The World Health Organization’s decision to declare mpox a global public health emergency for the second time in two years may seem like déjà vu — but there are key differences between the strain that’s causing international concern now and the one that spread in 2022. (Photo at left: WHO Director-General Dr Tedros Adhanom Ghebreyesus Photo credit: WHO)

Mpox, formerly known as monkeypox, is a viral infection characterized by painful lesions. It’s spread by direct contact with an infected person, animal or contaminated items like clothing or bedding.

The virus is classified into two distinct groups: clade I and clade II. Clade II was responsible for the 2022 outbreak, which has led to around 100,000 cases worldwide.

But now, a version of clade I has spread internationally. The outbreak started in January 2023 in the Democratic Republic of Congo, and has since reached 12 other countries in the region.

Last week, Sweden confirmed the first known infection of clade I outside Africa, though Swedish health officials said the person was infected while spending time in Africa. Health authorities in Pakistan also confirmed a case of mpox on Friday but have not identified the strain yet.

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Photo by Angele J

Numerous beef products have been recalled over fears that they may have been contaminated with E.coli, the U.S. Food Safety and Inspection Service (FSIS) has announced.

Six ground beef products produced by Cargill Meat Solutions of Pennsylvania are being recalled by the FSIS after a previously “segregated product” was

inadvertently used in the production of ground mince and burger patties. In all, 16,243 pounds of raw beef is believed to be affected.

Cargill Meat Solutions said the products have been shipped to Walmart stores in 12 states: Connecticut, Washington DC, Massachusetts, Maryland, North Carolina, New Hampshire, Virginia, West Virginia, Ohio, Pennsylvania, Vermont, and New York. All products have an establishment number of “EST. 86P” printed on the back of the label.

The FSIS has said consumers should check their refrigerators or freezers, and any affected purchases should not be consumed and either be thrown away or returned to the store. For any customers with queries regarding the recall, Cargill has set up a consumer hotline at 1-844-419-1574.

No one loves the preparation for a colonoscopy, but by staying up to date on yours, you’re greatly reducing your risk of colon and rectal cancer, sometimes referred to collectively as colorectal cancer. Regular colonoscopies can catch these cancers early, when they’re easiest to treat, and can even prevent them altogether.

“As Gastroenterologists (GI doctors), we do our best to remind everyone how important a colonoscopy or other screening methods can be. Unfortunately, we are seeing more and more patients being diagnosed with colon cancer at a younger age,” noted AAHPO member and Gastroenterologist Vahe Shahnazarian, MD MPH.

People who have no family history or symptoms of colorectal cancer should get their first colonoscopy at age 45, Dr. Shahnazarian said. That guideline has changed in recent years based on a troubling and so far unexplained trend of more young people being diagnosed with colon cancer.

“One common story I hear from patients or their family members is that they did not go for their colonoscopy because they felt fine and had no symptoms or complaints. However, the purpose of a screening procedure, like a colonoscopy, is to prevent the symptoms (and the cancer) from ever occurring. By the time you develop symptoms, we are typically dealing with an aggressive cancer, as opposed to either completely preventing the cancer or having a scenario with a much better outcome,” Dr. Shahnazarian observed.

Symptoms to call your doctor about include rectal bleeding, abdominal pain, weight loss, a change in bowel habits, and anemia.

“For those who are just opposed to colonoscopy for whatever reason, there are non-procedural tests that can be done, such as the Cologuard stool test. While these tests are not as accurate as a colonoscopy, they are still good screening tests and are better than not being screened at all,” Dr. Shahnazarian said. “In short, please speak to your Gastroenterologist about when you should be screened and what options you have. And like all my patients say, when you have a colonoscopy, it will be the best sleep you’ve ever had!”

Editors note: In the news, celebrities like Oprah Winfrey are showing off trimmer figures attributed to weight-loss drugs. AAHPO member and medical weight loss expert Tro Kalayjian, MD:

“Many of my patients have come to me with questions about this new class of medications that are being used for both diabetes and weight loss. The new blockbusters are called Ozempic, Wegovy, and Mounjaro and seemingly every celebrity has tried it. Some with wild success and others have seemingly already gained the weight back. The question everyone should be asking is what are the benefits and what are the risks?”

Click here to read more from Dr. Kalayjian

Below, read a related article from Johns Hopkins University

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Nearly 42% of American adults were obese from 2017 to 2020, up from roughly 30% in 2000, according to the Centers for Disease Control and Prevention. With that rise in obesity comes an increased risk for heart disease, stroke, type 2 diabetes, and some cancers.

Patients and their doctors are increasingly turning to in-demand drugs like Ozempic and Wegovy, but are they safe and effective? A recent episode of the Public Health on Call podcast explores the pros and cons with two Johns Hopkins University experts: gastroenterologist Sameer Khan of the Johns Hopkins School of Medicine and podcast host Joshua Sharfstein, vice dean for public health practice and communication engagement at the Bloomberg School of Public Health. Khan says the drugs work, but they are hard to find, expensive—around $700 a month without insurance for Wegovy which is prescribed for weight loss—and need to be taken forever to maintain weight loss and improve cardiovascular health when researchers don’t yet fully understand their long-term effects. Read on for three key takeaways from their conversation.

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Note from AAHPO Board Member John Bilezikian, MD, a renowned metabolic bone disease expert, regarding the article which appears below these remarks:

Osteoporosis, a disorder of weakened bones associated with increased risk of fracture, is a major international health problem. A recent update of the scope of this problem was recently published by Douglas Kiel, Professor at Harvard and a leader in studies related to the global epidemiology of osteoporosis. In the report recently published in the Journal of Bone and Mineral Research, the flagship journal of the American Society of Bone and Mineral Research, Dr. Kiel reports that the expected incidence of hip fracture, the most serious complication of osteoporosis, is likely to increase over the next 30 years, despite a downturn in hip fractures in many countries. The study accessed data from 19 different countries and included over 4 million hip fractures. The reason for the expected doubling in the number of hip fractures, worldwide, relates to the aging population. With aging comes increased risk of osteoporosis and fractures. Another important finding of the study confirms the point that many individuals who sustain an osteoporotic hip fracture do not received therapy to prevent another one. The risk of another fracture in someone who has sustained a hip fracture is markedly higher if treatment is not instituted. This study describes differences among countries but underscores, overall, the need for greater awareness of this disease and for implementation of measures to prevent and treat it.

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An international study that included researchers from Harvard Medical School indicates that while age- and sex-standardized hip fracture incidence rates have decreased in most regions around the globe, the number of hip fractures worldwide is projected to nearly double by 2050, compared to 2018.

A significant treatment gap in patients sustaining a hip fracture and not receiving therapy to prevent future fractures was also observed in all countries and regions, particularly in men.

The study, recently published in the Journal of Bone and Mineral Research, reviewed more than 4 million cases and highlights an urgent need for better strategies in hip fracture prevention and care.

Hip fracture remains a global public health concern contributing to increased dependency, morbidity, and mortality and placing a burden on patients, their families, and health care systems.

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Editor’s Note: Pediatric Infectious Disease Specialist and AAHPO Board Member Tsoline Kojaoghlanian, MD reviewed the article below and approved sharing it with AAHPO newsletter readers.

In early November 2023, the latest COVID variant, called JN.1, caused less than 5% of COVID-19 cases in the U.S. Now it is estimated to cause more than 60% of them. Virologists including Andy Pekosz, a professor in the Department of Molecular Microbiology and Immunology at the Johns Hopkins Bloomberg School of Public Health, are paying attention.

Here, Pekosz explains what virologists are seeing, what this new variant means for case rates and treatments, and why it’s so important for more people to get the updated COVID-19 vaccine rolled out this fall.

What’s most important to understand about this variant?
This latest variant should be a reminder that we have tools to fight off COVID infection and minimize severe disease: Tests detect JN.1, the new vaccines protect against severe disease, and antivirals are still capable of treating infection from JN.1. We just have to use these tools more effectively than we have over the last six months.

So far, only 8% of children and 19% of adults have received the latest vaccine, so a lot of people are missing out on protection from this virus.

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Editor’s Note: Pediatric Infectious Disease Specialist and AAHPO Board Member Tsoline Kojaoghlanian, MD agrees with the article below, which asserts that Paxlovid is helpful and should be more widely prescribed and taken.

With COVID-19 cases again on the upswing, the antiviral Paxlovid has been slow to gain traction among patients and doctors even though the medication reduces hospitalizations and deaths.

A recent National Institutes of Health study of about 1 million people found that only 15% at risk for severe disease took a five-day course of the prescription medicine. Of the patients who took Paxlovid, the medication reduced the risk of death by 73% and hospitalizations dropped 26%, showing the medicine is highly effective for people at risk of severe complications.

COVID-19 deaths, hospitalizations and visits to the emergency room increased at double-digit rates in the last week of December, the Centers for Disease Control and Prevention reported. But deaths and hospital stays remain far below earlier peaks.

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Aspirin has long been considered a lifesaving option to lower the risk of heart attack or stroke. In fact, aspirin has been used for centuries for medical purposes, beginning more than 2,500 years ago when Egyptian physicians used willow bark as a pain reliever. Aspirin is also one of the most studied therapies in cardiovascular disease over the last half century.

However, taking a daily aspirin isn’t an option for everyone. Is it right for you? It depends on a variety of factors including age, general health, history of heart health, and more. which you should discuss with your health care provider.

Fortunately, we have AAHPO members and cardiologists Shant Manoushagian, MD and George Petrossian, MD to help us sort it out.

“Generally speaking, the widespread use of aspirin for primary prevention of cardiovascular disease has fallen out of favor due to bleeding risk, especially in those over age 60,” noted Dr. Manoushagian. “Guidelines now call for individualized, shared decision-making between health care provider and patient after weighing risk/benefit and cardiovascular (CV) risk vs. bleeding risk.”

“If able to be tolerated, aspirin should be used in patients who have had a prior heart attack, stroke, have documented CV disease, a prior stent of a heart artery or peripheral vascular disease,” said Dr. Petrossian. “In these patients, aspirin reduces the risk of heart attack and stroke.”

Both of these specialists emphasized that the decision to use aspirin should be made in discussion with your health care provider.

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Editor’s Note: AAHPO Board Member Tsoline Kojaoghlanian, MD, a pediatric infectious disease specialist, agrees with the article below, and also recommends the flu vaccine for those age 6 months and older, and recommends the RSV vaccine for the elderly (scroll down to see additional article).

Though many people remain on the fence about getting the latest COVID vaccine booster, new research suggests a strong argument for getting the shot this winter: It sharply reduces the risk for COVID.

Researchers found that getting vaccinated led to a 69% reduction in long-COVID risk among adults who received three vaccines before being infected. The risk reduction was 37% for those who received two doses. Experts say the research provides a strong argument for getting the vaccine, noting that about 10% of people infected with COVID go on to have long COVID, which can be debilitating for one quarter of those with long-lasting symptoms.

The data come from a systematic literature review and meta-analysis published in October in Antimicrobial Stewardship & Epidemiology. Researchers examined 32 studies published between December 2019 and June 2023, involving 775,931 adults. Twenty-four studies, encompassing 620,221 individuals, were included in the meta-analysis.

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There are many reasons to get an influenza (flu) vaccine each year.

Below is a summary of the benefits of flu vaccination and selected scientific studies that support these benefits.

Flu vaccination can keep you from getting sick with flu.

• Flu vaccine prevents millions of illnesses and flu-related doctor’s visits each year. For example, during 2019-2020, the last flu season prior to the COVID-19 pandemic, flu vaccination prevented an estimated 36 million influenza illnesses, 16 million influenza-associated medical visits, 390,000 influenza-associated hospitalizations, and 25,000 influenza-associated deaths.
• During seasons when flu vaccine viruses are similar to circulating flu viruses, flu vaccine has been shown to reduce the risk of having to go to the doctor with flu by 40% to 60%.

LEARN MORE FROM THE CDC

Respiratory syncytial virus (RSV) is a common respiratory virus that usually causes mild, cold-like symptoms. However, it can be dangerous for older adults.

RSV vaccines help protect adults 60 years and older from severe RSV illness. Older adults are at greater risk than young adults for serious complications from RSV because immune systems weaken with age. In addition, certain underlying medical conditions may increase the risk of getting very sick from RSV. Older adults with these conditions may especially benefit from getting RSV vaccine. If you are 60 years and older, talk to your healthcare provider to see if RSV vaccination is right for you.

LEARN MORE FROM THE CDC