Curious About the Mpox Vaccine? Here’s What You Need to Know

Updated on Dec 6, 2022 | Featured, Infectious Diseases


As cases of mpox, the disease caused by the monkeypox virus, climb in New York City, health professionals and the city Department of Health and Mental Hygiene (DOHMH) have urged people at high risk of contracting the virus to receive the vaccine. DOHMH is making appointments for the vaccine available as quickly as possible, but the vaccine remains in extremely short supply nationwide. Richard Silvera, MD, MPH, Assistant Professor of Medicine (Infectious Diseases), at the Icahn School of Medicine at Mount Sinai, explains what the vaccine is and who should consider getting a shot.

Has a vaccine been approved by the FDA for mpox, and if so, when?

There are two vaccines approved by the U.S. Food and Drug Administration for mpox and smallpox, which are in the same Orthopoxvirus family. JYNNEOS, initially approved in 2019, is currently being used for mpox vaccination efforts. The other is ACAM2000, which was approved in 2007.

How do the vaccines work?

The JYNNEOS vaccine is approved to be administered as two shots subcutaneously, or into tissue under the skin, delivered at least four weeks apart. On August 9, the FDA granted emergency use authorization for the vaccine to be delivered intradermally, or between layers of the skin, to increase availability of doses up to fivefold. DOHMH adopted this guidance on August 23.

ACAM2000, which is not being used for the current outbreak, is administered as a single dose via multiple punctures into the skin using a bifurcated needle.

Both vaccines contain live vaccinia virus, which is also an Orthopoxvirus like mpox. The JYNNEOS vaccine contains attenuated virus. “What that means is there is a virus in the vaccine that has been medically altered to prevent it from reproducing,” Dr. Silvera said. Vaccinated individuals are unable to pass on vaccinia infections to other people around them, unlike with replication-competent vaccines such as ACAM2000.

The vaccine elicits two types of immunities: humoral and cellular, said Dr. Silvera. Humoral immunity involves the building of antibodies that fight off viruses if the body is exposed to them. Cellular immunity involves teaching cells to recognize cells that are infected with viruses and to eradicate those cells. Vaccinia virus has been used as a vaccine for nearly two centuries to fight off more lethal infections, such as smallpox, which was considered eradicated in the United States in the late 1970s.

Is intradermal administration of the vaccine as effective and safe as subcutaneous?

The guidance for intradermal administration of the JYNNEOS vaccine is only for those ages 18 and older. Individuals who are younger would still require the subcutaneous route.

The authorization was granted based on data of a 2015 clinical study that evaluated a two-dose intradermal regimen compared to a subcutaneous one, with the former administered at one-fifth the volume of the latter route of administration.

Results demonstrated that intradermal administration produced a similar immune response to subcutaneous administration. Administration by the intradermal route resulted in more redness, firmness, itchiness, and swelling at the injection site, but less pain, and that these side effects were manageable.

As per the Centers for Disease Control and Prevention (CDC), the city Health Department has adopted the guidance of using subcutaneous delivery to individuals with a history of developing keloid scars. These are raised scar tissue that might occur after a cut or a skin injury.

Am I protected with the first shot? How effective is the vaccine?

“The vaccine does offer some protection after the first shot, but it takes about two weeks after the vaccine is given before that protection comes into play,” said Dr. Silvera. When the two-shot series is complete, it confers about an 80-85 percent effectiveness against infection at the individual level, but its effectiveness at a community level is currently unknown, he added.

Given limited supplies of the JYNNEOS vaccine, the DOHMH is delaying second doses so that more people can get first doses and have some protection. In DOHMH guidance, it added that it is OK to wait longer than four weeks to receive the second dose. Those who received the first dose will be contacted by the Health Department when second doses are available.

Who is considered high-risk and should consider getting the vaccine?

The city is prioritizing appointments for high-risk groups, which currently include men who have sex with men and transgender or gender non-conforming/non-binary people, if they have had multiple or anonymous sex partners in the last 14 days, and transactional sex workers of any sexual orientation or gender identity.

That guidance may change as the epidemic evolves, Dr. Silvera said, adding that health officials are watching the situation closely.

Mpox, however, should not be stigmatized as a sexually transmitted infection unique to the LGBTQ community, Dr. Silvera pointed out. Infections are spread via intimate skin-to-skin contact and sex happens to be one such activity. “No particular person is at high risk of contracting an infection because of who they are,” he stressed.

Who should not get the vaccine?

People who have an allergy to the ingredients of the JYNNEOS vaccine should not receive it. The ingredients include gentamicin, ciprofloxacin, and egg protein.

Otherwise, people who meet the eligibility criteria should highly consider the vaccine, Dr. Silvera said.

If I had received a routine smallpox vaccine, am I still protected against mpox today?

Up until 1972, the United States had routine smallpox vaccination, which led to the disease being eradicated. However, people who received a smallpox vaccine then would not be considered to have adequate protection against the current mpox outbreak, Dr. Silvera said, adding that if those individuals meet the criteria for getting the JYNNEOS vaccine, they should seek it.

The CDC guidance, however, stipulates that people who previously have been vaccinated against smallpox can receive just one dose of the JYNNEOS vaccine for adequate protection.

Can I receive a mpox vaccine around the same time as a COVID-19 shot or booster?

The current recommendation is to space out four weeks between receiving a JYNNEOS vaccine and a COVID-19 shot or booster that uses mRNA technology, such as those from Pfizer or Moderna. “That’s to help prevent people from any adverse side effect,” Dr. Silvera said.

However, if vaccination is recommended due to a known exposure to mpox, the individual is encouraged to get the JYNNEOS vaccine even if the person recently received a Pfizer or Moderna vaccine, according to city Health Department guidance.

The story has been updated to include that DOHMH has adopted the guidance regarding administering the mpox vaccine intradermally.

Read more about infectious diseases

White Coat Ceremony at the Phillips School of Nursing Welcomes a New Generation of Nurses

Updated on Aug 5, 2022 | Community, Featured, School

The Phillips School of Nursing at Mount Sinai Beth Israel recently held its annual White Coat Ceremony for nursing students. Held on Monday, July 11, at the Hatch Auditorium at The Mount Sinai Hospital, the ceremony’s speakers included nursing administrators from throughout Mount Sinai Health System who shared their wisdom with the next generation.

“As you leave the stage today, you are now a part of an extraordinary interdisciplinary team, who provide and lead care to our patients,” Beth Oliver, DNP, MSN, Senior Vice President and Chief Nursing Executive at Mount Sinai Health System, said in an address.

Ms. Oliver added that she hoped the 128 students from the December Class of 2022, who donned traditional white coats for the ceremony, would continue their journey at Mount Sinai Health System after they graduated. “I look forward to following your progress as the next generation of nurse leaders and innovators,” she said.

Zeauriya Tabassum, left, and Mirza Tamanna

Originally established by the Arnold P. Gold Foundation in 1993 to welcome students into the medical profession and set expectations for their roles as future physicians, the White Coat Ceremony expanded to all future health care workers, including future nurses, in 2014. For all health care workers, the ceremony symbolizes a commitment to compassionate, humanistic, patient-centered care rooted in scientific proficiency.

The keynote address was given by Maria Vezina, EdD, RN, NEA-BC, FAAN, Vice President and Chief of Nursing Practice, Education, Advanced Practice Nursing Credentialing, and Nursing Labor Relations Partnerships for Mount Sinai Health System. She quoted the late Virginia Henderson, a nurse theorist and educator known as the “first lady of nursing,” who said nurses are “temporarily the consciousness of the unconscious” and “a voice for those too weak to speak.”

From left: Tam Ha, RaeAnne Haggard, and Valmira Helshani

The ceremony concluded with a standing ovation for Lorraine McGrath, MA, RN-BC, Senior Director of Clinical Affairs and Associate Professor of the Phillips School of Nursing, who was recognized for 40 years of exceptional teaching and strong commitment to excellence at the school. Ms. McGrath called the name of each student, while they were cloaked and received their pins from faculty. The pin with a gold Mobius loop from the Gold Foundation, symbolizes the continuous bond of trust, respect, and communication that connects nurses with their patients. Todd F. Ambrosia, DNP, MSN, MBA, APRN, FNP-BC, FNAP, Dean of the Phillips School of Nursing and Vice President of Nursing Affairs at Mount Sinai Health System, closed the ceremony by advising students to “remember always to care for yourselves and for each other.”

Learn more about the Phillips School of Nursing

Mount Sinai Morningside Unveils Photo Installation Celebrating Staff Who Battled COVID-19

Updated on Aug 4, 2022 | Community, COVID-19, Featured

Vani Gandhi, MD, and Kadidia Knight
Art Campbell and Patricia Menzie
Esther Maria Roman and Janice Fearon
Trish Campbell, RN, and Jocelyn Carasco-Alviar, RN
Theresa Sheehan and Larissa Leonardo, RN
Steven Miss and Julie Infante
Saman Setareh-Shenas, MD, and Elizabeth Kern, MD
Amy Bush and Yuderka Goris, RN
Carmen Sampson and Christine Gatling
Ugoeze Onyekelu-Eze, RN, and Kathleen Parisien Dory, RN

As the COVID-19 pandemic threatened to overwhelm hospitals in the spring of 2020, photographer Claudia Paul was inspired to tell the stories of health care workers battling the emerging virus. Her photo series, “Faces of Resilience,” portraits of front-line health care staff at Mount Sinai Morningside, was born, with 32 Mount Sinai Morningside employees volunteering to participate from departments across the hospital.

On Monday, June 27, the permanent exhibit was installed in the hospital lobby at Mount Sinai Morningside, which symbolizes the resilience of the Mount Sinai Morningside community while inspiring hope and courage as all hospitals continue to cope with multiple waves of the COVID-19 pandemic.

This carefully curated collection illustrates the teamwork it takes to fight the pandemic and the resilience required to carry on. Viewers are encouraged to take a moment to read the heartfelt words of Mount Sinai Morningside staff and pause to reflect on the work done by the hospital staff.

“Partnering with Claudia Paul on the exhibition has resulted in a transformed entrance to our hospital,” said Arthur Gianelli, FACHE, President of Mount Sinai Morningside and Chief Transformation Officer of Mount Sinai Health System. “It signals to staff, patients, and visitors that we embody all that is necessary to fight the pandemic. This inspiring installation reflects the staff of Mount Sinai Morningside’s commitment to excellence. The individuals featured represent the excellence, teamwork, compassion, and valor it takes for everyone to care for our patients and community.”

Jonathan Ripp, MD, MPH, Chief Wellness Officer at the Icahn School of Medicine at Mount Sinai, added: “These faces represent all our physicians and staff who have worked throughout the COVID-19 pandemic. One of the intents of these displays is to demonstrate that we recognize the incredible value of our staff and are continually working to value and support all of them.”

Ms. Paul thanked everyone who participated in the project for their “vulnerability in sharing your memories, struggles, and hopes.”

“It was a pleasure to work alongside each and every one of you and share your stories with the world,” she said.

Each of the photographs contains a quote from the person that captures the feeling from that time in the pandemic.

“It was scary, but everyone went above and beyond the call of duty, to safely take care of our patients,” reads the quote from Janice Fearon, PACU Nursing.

Added Trish Campbell, Emergency Nursing: “In the mist of all the chaos I had a moment where I realized this was why I went into nursing.”

You can visit the “Faces of Resilience” installation in the Main Hospital Lobby at Mount Sinai Morningside, 419 W. 114 Street.

The “Faces of Resilience” photo exhibit at Mount Sinai Morningside

View all of the original photos

Mount Sinai Cardio-Oncology Program Receives Highest Designation for Excellence

Updated on Aug 4, 2022 | Cancer, Cardiology, Featured, Heart Health

Gagan Sahni, MD, Director of Mount Sinai’s Cardio-Oncology Program, center, with team members Chime Lhamu, NP, left, and Lashawanda Rosser, patient services coordinator.

The Cardio-Oncology Program at The Mount Sinai Hospital, under the directorship of Gagan Sahni, MD, has been awarded Gold Center of Excellence status. This is the highest designation of certification from the International Cardio-Oncology Society (IC-OS), the largest international platform for physicians and nurse practitioners dedicated to cardiovascular care of cancer patients.

Mount Sinai is the first institution in New York State to be awarded Gold status as a Cardio-Oncology Center of Excellence by IC-OS. Only 22 cardio-oncology programs nationwide and 31 worldwide have been awarded this recognition acknowledging exceptional cardiovascular care of oncology patients. This international honor by IC-OS is awarded at three levels—bronze, silver, and gold. To receive a Gold certification, the institution must fulfill stringent requirements across six scoring categories, including patient volume, research and publications, interdisciplinary care, education, committee involvement, and program building. It is valid for three years and signifies the program has demonstrated outstanding professional contributions to Cardio-Oncology.

“Many cancer treatments—which includes chemotherapy, radiation, and immunotherapy—can adversely affect the heart, and it is imperative that the appropriate patients are referred to a specialist in the field of Cardio-Oncology in a timely way,” explains Dr. Sahni, Associate Professor of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai.

“My specialty focuses on early prevention, detection, treatment, and management of the potential cardiac effects of cancer treatments, so that the patients are able to safely continue their therapies. These cardiac adverse effects may include a myriad of conditions such as congestive heart failure, hypertension, arrhythmias, blood clots, angina, and pericardial effusion—a buildup of fluid around the heart. All of these conditions should be addressed promptly by a specialist who is familiar with the effects of cancer therapies and coordinates tailor-made cardiology care with the patient’s oncologist.”

The Cardio-Oncology clinic at Mount Sinai was established in 2013 by Dr. Sahni, who is a Fellow of the International Cardio-Oncology Society, one of fewer than 20 physicians in the world awarded this distinction for her contributions to the field. The program provides personalized cardio-oncology consultations to more than 2,500 cancer patients annually from The Tisch Cancer Center and across the Mount Sinai network with inpatient, outpatient, and telemedicine consultations. This includes nearly a decade of close multidisciplinary collaborations with oncologists, radiation oncologists, onco-surgeons, onco-generalists, onco-nephrologists, onco-neurologists, onco-endocrinologists, and nurse practitioners.

“This designation of Gold Center of Excellence recognizes the dedication of the Cardio-Oncology team at The Mount Sinai Hospital in advancing specialized heart care for our cancer patients at a nation-leading level, and we are proud to be able to provide state-of-the-art specialty care to them,” says Dr. Sahni.

Physicians can make Cardio-Oncology appointments for their patients by emailing Dr. Sahni at gagan.sahni@mountsinai.org or calling 212-241-4977.

Learn more about the Cardio-Oncology Program at The Mount Sinai Hospital

2022 Jacobi Medallion Award Ceremony

Updated on Jul 27, 2022 | Alumni, Featured

Seated, from left: Joseph D. Buxbaum, PhD; Yvette Calderon, MD, MS; Jean-Frederic M. Colombel, MD; Reena Karani, MD, MHPE; Ebby Elahi, MD, MBA, FACS; and Joanne L. Stone, MD, MSHCDL; Standing from left: Talia H. Swartz, MD, PhD; Naomi LC Luban, MD; Sandra K. Masur, PhD, FASCB; Annetine C. Gelijns, PhD; Dennis S. Charney, MD; Barbara J. Niss, BA, MA;  Rosalind J. Wright, MD, MPH and Carlos Cordon-Cardo, MD, PhD.

The Mount Sinai Alumni Association and Icahn School of Medicine at Mount Sinai presented accomplished physicians and researchers with the 2022 Jacobi Medallion, one of Mount Sinai’s highest awards. The annual ceremony was held Tuesday, June 21 at the Plaza Hotel. It was the first in-person ceremony in three years.

The recipients of the Jacobi Medallion are those physicians and faculty members that have made exceptional contributions to the Mount Sinai Health System, Icahn Mount Sinai, the Mount Sinai Alumni Association, or the fields of medicine or biomedicine.

Watch the ceremony video or read the digital program

Joseph D. Buxbaum, PhD

G. Harold and Leila Y. Mathers Research Professor of Geriatrics and Adult Development (Molecular Biology of Aging)

Professor, Departments of Psychiatry, Neuroscience and Genetics and Genomic Sciences

Director, Seaver Autism Center for Research and Treatment

Vice Chair for Research and Vice Chair for Mentoring, Department of Psychiatry

Icahn School of Medicine at Mount Sinai

Watch a video of Dr. Buxbaum

Yvette Calderon, MD, MS

Tenured Professor and Site Chair, Department of Emergency Medicine

Professor, Leni and Peter W. May Department of Medical Education

Icahn School of Medicine at Mount Sinai

Watch a video of Dr. Calderon

Jean-Frederic M. Colombel, MD

Director, The Leona M. and Harry B. Helmsley Charitable Trust Inflammatory Bowel Disease Center

Director, Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai

Professor, Samuel Bronfman Department of Medicine, Dr. Henry D. Janowitz Division of Gastroenterology

Icahn School of Medicine at Mount Sinai

Watch a video of Dr.Colombel

Carlos Cordon-Cardo, MD, PhD

Irene Heinz Given and John LaPorte Given Professor of Pathology

System Chair and Professor, Lillian and Henry M. Stratton-Hans Popper Department of Pathology, Molecular and Cell-Based Medicine

Senior Vice-President, Pathology and Laboratory Medicine, Mount Sinai Health System

Professor, Department of Genetics and Genomic Sciences

Watch a video of Dr. Cordon-Cardo

Ebby Elahi, MD, MBA, FACS, MSSM ’96, MSH ’00

Director, Fifth Avenue Associates

Clinical Professor, Department of Ophthalmology

Clinical Professor, Department of Otolaryngology-Head and Neck Surgery

Clinical Professor, Department of Environmental Medicine and Public Health

Icahn School of Medicine at Mount Sinai

Director, International Affairs at Virtue Foundation, New York

Watch a video of Dr.Elahi

Annetine C. Gelijns, PhD

Edmond A. Guggenheim Professor of Health Policy

System Chair, Department of Population Health Science and Policy

Co-Director, Institute for Transformative Clinical Trials

Icahn School of Medicine at Mount Sinai

Watch a video of Dr.Gelijns

Reena Karani, MD, MHPE, MSH ’02

Director, Institute for Medical Education

Professor, Leni and Peter W. May Department of Medical Education

Professor, Brookdale Department of Geriatrics and Palliative Medicine

Professor, Samuel Bronfman Department of Medicine

Icahn School of Medicine at Mount Sinai

Watch a video of Dr.Karani

Naomi LC Luban, MD, MSSM ’72

Vice Chair, Institutional Review Board, Office for the Protection of Human Subjects

Vice Chair for Academic Affairs, Children’s National Medical Center

Faculty Lead, Mentored Research Career Development, Clinical and Translational Science Institute at Children’s National

Professor, Pediatrics and Pathology, George Washington University School of Medicine and Health Sciences

Watch a video of Dr.Luban

Barbara J. Niss, BA, MA

Director, The Arthur H. Aufses, Jr., MD Archives & Mount Sinai Records Management Program (retd)

Icahn School of Medicine at Mount Sinai

Watch a video of Dr.Niss

Joanne L. Stone, MD, MSHCDL

Professor and System Chair

The Ellen and Howard C. Katz Chairman’s Chair The Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science at Mount Sinai

Icahn School of Medicine at Mount Sinai

Watch a video of Dr.Stone

Rosalind J. Wright, MD, MPH

Horace W. Goldsmith Professorship in Children’s Health Research

Dean for Translational Biomedical Research

Co-Director, Institute for Exposomic Research

Professor, Jack and Lucy Clark Department of Pediatrics

Professor, Department of Environmental Medicine and Public Health

Professor, Samuel Bronfman Department of Medicine, Catherine and Henry J. Gaisman Division of Pulmonary, Critical Care and Sleep Medicine

Icahn School of Medicine at Mount Sinai

Watch a video of Dr.Wright

 

Read more featured Mount Sinai news
Learn more about alumni at Mount Sinai

Have Questions About Alzheimer’s Disease? Here’s What You Need to Know

Updated on Jul 21, 2022 | Featured, Your Health

 

Alzheimer’s disease is the most common type of dementia—a general term that refers to difficulties with memory or reasoning that are serious enough to interfere with daily life. About one in nine people in the United States aged 65 and older has Alzheimer’s disease, according to the Alzheimer’s Association.

In this Q&A, Tianxu Xia, MD, a behavioral neurologist and neuropsychiatrist at The Mount Sinai Hospital, explains what causes Alzheimer’s disease, what are some of the early symptoms to watch for, and what you can do to support a healthy brain. Dr. Xia is also an Assistant Professor of Neurology and Psychiatry at the Icahn School of Medicine at Mount Sinai and a practitioner of the interdisciplinary team at The Barbara and Maurice Deane Healthy Brain Initiative.

Tianxu Xia, MD.

What causes Alzheimer’s disease?

Alzheimer’s disease is usually a slow progressive illness that begins probably many years before any symptoms even emerge. The hallmark pathologies of Alzheimer disease are the accumulation of two abnormal proteins in the human brain. One is called beta-amyloid, and the other one is called tau protein. These two proteins are neurotoxic in nature, and eventually lead to the death of the brain cells and subsequent brain shrinkage.

What are the early signs and symptoms of Alzheimer’s disease?

Neurological symptoms are closely correlated to anatomical locations. Alzheimer’s disease typically first shrinks the structure called the “hippocampal formation,” which is the short-term memory center of the human brain. If that happens, short term memory lapse is the most common early sign of the disease. People should pay attention if they find they are beginning to forget recent events, conversations, or medical appointments. Or if they are repeating themselves and constantly misplacing and losing items. Another part of the brain often affected by the Alzheimer’s pathology is called the parietal lobe, which is located at the back of our brain. It is the key component for the processing of visual-spatial information, language, and higher cognitive functions such as calculation, attention, and executive functioning. Therefore, aside from memory difficulty, a patient with Alzheimer’s disease may or may not experience early challenges in navigating, word-finding, planning, and figuring out complex day-to-day tasks, like how to manage their own finances and medical care.

What is the difference between Alzheimer’s disease and dementia?

Those two terms have been used interchangeably historically and that has caused confusion among patients, even among medical professionals. I like to explain to my patients that when it comes to the cognitive decline in the elderly, there are three tiers.

  • Normal: Normal aging of brain means the brain is getting smaller. We are becoming a little bit more forgetful. Everything is taking longer for us to memorize, to learn new things, as well as even simple things like searching for a word.
  • Mild cognitive impairment (MCI): MCI is a very important concept. However, many people are not familiar with it. In this tier, there is cognitive decline beyond what is normal and which can be detected by cognitive testing tools. However, a person’s ability to carry out everyday functions remains intact.
  •  Dementia: Dementia is not a disease but a clinical condition. When people enter a stage of dementia, that means they can have impairment that is severe enough to affect their ability to perform daily activities independently.

Many conditions can cause MCI and dementia. Alzheimer’s disease is just one of them. But it is the most common one.

Georges Naasan, MD, right, Co-Medical Director of the Barbara and Maurice Deane Healthy Brain Initiative, evaluates a patient.

If I was diagnosed with MCI, what does that mean?

Among those with MCI, about 15 percent develop dementia after two years. Some, though, return to normal cognition or do not have additional cognitive decline. Since MCI is an important intermediate stage between normal aging and dementia, identifying which individuals with MCI are more likely to develop dementia is a major goal for researchers.

What can we do to help maintain a healthy brain?

Brain heath is highly dependent on the health of your heart and blood vessels. A heathy heart ensures that enough blood is pumped to the brain. Healthy blood vessels enable oxygen and nutrient-rich blood to reach the brain so it can function normally. Maintaining your overall physical health and minimizing the neurovascular risk factors are essential. Optimizing your blood pressure and levels of sugar and cholesterol are a solid foundation to face brain aging. Studies also show continuous social and cognitively stimulating activities may help build cognitive reserve to compensate the decline caused by brain aging.

What is some of the current research into Alzheimer’s disease?

In the last 20 years, scientists and physicians have vastly expanded our understanding of Alzheimer’s disease and other neurodegenerative illnesses. Their efforts in research have produced more accessible and accurate testing methods to help us detect the disease in the early stages, as well as promising therapies now being studied in clinical trials. We need more patients to participate in Alzheimer disease research, so that we are able to accelerate the progress of defeating this devastating illness.

Caring for a loved one with dementia? Mount Sinai's private Facebook group offers guidance and support. Learn more
The Barbara and Maurice Deane Healthy Brain Initiative offers help to patients and caregivers
To make an appointment, go to the Prepare for Your Visit page

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