Infectious Diseases | Mount Sinai Today

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.

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

Worried About Mpox? Here’s How to Protect Yourself

Jul 29, 2022 | COVID-19, Your Health

Monkeypox is a virus that causes fever, swollen lymph nodes, and a painful rash. While rare, the virus has been spreading in the United States, with a third of the cases in New York City. These have been found predominantly among men who have sex with men, but anyone can get the virus, primarily through skin-to-skin contact. Vaccination to prevent mpox, the disease caused by the monkeypox virus, is not necessary for most people, though they are available for people who have been exposed or are at high risk.

In this Q&A, Bernard Camins, MD, Medical Director for Infection Prevention at the Mount Sinai Health System, offers some important insight on how to protect yourself from the virus.

What is mpox, and what are the symptoms to look out for?

If you are infected with mpox, you will first experience a flu-like illness characterized by fatigue, fever, muscle aches, and painful and swollen lymph nodes. These symptoms may be followed by a rash that can be described as blisters with pus. The rash can occur anywhere on the body but usually starts where the exposure occurred. If you are exposed during sex, the rash may first appear in the genital area.

Bernard Camins, MD

Do most people need to get vaccinated?

No. Vaccination is appropriate for people who are at high risk for mpox, or who were exposed to it and do not yet have symptoms. If you had close contact with someone diagnosed with mpox, see your doctor. It is generally recommended that you take the vaccine within four days of exposure to prevent infection. However, the vaccine can still be administered within 14 days of exposure as long as the person who exposed you remains asymptomatic. This may not prevent you from getting infected, but it may reduce the symptoms. Check this link from the New York City Department of Health to see if you are eligible to get vaccinated.

How is mpox treated?

There is no specific treatment approved for mpox. Most cases are mild and get better on their own. However, antivirals developed for use in patients with smallpox may prove beneficial.

Is mpox sexually transmitted? Should men who have sex with men be especially on alert?

Mpox is not a sexually transmitted disease. The virus can be spread through through skin-to-skin contact, respiratory droplets passed through prolonged face-to-face contact, or exposure to contaminated bedding—and sexual activity is just one way these things can happen. Men who have sex with men, and have multiple or anonymous sex partners, are at heightened risk for getting mpox because they are a small group with a lot of physical contact. However, anyone can get the virus through any direct or close physical contact.

How can I stay safe?

Casual contact, such as hugging a friend, does not put you at much risk, but you should avoid close skin-to-skin contact or sex if you or your sexual partners feel sick, especially if you or they have a rash or sores anywhere on the body. Other important ways to stay safe if you are infected or at high risk include:

Continue to avoid physical contact until all sores have healed and a fresh layer of skin has formed, which can take two to four weeks.
Wash your hands, bedding before and after sex, and any areas of your body that came into close physical contact with your partners, whether or not you or they have symptoms. And don’t share items like towels or bedding with anyone who is infected or may have been exposed.
When making plans, consider the level of risk. Having sex or other close physical contact with multiple or anonymous sexual partners increases your chance of exposure.
Consider that going to clubs, raves, saunas, and other places where you are likely to experience skin-to-skin or face-to-face contact with many people may also increase your risk.

Are children at risk for getting mpox, especially when schools reopen in the fall?

Though a handful of children have been diagnosed with mpox in the United States, their overall risk for getting it is currently low, as it is for the general population. However, children who are infected with mpox may experience more severe outcomes than adults, according to the World Health Organization. We have yet to see if mpox will spread when schools reopen, but this is just another reason it is important to reduce the spread now.

Learn more about mbox and how to protect yourself on mountsinai.org, the New York City Department of Health, and the Centers for Disease Control and Prevention.

Answers to Your Questions About the COVID-19 Vaccines Just Authorized for Kids Six Months to Five Years Old

Updated on Jun 30, 2022 | COVID-19, Featured, Vaccines, Your Health

Parents of young kids finally have important news they have been waiting for: health authorities have authorized COVID-19 vaccines for kids six months to five years old.

This is welcome news for families and their younger children who have had to face the prospect of getting sick and have had to avoid many of their regular activities.

Federal health authorities have authorized the Moderna vaccine for children ages 6 months through 5 years, and the Pfizer-BioNTech vaccine for children ages 6 months through 4 years. The Pfizer vaccine requires three doses; the Moderna vaccine requires two doses. Pfizer’s vaccine was authorized for children ages 5 and over last November; the Moderna vaccine has now also been authorized for the 5-17 age group.

In this Q&A, Lindsey C. Douglas, MD, MSCR, a pediatrician at Mount Sinai Kravis Children’s Hospital, explains why parents should get their young kids vaccinated as soon as possible. Dr. Douglas is Medical Director, Children’s Quality and Safety, and Pediatric Hospital Medicine, and she is also Associate Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai.

Why should I get the vaccine for my child six months to five years of age? What are the benefits and risks?

We’re really excited that the vaccine has been approved for children six months to five years of age, so now nearly all children can get vaccinated. The vaccine does, in fact, reduce the chances that a child will get COVID-19. Many people who have looked at the data believe the reduction doesn’t seem to be that much. But we know that the vaccine reduces the chance that a child will get severe COVID, and that is really important. Children are being hospitalized with COVID-19, and that is something we worry about. Also, the vaccine will help us truly get back to normal, with children being able to be around other children, around their grandparents, and reducing the risks of transmission in general. We hope this will get us back to where we were before the pandemic, so that we can all gather together and not be as worried about COVID-19.

Two vaccines are recommended. What are the differences and does it matter which vaccine I get?

We have some information about both of them. There were studies that were done for the authorization by the Food and Drug Administration, and the two vaccines seem to have similar efficacy. However, the doses are different, and the timing is different. There are three doses for the Pfizer vaccine and two doses for the Moderna vaccine. My recommendation is to get the one that’s easiest for you to get, the one that’s available at your pediatrician. The differences are probably not as important as the difference between having the vaccine and not having the vaccine. You can talk with your pediatrician if you have other questions.

Will children experience any side effects?

Side effects have been quite minimal, and they’re similar to other vaccines, which include soreness at the site of the shot, and some children experienced fevers and body aches. I like to think of these as proof that the vaccine is working, that your immune system is actually activated and working.

What can I do about these side effects?

You can give your young child acetaminophen (Tylenol) or ibuprofen (Advil or Motrin). They can help with fever and muscle aches. Some medications, such as ibuprofen, work as anti-inflammatory medications, whereas acetaminophen does not. Some believe anti-inflammatory medications may also block the immune response. I have two children of my own who are between five and 11 and had the vaccine, and I tried to wait it out with them, so that they could have the most potent response. The symptoms typically last only about a day. If you need to use something, I suggest acetaminophen.

What does the data show about how effective the vaccine is?

The effectiveness of the vaccine was shown in how often a child would get COVID-19. But that’s not the only thing that we worry about. The other thing that I worry about, as a pediatrician who takes care of hospitalized children, is preventing severe disease. There is not as much data on that, so it’s something that each parent should think about. Preventing severe disease in children is really important, and so is getting back to school and playgroups and all of the things that smaller children need for their development. Those to me are equally as important as not getting COVID-19 at all.

Are kids five and under at risk for serious disease?

People believe children don’t get COVID-19 as often or there are fewer cases of COVID-19 than in adults. That technically is true. More adults have been hospitalized. But there are children who have died from COVID-19. My opinion is this vaccine prevents both serious disease and hospitalization of a child, and that means it makes sense to get your child vaccinated.

Why is there no vaccine for kids under six months?

The studies for these vaccines were done in children over six months of age because the immune system is not fully formed in children under six months. We do start shots in infants as early as two months of age, but many vaccines can’t be given until kids are older, including the chickenpox shot. We tend to be much more careful with vaccines in children under six months of age.

If my child already had COVID-19, do they still need a vaccine?

Unfortunately, getting COVID-19 doesn’t prevent you from getting it again. I recommend that a child who has had COVID-19 be vaccinated. We know that vaccination is a strong way to prevent disease and prevent severe disease, and having some natural immunity from having the disease also provides some protection. The combination of the two is even better.

Is there anything else that patients and consumers should know?

The COVID-19 vaccines have been available for quite some time now. Kids under five are not that much different from those older than five. As a pediatrician, and as a parent myself, I’m thrilled that we can offer the vaccine to our most vulnerable and youngest children. This age group has been out of school the most of any age group because of not being eligible for the vaccine and not being able to wear masks easily. I urge parents to consider getting their children vaccinated today.

Staying Informed on Mpox

Jun 6, 2022 | Featured, Global Health, Infectious Diseases, Your Health

Mpox—a rare disease caused by the monkeypox virus that results in fever and a blistery rash—has been in the news lately. Normally found in parts of Africa, an increasing number of mpox cases have been confirmed in Europe and the United States. In this Q&A, Bernard Camins, MD, Medical Director for Infection Prevention at the Mount Sinai Health System, says most people shouldn’t be too worried about mpox, but calls for a bit of vigilance by physicians and the public. “It’s good to just inform people, even though the likelihood of the average person living in New York being exposed to someone with mpox is low,” Dr. Camins says.

What is mpox?

The monkeypox virus is a virus that is in the same family as smallpox and cowpox. As you probably know, smallpox was eradicated years ago. But we do have to worry about mpox every now and then.

Should I be concerned about mpox?

Most of us should not really worry about getting exposed to or getting mpox. The current situation is that some people who have traveled to countries in Europe or Africa have been exposed to people with mpox, and potentially they could be at risk for also having mpox. These returning travelers have exposed other people within their social circles, so there are reports of people contracting mpox who have not left the United States. You should only worry about mpox if you know someone who has symptoms of mpox or who has been diagnosed with mpox.

Click here to read the latest travel advisory on mpox from the CDC

What are the symptoms of mpox?

The hallmark of mpox is a rash, but before the rash appears, people can have a fever and a feeling of malaise or tiredness. Another hallmark is “diffuse lymphadenopathy” or enlarged lymph nodes. So if you do have fever and enlarged lymph nodes, and you were exposed to someone suspected of having mpox or someone who has been diagnosed with mpox, then you need to seek medical care.

What should doctors do if they see a patient with mpox symptoms?

If a doctor suspects a patient has mpox, even before the rash appears, we instruct them to isolate the person in a private room. The medical team will then wear personal protective equipment that includes an N95 respirator, gowns, and gloves, and then they will do an extensive interview. We need to know the details of the patient’s interactions with people who may have mpox. One of the key things that decides if someone needs to be tested is whether they have an epidemiological link to someone with mpox—meaning that either they traveled abroad and were exposed to someone with mpox or that they are at high risk for having mpox. While mpox is not usually considered a sexually transmitted infection, the latest outbreak has been observed among sexual partners.

Why are we talking about mpox now?

While mpox is a viral infection that is rare, a large outbreak has occurred in the United States before, in 2003. Mpox is endemic in Africa, meaning it is normally found there, but because we have a lot of people traveling around the world, it is spreading in countries where it is not endemic.

You can get more information about mpox and the latest updates from the New York City Department of Health and Mental Hygiene and the Centers for Disease Control and Prevention.

Traveling Safely as COVID-19 Rules Change

Updated on Jun 30, 2022 | COVID-19, Featured

More and more people in public spaces are no longer wearing masks to prevent the spread of COVID-19. In one of the biggest shifts, airlines have dropped requirements for wearing masks on flights, though mandates to wear masks remain for New York subways, buses, and commuter trains.

The changing rules can be confusing if you are trying to do all you can to reduce your risk of infection. In this Q&A, Bernard Camins, MD, Medical Director for Infection Prevention at the Mount Sinai Health System, who has been tracking COVID-19 since the first cases were identified in New York in March 2020, offers some basic guidance. As always, the best protection is to get your vaccination and booster shots as recommended by health authorities.

If you have to travel by plane, how can you do so safely?

Now that masking is no longer required on all airline flights, it is important to remember that masking does protect you. It also depends on what type of face mask you wear. For example, a well-fitting mask is better than a loosely fitting cloth mask. If you needed more protection—because you’re immunocompromised, which means you have a reduced ability to fight infections, or you have relatives or loved ones who may be at increased risk for complications from a COVID-19 infection—you may want to take additional steps to reduce the chance of getting infected. The best way to do this is by wearing a more protective mask. Double masking with a medical or surgical mask on your face and then wearing a cloth mask on top is an easy way to accomplish that. So the mask fits your face better. Other better protective masks are KN95s and N95s. They work better because they fit snugly against your face.

Anything else?

You could sit by the window, which keeps you away from everyone walking down the aisle. And it keeps you away from most interactions with other people, which reduces your risk for exposure. You can also board the plane as late as possible, and try to leave the plane as soon as possible.

Do the air filter systems in planes help?

Airplanes are equipped with very effective air filtering systems. While you’re up in the air, the air is filtered by HEPA filters, and they are very effective at eliminating droplets that can transmit the virus that causes COVID-19. (HEPA stands for high efficiency particulate air). But these filters are not functional while the plane is on the tarmac, during boarding, or takeoff. That’s why you may want to take extra precautions until you are in the air.

You are taking a trip yourself, what are you planning to do?

As a matter of fact, I am leaving on a trip to Europe. In order to prepare myself, and being over 50, I’ve taken a second booster shot of the COVID-19 vaccine because I did qualify for it. Just in case I need the extra protection in situations that I cannot control. We plan to dine outdoors as much as possible. If you are over 65, and certainly if you are immunocompromised, you should get the second booster once you’re eligible. That increases your chances of being able to avoid getting severe disease or being hospitalized from getting COVID-19 infection. I also plan on wearing more protective masks like an N95 and keeping it on even though they’re no longer mandatory while I’m on the plane.

If others around me are not wearing masks, does it still help if I wear a mask?

Yes. Wearing a mask, especially one that fits tightly on your face, can protect you if others are not wearing their mask. For example, health care workers rely on masks when they are taking care of patients. Most of the times, even COVID-19 patients are not wearing masks. Health care workers use N95 masks to protect themselves. So, if you are able to get an N95 or a KN95 masks that fits your face well, that will then be more protective for you. If you can’t get those masks, then studies have shown that putting on a medical or surgical mask, which are more loosely fitting, with a cloth mask on top is almost as good as wearing a tighter fitting mask.

When does it make sense to get a PCR test rather than a rapid test?

If you develop symptoms of COVID-19, you should get a PCR test if you have easy access to one. Antigen tests, more commonly referred to as rapid tests, are also helpful because they’re much more available to the public. But they are not as accurate. One of the ways you could use the antigen test is after your trip if you can’t easily access a PCR test. Test yourself two to four days after your trip, or sooner if you develop symptoms.

What about traveling by car or subway?

If you are taking a taxi or a ride sharing service like Uber, you can politely ask your driver to wear a mask if they are not doing so. And roll down your window for better ventilation. On a bus or subway, where it may be crowded, a well-fitting mask will provide additional protection.

Any final thoughts?

Keep in mind that you should evaluate your own risks when you travel. For example, eating outdoors may be safer than eating indoors, especially if you are immunocompromised. This includes those who have a weakened immune system, such as those receiving treatment for cancer, or if you’re at high risk for complications, such as those who are older than 65 years or those with chronic medical conditions. Parents of unvaccinated children may prefer to be more careful to avoid being infected. It’s also good for everybody to check themselves for symptoms of COVID-19 daily and get tested if you develop symptoms. That way, you can isolate appropriately if you test positive. Finally, you should be up to date on your vaccination. If you’re unvaccinated, please get vaccinated. If you are fully vaccinated you should get a booster shot when eligible. And if you are over 50 and potentially at risk for complications because of other illnesses, you should consider getting the second booster if you’re eligible.

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