed up with COVID, Chin-Hong told Health Policy Watch. Giving it a letter will give something to people to latch onto: lets vaccinate against Pi, get medicines, and have a global talk about sequencing.
These things have trickle-down effects, he continued. Giving it a name would also help the everyday person believe he still has something to pay attention to.
Chin-Hong and Cohen said that information remains crucial and that countries should continue to sequence to identify variants of concern.
We need to monitor those variants because it is not the end of COVID, Cohen said. Just like with flu, which has an intense strain every 10-20 years, he said that COVID-19 could also once again have a more dangerous strain.
As Topol wrote in the LA Times: Inevitably, there will be another strain in the future that we are not at all prepared for and will lead to yet another very big wave across the planet.
Image Credits: Photo by Mufid Majnun on Unsplash.
Combat the infodemic in health information and support health policy reporting from the global South. Our growing network of journalists in Africa, Asia, Geneva and New York connect the dots between regional realities and the big global debates, with evidence-based, open access news and analysis. To make a personal or organisational contribution click here on PayPal.
A large staggered cohort study from primary care patients in the UK, Spain, and Estonia finds that COVID-19 vaccination consistently reduced the risk of long-COVID symptoms. The study is published in The Lancet Respiratory Medicine.
The study used the World Health Organizations (WHO) definition of post COVID condition, or long COVID, as new or persisting symptoms 3 months after infection that cannot be explained by alternative causes. The WHO recognizes 25 long COVID symptoms, including fatigue, shortness of breath, and cognitive dysfunction.
In total, more than 10 million vaccinated people and 10 million unvaccinated people from each of the three countries and four databases were compared, and effectiveness of vaccination with either ChAdOx1 (AstraZeneca) and BNT162b2 (Pfizer-BioNTech) was assessed.
"For each database and country, we created four study cohorts, with each of them representing a specific stage of the national vaccination campaign rollout," the authors explained. "We defined long COVID as having at least one record of any of the pre-defined symptoms between 90 and 365 days after the date of a PCR-positive test or clinical diagnosis of COVID-19, with no record of that symptom 180 days before SARS-CoV-2 infection."
VE of 29% to 52% for long COVID
Across all four staggered cohorts in all three countries, vaccination was associated with a lowered risk of developing long COVID. And a slightly stronger preventative effect was seen for the first dose of BNT162b2 than for ChAdOx1, the authors said.
Vaccine efficacy (VE) against long COVID ranged from 29% to 52%.
The hazard ratio (HR) for long COVID symptoms in people vaccinated with a first dose of any COVID-19 vaccine were 0.54 (95% confidence interval [CI], 0.44 to 0.67) and, 0.48 (0.34 to 0.68) for the UK cohorts. In Spain the HR was 0.71 (0.55 to 0.91), and in Estonia the HR was 0.59 (0.40 to 0.87).
To our knowledge, this is the first multinational study assessing population-level vaccine effectiveness to prevent long COVID symptoms.
"To our knowledge, this is the first multinational study assessing population-level vaccine effectiveness to prevent long COVID symptoms," the authors concluded. "These findings were robust to multiple sensitivity analyses and various definitions of long COVID, including different duration of symptoms and clinically diagnosed long COVID in a secondary analysis."
Several recent studies have shown varying VE for COVID-19 vaccines against long COVID, including a recent meta-analysis which showed a 69% VE when three doses of vaccine were used.
In other long COVID research, in Switzerland, among those who remained outpatients during their first SARS-CoV-2 infection, women reported long-COVID symptoms more often than men (40.5% vs 25.5%).
However, there was no different rates between the sexes among long COIVD patients that had required hospitalization.
"The reasons for the differential impact of sex and gender in outpatients vs hospitalized patients can only be hypothesized, but might be attributed to the substantial differences in baseline characteristics between hospitalized patients and outpatients, the authors said.
Hospitalized patients were significantly older, with more comorbidities, and had cardiovascular risk factors.
