For years, global health officials have used billions of drops of an oral vaccine in a remarkably effective campaign aimed at wiping out polio in its last remaining strongholds — typically, poor, politically unstable corners of the world.

Now, in a surprising twist in the decades-long effort to eradicate the virus, authorities in London, New York and elsewhere have discovered evidence that polio is spreading there.

The original source of the virus? The oral vaccine itself.

Scientists have long known about this extremely rare phenomenon. That is why some countries have switched to other polio vaccines. But these incidental infections from the oral formula are becoming more glaring as the world inches closer to eradication of the disease and the number of polio cases caused by the wild, or naturally circulating, virus plummets.

Since 2017, there have been 396 cases of polio caused by the wild virus, versus more than 2,600 linked to the oral vaccine, according to figures from the World Health Organization and its partners.

“We are basically replacing the wild virus with the virus in the vaccine, which is now leading to new outbreaks,” said Scott Barrett, a Columbia University professor who has studied polio eradication. “I would assume that countries like the U.K. and the U.S. will be able to stop transmission quite quickly, but we also thought that about monkeypox.”

The latest incidents represent the first time in several years that vaccine-connected polio virus has turned up in rich countries.

Earlier this year, officials in Israel detected polio in an unvaccinated 3-year-old, who suffered paralysis. Several other children, nearly all of them unvaccinated, were found to have the virus but no symptoms.

In June, British authorities reported finding evidence in sewage that the virus was spreading, though no infections in people were identified. Last week, the government said all children in London ages 1 to 9 would be offered a booster shot.

In the U.S., an unvaccinated young adult suffered paralysis in his legs after being infected with polio, New York officials revealed last month. The virus has also shown up in New York sewers, suggesting it is spreading. Officials, however, said they are not planning a booster campaign because they believe the state’s high vaccination rate should offer enough protection.

Genetic analyses showed that the viruses in the three countries were all “vaccine-derived,” meaning that they were mutated versions of a virus that originated in the oral vaccine.

The oral vaccine at issue has been used since 1988 because it is cheap, easy to administer — two drops are put directly into children’s mouths — and better at protecting entire populations where polio is spreading. It contains a weakened form of the live virus.

But it can also cause polio in about two to four children per 2 million doses. (Four doses are required to be fully immunized.) In extremely rare cases, the weakened virus can also sometimes mutate into a more dangerous form and spark outbreaks, especially in places with poor sanitation and low vaccination levels.

These outbreaks typically begin when people who are vaccinated shed live virus from the vaccine in their feces. From there, the virus can spread within the community and, over time, turn into a form that can paralyze people and start new epidemics.

Many countries that eliminated polio switched to injectable vaccines containing a killed virus decades ago to avoid such risks; the Nordic countries and the Netherlands never used the oral vaccine. The ultimate goal is to move the entire world to the shots once wild polio is eradicated, but some scientists argue that the switch should happen sooner.

“We probably could never have gotten on top of polio in the developing world without the (oral polio vaccine), but this is the price we’re now paying,” said Dr. Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. “The only way we are going to eliminate polio is to eliminate the use of the oral vaccine.”

Aidan O’Leary, director of WHO’s polio department, described the discovery of polio spreading in London and New York as “a major surprise,” saying that officials have been focused on eradicating the disease in Afghanistan and Pakistan, where health workers have been killed for immunizing children and where conflict has made access to some areas impossible.

Still, O’Leary said he is confident Israel, Britain and the U.S. will shut down their newly identified outbreaks quickly.

The oral vaccine is credited with dramatically reducing the number of children paralyzed by polio. When the global eradication effort began in 1988, there were about 350,000 cases of wild polio a year. So far this year, there have been 19 cases of wild polio, all in Afghanistan, Mozambique and Pakistan.

In 2020, the number of polio cases linked to the vaccine hit a peak of more than 1,100 spread out across dozens of countries. It has since declined to around 200 this year so far.

Last year, WHO and partners also began using a newer oral polio vaccine, which contains a live but weakened virus that scientists believe is less likely to mutate into a dangerous form, but supplies are limited.

To stop polio in Britain, Israel and the U.S., what is needed is more vaccination, experts say. That is something Columbia University’s Barrett worries could be challenging in the COVID-19 era.

“What’s different now is a reduction in trust of authorities and the political polarization in countries like the U.S. and the U.K.,” Barrett said. “The presumption that we can quickly get vaccination numbers up quickly may be more challenging now.”

Oyewale Tomori, a virologist who helped direct Nigeria’s effort to eliminate polio, said that in the past, he and colleagues balked at describing outbreaks as “vaccine-derived,” wary it would make people fearful of the vaccine.

“All we can do is explain how the vaccine works and hope that people understand that immunization is the best protection, but it’s complicated,” Tomori said. “In hindsight, maybe it would have been better not to use this vaccine, but at that time, nobody knew it would turn out like this.”
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Echoing down the corridors of eastern Ukraine’s Pokrovsk Perinatal Hospital are the loud cries of tiny Veronika.

Born nearly two months prematurely weighing 1.5 kilograms (3 pounds, 4 ounces), the infant receives oxygen through a nasal tube to help her breathe while ultraviolet lamps inside an incubator treat her jaundice.

Dr. Tetiana Myroshnychenko carefully connects the tubes that allow Veronika to feed on her mother’s stored breast milk and ease her hunger.

Before Russia’s invasion of Ukraine in late February, three hospitals in government-controlled areas of the country’s war-torn Donetsk region had facilities to care for premature babies. One was hit by a Russian airstrike and the other had to close as a result of the fighting  — leaving only the maternity hospital in the coal mining town of Pokrovsk still operating.

Myroshnychenko, the site’s only remaining neonatologist, now lives at the hospital. Her 3-year-old son divides the week between staying at the facility and with his father, a coal miner, at home.

The doctor explains why it’s now impossible to leave: Even when the air-raid sirens sound, the babies in the hospital’s above-ground incubation ward cannot be disconnected from their lifesaving machines.

“If I carry Veronika to the shelter, that would take five minutes. But for her, those five minutes could be critical,” Myroshnychenko says.

Hospital officials say the proportion of births occurring prematurely or with complications has roughly doubled this year compared to previous times, blaming stress and rapidly worsening living standards for taking a toll on the pregnant women still left in the area.

Russia and Moscow-backed separatists now occupy just over half the Donetsk region, which is similar in size to Sicily or Massachusetts. Pokrovsk is still in a Ukrainian government-controlled area 60 kilometers (40 miles) west of the front lines.

Inside the hospital’s maternity wards, talk of the war is discouraged.

“Everything that happens outside this building of course concerns us, but we don’t talk about it,” Myroshnychenko said. “Their main concern right now is the baby.”

Although fighting in the Dontesk region started back in 2014, when Russia-backed separatists began battling the government and taking over parts of the region, new mothers are only now being kept in the hospital for longer periods because there’s little opportunity for them to receive care once they have been discharged.

Among them is 23-year-old Inna Kyslychenko, from Pokrovsk. Rocking her 2-day-old daughter Yesenia, she was considering joining the region’s massive evacuation westward to safer areas in Ukraine when she leaves the hospital. Many essential services in government-held areas of Donetsk — heat, electricity, water supplies — have been damaged by Russian bombardment, leaving living conditions that are only expected to worsen as the winter grows near.

“I fear for the little lives, not only for ours, but for all the children, for all of Ukraine,” Kyslychenko said.

More than 12 million people in Ukraine have fled their homes due to the war, according to U.N. relief agencies. About half have been displaced within Ukraine and the rest have moved to other European countries.

Moving the maternity hospital out of Pokrovsk, however, is not an option.

“If the hospital was relocated, the patients would still have to remain here,” said chief physician Dr. Ivan Tsyganok, who kept working even when the town was being hit by Russian rocket fire.

“Delivering babies is not something that can be stopped or rescheduled,” he noted.

The nearest existing maternity facility is in Ukraine’s neighboring Dnipropetrovsk region, a 3 1/2 hour drive along secondary roads, a journey considered too risky for women in late-term pregnancy.

Last week, 24-year-old Andrii Dobrelia and his wife Maryna, 27, reached the hospital from a nearby village. Looking anxious, they talked little as doctors carried out a series of tests and then led Maryna to the operating room for a C-section. Tsyganok and his colleagues hurriedly changed their clothes and prepared for the procedure.

Twenty minutes later, the cries of a newborn baby boy, Timur, could be heard. After an examination, Timur was taken to meet his father in an adjoining room.

Almost afraid to breathe, Andrii Dobrelia tenderly kissed Timur’s head and whispered to him. As the newborn calmed down on his father’s chest, tears came to Andrii’s eyes.

As the war reaches the six-month mark, Tsyganok and his colleagues says they have a more hopeful reason to stay.

“These children we are bringing into the world will be the future of Ukraine,” says Tsyganok. “I think their lives will be different to ours. They will live outside war.”
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While vacationers might enjoy the Mediterranean Sea’s summer warmth, climate scientists are warning of dire consequences for its marine life as it burns up in a series of severe heat waves.

From Barcelona to Tel Aviv, scientists say they are witnessing exceptional temperature hikes ranging from 3 degrees Celsius (5.4 Fahrenheit) to 5 degrees Celsius (9 Fahrenheit) above the norm for this time of year. Water temperatures have regularly exceeded 30 C (86 F) on some days.

Extreme heat in Europe and other countries around the Mediterranean has grabbed headlines this summer, but the rising sea temperature is largely out of sight and out of mind.

Marine heat waves are caused by ocean currents building up areas of warm water. Weather systems and heat in the atmosphere can also pile on degrees to the water’s temperature. And just like their on-land counterparts, marine heat waves are longer, more frequent and more intense because of human-induced climate change.

The situation is “very worrying,” says Joaquim Garrabou, a researcher at the Institute of Marine Sciences in Barcelona. “We are pushing the system too far. We have to take action on the climate issues as soon as possible.”

Garrabou is part of a team that recently published the report on heat waves in the Mediterranean Sea between 2015 and 2019. The report says these phenomena have led to “massive mortality” of marine species.

About 50 species, including corals, sponges and seaweed, were affected along thousands of kilometers of Mediterranean coasts, according to the study, which was published in the Global Change Biology journal.

The situation in the eastern Mediterranean basin is particularly dire.

The waters off Israel, Cyprus, Lebanon and Syria are “the hottest hot spot in the Mediterranean, for sure,” said Gil Rilov, a marine biologist at Israel’s Oceanographic and Limnological Research institute, and one of the paper’s co-authors. Average sea temperatures in the summer are now consistently over 31 C (88 F).

These warming seas are driving many native species to the brink, “because every summer their optimum temperature is being exceeded,” he said.

What he and his colleagues are witnessing in terms of biodiversity loss is what is projected to happen further west in the Mediterranean toward Greece, Italy and Spain in the coming years.

Garrabou points out that seas have been serving the planet by absorbing 90% of the earth’s excess heat and 30% of carbon dioxide emitted into the atmosphere by coal, oil and gas production. This carbon-sink effect shields the planet from even harsher climate effects.

This was possible because oceans and seas were in a healthy condition, Garrabou said.

“But now we have driven the ocean to an unhealthy and dysfunctional state,” he said.

While the earth’s greenhouse gas emissions will have to be drastically reduced if sea warming is to be curtailed, ocean scientists are specifically looking for authorities to guarantee that 30% of sea areas are protected from human activities such as fishing, which would give species a chance to recover and thrive.

About 8% of the Mediterranean Sea area is currently protected.

Garrabou and Rilov said that policymakers are largely unaware of the warming Mediterranean and its impact.

“It’s our job as scientists to bring this to their attention so they can think about it,” Rilov said.

Heat waves occur when especially hot weather continues over a set number of days, with no rain or little wind. Land heat waves help cause marine heat waves and the two tend to feed each other in a vicious, warming circle.

Land heat waves have become commonplace in many countries around the Mediterranean, with dramatic side effects like wildfires, droughts, crop losses and excruciatingly high temperatures.

But marine heat waves could also have serious consequences for the countries bordering the Mediterranean and the more than 500 million people who live there if it’s not dealt with soon, scientists say. Fish stocks will be depleted and tourism will be adversely affected, as destructive storms could become more common on land.

Despite representing less than 1% of the global ocean surface area, the Mediterranean is one of the main reservoirs of marine biodiversity, containing between 4% and 18% of the world’s known marine species.

Some of the most affected species are key to maintaining the functioning and diversity of the sea’s habitats. Species like the Posidonia oceanica seagrass meadows, which can absorb vast amounts of carbon dioxide and shelters marine life, or coral reefs, which are also home to wildlife, would be at risk.

Garrabou says the mortality impacts on species were observed between the surface and 45 meters (around 150 feet) deep, where the recorded marine heat waves were exceptional. Heat waves affected more than 90% of the Mediterranean Sea’s surface.

According to the most recent scientific papers, the sea surface temperature in the Mediterranean has increased by 0.4 C (0.72 F) each decade between 1982 and 2018. On a yearly basis, it has been rising by some 0.05 C (0.09 F) over the past decade without any sign of letting up.

Even fractions of degrees can have disastrous effects on ocean health, experts say.

The affected areas have also grown since the 1980s and now covers most of the Mediterranean, the study suggests.

“The question is not about the survival of nature, because biodiversity will find way to a survive on the planet,” Garrabou said. “The question is if we keep going in this direction maybe our society, humans, will not have a place to live.”

 
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Today’s sharks have nothing on their ancient cousins. A giant shark that roamed the oceans millions of years ago could have devoured a creature the size of a killer whale in just five bites, new research suggests.

For their study published Wednesday, researchers used fossil evidence to create a 3D model of the megalodon — one of the biggest predatory fish of all time — and find clues about its life.

At around 50 feet (16 meters) from nose to tail, the megalodon was bigger than a school bus, according to the study in the journal Science Advances. That’s about two to three times the size of today’s great white shark. The megalodon’s gaping jaw allowed it to feed on other big creatures. Once it filled its massive stomach, it could roam the oceans for months at a time, the researchers suggest.

The megalodon was a strong swimmer, too: Its average cruising speed was faster than sharks today and it could have migrated across multiple oceans with ease, they calculated.

“It would be a superpredator just dominating its ecosystem,” said co-author John Hutchinson, who studies the evolution of animal movement at England’s Royal Veterinary College. “There is nothing really matching it.”

It’s been tough for scientists to get a clear picture of the megalodon, said study author Catalina Pimiento, a paleobiologist with the University of Zurich and Swansea University in Wales.

The skeleton is made of soft cartilage that doesn’t fossilize well, Pimiento said. So the scientists used what few fossils are available, including a rare collection of vertebrae that’s been at a Belgium museum since the 1860s.

Researchers also brought in a jaw’s worth of megalodon teeth, each as big as a human fist, Hutchinson said. Scans of modern great white sharks helped flesh out the rest.

Based on their digital creation, researchers calculated that the megalodon would have weighed around 70 tons, or as much as 10 elephants.

Even other high-level predators may have been lunch meat for the megalodon, which could open its jaw to almost 6 feet (2 meters) wide, Pimiento said.

Megalodons lived an estimated 23 million to 2.6 million years ago.

Since megalodon fossils are rare, these kinds of models require a “leap of imagination,” said Michael Gottfried, a paleontologist at Michigan State University who was not involved in the study. But he said the study’s findings are reasonable based on what is known about the giant shark.

 
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Africa’s migratory birds are threatened by changing weather patterns in the center and east of the continent that have depleted natural water systems and caused a devastating drought.

Hotter and drier conditions due to climate change make it difficult for traveling species who are losing their water sources and breeding grounds, with many now endangered or forced to alter their migration patterns entirely by settling in cooler northern areas.

Roughly 10% of Africa’s more than 2,000 bird species, including dozens of migratory birds, are threatened, with 28 species — such as the Madagascar fish eagle, the Taita falcon and hooded vultures — classed as “critically endangered.” Over one-third of them are especially vulnerable to climate change and extreme weather, an analysis by the environmental group BirdLife International said.

“Birds are being affected by climate change just like any other species,” BirdLife policy coordinator Ken Mwathe said. “Migratory birds are affected more than other groups of birds because they must keep on moving,” which makes it more likely that a site they rely on during their journey has degraded in some way.

The African-Eurasian flyway, the flight corridor for birds that travel south through the Mediterranean Sea and Sahara Desert for the winter, harbors over 2,600 sites for migrating birds. An estimated 87% of African sites are at risk from climate change, a greater proportion than in Europe or Asia, a study by the United Nations environment agency and conservation group Wetlands International found.

Africa is more vulnerable to climate change because it is less able to adapt, said Evans Mukolwe, a retired meteorologist and science director at the World Meteorological Organization.

“Poverty, biodiversity degradation, extreme weather events, lack of capital and access to new technologies” make it more difficult for the continent to protect habitats for wild species, Mukolwe said.

Hotter temperatures due to human-caused climate change and less rainfall shrink key wetland areas and water sources, which birds rely on during migratory journeys.

“Lake Chad is an example,” Mwathe said. “Before birds cross the Sahara, they stop by Lake Chad, and then move to the Northern or Southern Hemisphere. But Lake Chad has been shrinking over the years,” which compromises its ability to support birds, he said.

Parched birds mean tougher journeys, which has an impact on their ability to breed, said Paul Matiku, executive director of Nature Kenya.

Flamingoes, for example, which normally breed in Lake Natron in Tanzania are unlikely to be able to “if the migration journey is too rough,” Matiku said.

He added that “not having water in those wetlands means breeding will not take place” since flamingoes need water to create mud nests that keep their eggs away from the intense heat of dry ground.

Non-migratory birds are also struggling with the changing climate. African fish eagles, found throughout sub-Saharan Africa, are now forced to travel farther in search of food. The number of South African Cape Rockjumpers and Protea canaries is severely declining.

Bird species living in the hottest and driest areas, like in the Kalahari Desert that spans Botswana, Namibia and South Africa, are approaching their “physiological limits,” the most recent assessment by the U.N.’s expert climate panel said. It added that birds are less able to find food and are losing body mass, causing large-scale deaths for those living in extreme heat.

“Forest habitats get hotter with climate change and … dryland habitats get drier and savannah birds lack food because grass never seeds, flowers never fruit, and insects never emerge as they do when it rains,” Matiku said.

Other threats, such as the illegal wildlife trade, agriculture, the growth of urban areas and pollution are also stunting bird populations like African fish eagles and vultures, he said.

Better land management projects that help restore degraded wetlands and forests and protect areas from infrastructure, poaching or logging will help preserve the most vulnerable species, the U.N. environmental agency said.

Birds and other species would benefit from concerted efforts to improve water access and food security, especially as sea levels rise and extreme weather events are set to continue, said Amos Makarau, the Africa regional director of the U.N. weather agency.

Scientists say that curbing emissions of planet-warming gases, especially in high-emitting nations, could also limit future weather-related catastrophes.
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Indonesia has confirmed its first monkeypox infection, detected in a person who had returned from an unidentified country with documented cases, a health ministry spokesman said Saturday.

The 27-year-old male tested positive in the capital Jakarta late Friday, Mohammad Syahril told a news conference.  

The Indonesian national, who is doing “well” and showing only mild symptoms, is self-isolating at home, said Syahril, who did not say where the patient had come from.

“We have followed up with tracing of close contacts and will check up on them,” he said, adding the government is in the process of procuring around 10,000 vaccines for monkeypox.

The health ministry is urging calm and has reassured the public that monkeypox is treatable. It has so far tested 22 suspected cases from across the country, all of which were negative.

Neighboring Singapore reported its first local case of monkeypox last month and had 15 confirmed cases as of August 5.

Elsewhere in Southeast Asia, the Philippines and Thailand also have confirmed cases.

The World Health Organization has declared a global health emergency, with more than 40,000 confirmed cases of monkeypox, including a handful of deaths, in more than 80 countries where the virus is not endemic.
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When Stephen Nixon recently noticed a “beautiful” spotted lanternfly by his bag as he skateboarded in Brooklyn, he heeded the request of city officials. 

He stomped on it. 

“I don’t like killing things. Not many people do. I’ll catch and release cockroaches if I find them in my apartment,” Nixon said. But he said it “seems like something worse” if the insect’s population explodes. 

Kill-on-sight requests in New York City and elsewhere are a part of public campaigns to fight an invasive insect now massing and feeding on plants around much of the eastern United States. Pretty with red wing markings, the spotted lanternfly is nonetheless a nuisance and a threat — the sort of insect that inspires people to post about squishing and stomping them on social media. 

In cities, they swarm outside buildings and land on pedestrians. They excrete a sticky substance called honeydew that can collect on outdoor furniture. The sap-sucking insects also pose a danger to grapes and other agricultural crops, which is raising alarms this summer in New York state wine country. 

Across mid-Atlantic states, officials are asking people to help them track and slow the insect’s spread, even if they have to put their foot down. 

“Be vigilant,” said Chris Logue of New York’s Department of Agriculture. 

Entered country in 2014

A native of Asia, the spotted lanternfly was first identified in the United States in 2014, northwest of Philadelphia. It’s likely that insect eggs came over with a load of landscaping stones. Eight years later, there are reported infestations in 13 states, mostly on the East Coast, according to the New York State Integrated Pest Management program at Cornell University. Individual insects have been spotted in more states, with two turning up in Iowa this summer. 

The insect has been able to spread so far, so fast because it is a stealthy hitchhiker. Drivers this time of year unwittingly give lifts to adults, which look like moths, perched inside trunks, on wheel wells or on bumpers. 

“Check your vehicle,” Logue said. “What you’re really after is anything that maybe is alive, that is kind of hunkered down in there and is not going to get blown off the vehicle during the trip. Really, really important.” 

People also unknowingly transport spotted lanternfly eggs, which are laid later in the season. Females leave masses of 30 or more eggs on all sorts of surfaces, from tree trunks to patio furniture. Eggs laid on portable surfaces, like camping trailers and train cars, can hatch in the spring many miles away. 

Spotted lanternfly fighters are doing everything from applying pesticides to cutting down trees of heaven — another invasive species that is a favored host of the spotted lanternfly. But public involvement is front and center. 

In Pennsylvania, residents in quarantined counties are asked to check for the pests on dozens of items — from their vehicles to camping gear to lumber and shrubs — before heading to nonquarantined destinations. 

Be merciless

Around the East, people are being asked to report sightings to help track the spread. 

And if you see one? Show no mercy. 

“Kill it! Squash it, smash it … just get rid of it,” reads a post by Pennsylvania agricultural officials. 

New York City parks officials agree, advising: “Please squish and dispose.” 

“Join Jersey’s Stomp Team” read billboards in New Jersey showing a shoe about to stamp out an insect. 

Heide Estes did just that after seeing a spotted lanternfly on a Sunday walk in Long Branch, New Jersey, this month. 

“I came back, and I said to my partner, ‘You know, I saw a spotted lanternfly,’ ” Estes said, “and she was like, ‘Oh, I’m sure there’s more. Let’s go look.’ ” 

There were more. 

Her partner, an entomologist, put four in a plastic bottle to show co-workers on campus what they look like. They killed at least a dozen more. Many were massed on trees of heaven. 

“Clearly, the whole spot was infested,” she said. 

Nearing vineyards

Infestations in New York state had been concentrated in the metropolitan area but have spread close to the state’s wine-growing vineyards. Agricultural officials are concerned about the fate of vineyards in the Finger Lakes, the Hudson Valley and Long Island if infestations spread. U.S. Senator Chuck Schumer said Sunday that the insect could cost the state millions. 

“The spotted lanternfly sucks the sap out of the vines,” said Brian Eshenaur, an expert with the Cornell pest program. “And it makes them less hardy for the winter, so vines can be lost over the growing season.” 

Eshenaur said they’re more likely to spread into vineyards later in the season, when trees of heaven enter dormancy.

At Sheldrake Point Winery in the Finger Lakes, vineyard manager David Wiemann said workers in the rows already know to be on guard. 

“We’ve talked about how detrimental it would be to the vineyards,” Wiemann said. “So if they see one, they would let me know.”
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A smaller dose of the monkeypox vaccine appears to still be effective and can be used to stretch the current supply by five times, the European Medicines Agency said Friday, echoing a recommendation made earlier this month by the U.S. Food and Drug Administration.

The EU drug regulator said in a statement that injecting people with one-fifth of the regular dose of the smallpox vaccine made by Bavarian Nordic appeared to produce similar levels of antibodies against monkeypox as a full dose.

The approach calls for administering Bavarian Nordic’s vaccine with an injection just under the skin rather than into deeper tissue, a practice that may stimulate a better immune response. People still need to get two doses, about four weeks apart.

The EMA said national authorities could decide, “as a temporary measure” to use smaller doses of the vaccine to protect vulnerable people during the ongoing monkeypox outbreak.

EU health commissioner Stella Kyriakides said the decision would allow the vaccination of five times as many people with the continent’s current supply.

“This ensures greater access to vaccination for citizens at risk and health care workers,” she said in a statement.

Earlier this month, the U.S. FDA authorized a similar plan to extend the country’s monkeypox vaccine stocks. The technique has previously been used to stretch supplies of vaccines during other outbreaks, including yellow fever and polio.

The unusual recommendations from both regulators acknowledge the extremely limited global supplies of the Jynneos vaccine, originally developed against smallpox. Bavarian Nordic is the only company that makes it, and it expects to have about 16 million doses available this year. On Thursday, the U.S. also announced a new agreement with a Michigan manufacturer to help speed production of 5.5 million vaccine vials recently ordered by the government.

The EMA authorized the vaccine in July based on experimental data that suggested it would work; the World Health Organization has estimated the shot is about 85% effective at preventing monkeypox.

Globally, there are more than 40,000 cases of monkeypox, of which about half are in Europe. Earlier this week, WHO chief Tedros Adhanom Ghebreyesus said there has been a 20% increase in cases reported in the last two weeks and that nearly all infections have been reported in men who are gay, bisexual or have sex with other men.

Tedros said WHO was in talks with vaccine manufacturers and countries to see if any might be willing to share doses. Africa has reported the highest number of suspected monkeypox deaths and although the disease has been endemic in parts of central and west Africa for decades, it has only a small supply of vaccines being used as part of a research study.

About 98% of monkeypox cases beyond Africa have been reported in men who are gay, bisexual or have sex with other men. WHO said there is no sign of sustained transmission beyond men who have sex with men, although a small number of women and children have also been sickened by the disease.

Monkeypox spreads when people have close, physical contact with an infected person’s lesions, their clothing or bed sheets. Most people recover without needing treatment, but the lesions can be extremely painful and more severe cases can result in complications including brain inflammation and death.

In the U.K., which at one point had the biggest outbreak outside Africa, officials said earlier this week they have seen signs the outbreak is slowing down.
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The World Health Organization says clinical evidence shows two monoclonal antibody treatments are effective at saving the lives of many people stricken with the deadly Ebola virus.

The action follows a systematic review and analysis of randomized clinical trials of therapeutics for the disease.

WHO Team Lead for Clinical Care Janet Diaz says the evidence underpinning the recommendations comes from two clinical trials. The largest was done in the Democratic Republic of Congo in 2018 and 2019.

She says the trials were conducted during Ebola outbreaks, demonstrating quality control trials can be done even under the most difficult circumstances.

“The evidence synthesis that informs this guideline shows that mAb114 and Regeneron-EB3 reduced mortality. The relative risk reduction was about 60 percent…Between 230 to 400 lives saved per 1,000 patients. Translate that into the number needed to treat, you treat two to four patients, and you save one life.”

Ebola hemorrhagic fever is spread through blood or body fluids of a person who is sick with or has died of the disease. The worst Ebola outbreak occurred in West Africa between 2014 and 2016. Of the nearly 29,000 reported cases, more than 11,300 people died.

Diaz calls the development of monoclonal antibody therapeutics a very important advancement. However, she notes the drug itself is not the only solution. She says it must be given in a comprehensive, clinical setting along with other treatments.

“That includes early diagnosis so that treatments can be given as soon as possible and also the implementation of appropriate infection prevention and control to stop transmission…and treatment of co-infections and access to nutrition, psycho-social support, and, of course, access to care after discharge.”

Diaz says the two recommended therapeutics have shown clear benefits for people of all ages. She says they can be used on all patients confirmed positive for Ebola virus disease. That, she says, includes older people, pregnant and breastfeeding women, children, and babies born to mothers with confirmed Ebola within the first seven days after birth.
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A group of World Health Organization experts is recommending COVID-19 booster shots for people at the highest risk of severe illness and death. The Strategic Advisory Group of Experts on Immunization or SAGE, which met in extraordinary session August 11, issued its updated guidance Thursday.

SAGE recommends continued use of the two-dose mRNA COVID-19 vaccines. Since the vaccines’ efficacy wanes after several months, however, the group of experts advises a booster shot for everyone, beginning with those at highest risk.

This is the first time SAGE has updated its guidance on the administration of a second booster shot. Its recommendations are based on increasing evidence on the benefits of a second booster dose of COVID-19 vaccines for select groups of people.

SAGE chairman Alejandro Cravioto said the group recommends a second booster shot for people older than 55 who are considered at highest risk of developing severe disease and in need of hospitalization. He said SAGE does not advocate a second booster for the general public, for adults who are generally healthy and do not suffer from severe immunodeficiency.

“We also include persons with moderate and severe immuno-compromising conditions from, say, 6 months and above,” Cravioto said. “And that includes the children and adults with co-morbidities at higher risk of severe disease. We also include pregnant women and health workers.”

SAGE recommends a second booster be given four to six months after the administration of the first. It says healthy children and adolescents remain at low risk of severe disease from COVID-19, so there currently is no recommendation for youth groups to be vaccinated.

Cravioto, however, said SAGE has made interim recommendations for the use of Pfizer and Moderna vaccines in relation to their use in children.

“In the case of both vaccines, children from 6 months to 17 years with co-morbidities should be vaccinated to avoid a higher risk in these groups of severe disease. … This includes, of course, children with Down syndrome, who we know are at the highest risk of dying of COVID if they get infected.”

The group of experts notes the recommendations are based on the current available data. They say it is not a projection into the future but relates specifically to the omicron variant of the coronavirus. It says the guidance is likely to change depending on how the pandemic evolves and new variants circulate.
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The White House announced Thursday it will make an additional 1.8 million doses of monkeypox vaccine available for distribution beginning next week.

At a news conference, White House national monkeypox response coordinator Bob Fenton said the additional doses will be available for U.S. jurisdictions to order starting Monday, through the Department of Health and Human Services (HHS).

U.S. Centers for Disease Control and Prevention Director Rochelle Walensky and HHS Secretary Xavier Becerra also took part in the news briefing.

Fenton said in the less than 10 days since the U.S. Food and Drug Administration and the CDC authorized the Jynneos vaccine for emergency use against monkeypox in individuals 18 years of age and older, HHS has delivered nearly 1 million doses to U.S. states and cities, making it the largest program of its kind for monkeypox vaccine in the world.

Fenton said the additional doses are part of the National Monkeypox Response Team’s plan to address the viral disease’s outbreak in the United States and mitigate its spread.

He said HHS has been working on launching a pilot program that will provide up to 50,000 doses from the national stockpile to be made available for events that will have high attendance of gay and bisexual men.

While monkeypox is not classified as a sexually transmitted infection, or STI, it has been found to be disproportionally affecting men who have sex with men. The disease can spread through close or intimate physical contact such as hugging, kissing and sex. It can also be transmitted by touching infected items such as clothing, bedding or towels.

Fenton said the Biden administration has also significantly increased availability and convenience of monkeypox tests, expanding capacity from 6,000 tests per week to 80,000 tests per week.

Some information for this report was provided by The Associated Press and Reuters.
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Today’s sharks have nothing on their ancient cousins. A giant shark that roamed the oceans millions of years ago could have devoured a creature the size of a killer whale in just five bites, new research suggests.

For their study published Wednesday, researchers used fossil evidence to create a 3D model of the megalodon — one of the biggest predatory fish of all time — and find clues about its life.

At around 16 meters from nose to tail, the megalodon was bigger than a school bus, according to the study in the journal Science Advances. That’s about two to three times the size of today’s great white shark. The megalodon’s gaping jaw allowed it to feed on other big creatures. Once it filled its massive stomach, it could roam the oceans for months at a time, the researchers suggest.

The megalodon was a strong swimmer, too: Its average cruising speed was faster than sharks today and it could have migrated across multiple oceans with ease, they calculated.

“It would be a superpredator just dominating its ecosystem,” said co-author John Hutchinson, who studies the evolution of animal movement at England’s Royal Veterinary College. “There is nothing really matching it.

It’s been tough for scientists to get a clear picture of the megalodon, said study author Catalina Pimiento, a paleobiologist with the University of Zurich and Swansea University in Wales.

The skeleton is made of soft cartilage that doesn’t fossilize well, Pimiento said. So the scientists used what few fossils are available, including a rare collection of vertebrae that’s been at a Belgium museum since the 1860s.

Researchers also brought in a jaw’s worth of megalodon teeth, each as big as a human fist, Hutchinson said. Scans of modern great white sharks helped flesh out the rest.

Based on their digital creation, researchers calculated that the megalodon would have weighed around 70 tons, or as much as 10 elephants.

Even other high-level predators may have been lunch meat for the megalodon, which could open its jaw to almost 2 meters wide, Pimiento said.

Megalodons lived an estimated 23 million to 2.6 million years ago.

Since megalodon fossils are rare, these kinds of models require a “leap of imagination,” said Michael Gottfried, a paleontologist at Michigan State University who was not involved in the study. But he said the study’s findings are reasonable based on what is known about the giant shark. 
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A federal judge in Cleveland awarded $650 million in damages Wednesday to two Ohio counties that won a landmark lawsuit against national pharmacy chains CVS, Walgreens and Walmart, claiming the way they distributed opioids to customers caused severe harm to communities and created a public nuisance.

U.S. District Judge Dan Polster said in the ruling that the money will be used to abate a continuing opioid crisis in Lake and Trumbull counties, outside Cleveland. Attorneys for the counties put the total price tag at $3.3 billion for the damage done to the counties.

Lake County is to receive $306 million over 15 years. Trumbull County is to receive $344 million over the same period. Polster ordered the companies to immediately pay nearly $87 million to cover the first two years of the abatement plan.

In his ruling, Polster admonished the three companies, saying they “squandered the opportunity to present a meaningful plan to abate the nuisance” after a trial that considered what damages they might owe.

CVS, Walmart and Walgreens said they will appeal the ruling. It is unclear whether the companies will have to immediately pay the nearly $87 million during their appeals.

Trumbull County Commissioner Frank Fuda praised the award in a statement, saying “the harms caused by this devastating epidemic” can now be addressed.

Lake County Commissioner John Hamercheck said in a statement: “Today marks the start of a new day in our fight to end the opioid epidemic.”

A jury returned a verdict in November in favor of the counties after a six-week trial. It was then left to Polster to decide how much the counties should receive from the three pharmacy companies. He heard testimony in May to determine damages.

The counties convinced the jury that the pharmacies played an outsized role in creating a public nuisance in the way they dispensed pain medication into their communities.

It was the first time pharmacy companies completed a trial to defend themselves in a drug crisis that has killed a half-million Americans since 1999.

Attorneys for the pharmacy chains maintained they had policies to stem the flow of pills when their pharmacists had concerns and would notify authorities about suspicious orders from doctors. They also said it was doctors who controlled how many pills were prescribed for legitimate medical needs, not their pharmacies.

Walmart issued a statement Wednesday saying the counties’ attorneys “sued Walmart in search of deep pockets, and this judgment follows a trial that was engineered to favor the plaintiffs’ attorneys and was riddled with remarkable legal and factual mistakes.”

Walgreens spokesperson Fraser Engerman said, “The facts and the law did not support the jury verdict last fall, and they do not support the court’s decision now.

“The court committed significant legal errors in allowing the case to go before a jury on a flawed legal theory that is inconsistent with Ohio law and compounded those errors in reaching its ruling regarding damages.”

CVS spokesperson Michael DeAngelis said, “We strongly disagree with the court’s decision regarding the counties’ abatement plan, as well as last fall’s underlying verdict.”

CVS is based in Rhode Island, Walgreens in Illinois and Walmart in Arkansas.

Two chains — Rite Aid and Giant Eagle — settled lawsuits with the counties before trial. The amounts they paid have not been disclosed publicly.

Mark Lanier, an attorney for the counties, said during the trial that the pharmacies were attempting to blame everyone but themselves.

The opioid crisis has overwhelmed courts, social services agencies and law enforcement in Ohio’s blue-collar corner east of Cleveland, leaving behind heartbroken families and babies born to addicted mothers, Lanier told jurors.

Roughly 80 million prescription painkillers were dispensed in Trumbull County alone between 2012 and 2016 — equivalent to 400 for every resident. In Lake County, 61 million pills were distributed during that period.

The rise in physicians prescribing pain medications such as oxycodone and hydrocodone came as medical groups began recognizing that patients have the right to be treated for pain, Kaspar Stoffelmayr, an attorney for Walgreens, said at the opening of the trial.

The problem, he said, was “pharmaceutical manufacturers tricked doctors into writing way too many pills.”

The counties said pharmacies should be the last line of defense to prevent the pills from getting into the wrong hands.

The trial before Polster was part of a broader constellation of about 3,000 federal opioid lawsuits consolidated under his supervision. Other cases are moving ahead in state courts.

Kevin Roy, chief public policy officer at Shatterproof, an organization that advocates for solutions to addiction, said in November that the verdict could lead pharmacies to follow the path of major distribution companies and some drugmakers that have reached nationwide settlements of opioid cases worth billions. So far, no pharmacy has reached a nationwide settlement.

Also on Wednesday, attorneys general from numerous states announced they had reached an agreement with Endo International to pay as much as $450 million over 10 years to settle allegations the company used deceptive marketing practices “that downplayed the risk of addiction and overstated the benefits” of opioids it produced.

Based in Ireland, Endo’s U.S. headquarters are in Malvern, Pennsylvania. The company did not respond Wednesday to telephone and email requests for comment.

The agreement calls for the $450 million to be divided among participating states and communities. It also calls for Endo to put opioid-related documents online for public viewing and pay $2.75 million in expenses to publicly archive those documents.

Endo can never again market opioids, according to the agreement.

The company filed for Chapter 11 bankruptcy protection Tuesday night.

Endo produces generic opioids and name brands such as Percocet and Endocet. The company’s Opana ER opioid was withdrawn from the market in 2017. The attorneys general say Endo “falsely promoted the benefits” of Opana ER’s “so-called abuse deterrent formulation.” The attorneys general said the formulation did not deter abuse of the drug and led to deadly outbreaks of hepatitis and HIV resulting from people injecting the drug.
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Studies are underway to see whether genetic changes in the monkeypox virus are driving the rapid spread of the disease, the World Health Organization told AFP on Wednesday.

The two distinct clades, or variants, of the virus were called the Congo Basin (Central African) and West African clades, after the two regions where they are each endemic.

On Friday, the WHO renamed the groupings as clade I and clade II respectively, to avoid geographic stigmatization.

It also announced that clade II had two sub-clades, IIa and IIb, with viruses within the latter identified as being behind the current global outbreak.

On Wednesday, the U.N. health agency specified that clades IIa and IIb are related and share a recent common ancestor, therefore IIb is not an offshoot of IIa.

Research into mutations

Clade IIb contains viruses collected in the 1970s, and from 2017 onward.

“Looking through the genome, indeed there are a few genetic differences between the viruses from the current outbreak and the older clade IIb viruses,” the WHO told AFP.

“However, nothing is known about the significance of these genetic changes, and research is ongoing to establish the effects (if any) of these mutations on transmission and disease severity.

“It is still early on in both the outbreak and laboratory studies to tell if the rise in infections could be driven by the observed genotypic changes in the virus or are due to host (human) factors.”

There is also no information yet on what the mutations mean in terms of how the virus interacts with the human immune response.

A surge in monkeypox infections has been reported since early May outside the endemic African countries.

The WHO declared the situation an international public health emergency on July 23.

More than 35,000 cases in 92 countries, and 12 deaths, have now been reported to the WHO.

Almost all new cases are being reported from Europe and the Americas.

Experts have been studying samples from cases.

“The diversity between the viruses responsible for the current outbreak is minimal, and there is no obvious genotypic differences between the viruses from the non-endemic countries,” the WHO said.

Renaming monkeypox could take months

Meanwhile the WHO said its drive to rename monkeypox could take “a number of months.”

The organization has for weeks voiced concern about the name, with experts concerned that it is misleading.

Monkeypox received its name because the virus was originally identified in monkeys kept for research in Denmark in 1958.

However, the disease is found most frequently in rodents, and the current outbreak is being spread through human-to-human close contact.

The WHO has called for help from the public in coming up with a new name, with a dedicated website where anyone can make suggestions.

“We will update the public by the end of the year,” the WHO said.
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The head of the top U.S. public health agency on Wednesday announced a shake-up of the organization, intended to make it more nimble.

The planned changes at the Centers for Disease Control and Prevention — CDC leaders call it a “reset”— come amid ongoing criticism of the agency’s response to COVID-19, monkeypox and other public health threats. The changes include internal staffing moves and steps to speed up data releases.

The CDC’s director, Dr. Rochelle Walensky, told the agency’s staff about the changes on Wednesday. It’s a CDC initiative, and was not directed by the White House or other administration officials, she said.

“I feel like it’s my my responsibility to lead this agency to a better place after a really challenging three years,” Walensky told The Associated Press.

The CDC, with a $12 billion budget and more than 11,000 employees, is an Atlanta-based federal agency charged with protecting Americans from disease outbreaks and other public health threats. It’s customary for each CDC director to do some reorganizing, but Walensky’s action comes amid a wider demand for change.

The agency has long been criticized as too ponderous, focusing on collection and analysis of data but not acting quickly against new health threats. But public unhappiness with the agency grew dramatically during the COVID-19 pandemic. Experts said the CDC was slow to recognize how much virus was entering the U.S. from Europe, to recommend people wear masks, to say the virus can spread through the air, and to ramp up systematic testing for new variants.

“We saw during COVID that CDC’s structures, frankly, weren’t designed to take in information, digest it and disseminate it to the public at the speed necessary,” said Jason Schwartz, a health policy researcher at the Yale School of Public Health.

Walensky, who became director in January 2021, has long said the agency has to move faster and communicate better, but stumbles have continued during her tenure.

In April, she called for an in-depth review of the agency, which resulted in the announced changes. Her reorganization proposal must be approved by the Department of Health and Human Services secretary. CDC officials say they hope to have a full package of changes finalized, approved, and underway by early next year.

Some changes still are being formulated, but steps announced Wednesday include:

—Increasing use of preprint scientific reports to get out actionable data, instead of waiting for research to go through peer review and publication by the CDC journal Morbidity and Mortality Weekly Report.

—Restructuring the agency’s communications office and further revamping CDC websites to make the agency’s guidance for the public more clear and easier to find.

—Altering the length of time agency leaders are devoted to outbreak responses to a minimum of six months — an effort to address a turnover problem that at times caused knowledge gaps and affected the agency’s communications.

—Creation of a new executive council to help Walensky set strategy and priorities.

—Appointing Mary Wakefield as senior counselor to implement the changes. Wakefield headed the Health Resources and Services Administration during the Obama administration and also served as the No. 2 administrator at HHS. Wakefield, 68, started Monday.

—Altering the agency’s organization chart to undo some changes made during the Trump administration.

—Establishing an office of intergovernmental affairs to smooth partnerships with other agencies, as well as a higher-level office on health equity.

Walensky also said she intends to “get rid of some of the reporting layers that exist, and I’d like to work to break down some of the silos.” She did not say exactly what that may entail, but emphasized that the overall changes are less about redrawing the organization chart than rethinking how the CDC does business and motivates staff.

“This will not be simply moving boxes” on the organization chart, she said.

Schwartz said flaws in the federal response go beyond the CDC, because the White House and other agencies were heavily involved.

A CDC reorganization is a positive step but “I hope it’s not the end of the story,” Schwartz said. He would like to see “a broader accounting” of how the federal government handles health crises.
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Despite a nationwide vaccination campaign that started in May, Malawi is struggling to contain a cholera outbreak that has infected more than 1,073 people and caused 44 deaths. 

The figures from the Malawi Ministry of Health, updated as of Aug. 16, 2022, are triple the numbers recorded when the vaccination campaign was launched three months ago. 

 

The report also says the outbreak has spread to 10 districts from eight in May. The hardest hit districts include Blantyre with 489 cases, Neno with 128 cases, and Nsanje with 289 cases.  

 

George Mbotwa, spokesperson for a health office in Nsanje district, which borders Mozambique south of Malawi, said continued incidents of cholera in the district are largely because of movements of people between the two countries. 

 

“What is worrisome is that we have now continued to record the cases when by now we would have contained the situation,” he said. “It’s because some of these cases we are sharing with Mozambique. So, the cases will be coming from Mozambique and then reporting to health facilities in Nsanje, then being recorded as Nsanje cases.”

Mbotwa said the situation is slowly improving, after officials on the Mozambican side agreed during recent discussions to set up cholera treatment sites on their side of the border.  

“The Mozambican side by then didn’t have cholera treatment sites, and now they have them there, so people are able to report the cases right there, unlike coming with cases to Malawi,” he said. 

Cholera is an acute diarrheal infection caused by ingesting food or water contaminated with bacteria. The disease affects both children and adults, and if untreated, it can kill within hours.  

 

Penjani Chunda, environmental health officer in Blantyre, said although Blantyre is largely an urban area, cholera cases are on the rise because most people fetch water from unprotected sources like rivers and streams. 

 

“In most parts of Blantyre, we don’t have portable water sources,” he said. “It might be like an urban setup, but it has no portable water sources, and we have got dry taps in some of the areas and [water] kiosks are not working at all.”  

The spokesperson for the Health Ministry, Adrian Chikumbe, said health authorities are currently distributing chlorine for water treatment, and providing public education on good hygiene.  

 

Chikumbe also hopes the second phase of the national oral cholera vaccination campaign, which is expected to start soon in the most-hit districts, will help contain the situation.     

 
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