It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Tuesday, September 05, 2023
Racial and socioeconomic differences still determine survival rates of premature babies in the US
The US continues to face stark inequalities in preterm birth and mortality rates between mothers of differing socioeconomic status and race, finds a new report led by UCL researchers.
The study, published in JAMA Paediatrics, examined data from the US National Centre for Health Statistics Birth Infant/Death Dataset, of over 12 million preterm infant births over the course of 25 years, between 1995 and 2020.
Preterm birth is defined as any infant born before 37 weeks and is the leading cause of infant death worldwide.
Despite its leading economic status, the US has one of the top ten highest rates of preterm births across the globe. Mothers also face large inequalities as a result of their socioeconomic status, race and geographic region.
The researchers wanted to examine how these inequalities had changed over time.
Using information reported on an infant’s US birth certificate, the team considered the race of the mother, alongside her smoking status, educational attainment, antenatal care and insurance status, to see how these issues affected preterm mortality rates.
They found that, although all preterm infants born in 2020 were less likely to die than in 1995, the gap in preterm infant mortality between mothers of differing races had remained constant - with Black infants 1.4 times more likely to die following preterm birth than White and Hispanic infants.
They also found that the gap in preterm infant mortality rates between mothers of differing socioeconomic status had widened. For example, the relative risk of preterm infant mortality in mothers of a lower educational level compared to a higher education level has increased from 25% to 40%. Equally, the relative risk for mothers who smoked compared to those who didn’t has increased from 20% to 30%.
Lead author, Dr Tim Venkatesan (UCL Great Ormond Street Institute of Child Health) said: “While preterm infant mortality has improved in the US over the past 25 years, racial and socioeconomic inequalities still exist and are having a devastating effect on many families.
“Quantifying these differences is important for highlighting both the size of this issue and the need for health and social policy to close these gaps.”
The researchers found that overall, the adequacy of antenatal care received by the mother was one of the biggest predictors of preterm mortality across the study period. Mothers receiving inadequate antenatal care remain at over 50% higher risk of preterm infant mortality than those with adequate care.
Dr Venkatesan said: “We must aim to tackle the complex financial, structural, and geographical barriers that contribute to parents’ ability to access antenatal care. The findings from our study add support to calls for provision of free universal antenatal care for all pregnant Americans.”
The research was funded by the NIHR Great Ormond Street Hospital Biomedical Research Centre.
National Trends in Preterm Infant Mortality in the United States by Race and Socioeconomic Status, 1995-2020
ARTICLE PUBLICATION DATE
5-Sep-2023
Disparities in who dwells behind crumbling US levees
Historically underserved and disadvantaged populations disproportionately live behind levees throughout the United States. Many of these communities lack resources to maintain and upgrade necessary infrastructure, putting them at greater flood risk
IMAGE: MILLIONS OF PEOPLE LIVE BEHIND LEVEES IN THE UNITED STATES, AND HISTORICALLY UNDERSERVED AND SOCIALLY VULNERABLE POPULATIONS DISPROPORTIONATELY LIVE IN LEVEE-PROTECTED AREAS, PUTTING THEM AT INCREASED FLOOD RISK, AS IN THE AFTERMATH OF HURRICANE KATRINA IN 2011.view more
CREDIT: NOAA
American Geophysical Union 5 September 2023 Release 23-33 For Immediate Release
Tens of millions of people live in areas protected by at least one levee in the United States
Nationally, members of historically disadvantaged or underserved groups are more likely to be overrepresented in communities living behind levees
People of Hispanic descent are most likely to be overrepresented behind levees, with ~40% overrepresentation nationally
The Northeast and West had the greatest disparities in who lives behind levees
Contact information for the researcher: Farshid Vahedifard, Tufts University, farshid.vahedifard@tufts.edu (UTC-4 hours)
WASHINGTON — In the United States, tens of millions of people live behind levees, but historically disadvantaged groups are more likely to live behind subpar levees and have fewer resources to maintain critical levee infrastructure, a new study reveals. The study is the first to quantify the national disparity of disadvantaged communities living in levee-protected areas, which puts people at increased risk of flooding and other issues.
The United States is crosscut by several thousand miles of levees. Most are earthworks dating to the 18th and 19th centuries, when they were built to protect farmers’ fields and small riverside communities. They were not designed or built to serve as critical infrastructure protecting millions of people 150 years later.
“The overall impact of a levee failure depends heavily on the community living behind the levee,” said Farshid Vahedifard, a civil engineer at Tufts University who led the study. “Levees are one of the most important examples of infrastructure inequity, which is a longstanding issue in our country. The recent infrastructure law shows there’s consensus that we have to do something, but we need to have a better understanding of the problem before we can tackle it. This paper is a step toward that.”
The study was published in Earth’s Future, which publishes interdisciplinary research on the past, present and future of our planet and its inhabitants.
When properly maintained, levees essentially serve as built-up, armored riverbanks, protecting the area behind them from flooding. But when a levee is left to crumble, either because of a lack of resources or knowledge, it increases the community’s risk of catastrophic levee failure and subsequent flooding. Most levees in the country today are in a state of disrepair and are approaching or at the end of their useful life, according to a 2021 assessment of levee infrastructure.
The 2022 Jobs Act set aside $1.2 billion for infrastructure with an emphasis on historically underserved or disadvantaged communities. A previous estimate suggested the U.S. needs to allocate approximately $27 billion over the next 10 years to bring the country’s infrastructure up to acceptable standards before climate change is factored in.
“No matter how much funding we get, there’s greater need,” Vahedifard said. “That’s the main reason we have to identify our priority areas, the places at the greatest risk.”
To quantify disparities in who lives behind levees and highlight regions most in need of funds, Vahedifard analyzed census tract-level demographic data and levee information from the National Levee Database.
In census tracts around the country, areas behind levees have higher concentrations of people of Hispanic, Native American, Asian and Black backgrounds than areas not protected by levees, the study found. Hispanic people were the most overrepresented in levee-protected areas, with a 40% disparity nationwide. In the U.S. Midwest and Southeast, 60.6% and 40.2%, respectively, more Black populations live behind levees.
People with less education (particularly in the West) or lower wealth were also overrepresented in levee-protected areas.
In addition to individual factors such as race, wealth and education, the researchers analyzed the proportion of leveed versus non-leveed communities designated as "disadvantaged" based on the Climate and Economic Justice Screening Tool (CEJST). This tool identifies tracts nationwide where communities face significant burdens across various categories, including climate change, energy, health, housing, legacy pollution, transportation, water and wastewater, and workforce development. CEJST serves as a tool for federal agencies to identify disadvantaged communities to operationalize the White House's Justice40 program.
Communities classified as “disadvantaged” under CEJST are overrepresented behind levees in 43 states, with a national disparity percentage of 41%. The Northeast and West had the most unequal representation in leveed communities, with 57% and 51% overrepresentation of disadvantaged groups behind levees, respectively.
“We consistently saw an overrepresentation of disadvantaged or underserved communities living behind levees,” said Vahedifard, who serves as the Resilient and Equitable Infrastructure Lead with the United Nations University Institute for Water, Environment and Health. “These people already face more barriers and limitations — less knowledge of risks and fewer resources to fix things — so it’s a compounding issue.”
Beyond allocating maintenance funds to communities in need and mapping uncounted levees, educating communities about levee condition and risk is a key next step, according to the authors.
“Public awareness and education are critical and inexpensive,” Vahedifard said. “People need to know about the risks. And we need to have more transparency with these communities when it comes to data about the levees.” Making information like that found in the National Levee Database more accessible — and comprehensible — to communities around the country.
“This is not a simple problem,” Vahedifard said. “No matter how much money you have, you can’t just say, ‘Okay, now let’s rebuild this.’ The network is too extensive. But there are other ways we can reduce risk to these communities.”
And that’s only for the levees we know about. The National Levee Database may only capture about 25% of the country’s levees, according to a recent study, and the Infrastructure Report Card estimated about an extra one-third of levees are of unknown location and condition. Advanced sensing technologies and remote sensing-based monitoring tools are coming, but are not widely deployed today, Vahedifard said.
“We definitely need to do more to improve our levee documentation and monitoring. That’s critical,” he said.
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“Overrepresentation of historically underserved and socially vulnerable communities behind levees in the United States”
Authors:
Farshid Vahedifard (corresponding author), Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA, and United Nations University Institute for Water, Environment and Health (UNU-INWEH), Hamilton, ON, Canada
Mohammed Azhar, Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA
Dustin C. Brown, Department of Sociology and Social Science Research Center, Mississippi State University, MS, USA
It seems intuitive that forests would provide better habitat for forest-dwelling wildlife than farms. Yet, in one of the longest-running studies of tropical wildlife populations in the world, Stanford researchers found that over 18 years, smaller farms with varying crop types – interspersed with patches or ribbons of forest – sustain many forest-dependent bird populations in Costa Rica, even as populations decline in forests.
In a paper published Sept. 4 in the Proceedings of the National Academy of Sciences, Nicholas Hendershot and colleagues compared trends in specific bird populations across three landscape types in Costa Rica: forests, diversified farms, and intensive agriculture. The steepest declines were found in forests, then in intensive agriculture (and the species succeeding in intensive agriculture were often invasive). But on diversified farms, a significant subset of bird species typically found in forests, including some of conservation concern, actually increased over time.
“Birds are kind of a proxy we use to track the health of ecosystems. And the birds we’re seeing today aren’t the same as we saw 18 to 20 years ago. This paper really documents this pattern,” said Hendershot, a postdoctoral fellow at the time of this research in Stanford’s Department of Biology in the School of Humanities and Sciences (H&S), the Stanford Center for Conservation Biology (CCB), and the Stanford-based Natural Capital Project (NatCap).
Food security at stake
While this research implies that diversified farming could be key for biodiversity, the relationship goes both ways: biodiversity is key for food security. In this case, that means having a variety of types of birds feeding on insects and helping to pollinate crops.
“Identity does seem to matter a lot for pest control and other ecosystem services birds provide. These species are not interchangeable,” said Hendershot.
“We need a constant stream of pollinators servicing farms. About three-quarters of the world’s crops require pollinators to some extent, and that 75% is our most nutritious food – think of all the vitamins and minerals packed into fruits, nuts, and veggies,” explained Gretchen Daily, faculty director of NatCap and CCB, Bing Professor of Environmental Science in H&S, and a senior author on the paper. “We need a constant stream of birds, bats, and other wildlife to help control pests: they suppress the vast majority naturally. And we need to start building flood protection, water purification, carbon storage, and many other vital benefits back into agricultural landscapes, way beyond what can be achieved in protected areas alone.”
Daily also noted that, in terms of food production, diversified farms are not necessarily lower yielding than intensive agriculture. “This is a recent assumption that is being overturned,” she said.
Beyond protected areas
It has become increasingly apparent around the world that while protected areas remain critical, they are too few and far between to provide the ecosystem services people and nature need to thrive. Working landscapes are crucial now for preserving biodiversity and its benefits. “People, including scientists, had the idea that farmland would not support a meaningful amount of biodiversity,” said Daily. In this case, not only are diversified farms themselves providing habitat, they connect otherwise fragmented forested areas.
Over time, Hendershot said, “I have moved away from the ‘fortress conservation’ model, which focused more on creating protected areas separate from human activities, and see more and more how much potential there is outside of forests. The forests are key – we need them, of course. But in addition to that, I’m always surprised by how important how you manage a farm is for biodiversity.”
“We believe the findings of our research are new to science, but in a sense, it merely confirms what Indigenous communities around the world have already known for a long time, which is that humans can and should have reciprocal relationships with the rest of the local ecological community they are part of,” said Tadashi Fukami, a professor of biology in H&S and of Earth system science in the Stanford Doerr School of Sustainability and a co-author of the paper.
Incentivizing farmers
In the 1980s and 90s, deforestation was occurring in Costa Rica at the fastest rate ever seen on a country scale. Then, they turned it around – becoming a renowned model of success. By setting up the world’s first countrywide payment for ecosystem services (PES) program, Costa Rica reversed this trend: today, forests cover almost 60% of its land, up from 40% in 1987.
The country currently aims to double the amount of protected forest in just a few years. In its existing PES program, any landowner can receive money for reforesting even small parts of their land. Now, the government is also working toward a new PES program to incentivize farmers to adopt best management practices.
This study will help inform Costa Rican policymakers in understanding the benefits provided over time by different farming practices. Said Daily, “We need to recognize the vital work many farmers are doing that supports biodiversity.”
Nicholas Hendershot was a postdoctoral researcher with the Center for Conservation Biology at Stanford and is now a forest ecologist with The Nature Conservancy-California. Gretchen Daily is also a senior fellow in the Stanford Woods Institute for the Environment. Other co-authors on the paper are Alejandra Echeverri, a senior scientist at the Natural Capital Project, Luke Frishkoff of the University of Texas at Arlington, and prominent Costa Rican ornithologist Jim Zook.
Hendershot’s work was supported by the Gerhard Casper and John P. Morgridge Stanford Graduate Fellowship, the OTS Emerging Challenges in Tropical Science Fellowship, and the Winslow Foundation. Funding for data collection from 1999-2017 was generously provided to Daily by the LuEsther T. Mertz Charitable Trust, the Moore Family Foundation, and the Winslow Foundation.
Farmer dedicates nearly 15 years to single-handedly reviving a barren forest: ‘The result was amazing’
Mary Swansburg Mon, September 4, 2023
Eoghan Daltun has held many titles in his lifetime — farmer, sculptor, and now author and activist for conservation in rural Ireland. In the past 14 years, he has undertaken an effort to restore the native wildlife to the Beara hillside.
The Beara hillside is known for its beautiful landscapes and historical remains of the Bronze Age, but 15 years ago, the wildlife wasn’t an accurate representation of Ireland’s biodiversity. A large portion of the native plants were stripped away as a result of an overabundance of animals that feed on them and invasive plant species.
In an interview with the Guardian, Daltun described the area as “biologically empty” and explained how he began to remedy this by purchasing and rewilding a portion of the land.
Rewilding prioritizes the natural biodiversity of an area — it involves reintroducing previously pushed-out species and restoring the local wildlife to a landscape. The process allows the native plants and animals in the area to flourish as they did before other factors — like invasive species and human intervention — made that difficult.
According to the Guardian, native forests used to make up 80% of Ireland’s landscape, and by the time the Daltun began rewilding, that number had shrunk to 1%.
His strategy included removing invasive, non-native plants — such as rhododendron — and adding fencing to keep non-native animals. These animals, such as sika deer, are known to damage trees by stripping their bark and causing harm to their trunks, as well as eating shoots and seedlings, making it difficult for wildlife to grow.
After removing the elements that made it difficult for the native wildlife to thrive, it was a waiting game to see when the ecosystem would rebuild itself — and Daltun reported that it began the process shortly after.
It’s not just native species that benefit from rewilding, though — restoring healthy, natural wildlife produces cleaner air and water, as well as perks for local buildings and the economy.
A thick tree canopy slows down the speed at which rain gets to the ground, and the roots anchor the soil — decreasing flooding and erosion. Plus, the natural beauty can stand alone as a tourist attraction — giving the local economy a boost.
Daltun told the Guardian that the transformation began immediately, but the restoration was still a gradual process. Over the years, previously suppressed wildlife began to truly flourish in the area. There is now a noticeable abundance of native wildlife, and Daltun describes how the soil was healthier and taking in more water — faring well in a recent drought.
“The result was amazing,” Daltun added.
His contribution was impressive and well appreciated — but it’s important to remember that you don’t need to have the same kind of time or funds to dedicate to the movement. This article by Mossy Earth has some great ways to help the conservation effort — some of which are free or take only a few minutes.
“We either start protecting the little natural habitats we have left, or we lose them,” Daltun told the Guardian.
Most species are rare. But not very rare
Over time, biodiversity observations around the world have unveiled a potential universal pattern of how many species are common, very rare or somewhere in-between
GERMAN CENTRE FOR INTEGRATIVE BIODIVERSITY RESEARCH (IDIV) HALLE-JENA-LEIPZIG
IMAGE: THE SRI LANKA HANGING-PARROT (LORICULUS BERYLLINUS) LIVES ONLY IN SRI LANKA. IT IS GLOBALLY A VERY RARE SPECIES, MEANING THERE ARE FEW INDIVIDUALSview more
CREDIT: COREY CALLAGHAN
Halle/Saale, Fort Lauderdale. More than 100 years of observations in nature have revealed a universal pattern of species abundances: Most species are rare but not very rare, and only a few species are very common. These so-called global species abundance distributions have become fully unveiled for some well-monitored species groups, such as birds. For other species groups, such as insects, however, the veil remains partially unlifted. These are the findings of an international team of researchers led by the German Centre for Integrative Biodiversity Research (iDiv), the Martin Luther University Halle-Wittenberg (MLU) and the University of Florida (UF), published in the journal Nature Ecology and Evolution. The study demonstrates how important biodiversity monitoring is for detecting species abundances on planet Earth and for understanding how they change.
“Who can explain why one species ranges widely and is very numerous, and why another allied species has a narrow range and is rare?” This question was asked by Charles Darwin in his ground-breaking book “The Origin of Species”, published over 150 years ago. A related challenge has been to understand how many species are common (numerous) and how many are rare, the so-called global species abundance distribution (gSAD).
Two main gSAD models have been proposed in the last century: R. A. Fisher, a statistician and biologist, proposed that most species are very rare and that the number of species declines for more common species (so-called log-series model). On the other hand, F. W. Preston, an engineer and ecologist, argued that only few species are actually very rare and that most species have some intermediate level of commonness (so-called log-normal model). However, until now and despite decades of research, scientists did not know which model describes the planet’s true gSAD.
Solving this problem calls for vast amounts of data. The study authors used data from the Global Biodiversity Information Facility (GBIF) and downloaded data representing over 1 billion species observations in nature from 1900 to 2019.
“The GBIF database is an amazing resource for all sorts of biodiversity related research, particularly because it brings together both data collected from professional and citizen scientists all over the world,” says first author Dr Corey Callaghan. He began the study while working at iDiv and MLU and is now working at the UF.
Callaghan and his fellow researchers divided the downloaded data into 39 species groups, for instance, birds, insects, or mammals. For each, they compiled the respective global species abundance distribution (gSAD).
The researchers detected a potentially universal pattern, which emerges once the species abundance distribution is fully unveiled: Most species are rare but not very rare, and only a few species are very common, as predicted in the log-normal model. However, the researchers also found that the veil has been fully lifted only for a few species groups like cycads and birds. For all other species groups, the data are yet insufficient.
“If you don’t have enough data, it looks as though most species are very rare,” says senior author Prof Henrique Pereira, research group head at iDiv and the MLU. “But by adding more and more observations, the picture changes. You start seeing that there are, in fact, more rare species than very rare species. You can see this shift for cycads and birds when comparing the species observations from back in 1900, when less data was available, with the more comprehensive species observations we have today. It is fascinating: we can clearly see the phenomenon of unveiling the full species abundance distribution, as predicted by Preston several decades ago, but only now demonstrated at the scale of the entire planet.”
“Even though we have been recording observations for decades, we have only lifted the veil for a few species groups,” says Callaghan. “We still have a long way to go. But GBIF and the sharing of data really represents the future of biodiversity research and monitoring, to me.”
The new study's findings enable scientists to assess how far the gSADs have been unveiled for different species groups. This allows for answering another long-standing research question: How many species are out there? This study finds that while for some groups like birds, nearly all species have been identified, this is not the case for other taxa such as insects and cephalopods.
The researchers believe that their findings may help in answering Darwin’s question of why some species are rare, and others are common. The universal pattern they found may point to general ecological or evolutionary mechanisms that govern the commonness and rarity of species. While more research is being done, humans continue to alter the planet’s surface and the abundance of species, for instance, by making common species less common. This complicates the researchers’ task: They need not only to understand how species abundances evolve naturally but also how human impacts are altering these patterns simultaneously. There may still be a long way to go before Darwin’s question is finally answered.
The leopard (Panthera pardus) is a rare to intermediate species
CREDIT
Corey Callaghan
The global species abundance distribution (gSAD) has been fully unveiled for birds and shows a potentially universal pattern: There are a few very rare species like the Sri Lanka Hanging-Parrot, many rare species like the Northern Goshawk, and few common species like the House Sparrow. This pattern was first proposed by F. W. Preston in 1948
CREDIT
Gabriele Rada (illustration), Corey Callaghan (photos)
A new study showing the impact of the COVID-19 pandemic and mitigation strategies used to manage the virus on emergency department (ED) visits in British Columbia can help with future planning. The study is published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.221516.
"Evaluation of the effects of the pandemic and associated measures can provide a historical account and inform health care service planning for both postpandemic recovery and mitigation of potential consequences of restrictions for future pandemics," write scientists from the British Columbia Centre for Disease Control (BCCDC) and Vancouver Coastal Health, Vancouver, British Columbia. "Insights from this study can also trigger further research on the drivers of the changes and inform strategies for emergency care."
Previous studies have assessed the impact of the pandemic on ED visits, but few have looked at the health reasons for these visits.
To understand the impact of the pandemic according to health visit type over the first 3 years of the pandemic, scientists looked at data from 30 emergency departments and more than 10.7 million visits across British Columbia from January 2016 to December 2022. Using modelling, they estimated what usual patterns of ED visits would have been compared with actual visits during the pandemic. The smallest number of ED visits were in April and December 2020, reflecting the effects of the strong virus mitigation measures, and visits returned to pre-pandemic levels in May 2021.
After accounting for seasonal and annual trends in ED visits, the April and December dips saw a 42% and 19% reduction, respectively, compared to what would be expected in the absence of the pandemic. The largest reductions were for respiratory issues (35%), with a 48% drop in December 2020, which would normally have been peak season for respiratory illnesses. Visits for mental health concerns and substance misuse had the smallest reductions.
By age group, the largest reductions in visits were in children younger than 10 years, accounting for almost one-third of the decrease in visits.
"By looking at the time window that captured most of the pandemic period, we were able to tell a fuller story by showing not only the short-term impacts, but also longer-term impacts," says Dr. Kate Smolina, interim scientific director, BCCDC Data and Analytic Services and Knowledge Translation and senior author of the paper. "It was particularly interesting to see those longer-term patterns for children's visits and visits related to respiratory and ears, nose, and throat symptoms, which, after returning to normal in 2021, went on to surpass the expected levels in 2022."
In summer 2021, there was a substantial increase in visits, possibly related to the extreme heat in June in British Columbia as well as opioid-related overdoses.
The authors hope that the data will be useful in helping manage health care resources. "There was a huge drop in volumes in the emergency department at the beginning of the pandemic, but we have ultimately returned to pre-pandemic growth of volumes," says Dr. Eric Grafstein, chief medical information officer and regional emergency department head at Vancouver Coastal Health and Providence Health Care. "This return toward normal emergency department volumes can help with future understanding of the impact of pandemics on health care needs."
"More studies on the drivers of these trends will not only aid in better planning of emergency department capacity for future public health emergencies, but can also inform strategies to help the public make decisions about seeking emergency care. The statistical modelling approach can be further developed into surveillance tools to monitor health care services use and plan for surge capacity," conclude the authors.
In a related editorialhttps://www.cmaj.ca/lookup/doi/10.1503/cmaj.231156, Dr. Catherine Varner, deputy editor, CMAJ, and an emergency physician in Toronto, says until acute care capacity is increased, Canadian hospitals will continue to face severe emergency department overcrowding. With hospitals frequently exceeding 100% bed occupancy, she proposes several steps to help mitigate the burden on emergency department patients and staff. These include implementing demand-driven overcapacity protocols when overcrowding is compromising care, extending hours for in-hospital consults and procedures, increasing access to urgent but nonemergency testing and other interventions, and ensuring safety of staff and patients by embedding security and mental health professionals trained in de-escalation in emergency departments.
A new international study led by Queen Mary University of London has shown mpox (formerly known as monkeypox) infections to be less severe among those who are vaccinated or had a previous infection in 2022, underlining the importance and effectiveness of vaccination.
The research, published in The Lancet Infectious Diseases, was delivered by the SHARE-net collaborative and looked at 38 mpox infections in 37 gay and bisexual men. Eight of the 38 were reinfections, and 30 infections occurred after a complete vaccination course. In the people who had been vaccinated, the results showed that the patients had fewer lesions (abnormal tissue such as a wound or rash), less mucosal disease (diseases of the mucous membranes of the mouth and genitals), and a minimal need for pain medication or hospitalisation.
The severity of symptoms was observed and assessed using the Mpox-SSS score, which was developed during the 2022 multi-country outbreak. The Mpox-SSS score is a numerical score given considering seven different factors including the number of lesions, the level of care required for the patient, the amount of pain medication needed, the extent of mucosal areas affected, and whether there is any bacterial superinfection – i.e., additional infections.
Using this scoring system it was possible to demonstrate and measure severity. In those who had been reinfected, the disease was less severe with a lesser requirement for pain medication compared to their first bout, and fewer areas of the body were affected while recovery was also faster. The first infection lasted 21 days (median) whereas the second infection lasted 15 days (median).
The study is the largest and only case series to examine both reinfections and infections after a complete vaccine course of Modified Vaccinia Ankara-Bavarian Nordic (MVA-BN).
Since May 2022, there have been more than 87,000 cases of human mpox across 112 countries. Transmissions have primarily affected sexually active gay and bisexual men and been caused by skin-to-skin and bodily fluid contact. As evidenced by the two previous SHARE-net global case series published in TheNEJM and The Lancet, infection often causes rashes, fevers, and blisters. It can also lead to brain inflammation and seizures. In people with advanced HIV disease, it carries a mortality of up to 27% in the most immunosuppressed group.
Neither natural immunity from a prior mpox infection nor post-vaccination immunity can prevent someone from getting the virus. However, the study shows that the immunity from both reduces severity.
Research lead author Chloe Orkin, Professor of HIV Medicine at Queen Mary University of London and Director of the SHARE collaborative, said: “This is good news and shows that post-vaccination infections are less severe and the need for hospitalisation is lower. This is clear evidence that vaccination is an important tool in reducing morbidity and controlling further outbreaks.
“We have to ensure global access to vaccinations and treatments if we want to curb this global outbreak, especially in the African regions that have been historically worst affected and are still without access to vaccines or treatment for mpox.”
