Among infectious-disease doctors like me, Banu is famous as a symbol of the power of science and modern medicine.

And yet, beyond that distinction, Banu has largely been forgotten by the public. That fate is a reminder that, well after a global pandemic recedes from headlines in wealthy countries, its survivors have needs that go unmet. Although Banu survived smallpox, she’s been sickly her whole life. She was once bedridden for three months with fevers and vomiting, but she couldn’t afford to see a good doctor. The doctor she could afford, she recalled, prescribed her cooked fish heads. Banu also complains of poor vision: “I cannot thread a needle, because I cannot see clearly,” she told me, via a translator, during an interview in Digholdi, the village where she lives.

“I cannot examine the lice on my son’s head and cannot read the Quran well because of my vision,” she said.

In the years following smallpox eradication, journalists from all over the world traveled to interview Banu, but they petered out years ago. “Mother is so famous, but they do not take any follow-up of Mom to know whether she is in a good or bad state,” her middle daughter, Nazma Begum, told me.

Banu and her family are proud of her place in history, but their role in the eradication of smallpox speaks to the limits of merely fighting diseases. In his biography of the doctor and philanthropist Paul Farmer, author Tracy Kidder recorded a Haitian saying: “Giving people medicine for TB and not giving them food is like washing your hands and drying them in the dirt.”

After Banu and her family survived smallpox, the rest of the world dried its hands in the dirt — just as it did for the poorest victims of covid-19 and later the most marginalized people with mpox, formerly known as monkeypox.

I traveled to South Asia to speak with aging public health workers and smallpox survivors in South Asia for the audio-documentary podcast “Epidemic: Eradicating Smallpox.”

To meet Banu, I flew 14 hours to Delhi and another two hours the next day to Dhaka, then took a five-hour drive to Barishal, followed the next day by a 90-minute ferry ride and a two-hour drive to arrive in Digholdi. Banu and her family — her husband, their three daughters, and their son — share a one-room bamboo-and-corrugated-metal home with a mud floor. The home, which lacks indoor plumbing, is divided down the middle by a screen and a curtain. Water leaks in through the roof, soaking their beds. A bare bulb hangs from a wire overhead. Her in-laws used to live with them, too, but they have passed away.

Women in rural Bangladesh rarely work outside the home. Banu’s husband, Rafiqul Islam, pedals a rickshaw. Some days he earns nothing. On a good day, he might make 500 taka (not quite $5). Although the World Health Organization arranged for a plot of land in her name, Banu said, the family has nowhere to cultivate. “They gave me the land, but the river consumes that. Some of it is in the river,” she said. Cyclones and rising sea levels have led to coastal erosion and saltwater intrusion, and there have also been land disputes.

Begum, now 23, completed a year of college but then dropped out. Banu and her husband couldn’t afford the fees. Instead, they arranged for her to marry. Her mother’s fame “did not help me in any way in my studies or financially,” Begum told me.

The family’s financial life is precarious. Five hundred taka used to buy a 10-kilogram bag of rice and vegetables. During my visit in 2022, the instability of the Russia-Ukraine war created fluctuating oil prices, and Banu said that amount was enough to pay only for the rice.

Banu is well aware that thanks to vaccination, millions of people no longer die of smallpox and other infectious diseases. By one estimate, the eradication of smallpox has prevented at least 5 million deaths around the world each year. Vaccines remain one of the most cost-effective and lifesaving gifts of modern medicine. The Centers for Disease Control and Prevention estimates that the U.S. saves 10 times what it spends on childhood vaccination. But all this is cold comfort to Banu when she and her family are struggling to survive.

Every public health crisis leaves people behind. When I worked as an Ebola aid worker in Guinea in 2015, residents asked why I cared so much about Ebola when local women were hemorrhaging in childbirth and didn’t have enough to eat. They were right not to trust our efforts. Why should they upend their lives to help us defeat Ebola? They knew their lives wouldn’t be materially better when we declared victory and left, as we had done so many times before as soon as our own interests were protected. Their prediction was correct.

As the coronavirus pandemic winds down in the United States, Banu’s life is a reminder that illness has a long tail of consequences and doesn’t end with a single shot. The world’s most powerful nation hasn’t ensured equitable access for its own citizens to health care and lifesaving tools such as covid vaccines, Paxlovid, and monoclonal antibodies. The resulting disparities will get worse as the federal government finishes turning America’s emergency covid response over to the routine health care system. Many Americans can’t afford to stay home when they or their children are sick. Families lack support to care for young or elder family members or people with medical illnesses or disabilities. Many say their biggest worry is paying for groceries or gas to get to work.

Their plight is less extreme than Banu’s, but their suffering is real — and it is magnified worldwide. As long as vulnerable communities are deprived of holistic, comprehensive responses to mpox, covid, Ebola, or other public health emergencies to come, these people will have a reason to be suspicious, and enlisting their help to fight the next crisis will be that much harder.

A version of this article first appeared in The Atlantic in August 2022.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Last year, the emergence of the highly transmissible omicron variant of the covid-19 virus caught many people by surprise and led to a surge in cases that overwhelmed hospitals and drove up fatalities. Now we’re learning that omicron is mutating to better evade the immune system.

Omicron-specific vaccines were authorized by the FDA in August and are recommended by U.S. health officials for anyone 5 or older. Yet only half of adults in the United States have heard much about these booster shots, according to a recent KFF poll, and only a third say they’ve gotten one or plan to get one as soon as possible. In 2020 and 2021, covid cases spiked in the U.S. between November and February.

Although we don’t know for sure that we’ll see another surge this winter, here’s what you should know about covid and the updated boosters to prepare.

1. Do I need a covid booster shot this fall?

If you’ve completed a primary vaccination series and are 50 or older, or if your immune system is compromised, get a covid booster shot as soon as possible. Forty percent of deaths are occurring among people 85 and older and almost 90% among people 65 and over. Although people of all ages are being hospitalized from covid, those hospitalizations are also skewing older.

Unvaccinated people, while in the minority in the U.S., are still at the highest risk of dying from covid. It’s not too late to get vaccinated ahead of this winter season. The United Kingdom, whose covid waves have presaged those in the United States by about a month, is beginning to see another increase in cases.

If you’ve already received three or more covid shots, you’re 12 to 49 years old, and you’re not immunocompromised, your risk of hospitalization and death from the disease is significantly reduced and additional boosters are not likely to add much protection.

However, getting a booster shot provides a “honeymoon” period for a couple of months after vaccination, during which you’re less likely to get infected and thus less likely to transmit the virus to others. If you’ll be seeing older, immunocompromised, or otherwise vulnerable family and friends over the winter holidays, you might want to get a booster two to four weeks in advance to better shield them against covid.

You may have other reasons for wanting to avoid infection, like not wanting to have to stay home from work because you or your child is sick with covid. Even if you aren’t hospitalized from covid, it can be costly to lose wages or arrange for backup child care.

One major caveat to these recommendations: You should wait four to six months after your last covid infection or vaccination before getting another shot. A dose administered too soon will be less effective because antibodies from the previous infection or vaccination will still be circulating in your blood and will prevent your immune cells from seeing and responding to vaccination.

2. Do kids need to be vaccinated even if they’ve had covid?

Although children are at lower risk for severe covid than are adults, the stakes for kids are higher than many diseases already recognized as dangerous. Their risk shouldn’t be measured against the risk that covid poses to other age groups but against the risk they face from other preventable diseases. In the first two years of the pandemic, covid was the fourth- or fifth-leading cause of death in every five-year age bracket from birth to 19, killing almost 1,500 children and teenagers. Other vaccine-preventable diseases like chickenpox, rubella, and rotavirus killed an average of about 20-50 children and teens a year before vaccines became available. By that measure, vaccinating kids against covid is a slam-dunk.

Children who have had covid also benefit from vaccination. The vaccine reduces their risk of hospitalization and missing days of school, when parents might need to stay home with them.

But it’s precisely because the stakes are higher for kids that many parents are anxious about getting their children vaccinated. As recently as July, just after the FDA authorized covid vaccines for children as young as 6 months, a KFF poll found that over half of parents of children under age 5 said they thought vaccines posed a greater risk to the health of their child than getting the disease. And in the most recent poll, half said they had no plans to get their children vaccinated. Covid vaccination rates range from 61% among children ages 12 to 17 to 2% among kids younger than 2.

Similar to influenza, covid is most deadly for the very youngest and oldest. At especially high risk are infants. They’re unlikely to have immunity from infection, and a small share have been vaccinated. Unless their mothers were vaccinated during pregnancy or got covid during pregnancy — the latter of which poses a high risk of death for the mother and of preterm birth for the baby — infants are probably not getting protective antibodies against covid through breast milk. And because infants have small airways and weaker coughs, they’re more likely to have trouble breathing with any respiratory infection, even one less deadly than covid.

3. Will I need a covid shot every year?

It depends on the targets set by public health officials whether covid becomes a seasonal virus like the flu, and how much the virus continues to mutate and evade humanity’s immune defenses.

If the goal of vaccination is to prevent severe disease, hospitalization, and death, then many people will be well protected after their primary vaccination series and may not need additional shots. Public health officials might strongly recommend boosters for older and immunocompromised people while leaving the choice of whether to get boosted to those with lower risk. If the goal of vaccination is to prevent infection and transmission, then repeat boosters will be needed after completing the primary vaccination series and as often as a couple of times a year.

Influenza is a seasonal virus causing infections and disease generally in the winter, but scientists don’t know whether covid will settle into a similar, predictable pattern. In the first three years of the pandemic, the United States has experienced waves of infection in summer. But if the covid virus were to become a wintertime virus, public health officials might recommend yearly boosters. The Centers for Disease Control and Prevention recommends that people 6 months and older get a flu shot every year with very rare exceptions. However, as with the flu, public health officials might still place a special emphasis on vaccinating high-risk people against covid.

And the more the virus mutates, the more often public health officials may recommend boosting to overcome a new variant’s immune evasion. Unfortunately, this year’s updated omicron booster doesn’t appear to provide significantly better protection than the original boosters. Scientists are working on variant-proof vaccines that could retain their potency in the face of new variants.

4. Are more covid variants on the way?

The omicron variant has burst into an alphabet soup of subvariants. The BA.5 variant that surfaced earlier this year remains the dominant variant in the U.S., but the BA.4.6 omicron subvariant may be poised to become dominant in the United States. It now accounts for 14% of cases and is rising. The BA.4.6 omicron subvariant is better than BA.5 at dodging people’s immune defenses from both prior infection and vaccination.

In other parts of the world, BA.4.6 has been overtaken by BA.2.75 and BF.7 (a descendant of BA.5), which respectively account for fewer than 2% and 5% of covid cases in the U.S. The BA.2.75.2 omicron subvariant drove a wave of infections in South Asia in July and August. Although the U.S. hasn’t yet seen much in the way of another variant descended from BA.5 — BQ.1.1 — it is rising quickly in other countries like the U.K., Belgium, and Denmark. The BA.2.75.2 and BQ.1.1 variants may be the most immune-evasive omicron subvariants to date.

BA.4.6, BA.2.75.2, and BQ.1.1 all evade Evusheld, the monoclonal antibody used to prevent covid in immunocompromised people who don’t respond as well to vaccination. Although another medication, bebtelovimab, remains active in treating covid from BA.4.6 and BA.2.75.2, it’s ineffective against BQ.1.1. Many scientists are worried that Evusheld will become useless by November or December. This is concerning because the pipeline for new antiviral pills and monoclonal antibodies to treat covid is running dry without a guaranteed purchaser to ensure a market. In the past, the federal government guaranteed it would buy vaccines in bulk, but funding for that program has not been extended by Congress.

Other omicron subvariants on the horizon include BJ.1, BA.2.3.20, BN.1, and XBB, all descendants of BA.2.

It’s hard to predict whether an omicron subvariant or yet another variant will come to dominate this winter and whether hospitalizations and deaths will again surge in the U.S. Vaccination rates and experience with prior infections vary around the world and even within the United States, which means that the different versions of omicron are duking it out on different playing fields.

While this might all sound grim, it’s important to remember that covid booster shots can help overcome immune evasion by the predominant omicron subvariants.

5. What about long covid?

Getting vaccinated does reduce the risk of getting long covid, but it’s unclear by how much. Researchers don’t know if the only way to prevent long covid is to prevent infection.

Although vaccines may curb the risk of infection, few vaccines prevent all or almost all infections. Additional measures — such as improving indoor air quality and donning masks — would be needed to reduce the risk of infection. It’s also not yet known whether prompt treatment with currently available monoclonal antibodies and antiviral drugs like Paxlovid reduces the risk of developing long covid.

6. Do I need a flu shot, too?

The CDC recommends that anyone 6 months of age or older get an annual flu shot. The ideal timing is late October or early November, before the winter holidays and before influenza typically starts spreading in the U.S. Like covid shots, flu shots provide only a couple of months of immunity against infection and transmission, but an early flu shot is better than no flu shot. Influenza is already circulating in some parts of the United States.

It’s especially important for people 65 or older, pregnant women, people with chronic medical conditions, and children under 5 to get their yearly flu shots because they’re at highest risk of hospitalization and death. Although younger people might be at lower risk for severe flu, they can act as vectors for transmission of influenza to higher-risk people in the community.

High-dose flu vaccines and “adjuvanted” flu vaccines are recommended for people 65 and older. Adjuvants strengthen the immune response to a vaccine.

It is safe to get vaccinated for covid and the flu at the same time, but you might experience more side effects like fevers, headache, or body aches.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Ahora que la poliomielitis vuelve a aparecer décadas después de que se considerara eliminada en Estados Unidos, los que no están familiarizados con la temida enfermedad necesitan una guía para protegerse a sí mismos y a sus hijos, muchos de los cuales están saliendo del trauma de la pandemia de covid-19.

¿Qué es la poliomielitis?

Polio es la abreviatura de “poliomielitis”, una enfermedad neurológica causada por una infección por poliovirus. De los tres tipos de poliovirus salvajes —serotipos 1, 2 y 3—, el serotipo 1 es el más virulento y el que tiene más probabilidades de causar parálisis.

La mayoría de las personas infectadas por el poliovirus no enferman ni presentan síntomas. Alrededor de una cuarta parte de los infectados pueden experimentar síntomas leves como fatiga, fiebre, dolor de cabeza, rigidez de cuello, dolor de garganta, náuseas, vómitos y dolor abdominal. Por tanto, al igual que con el covid-19, las personas que no presentan síntomas pueden contagiar sin saberlo al interactuar con otras personas.

Pero en hasta una de cada 200 personas con esta infección, el virus puede atacar la médula espinal y el cerebro. Cuando infecta la médula espinal, las personas pueden desarrollar debilidad muscular o parálisis, incluso de las piernas, el brazo o la pared torácica. El poliovirus también puede infectar el cerebro, provocando dificultades para respirar o tragar.

Las personas pueden desarrollar el síndrome post-polio décadas después de la infección. Los síntomas pueden incluir dolor muscular y debilidad.

Las personas con poliomielitis pueden permanecer en silla de ruedas o ser incapaces de respirar sin la ayuda de un respirador por el resto de sus vidas.

¿Cómo se propaga la poliomielitis?

El virus que causa la poliomielitis se propaga por la “vía oral-fecal”, lo que significa que entra en el cuerpo a través de la boca por medio de las manos, el agua, los alimentos u otros artículos contaminados con heces que contienen el poliovirus. En raras ocasiones, el poliovirus puede propagarse a través de la saliva y las gotitas de las vías respiratorias superiores. El virus infecta entonces la garganta y el tracto gastrointestinal, se extiende a la sangre e invade el sistema nervioso.

¿Cómo se diagnostica la poliomielitis?

La poliomielitis se diagnostica mediante una combinación de charlas con el paciente, exámenes físicos, pruebas de laboratorio y exploraciones de la médula espinal o el cerebro. Los proveedores de salud pueden enviar heces, frotis de garganta, líquido cefalorraquídeo y otras muestras para su análisis en el laboratorio. Pero como la poliomielitis ha sido cada vez menos frecuente en Estados Unidos durante décadas, los médicos pueden no considerar el diagnóstico en pacientes con síntomas. Y las pruebas para la sospecha de poliomielitis deben enviarse a los Centros para el Control y la Prevención de Enfermedades (CDC), ya que incluso los centros académicos ya no realizan las pruebas.

¿Cómo se puede prevenir la transmisión del poliovirus?

Los CDC recomiendan que se vacune a todos los niños contra la poliomielitis a las edades de 2, 4, 6 a 18 meses y 4 a 6 años, para un total de cuatro dosis. Los 50 estados y el Distrito de Columbia exigen que los niños que van a la guardería o a la escuela pública sean vacunados contra la polio, pero algunos estados permiten exenciones médicas, religiosas o personales.

El programa Vaccines for Children proporciona la vacuna contra la polio de forma gratuita a los niños que tienen Medicaid, que no tienen seguro o que tienen un seguro insuficiente, o que son miembros de comunidades indígenas americanas o nativos de Alaska.

La mayoría de las personas nacidas en Estados Unidos después de 1955 probablemente hayan recibido la vacuna contra la polio. Pero en algunas zonas las tasas de vacunación son peligrosamente bajas, como en el condado neoyorquino de Rockland, donde es del 60%, y en el condado de Yates, donde es del 54%, debido a que muchas familias alegan exenciones religiosas.

Hay dos tipos de vacunas contra la polio: la vacuna antipoliomielítica inactivada (IPV) y la vacuna antipoliomielítica oral debilitada (OPV). La IPV es una vacuna inyectable. La OPV puede administrarse en gotas o en un terrón de azúcar, por lo que es más fácil de administrar. Ambas vacunas son muy eficaces contra la poliomielitis paralítica, pero la OPV parece ser más eficaz para prevenir la infección y la transmisión.

Tanto el poliovirus salvaje como los virus vivos y debilitados de la OPV pueden causar la infección. Dado que la VPI es una vacuna de virus muertos, no puede infectar ni replicarse, ni dar lugar a poliovirus derivados de la vacuna, y tampoco causar la enfermedad de la poliomielitis paralítica. Los virus debilitados de la OPV pueden mutar y recuperar su capacidad de causar parálisis, lo que se denomina poliomielitis derivada de la vacuna.

Desde el año 2000, en Estados Unidos sólo se administra la IPV. Dos dosis de IPV tienen una eficacia de al menos el 90% y tres dosis de IPV tienen una eficacia de al menos el 99% en la prevención de la enfermedad de la poliomielitis paralítica. Estados Unidos dejó de utilizar la OPV debido al riesgo de parálisis de 1 en 2,000 entre las personas no vacunadas que la recibían. Algunos países siguen utilizando la OPV.

En Estados Unidos, la vacunación contra la poliomielitis comenzó en 1955. Los casos de poliomielitis paralítica se redujeron de más de 15,000 al año a principios de esa década a menos de 100 en la década de 1960, y luego a menos de 10 en la década de 1970. En la actualidad, el poliovirus tiene más probabilidades de propagarse en los lugares donde la higiene y el saneamiento son deficientes, y las tasas de vacunación son bajas.

¿Por qué la polio se está extendiendo de nuevo?

La Organización Mundial de la Salud (OMS) declaró a Norteamérica y Sudamérica libre de poliomielitis a partir de 1994, pero en junio de 2022, a un joven adulto que vivía en el condado de Rockland, Nueva York, se le diagnosticó el poliovirus del serotipo 2 derivado de la vacuna.

El paciente se quejó de fiebre, rigidez en el cuello y debilidad en las piernas. No había viajado recientemente fuera del país por lo que se supuso que se había infectado en Estados Unidos. Desde entonces, los CDC han empezado a vigilar las aguas residuales para detectar el poliovirus.

El poliovirus vinculado genéticamente al caso del condado de Rockland se ha detectado en muestras de aguas residuales de los condados de Rockland, Orange y Sullivan, lo que demuestra la propagación en la comunidad desde mayo de 2022. También se han detectado poliovirus no relacionados con la vacuna en las aguas residuales de la ciudad de Nueva York.

¿Cómo puedo saber si he sido vacunado contra la poliomielitis?

No existe una base de datos nacional de registros de vacunación, pero los 50 estados y el Distrito de Columbia tienen sistemas de información sobre vacunación con registros que se remontan a la década de 1990. Tu departamento de salud estatal o territorial también puede tener registros de tus vacunas.

Las personas vacunadas en Arizona, el Distrito de Columbia, Louisiana, Maryland, Mississippi, Dakota del Norte y Washington pueden acceder a sus registros de vacunación mediante la aplicación MyIR Mobile, y quienes se vacunaron en Idaho, Minnesota, Nueva Jersey y Utah pueden hacerlo mediante la aplicación Docket.

También puedes preguntar a tus padres, al pediatra, a tu médico o farmacéutico, o a las escuelas de K-12, colegios o universidades a las que fuiste si tienen registros de tus vacunas. Algunos empleadores, como los sistemas de salud, también pueden guardar registros de tus vacunas en su oficina de salud ocupacional.

No hay ninguna prueba para determinar si eres inmune a la polio.

¿Necesito un refuerzo de la vacuna antipoliomielítica si fui vacunado completamente contra la poliomielitis cuando era niño?

Todos los niños y adultos no vacunados deben completar la serie de cuatro dosis de vacunas contra la polio recomendada por los CDC. No necesitas un refuerzo de la IPV si recibiste la OPV.

Los adultos que estén inmunodeprimidos, que viajen a un país en el que circule el poliovirus o que estén en mayor riesgo de exposición al poliovirus en el trabajo, como algunos trabajadores de laboratorio y sanitarios, pueden recibir un refuerzo de la IPV una sola vez.

¿Cómo se trata la polio?

Las personas con una infección leve por poliovirus no necesitan tratamiento. Los síntomas suelen desaparecer por sí solos en un par de días.

La poliomielitis paralítica no tiene cura. El tratamiento se centra en la fisioterapia y la terapia ocupacional para ayudar a los pacientes a adaptarse y recuperar la funcionalidad.

¿Por qué no se ha erradicado el poliovirus?

La viruela es el único virus humano que se ha declarado erradicado hasta la fecha. Una enfermedad puede ser erradicada si solo infecta a los seres humanos, si la infección viral induce una inmunidad a largo plazo contra la reinfección y si existe una vacuna eficaz u otro tipo de prevención. Cuanto más infeccioso sea un virus, más difícil será su erradicación. Los virus que se propagan sin presentar síntomas también son más difíciles de erradicar.

En 1988, la Asamblea Mundial de la Salud se propuso erradicar la poliomielitis para el año 2000. Los conflictos violentos, la propagación de teorías conspirativas, el escepticismo sobre las vacunas, la financiación y la voluntad política inadecuadas, y los esfuerzos de vacunación de baja calidad ralentizaron el progreso hacia la erradicación, pero antes de la pandemia de coronavirus, el mundo había estado muy cerca de erradicar la poliomielitis.

Durante la pandemia, la vacunación infantil, incluida la de la poliomielitis, disminuyó en Estados Unidos y en todo el mundo.

Para erradicar la poliomielitis, el mundo debe eliminar todos los poliovirus salvajes y los poliovirus derivados de las vacunas. Los serotipos 2 y 3 del poliovirus salvaje han sido erradicados. El serotipo 1 del poliovirus salvaje, la forma más virulenta, sigue siendo endémico solo en Pakistán y Afganistán, pero los poliovirus derivados de la vacuna siguen circulando en algunos países de África y otras partes del mundo.

Para erradicar definitivamente la poliomielitis del planeta, es probable que se necesite un enfoque por etapas que incluya el uso de la OPV, luego una combinación de OPV y IPV, y después, la IPV sola.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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What is poliomyelitis?

Polio is short for “poliomyelitis,” a neurological disease caused by a poliovirus infection. Of the three types of wild poliovirus — serotypes 1, 2, and 3 — serotype 1 is the most virulent and the most likely to cause paralysis.

Most people infected with poliovirus don’t get sick and won’t have symptoms. About a quarter of those infected might experience mild symptoms like fatigue, fever, headache, neck stiffness, sore throat, nausea, vomiting, and abdominal pain. So, as with covid-19, people who don’t have symptoms can unknowingly spread it as they interact with others. But in up to 1 in 200 people with a poliovirus infection, the virus may attack the spinal cord and brain. When it infects the spinal cord, people may develop muscle weakness or paralysis, including of the legs, arm, or chest wall. Poliovirus may also infect the brain, leading to difficulty breathing or swallowing.

People can develop post-polio syndrome decades after infection. Symptoms may include muscle pain, weakness, and wasting.

People with poliomyelitis may remain wheelchair-bound or unable to breathe without the help of a ventilator for the rest of their lives.

How does polio spread?

The virus that causes polio spreads through the “oral-fecal route,” which means it enters the body through the mouth by way of the hands, water, food, or other items contaminated with poliovirus-containing feces. Rarely, poliovirus may spread through saliva and upper respiratory droplets. The virus then infects the throat and gastrointestinal tract, spreads to the blood, and invades the nervous system.

How do doctors diagnose polio?

Poliomyelitis is diagnosed through a combination of patient interviews, physical examinations, lab testing, and scans of the spinal cord or brain. Health care providers may send feces, throat swabs, spinal fluid, and other specimens for lab testing. But because polio has been vanishingly rare in the United States for decades, doctors may not consider the diagnosis for patients with symptoms. And tests for suspected polio must be sent to the Centers for Disease Control and Prevention, since even academic centers no longer perform the tests.

How can poliovirus transmission be prevented?

The CDC recommends that all children be vaccinated against polio at ages 2 months, 4 months, 6 to 18 months, and 4 to 6 years, for a total of four doses. All 50 states and the District of Columbia require that children attending day care or public school be immunized against polio, but some states allow medical, religious, or personal exemptions. The Vaccines for Children program provides polio vaccine free of charge for children who are eligible for Medicaid, uninsured, or underinsured, or who are American Indian or Alaska Native. Most people born in the United States after 1955 likely have been vaccinated for polio. But in some areas the vaccination rates are dangerously low, such as New York’s Rockland County, where it is 60%, and Yates County, where it is 54%, because so many families there claim religious exemptions.

There are two types of polio vaccine: killed, inactivated polio vaccine (IPV) and weakened, live, oral polio vaccine (OPV). IPV is an injectable vaccine. OPV may be given by drops in the mouth or on a sugar cube, so it’s easier to administer. Both vaccines are highly effective against paralytic poliomyelitis, but OPV appears to be more effective in preventing infection and transmission.

Both the wild poliovirus and the live, weakened OPV viruses can cause infection. Because IPV is a killed virus vaccine, it cannot infect or replicate, give rise to vaccine-derived poliovirus, or cause paralytic poliomyelitis disease. The weakened, OPV viruses can mutate and regain their ability to cause paralysis — what’s called vaccine-derived poliomyelitis.

Since 2000, only IPV has been given in the United States. Two doses of IPV are at least 90% effective and three doses of IPV are at least 99% effective in preventing paralytic poliomyelitis disease. The United States stopped using OPV due to a 1-in-2,000 risk of paralysis among unvaccinated persons receiving OPV. Some countries still use OPV.

Vaccination against polio began in 1955 in the United States. Cases of paralytic poliomyelitis disease plummeted from over 15,000 a year in the early 1950s to under 100 in the 1960s and then down to fewer than 10 in the 1970s. Today, poliovirus is most likely to spread where hygiene and sanitation are poor and vaccination rates are low.

Why is polio spreading again?

The World Health Organization declared North and South America polio-free as of 1994, but in June 2022, a young adult living in Rockland County, New York, was diagnosed with serotype 2 vaccine-derived poliovirus. The patient complained of fever, neck stiffness, and leg weakness. The patient had not traveled recently outside the country and was presumably infected in the United States. The CDC has since started to monitor wastewater for poliovirus. Poliovirus genetically linked to the Rockland County case has been detected in wastewater samples from Rockland, Orange, and Sullivan counties, demonstrating community spread as far back as May 2022. Unrelated vaccine-derived poliovirus has also been detected in New York City wastewater.

How do I know if I’ve been vaccinated against polio?

There is no national database of immunization records, but all 50 states and the District of Columbia have immunization information systems with records going as far back as the 1990s. Your state or territorial health department may also have records of your vaccinations. People immunized in Arizona, the District of Columbia, Louisiana, Maryland, Mississippi, North Dakota, and Washington can access their immunization records using the MyIR Mobile app, and those who got vaccines in Idaho, Minnesota, New Jersey, and Utah can do so using the Docket app.

You may also ask your parents, your childhood pediatrician, your current doctor or pharmacist, or the K-12 schools, colleges, or universities you attended if they have records of your vaccinations. Some employers, like health care systems, may also keep records of your vaccinations in their occupational health office.

There is no test to determine if you’re immune to polio.

Do I need a polio vaccine booster if I was fully vaccinated against polio as a child?

All children and unvaccinated adults should complete the CDC-recommended four-dose series of polio vaccinations. You do not need an IPV booster if you received OPV.

Adults who are immunocompromised, traveling to a country where poliovirus is circulating, or at increased risk for exposure to poliovirus on the job, such as some lab workers and health care workers, may get a one-time IPV booster.

How is polio treated?

People with mild poliovirus infection don’t require treatment. Symptoms usually go away on their own within a couple of days.

There is no cure for paralytic poliomyelitis. Treatment focuses on physical and occupational therapy to help patients adapt and regain function.

Why hasn’t poliovirus been eradicated?

Smallpox is the only human virus to have been declared eradicated to date. A disease may be eradicated if it infects only humans, if viral infection induces long-term immunity to reinfection, and if an effective vaccine or other preventive exists. The more infectious a virus, the more difficult it is to eradicate. Viruses that spread asymptomatically are also more difficult to eradicate.

In 1988, the World Health Assembly resolved to eradicate polio by 2000. Violent conflict, the spread of conspiracy theories, vaccine skepticism, inadequate funding and political will, and poor-quality vaccination efforts slowed progress toward eradication, but before the covid pandemic, the world had gotten very close to eradicating polio. During the pandemic, childhood immunizations, including polio vaccinations, dipped in the U.S. and around the world.

To eradicate polio, the world must eradicate all wild polioviruses and vaccine-derived polioviruses. Wild poliovirus serotypes 2 and 3 have been eradicated. Wild poliovirus serotype 1, the most virulent form, remains endemic only in Pakistan and Afghanistan, but vaccine-derived polioviruses continue to circulate in some countries in Africa and other parts of the world. A staged approach involving the use of OPV, then a combination of OPV and IPV, and then IPV alone would likely be needed to finally eradicate polio from the planet.

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But for those familiar with the business tactics of the pharmaceutical industry, that exuberant messaging — combined with the lack of completed studies — has caused considerable heartburn and raised an array of unanswered concerns.

The updated shots easily clear the “safe and effective” bar for government authorization. But in the real world, are the omicron-specific vaccines significantly more protective — and in what ways — than the original covid vaccines so many have already taken? If so, who would benefit most from the new shots? Since the federal government is purchasing these new vaccines — and many of the original, already purchased vaccines may never find their way into taxpayers’ arms — is the $3.2 billion price tag worth the unclear benefit? Especially when these funds had to be pulled from other covid response efforts, like testing and treatment.

Several members of the CDC advisory committee that voted 13-1 for the recommendation voiced similar questions and concerns, one saying she only “reluctantly” voted in the affirmative.

Some said they set aside their desire for more information and better data and voted yes out of fear of a potential winter covid surge. They expressed hope that the new vaccines — or at least the vaccination campaign that would accompany their rollout — would put a dent in the number of future cases, hospitalizations, and deaths.

That calculus is, perhaps, understandable at a time when an average of more than 300 Americans are dying of covid each day.

But it leaves front-line health care providers in the impossible position of trying to advise individual patients whether and when to take the hot, new vaccines without complete data and in the face of marketing hype.

Don’t get us wrong. We’re grateful and amazed that Pfizer-BioNTech and Moderna (with assists from the National Institutes of Health and Operation Warp Speed) developed an effective vaccine in record time, freeing the nation from the deadliest phase of the covid pandemic, when thousands were dying each day. The pandemic isn’t over, but the vaccines are largely credited for enabling most of America to return to a semblance of normalcy. We’re both up-to-date with our covid vaccinations and don’t understand why anyone would choose not to be, playing Russian roulette with their health.

But as society moves into the next phase of the pandemic, the pharmaceutical industry may be moving into more familiar territory: developing products that may be a smidgen better than what came before, selling — sometimes overselling — their increased effectiveness in the absence of adequate controlled studies or published data, advertising them as desirable for all when only some stand to benefit significantly, and in all likelihood raising the price later.

This last point is concerning because the government no longer has funds to purchase covid vaccines after this autumn. Funding to cover the provider fees for vaccinations and community outreach to those who would most benefit from vaccination has already run out. So updated boosters now and in the future will likely go to the “worried well” who have good insurance rather than to those at highest risk for infection and progression to severe disease.

The FDA’s mandated task is merely to determine whether a new drug is safe and effective. However, the FDA could have requested more clinical vaccine effectiveness data from Pfizer and Moderna before authorizing their updated omicron BA.5 boosters.

Yet the FDA cannot weigh in on important follow-up questions: How much more effective are the updated boosters than vaccines already on the market? In which populations? And what increase in effectiveness is enough to merit an increase in price (a so-called cost-benefit analysis)? Other countries, such as the United Kingdom, perform such an analysis before allowing new medicines onto the market, to negotiate a fair national price.

The updated booster vaccine formulations are identical to the original covid vaccines except for a tweak in the mRNA code to match the omicron BA.5 virus. Studies by Pfizer showed that its updated omicron BA.1 booster provides a 1.56 times higher increase in neutralizing antibody titers against the BA.1 virus as compared with a booster using its original vaccine. Moderna’s studies of its updated omicron BA.1 booster demonstrated very similar results. However, others predict that a 1.5 times higher antibody titer would yield only slight improvement in vaccine effectiveness against symptomatic illness and severe disease, with a bump of about 5% and 1% respectively. Pfizer and Moderna are just starting to study their updated omicron BA.5 boosters in human trials.

Though the studies of the updated omicron BA.5 boosters were conducted only in mice, the agency’s authorization is in line with precedent: The FDA clears updated flu shots for new strains each year without demanding human testing. But with flu vaccines, scientists have decades of experience and a better understanding of how increases in neutralizing antibody titers correlate with improvements in vaccine effectiveness. That’s not the case with covid vaccines. And if mouse data were a good predictor of clinical effectiveness, we’d have an HIV vaccine by now.

As population immunity builds up through vaccination and infection, it’s unclear whether additional vaccine boosters, updated or not, would benefit all ages equally. In 2022, the U.S. has seen covid hospitalization rates among people 65 and older increase relative to younger age groups. And while covid vaccine boosters seem to be cost-effective in the elderly, they may not be in younger populations. The CDC’s Advisory Committee on Immunization Practices considered limiting the updated boosters to people 50 and up, but eventually decided that doing so would be too complicated.

Unfortunately, history shows that — as with other pharmaceutical products — once a vaccine arrives and is accompanied by marketing, salesmanship trumps science: Many people with money and insurance will demand it whether data ultimately proves it is necessary for them individually or not.

We are all likely to encounter the SARS-CoV-2 virus again and again, and the virus will continue to mutate, giving rise to new variants year after year. In a country where significant portions of at-risk populations remain unvaccinated and unboosted, the fear of a winter surge is legitimate.

But will the widespread adoption of a vaccine — in this case yearly updated covid boosters — end up enhancing protection for those who really need it or just enhance drugmakers’ profits? And will it be money well spent?

The federal government has been paying a negotiated price of $15 to $19.50 a dose of mRNA vaccine under a purchasing agreement signed during the height of the pandemic. When those government agreements lapse, analysts expect the price to triple or quadruple, and perhaps even more for updated yearly covid boosters, which Moderna’s CEO said would evolve “like an iPhone.” To deploy these shots and these dollars wisely, a lot less hype and a lot more information might help.

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Behind those questions are concerns about stigma and how best to allocate scarce resources. But they also reflect an individualistic understanding of public health. Rather than asking what the monkeypox outbreak means for them now, the public could be asking how the monkeypox outbreak could affect them in the future and why and how it could be contained now.

The longer monkeypox transmission goes unchecked, the more likely it is to spill over into other populations. There have already been a handful of cases among women and a couple of cases in children because of household transmission. In otherwise healthy people, monkeypox can be extremely painful and disfiguring. But in pregnant women, newborns, young children, and immunocompromised people, monkeypox can be deadly. Those groups would all be in danger if monkeypox became entrenched in this country.

Stopping transmission among men who have sex with men will protect them in the here and now and more vulnerable populations in the future. But with a limited supply of monkeypox vaccine available, how can public health officials best target vaccines equitably for impact?

It won’t be enough to vaccinate close contacts of people with monkeypox to stop the spread. Public health officials have been unable to follow all chains of transmission, which means many cases are going undiagnosed. Meanwhile, the risk of monkeypox (and other sexually transmissible diseases) isn’t evenly distributed among gay and bisexual men and trans women, and targeting all of them would outstrip supply. Such a strategy also risks stigmatizing these groups.

The Centers for Disease Control and Prevention recently expanded eligibility for monkeypox vaccination to include people who know that a sexual partner in the past 14 days was diagnosed with monkeypox or who had multiple sexual partners in the past 14 days in a jurisdiction with known monkeypox cases. But this approach depends on people having access to testing. Clinicians are testing much more in some jurisdictions than in others.

Alternatively, public health officials could target monkeypox vaccinations to gay and bisexual men and trans women who have HIV or are considered at high risk for HIV and are eligible for preexposure prophylaxis, or PrEP (medication to prevent HIV infection). After all, there’s a lot of overlap between these populations and those at risk for monkeypox. But only 25% of people eligible for PrEP in the U.S. are prescribed it, and that proportion drops to 16% and 9% among Hispanic and Black people, respectively. This approach risks missing many people who are at risk and exacerbating racial and ethnic disparities.

This is why some LGBTQ+ activists are advocating for more aggressive outreach. “We talk about two kinds of surveillance,” said Gregg Gonsalves, an epidemiologist at the Yale School of Public Health and a longtime AIDS activist. “Passive surveillance, where I show up to my doctor’s office. Active surveillance is where we go out and we seek cases actively by going where people are at. There are parties, social venues, sex clubs where we could be doing monkeypox testing.”

This will be especially critical outside gay-friendly cities, where both patients and providers may be less informed and gay sex more stigmatized.

In New York City, the epicenter of monkeypox in the U.S., disparities in access to monkeypox vaccines have already emerged. The city’s health department offered appointments for first doses of the vaccine through an online portal and promoted them on Twitter. Those initial doses were administered at a sexual health clinic in the well-to-do Chelsea neighborhood.

“It was in the middle of the day,” Gonsalves said. “It was in a predominantly gay white neighborhood. … It really was targeted at a demographic that will be first in line for everything. This is the problem with relying on passive surveillance and people coming to you.”

Michael LeVasseur, an epidemiologist at Drexel University, said, “The demographics of that population may not actually reflect the highest-risk group. I’m not even sure that we know the highest-risk group in New York City at the moment.”

Granted, three-quarters of the city’s cases had been reported in Chelsea, a neighborhood known for its large LGBTQ+ community, but that’s also a reflection of awareness and access to testing. Although more labs are offering monkeypox testing, many clinicians are still unaware of monkeypox or unwilling to test patients for it. You have to be a strong advocate for yourself to get tested, which disadvantages already marginalized populations.

The health department opened a second vaccination site, in Harlem, to better reach communities of color, but most of those accessing monkeypox vaccines there have been white men. And then New York City launched three mass vaccination sites in the Bronx, Queens, and Brooklyn, which were open for one day only. To get the vaccine, you had to be in the know, have the day off, and be willing and able to stand in line in public.

How can public health officials do the active surveillance that Gonsalves is talking about to target monkeypox vaccination equitably and to those at highest risk? Part of the answer may lie in efforts to map sexual networks and the spread of monkeypox, like the Rapid Epidemiologic Study of Prevalence, Networks, and Demographics of Monkeypox Infection, or RESPND-MI. Your risk of exposure to monkeypox depends on the probability of someone in your sexual network having monkeypox. The study may, for example, help clarify the relative importance of group sex at parties and large events versus dating apps in the spread of monkeypox across sexual networks.

“A network map can tell us, given that vaccine is so scarce, the most important demographics of folk who need to get vaccine first, not just to protect themselves, but actually to slow the spread,” said Joe Osmundson, a molecular microbiologist at New York University and co-principal investigator of the RESPND-MI study.

During the initial phase of covid-19 vaccine rollout, when vaccines were given at pharmacies and mass vaccination centers, a racial gap emerged in vaccination rates. Public health officials closed that gap by meeting people where they were, in approachable, community-based settings and through mobile vans, for example. They worked hard with trusted messengers to reach people of color who may be wary of the health care system.

Similarly, sexual health clinics may not be a one-size-fits-all solution for monkeypox testing and vaccination. Although sexual health clinics may feel welcoming to some, others may fear being seen there. Others may not be able to go to sexual health clinics because of their limited hours of operation, on weekdays only.

It isn’t new for public health officials to meet members of the LGBTQ+ community where they are. During a 2013 outbreak of meningitis among gay and bisexual men and trans women, health departments across the country forged relationships with community-based LGBTQ+ organizations to distribute meningitis vaccines. Unlike New York, Chicago is now leveraging those relationships to vaccinate people at highest risk for monkeypox.

Massimo Pacilli, Chicago’s deputy commissioner for disease control, said, “The vaccine isn’t indicated for the general public nor, at this point, for any [man who has sex with men].” Chicago is distributing monkeypox vaccines through venues like gay bathhouses and bars to target those at highest risk. “We’re not having to screen out when people present because we’re doing so upstream by doing the outreach in a different way,” Pacilli said.

Monkeypox vaccination “is intentionally decentralized,” he said. “And because of that, the modes by which any individual comes to vaccine is also very diverse.”

Another reason to partner with LGBTQ+ community organizations is to expand capacity. The New York City Department of Health and Mental Hygiene is one of the biggest and best-funded health departments in the country, and even it is struggling to respond quickly and robustly to the monkeypox outbreak.

“Covid has overwhelmed many public health departments, and they could use the help, frankly, of LGBTQ and HIV/AIDS organizations” in controlling monkeypox, Gonsalves said.

But even as public health officials try to control the transmission of monkeypox among gay and bisexual men and trans women in this country, it’s important not to forget that monkeypox has been spreading in West and Central Africa for years. Not all of that transmission has been occurring among men who have sex with men. Strategies for controlling monkeypox will need to be informed by the local epidemiology. Social and sexual mapping will be even more critical but challenging in countries, like Nigeria, where gay sex is illegal. Sadly, wealthier nations are already hoarding monkeypox vaccine supply as they did covid vaccines. If access to monkeypox vaccine remains inequitable, it will leave all countries vulnerable to resurgences in the future.

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Todos deberían saber sobre los símtomas, cómo se disemina y los riesgos.

¿Debería preocuparme por la viruela del simio?

Actualmente, los estadounidenses tienen un bajo riesgo de contraer la viruela del simio. Se está extendiendo entre hombres que tienen sexo con hombres, pero es solo cuestión de tiempo antes de que pase a otros. Al 27 de junio, el Centro Europeo para la Prevención y el Control de Enfermedades había informado 10 casos en mujeres.

Generalmente es una enfermedad leve, pero puede ser grave o incluso mortal para las personas inmunodeprimidas, embarazadas, fetos o recién nacidos, mujeres lactantes, niños pequeños y personas con enfermedades de la piel, como eccema.

Podría volverse endémica en los Estados Unidos, y en todo el mundo, si continúa propagándose sin control.

¿Cómo se propaga?

La viruela del simio es una infección viral, prima cercana de la viruela. Pero causa una enfermedad mucho más leve.

Se transmite a través del contacto cercano, incluido el sexo, besos y masajes: cualquier tipo de contacto del pene, la vagina, el ano, la boca, la garganta o incluso la piel. En este brote, se ha transmitido principalmente por vía sexual.

Los condones y los protectores dentales reducirán, pero no evitarán, toda la transmisión porque solo protegen contra el contagio por piel, y por las mucosas cubiertas por estos dispositivos. Es importante saber que el virus puede entrar por una abertura en la piel, y penetrar las membranas mucosas de la nariz, la boca, los genitales y el ano.

Los científicos no saben si la viruela del simio se puede transmitir a través del semen o del fluido vaginal.

La viruela del simio se puede transmitir a través de gotitas respiratorias a unos pocos pies, pero no es un modo de transmisión particularmente eficiente. Todavía no se ha documentado transmission aérea, como covid-19.

No se sabe si la infección se puede transmitir cuando la persona no presenta síntomas.

¿Cuáles son los síntomas comunes?

Los síntomas pueden desarrollarse hasta 21 días después de la exposición y pueden incluir fiebre y escalofríos, ganglios linfáticos inflamados, sarpullido y dolores de cabeza.

No se sabe si siempre muestra alguno o todos esos síntomas.

Actualmente, los expertos creen que la viruela del simio, como la viruela, siempre causará al menos algunos de estos síntomas, pero esa creencia se basa en la ciencia anterior a 1980, antes de que existieran pruebas de diagnóstico más sofisticadas.

¿Cómo se ve la erupción de la viruela del simio?

La erupción generalmente comienza con manchas rojas. Luego se convierten en protuberancias llenas de líquido y después pus que pueden parecer ampollas o granos. Estas protuberancias luego se abren en llagas y forman costras. Las personas con viruela del simio se deben considerar infecciosas hasta que aparecen las costras y se caen.

Estas llagas son dolorosas. Antes, la erupción se observaba más en las palmas de las manos y las plantas de los pies, pero muchas personas en este brote presentan lesiones externas e internas en la boca, los genitales y el ano.

También dolor rectal o la sensación de necesitar defecar cuando sus intestinos están vacíos.

¿Cómo hacerse la prueba?

Si la persona tiene síntomas de viruela del simio, hay que hacerse una prueba en una clínica de salud sexual. Un profesional médico debe tomar una muestra de cualquier lesión sospechosa para su análisis. También hay evidencia emergente de que los frotis de garganta pueden detectar la viruela del simio, pero hasta ahora los funcionarios de salud no los recomiendan.

¿Hay una vacuna para la viruela del simio?

Sí. Dos vacunas son eficaces para prevenir la viruela del simio: la vacuna Jynneos y la vacuna ACAM2000. La FDA aprobó la vacuna Jynneos para prevenir la viruela del simio y la viruela en personas mayores de 18 años. ACAM2000 está aprobada por la FDA para prevenir la viruela. Actualmente, en el país se usa solo la vacuna Jynneos porque es más segura y tiene menos efectos secundarios.

La vacuna Jynneos es segura. Se ha probado en miles de personas, incluidas aquéllas inmunocomprometidas o con enfermedades de la piel. Los efectos secundarios comunes de la vacuna Jynneos son similares a los de otras vacunas: fiebre, fatiga, glándulas inflamadas e irritación en el lugar de la inyección.

La vacuna Jynneos es eficaz para prevenir la viruela del simio hasta cuatro días después de la exposición y puede reducir la gravedad de los síntomas si se administra hasta 14 días después de la exposición.

¿Puedo vacunarme contra la viruela del simio?

Actualmente, los Centros para el Control y la Prevención de Enfermedades (CDC) recomiendan la vacunación contra la viruela del simio solo para aquellos en mayor riesgo: personas que han tenido contacto cercano con alguien infectado; hombres que tienen relaciones sexuales con hombres y mujeres trans que recientemente han tenido múltiples parejas sexuales en un lugar donde la infección se está propagando; y algunos trabajadores de la salud, socorristas y militares que podrían entrar en contacto con los afectados.

Actualmente, los suministros de la vacuna Jynneos son limitados. El Departamento de Salud y Servicios Humanos liberará 56,000 dosis de la reserva nacional estratégica de inmediato. En las próximas semanas estarán disponibles 240,000 dosis adicionales, 750,000 a finales del Verano, y 500,000 este otoño. Un total de 1.5 millones de dosis.

¿Cuáles son otras formas de reducir el riesgo de transmisión de la viruela del simio?

La mejor manera es informarse. Si la persona está preocupada, el enlace de los CDC es el mejor recurso para encontrar una clínica de salud sexual: https://gettested.cdc.gov/. Muchas salas de emergencia o centros de urgencia, y otros centros de salud, todavía pueden no estar actualizados con lo ultimo sobre la viruela del simio.

Hay que abstenerse de tener relaciones sexuales si un miembro de la pareja está infectado. Los CDC también advierten sobre el riesgo de ir a raves u otras fiestas o lugares en donde la gente usa poca ropa. Y ofrece otros consejos de prevención, como el lavado de sábanas o juguetes sexuales.

¿Existe un tratamiento para la viruela del simio?

No existe un tratamiento seguro y probado específicamente para la viruela del simio. La mayoría de los casos son leves y mejoran sin tratamiento en un par de semanas. Medicamentos como el paracetamol y el ibuprofeno se pueden usar para reducir la fiebre y los dolores musculares. En casos raros, algunos pacientes desarrollarán una enfermedad más grave y pueden requerir un tratamiento más específico. Los médicos están probando terapias experimentales como cidofovir, brincidofovir, tecovirimat e inmunoglobulina vaccinia. Si se administran temprano en el curso de la infección, las vacunas Jynneos y ACAM2000 también pueden ayudar a reducir la gravedad de la enfermedad.

¿Qué información errónea circula sobre la viruela del simio?

Abundan las teorías conspirativas. Pero no es un engaño. Es real. Esta infección no fue inventada por Bill Gates ni por las farmacéuticas. El virus no salió de un laboratorio de China o Ucrania. Los migrantes que cruzan la frontera con México no traen la viruela del simio a los Estados Unidos. No hay mandato de vacunación ni cuarentenas establecidas para la viruela del simio.

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Q: Should I be worried about monkeypox?

The American public is currently at low risk for monkeypox. It is spreading among men who have sex with men, but it is only a matter of time before it spreads to others. As of June 27, the European Centre for Disease Prevention and Control had reported 10 cases among women. Monkeypox is generally a mild disease but can be serious or even deadly for people who are immunocompromised, pregnant women, a fetus or newborn, women who are breastfeeding, young children, and people with severe skin diseases such as eczema.

But monkeypox could become endemic in the U.S. and around the world if it continues to spread unchecked.

Q: How does monkeypox spread?

Monkeypox is a viral infection, a close cousin of smallpox. But it causes a much milder disease.

It is transmitted through close contact, including sex, kissing, and massage — any kind of contact of the penis, vagina, anus, mouth, throat, or even skin. In the current outbreak, monkeypox has primarily been transmitted sexually.

Condoms and dental dams will reduce but won’t prevent all transmission because they protect only against transmission to and from the skin and mucosal surfaces that are covered by those devices. It’s important to know that the virus can enter broken skin and penetrate mucous membranes, like in the eyes, nose, mouth, genitalia, and anus. Scientists don’t know whether monkeypox can be transmitted through semen or vaginal fluid.

Monkeypox can be transmitted through respiratory droplets or “sprays” within a few feet, but this is not thought to be a particularly efficient mode of transmission. Whether monkeypox could be transmitted through aerosols, as covid-19 is, is unknown, but it hasn’t been documented so far.

It is not known whether monkeypox can be transmitted when someone doesn’t have symptoms.

Q: What are the common symptoms of monkeypox?

Symptoms of monkeypox may develop up to 21 days after exposure and can include fevers and chills, swollen lymph nodes, rash, and headaches.

It is not known whether monkeypox always shows any or all of those symptoms.

Experts currently think monkeypox, like smallpox, will always cause at least some of these symptoms, but that belief is based on pre-1980 science, before there were more sophisticated diagnostic tests.

Q: What does the monkeypox rash look like?

The monkeypox rash usually starts with red spots and then evolves into fluid-filled and then pus-filled bumps that may look like blisters or pimples. The bumps then open into sores and scab over. People with monkeypox should be considered infectious until after the sores scab over and fall off. Monkeypox sores are painful. The rash was often seen on palms and soles in the past, but many people in this outbreak have experienced external and internal lesions of the mouth, genitalia, and anus. People may also experience rectal pain or the sensation of needing to have a bowel movement when their bowels are empty.

Q: How do I get tested for monkeypox?

If you have symptoms of monkeypox, including oral, genital, or anal lesions, go to your nearest sexual health clinic for testing. A medical professional should swab any suspicious lesion for testing. There’s also emerging evidence that throat swabs may be useful in screening for monkeypox, but health officials in the U.S. are so far not recommending them.

Q: Is there a vaccine for monkeypox?

Yes. Two vaccines are effective in preventing monkeypox: the Jynneos vaccine and the ACAM2000 vaccine. The FDA has approved the Jynneos vaccine for preventing monkeypox and smallpox among people 18 and older. The ACAM2000 is FDA-approved to prevent smallpox. The U.S. is currently using only the Jynneos vaccine because it’s safer and has fewer side effects.

The Jynneos vaccine is safe. It has been tested in thousands of people, including people who are immunocompromised or have skin conditions. Common side effects of the Jynneos vaccine are similar to those of other vaccines and include fevers, fatigue, swollen glands, and irritation at the injection site.

The Jynneos vaccine is effective in preventing monkeypox disease up to four days after exposure and may reduce the severity of symptoms if given up to 14 days after exposure.

Q: Can I be vaccinated against monkeypox?

The Centers for Disease Control and Prevention currently recommends vaccination against monkeypox only for those at heightened risk: people who have had close contact with someone with monkeypox; men who have sex with men and trans women who have recently had multiple sex partners in a venue where there was known to be monkeypox or in an area where monkeypox is spreading; and some health care workers, laboratory staffers, first responders, and members of the military who might come into contact with the affected.

Supplies of the Jynneos vaccine are currently limited. The U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response will release 56,000 doses from the strategic national stockpile immediately. An additional 240,000 doses will be made available in the coming weeks, 750,000 doses later this summer, and 500,000 this fall, for a total of more than 1.5 million doses.

Q: What are other ways to lower the risk of monkeypox transmission?

The best way is to educate yourself and your sex partners about monkeypox. If you’re worried you might have monkeypox, get tested at a sexual health clinic. Many emergency rooms, urgent care centers, and other health care facilities may not be up to date on monkeypox. The CDC link to find the nearest sexual health clinic is https://gettested.cdc.gov/.

Abstain from sex if you or your partner has monkeypox. And remember that condoms and dental dams can reduce but not eliminate the risk of transmission. The CDC also warns about the risk of going to raves or other parties where lots of people are wearing little clothing and of saunas and sex clubs. It has other suggestions like washing sex toys and bedding.

Q: Is there a treatment for monkeypox?

There is no proven, safe treatment specifically for monkeypox. Most cases of monkeypox are mild and improve without treatment over a couple of weeks. Medications like acetaminophen and ibuprofen can be used to reduce fevers and muscle aches, and medications like acetaminophen, ibuprofen, and opioids may be used for pain. In rare cases, some patients — such as immunocompromised people, pregnant women, a fetus or newborn, women who are breastfeeding, young children, and people with severe skin diseases — will develop more severe illness and may require more specific treatment. Doctors are trying experimental therapies like cidofovir, brincidofovir, tecovirimat, and vaccinia immune globulin. If administered early in the course of infection, the Jynneos and ACAM2000 vaccines may also help reduce the severity of disease.

Q: What misinformation is circulating about monkeypox?

Conspiracy theories about monkeypox abound. Monkeypox is not a hoax. Monkeypox is real. Covid vaccines can’t give you monkeypox. Monkeypox was not invented by Bill Gates or pharmaceutical companies. Monkeypox didn’t come from a lab in China or Ukraine. Migrants crossing the U.S.-Mexico border haven’t brought monkeypox into the U.S. Monkeypox isn’t a ploy to allow for mail-in ballots during elections. There is no need for a monkeypox vaccine mandate or lockdowns due to monkeypox.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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