The Covid-19 vaccinations have been the subject of public scrutiny ever since their initial rollout in January 2021. With both pharmaceutical companies and country governments pushing for their rapid distribution, questions have arisen regarding their safety and efficacy in various proportions. There was particular apprehension regarding the effects on fertility and pregnancy. While rumors about the vaccines affecting fertility have been largely dismissed by healthcare professionals, the skepticism around their effects on pregnancy and lactation still remains widespread. A major reason of that being the exclusion of pregnant women from the clinical trials for the vaccines. The paradoxical nature of this decision comes to light as several healthcare organizations have since then classified pregnant women as a high-risk group.
Pregnant individuals are at a significantly higher risk of serious illness from Covid-19 in comparison to non-pregnant individuals, which can result in the need of hospitalization, intensive care or artificial ventilation. There are also higher chances of adverse outcomes such as spontaneous abortion or preterm birth for pregnant Covid-19 patients. These dangers have brought developments in the global vaccination advice. The most recent guidelines from the Center for Disease Control (CDC), the World Health Organization (WHO) and the Joint Committee on Vaccination and Immunization (JCVI) have strongly recommended vaccination for pregnant women and have also endorsed it for lactating women. Doctors, healthcare professionals and experts worldwide advocate for the same, as they believe the benefits of getting vaccinated outweigh the risks. These claims are backed by studies carried out on pregnant animal models and their offspring, which haven’t raised any evident red flags when it comes to concerns about safety, in both the mother and child. There are, however, reservations regarding the extrapolation of these results to humans.
The nature of vaccines make it difficult to predict the side effects it may have on different individuals or groups of individuals. As the initial data is so limited, the CDC has invited pregnant women who have received the Covid-19 vaccination to participate in their in v-safe Covid-19 Vaccine Pregnancy Registry. The purpose of this initiative is to collect health information from people who have received the vaccine in either periconception (within 30 days prior to their last menstrual period) or pregnancy period. This allows them to monitor progress and outcome of pregnancy and report any adverse side effects that may have potential links to the vaccine.
Although participation is voluntary, the CDC encourages women to enroll in the v-safe registry for improved record of data that would help anticipate future directives. Unfortunately, the numbers of enrolled participants in the registry is low, as many of the women who self-identified as pregnant during the time of vaccination either could not be traced or refused to participate. An overwhelmingly large number of women who have enrolled are healthcare professionals, which leads to possible biases in results. Interestingly, this also highlights the lack of awareness amongst non-healthcare professionals about the prospective benefits of Covid-19 vaccination and its studies. In an online survey conducted by researchers at the Harvard T.H. Chan School of Public Health, only 52% of pregnant women across 16 countries (around 18,000 participants) said they were likely to get the vaccine.
The New England Journal of Medicine (NEJM) published an article by a team of American researchers, titled, ‘Preliminary Findings mRNA Covid-19 Vaccine Safety in Pregnant Persons’ based on data from the CDC’s the v-safe registry, the v-safe after vaccination health checker and the Vaccine Adverse Event Reporting System (VAERS). While not exactly alike, the report states that the adverse pregnancy and neonatal outcomes were “similar to incidences reported in studies involving pregnant women that were conducted before the Covid-19 pandemic”, thus deducing that no clear associations could be made between the vaccine and the outcomes. While there aren’t any obvious safety concerns regarding the approved vaccines for pregnant women, further follow up studies are highly suggested.
On the flip side, reassuring progress has been made in understanding the benefits of the vaccines for pregnant and lactating women. Results for several studies show that the levels of antibodies against Covid-19 in the bloodstream of pregnant or lactating women who received the vaccine are comparable to their non-pregnant peers. Evidence reveals that these are passed on to the newborns as well, particularly if the mother had been inoculated during the third trimester or while lactating, proving that it gives them a certain degree of protection against the disease. More studies are underway to determine the exact mechanisms of antibody transference to the neonates.
When it comes to determining vaccine safety, the most vital tool is clinical trials. Despite being excluded originally, the National Institutes of Health (NIH) is commencing a clinical trial in the United States to evaluate the immune responses generated by Covid-19 vaccines in pregnant or postpartum women. This trial will allow the participants to be studied in a more controlled environment, in the hopes to yield results that are more reliable. It is likely that with the success of this trial, more are to come with further enhancements including populations from other countries as well.
The general consensus is that vaccination is safe, and more so is encouraged for pregnant and lactating women. So far, the Pfizer-BioNTech, Moderna, Johnson&Johnson/Janssen and Oxford-AstraZeneca vaccines have been approved. Even though there are limited data about safety for the Sinovac and Sinopharm vaccines during pregnancy, the WHO in the interim recommends their use as well. The only exceptions are the Covishield and Covaxin vaccines that have been authorized in India, which have not yet received approval for pregnant women.
Despite the green light from healthcare organizations, it is always best to contact and discuss your obstetrician/gynecologist or primary healthcare provider before taking the vaccine. The effect of vaccines is always a multifactorial event and can vary widely depending upon individual conditions. Thus, is it necessary to consider your health status and seek advice from your doctor before taking the Covid-19 vaccination when pregnant.
UN World Food Program Lowers Aid in South Sudan
The United Nations World Food Programme (WFP) recently decreased aid services in South Sudan, a major blow for the Central African country where over two-thirds of the population faces food shortages and hunger.
“Faced with increasing humanitarian needs and insufficient funding, we have taken the painful step to suspend food assistance to 1.7 million people,” said Adeyinka Badejo-Sanogo, WFP Acting Country Director in South Sudan. Instead of assisting an estimated 6.2 million people in the country, the WFP will now only provide aid for 4.5 million.
Large floods over the last three years have destroyed farms and homes across South Sudan, displacing hundreds of thousands of people. This year, UN officials anticipate more flooding, which will put around 600,000 people at risk of displacement. Violence in South Sudan has similarly forced many people to leave their homes, placing them in vulnerable situations. According to Ms. Badejo-Sanogo, “So far this year, we have seen 200,000 people newly displaced as a result of conflicts.”
South Sudan’s people are in a dire situation, and the international community must make greater efforts to send humanitarian aid to the country. Unfortunately, the Russia-Ukraine War has already diverted many countries’ focus, and nations are struggling with their own economic problems.
But ultimately, even if aid to South Sudan can be increased, it is only a temporary solution. Developing the infrastructure to combat flooding and quelling violence in the nation will create more sustainable long-term solutions.
The End of Roe v. Wade Has Dangerous Consequences for Women’s Health
When the Supreme Court overturned Roe v. Wade, they did not just steal bodily autonomy from women, but also their future health. By overturning Roe, the Supreme Court has now put pressure on physicians prescribing life saving medications to women.
Abortion has now been banned in six states, and that number is likely to rise swiftly to 16 states. Twelve states have passed trigger laws. Some states have not completely banned abortions, however they have implemented gestational age limits on abortions. While other states have not decided whether or not to ban abortions, the courts and lawmakers will be deciding the fate of women. Only 20 states have abortion protections in place.
These new bans have also brought into question the future of birth control. Will states begin restricting or even outlawing birth control? Although Republicans have dismissed concerns about banning birth control, Democrats have been warning that it is a distinct possibility. Indeed, after Missouri’s strict new ban on abortion went into effect, one major hospital system in Kansas briefly stopped providing emergency birth control, even to victims of rape.
But the potential healthcare ramifications of these laws do not end there. Many drugs cause birth defects in pregnant women, which raises the question: If women cannot legally terminate a pregnancy, can these drugs legally be prescribed to women of child-bearing ages in states with abortion bans?
“I believe that prescribing is going to become much more defensive and conservative,” rheumatologist Mehret Talabi told Medscape. “Some clinicians may choose not to prescribe these medications to patients who have childbearing potential, even if they don’t have much risk for pregnancy.”
Teratogens are medications which can cause birth defects. Many teratogenic medications include treatments for acne, cancer, rheumatoid arthritis and psoriasis.
“Doctors are going to understandably be terrified that a patient may become pregnant using a teratogen that they have prescribed,” Talabi said. “While this was a feared outcome before Roe v. Wade was overturned, abortion provided an escape hatch by which women could avoid having to continue a pregnancy and potentially raise a child with congenital anomalies.” “
Other physicians also shared their fears that doctors would now be wary of prescribing many medications, some of those with little data on pregnancy.
Dr. Megan Clowse, a Duke University rheumatologist who works with women who are or wish to become pregnant, told Medcape: “Women who receive these new or teratogenic medications will likely lose their reproductive autonomy and be forced to choose between having sexual relationships with men, obtaining procedures that make them permanently sterile, or using contraception that may cause intolerable side effects..”
Dr. Clowse noted that many drugs commonly prescribed to patients with rheumatic diseases, including methotrexate, mycophenolate and cyclophosphamide, are linked to birth defects and loss of pregnancy..
“I am very concerned that young women with rheumatic disease will now be left with active disease resulting in joint damage and renal failure,” she said.
One of these drugs, methotrexate, is an effective cancer treatment and many rheumatic conditions, but has also been used to cause abortions. “If legislators try to restrict access to methotrexate, we may see increasing disability and even death among people who need this medication but cannot access it,” Dr. Talabi said.
Mayo Clinic gastroenterologist Dr. Sunanda Kane told Medscape she feared that several of the teratogenic medications used in her field to treat viral hepatitis, constipation and inflammatory bowel disease, would now be affected. While she said doctors in her field generally only prescribe medications with high teratogenic potential to women of childbearing age when they use multiple forms of birth control to prevent pregnancy, she noted that doctors may be less likely to prescribe such drugs if abortion is not available as a legal option.
“The removal of abortion rights puts the lives and quality of life for women with rheumatic disease at risk,” Dr. Clowse added. “For patients with lupus and other systemic rheumatic disease, pregnancy can be medically catastrophic, leading to permanent harm and even death to the woman and her offspring. I am worried that women in these conditions will die without lifesaving pregnancy terminations, due to worries about the legal consequences for their physicians.”
Children Under 5 to get Covid-19 Vaccine by Next Week
- The FDA’s outside vaccine advisers finally approved Moderna’s two-shot vaccine for children under age 5. The panel is also set to vote on whether Pfizer’s three-shot series is suitable and safe for this age group.
- This is the last remaining group in the US to get vaccinated and many outside experts agree that the benefits of Moderna’s COVID-19 vaccine outweigh the risks for children under 5. If all the regulatory steps are cleared, vaccines can be available by next week.
- Dr. Joy Portnoy of Children’s Hospital in Kansas City, MO, also a panel member, stated “there are so many parents who are absolutely desperate to get this vaccine and I think we owe it to them to give them a choice to have the vaccine if they want to.”
- FDA reviewers stated that both brands appear to be effective and safe for children as young as 6 months, and the most common side effects, which are fever and fatigue, appear to be less common than seen in adults.
- Although the two vaccines use the same technology, the shots have not been tested against one another.
- Once the FDA approves the shots, the CDC will decide on a formal recommendation. Pfizer’s vaccine will be available to children 6 months to 4 years, while Moderna’s vaccine will be for 6 months to 5 years.
- Pfizer’s shots are 1/10 of the adult dose, while Moderna’s shots are ¼ of the adult dose.
- Moderna is also seeking regulatory approval outside the US for younger children as well. 12 countries already vaccinate children under 5 with other brands.
Monkeypox could be sexually transmitted disease – WHO
Monkeypox virus is caused by skin to skin contact and may be a sexually transmitted disease, warns the World Health Organisation.
The World Health Organisation (WHO) has started its research on the reports that the monkeypox virus is present in the semen of patients.
This presents a possibility that monkeypox could be sexually transmitted from one patient to their partners.
It is reported that most cases are in men who have sexual relations with men.
The WHO has said that the main transmission of the rare disease is through close interpersonal contact.
In Italy and Germany, scientists say that they have detected viral DNA in semen for a small number of monkeypox patients. The virus found in the semen was capable of infecting another person.
The WHO monkeypox incident manager in Europe, Catherine Smallwood said during a press briefing “this may have been something that we were unaware of in this disease before.”
“We really need to focus on the most frequent mode of transmission and we clearly see that to be associated with skin to skin contact,” she added.
The monkeypox outbreak is now considered a global outbreak. In more than 30 countries there have been more than 1,600 with over 500 cases in the UK.
A vaccine of monkeypox is available and the WHO has recommended that close contacts and healthcare workers should be vaccinated first.
WHO’s regional director for Europe, Hans Kluge said “Europe remains the epicentre of this escalating outbreak, with 25 countries reporting more than 1,500 cases, or 85% of the global total.”
Regarding the race to stockpile vaccines, he added “once again, a ‘me first’ approach could lead to damaging consequences down the road.”
“I beseech governments to tackle monkeypox without repeating the mistakes of the pandemic – and keeping equity at the heart of all we do.”
In the current outbreak, so far no deaths have been reported. But experts warn that every year monkeypox causes deaths in some countries, where the disease exists as endemic.
The WHO is also considering changing the name of the Monkeypox virus. Consideration came after 30 scientists wrote letters to the WHO that it is not correct but rather discriminatory to give the name of the rare disease as African.
Some of the Scientists has suggested hMPXV as new name of the virus to address the “urgent need” for a “non-discriminatory and non-stigmatising” name for the virus.
Monkeypox: Something To Be ‘Concerned About’ Says Biden
On Sunday, President Joe Biden, in his first public comments on the disease, said that recent cases of monkeypox that have been identified in Europe and the United States were something “to be concerned about. It is a concern in that if it were to spread it would be consequential.”
During the President’s first trip to Asia he was asked about the disease as he spoke to reporters at Osan Air Base in South Korea – “They haven’t told me the level of exposure yet but it is something that everybody should be concerned about,” Biden said. As for the vaccine, Jake Sullivan, Biden’s national security adviser, told reporters that the United States has a supply of “vaccine that is relevant to treating monkeypox. We have vaccines available to be deployed for that purpose,” he said.
Monkeypox is a virus that originates in wild animals like rodents and primates, and occasionally jumps to people. Most human cases have been in central and west Africa, where the disease is endemic.
According to CDC’s website, Centers for Disease Control and Prevention, Monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, hence the name ‘monkeypox.’ The first human case of monkeypox was recorded in 1970 in the Democratic Republic of Congo during a period of intensified effort to eliminate smallpox. Since then monkeypox has been reported in humans in other central and western African countries.
A detailed investigation of the outbreak in Europe, including determining who the first patients were, is now critical, says Shabir Mahdi, a professor of vaccinology at the University of Witwatersrand in Johannesburg.
“We need to really understand how this first started and why the virus is now gaining traction. In Africa, there have been very controlled and infrequent outbreaks of monkeypox. If that’s now changing, we really need to understand why.”
WHO reports about 3,000 monkeypox cases a year in Nigeria. Oyewale Tomori, a virologist who formerly headed the Nigerian Academy of Science, said that outbreaks are usually in rural areas when people have close contact with infected rats and squirrels.
Monkeypox typically causes fever, chills, rash and lesions on the face or genitals. Luckily, to date, no one has died in the outbreak. The estimation by WHO suggests that the disease is fatal for up to one in 10 people. The infection typically lasts two to four weeks and usually clears up on its own.
Britain’s Health Security Agency reported 11 new monkeypox cases on Friday, saying “a notable proportion” of the infections in the U.K. and Europe have been in young men with no history of travel to Africa and who were gay, bisexual or had sex with men.
Dr Susan Hopkins, the Chief Medical Adviser for the U.K.’s Health Security Agency stated that “the evidence suggests that there may be transmission of the monkeypox virus in the community, spread by close contact. We are particularly urging men who are gay and bisexual to be aware of any unusual rashes or lesions and to contact a sexual health service without delay.”
Monkeypox spreads when someone comes into close contact with another person, animal or material infected with the virus. The virus can enter the body through broken skin, the respiratory tract or through the eyes, nose and mouth. Monkeypox is not generally considered a sexually transmitted disease, though it can be passed on during sex. Health authorities stress that we are not on the brink of a serious outbreak and the risks to the general public remain very low.
Oklahoma’s Anti-Abortion Bill: The Newest Development in the United States’ Abortion Controversy
This Thursday, Oklahoma legislators passed what many have deemed as the most restrictive bill banning abortions in the U.S. The bill prohibits all abortions, except those that are required to save the mother’s life or are the result of rape/incest. The draft law is likely to be ratified by the state governor, Kevin Stitt, and further limit abortion access in the state.
Oklahoma’s measure has garnered national attention for a multitude of reasons. For one, the bill bans abortions immediately after fertilization; this is in stark contrast to pro-abortion laws across the U.S., which permit abortions up to 24 weeks of pregnancy. In September 2021, Texas passed a similarly restrictive abortion law, but even that measure enables abortions up to six weeks of pregnancy. Moreover, the Oklahoma measure comes right after the recent Supreme Court leak draft, which shows that the majority of the court is in favor of overturning the landmark Roe v. Wade ruling. If Roe v. Wade is overturned — which could happen as soon as late June or early July — many U.S. states (including Oklahoma) stand poised to immediately prohibit access to abortions.
Oklahoma’s bill, along with the SCOTUS leak, highlights how abortion rights in the U.S. are contingent upon the 1973 Roe v. Wade ruling and subject to change suddenly. Indeed, the recent discussions surrounding abortion shed light on the American judicial system and how volatile landmark rulings can be. Looking ahead, Americans must see whether or not the Supreme Court overturns Roe v. Wade. If so, abortion laws across the country will change drastically, and Americans will have to familiarize themselves with dozens of new laws and restrictions. If not, the legal systems of the U.S. will have been examined and questioned nonetheless.
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