Infectious Diseases | Mount Sinai Today

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.

Lucio Barreto: COVID-19: What Have We Learned, and What Lies Ahead?

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

Lucio Barreto, BSN, RN

It has been two years…

As the nation went into lockdown, we were activated to respond in overdrive to the needs of our communities. We were as blind about what the future held as the rest of the country, but we knew it was our time to carry the burden and make sure that our patients received the care they deserved. The most transformative power of this pandemic was not what we have learned, but rather how we learned.

We faced more than a virus…

During the last two years, we dealt with racial inequality. We understood that we did not have an America for all. We saw that the ideal of equal rights was not there yet. We faced racism against blacks, Asians, Latin Americans—all normalized under the lens of nationalism and political rhetoric.

We learned that disinformation in the media—falsely claiming that COVID-19 is “nothing to worry about”—can derange our society and work as an obstacle for the common good.

We learned that competent leadership must be brave and walk side by side with their team. That leadership must be transformative and undertake rapid and radical changes to manage any imminent threat.

The pandemic created an opportunity to re-evaluate our lives. We had the time to measure what is important. We had the chance to understand the importance of human connections. We faced our own terrors, hidden by the busy workday, and stood in the mirror to finally see ourselves. We saw how important mental health is in our lives and the lives of others. We took the first step to destigmatize seeking help with mental health (though we are still far from the dreamed ideal).

We learned how adaptable we are. We saw the best and the worst in each other. We came to work filled with anxiety, fatigue, stress and burnout. We knew we were needed. We knew that our patients counted on us.

We cried with strangers at the bedside. We shared our own burden of family members and friends dying when we could not be there. However, we knew that wherever they were being cared for, someone like us was by their side, holding their hand.

We were happy and celebrated every time a patient was able to walk out of the hospital. We were angry when there was nothing else to do to save a life. We were frustrated when a coworker was sick. We were afraid to be the next patient on the stretcher.

We were flexible. We took good care of each other. We dried each other’s tears.

We were resilient. They called us “heroes”. Heroes in scrubs.

What lies ahead: HOPE…

Hope that we do not repeat the same mistakes. Hope that we learned the lesson. Hope that tomorrow will be better.

We learned that we are strong together. We learned that we find a way.

Lucio Barreto, BSN, RN, CCRN, NE-BC, MICN, Clinical Program Manager, Emergency Medicine Quality and Safety, The Mount Sinai Hospital

Submit your own story, or recognize a co-worker

Miriam Merad, MD, PhD: COVID-19: What Have We Learned, and What Lies Ahead?

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

A review of the immunology of COVID-19 was published in March 2022 in Science by Miriam Merad, MD, PhD, Mount Sinai Professor in Cancer Immunology and Director of the Precision Immunology Institute at the Icahn School of Medicine at Mount Sinai, and an international team of scientists. Here are excerpts:

Variants of Concern

As the virus evolves and new variants emerge, there have been concerns that such variants could increase pathogenesis by escaping from immunity generated through previous infection or vaccination or by inducing more severe disease. Some variants of concern, such as 1.351 (Beta), P.1 (Gamma), and the recently described B.1.1.529 (Omicron), have mutations that render them less susceptible to vaccine-mediated and infection-acquired immunity. It is less apparent whether some variants induce more severe disease upon primary infection than others, though strains such as B.1.1.7 (Alpha) and B.1.617.2 (Delta) are known to spread more efficiently, making it difficult to distinguish increased infection rates from increased severity. As new variants emerge, it will be important to direct continued research efforts into identifying how such variants escape from either innate or adaptive immune responses.

Immunology of Long COVID

It is now clear that COVID-19 can lead to long-term disease—often referred to as Long COVID syndrome or post-acute sequelae of SARS-CoV-2infection (PASC)—in a significant proportion of survivors. Although there is no universal consensus in the definition of PASC, the Centers for Disease Control and Prevention defines it as a wide range of new, returning, or ongoing health problems that people experience four or more weeks after first being infected with SARS-CoV-2. By contrast, the World Health Organization defines it as a condition that occurs in people with confirmed or probable SARS-CoV-2infection, usually three months from the onset of COVID-19 with symptoms and that last for at least two months and cannot be explained by an alternative diagnosis.

A systematic review of 57 peer-reviewed studies with 250,351 survivors of COVID-19 who met their inclusion criteria for PASC showed that the median age of patients was 54.4 years, 56 percent were male, and 79 percent were hospitalized during acute COVID-19. At six months, 54 percent of survivors suffered at least one PASC symptom. However, non-hospitalized COVID-19 survivors who developed PASC were primarily middle-aged women.

In a survey of 445 non-hospitalized Danish COVID-19 patients, persistent symptoms—most commonly fatigue and difficulty with memory and concentration—were reported by 36 percent of symptomatic participants with a follow-up of more than four weeks. Risk factors for persistent symptoms included female sex (44 percent for women and 24 percent for men) and body mass index. The immunobiology of PASC is currently under investigation. Leading hypotheses include:

persistent virus or viral antigens and RNA in tissues that drive chronic inflammation;
the triggering of autoimmunity after acute viral infection;
a disruption of the gut microbiota, potentially driven by virus persistence in the intestine;
and unrepaired tissue damage.

Concluding remarks and future directions

The COVID-19 pandemic has wrought massive disruption and resulted in the loss of countless lives; however, there have been silver linings. The particularly rapid development of highly efficacious vaccines is foremost among these and has established a playbook for the response to future pandemics.

One comforting prospect is the degree to which advances in our understanding and treatment of COVID-19 have been aided by an unprecedented degree of scientific cooperation. Free sharing of data has allowed us to rapidly glean critical insights into the role of the immune system in contributing to both protection and pathogenesis in COVID-19. Such insights will undoubtedly help us prepare for the next pandemic, just as decades of previous immunological research led to our current COVID-19 vaccines. However, many challenges remain, and our progress in ending this pandemic is threatened by inequitable distribution of vaccines and the rise of variants that are less susceptible to vaccination and prior-infection-mediated immunity.

As infections continue to occur, there remains a need for new therapeutics and hence a need for a better understanding of the pathophysiology of COVID-19. In addition to treating acute infections, there is a dire need to better understand and develop treatments for individuals with Long COVID. Another threat is the amount of misinformation and erroneous theories about the pandemic, vaccines, and therapeutic efforts that have been circulating in social media, some unfortunately introduced by scientists.

More than ever, interdisciplinary and integrative approaches to scientific collaboration and fighting misinformation are necessary to tackle these and other challenges that lie ahead.

Submit your own story, or recognize a co-worker

« Older Entries

Next Entries »