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Routine vaccines, extraordinary impact: Polio


The discovery in the summer of 2022 that poliovirus had been found in sewers in London as well as in an unvaccinated community in New York started many who had long forgotten about polio. The outbreak was a perfect demonstration that vaccines are often so successful at stopping deadly diseases, that we can be lulled into a false complacency.

Although polio only affects a handful of countries currently, the potential threat from its continued circulation means that the World Health Organization still classifies it as a Public Health Emergency of International Concern (PHEIC) despite this classification being given back in 2014.

Although the disease is now endemic only in Afghanistan and Pakistan, it was a dangerous childhood disease across the world for much of the late 19th and early 20th centuries. Although polio vaccines were introduced as routine immunisations in the 1970s, which reduced cases substantially, by the late 1980s, polio still was paralysing over 1,000 children a day.

In 1988, the launch of the Global Polio Eradication Initiative (GPEI, of which Gavi is a member) had a galvanising effect on efforts to eliminate the disease, bringing together governments, donors, local communities and health workers in a joint effort to raise awareness of the disease and widen access to polio vaccines.

Cases began to drop and are down 99%, with most countries having zero cases. An estimated 20 million children have been prevented from getting polio since the GPEI was launched. When Nigeria was declared free of wild poliovirus in 2020, it was a major achievement: it had been one of the last few countries where the disease had clung on.

As remarkable as these successes have been, polio experts warn that there is no room for easing off on eradication efforts until the world is polio-free. Infectious diseases that are nearly wiped out can bounce back with alarming ease when the global circumstances change – measles rates have started climbing in the past few years as vaccination rates have fallen in Europe and the US.

Uneven polio vaccine coverage across the world, compounded by the COVID-19 pandemic’s toll on routine immunisation worldwide, has meant the disease has popped up in unexpected places. In October 2021, Ukraine saw an outbreak, followed by a case of wild poliovirus in February 2022 in Malawi. In March, vaccine-derived polio was spotted in Israel, and in Pakistan, where the disease is still entrenched, more polio cases were recorded in the first quarter of 2022 than in the whole of 2021.

Although polio only affects a handful of countries currently, the potential threat from its continued circulation means that the World Health Organization still classifies it as a Public Health Emergency of International Concern (PHEIC) despite this classification being given back in 2014.

An ancient disease

Polio is one of the world’s oldest diseases – 14th century Egyptian engravings have been found depicting a priest with a withered leg, the trademark of a disease that can paralyse the leg, leading to muscle weakness and shrinking. The British physician Michael Underwood produced the first clinical description of the disease in 1789. In 1840, the German orthopedic doctor Dr Jacob Von Heine understood that poliomyelitis was a distinct disease from other forms of paralysis and theorised it had an infectious cause. The poliovirus that causes the disease was identified in 1909 by Austrian immunologist Karl Landsteiner.

The disease is caused by a highly infectious virus that spreads when people ingest food or water contaminated by human hygiene faeces, or through poor. Because of this it is common in areas where there is poor access to clean water and sanitation.

The virus mostly affects children. Around 70% of infections are asymptomatic or cause mild symptoms such as headache, fever, and neck stiffness, but it can also invade the nervous system and cause paralysis and, in extreme cases when the person’s breathing muscles are paralysed, it can kill. In some survivors, the nerve damage can cause post-polio syndrome, a disorder in which they may have muscle weakness that deteriorates over time, causing pain and fatigue and leaving them disabled.

There are three wild types of poliovirus (WPV) – type 1, type 2, and type 3. Type 2 was declared eradicated in September 2015, with the last case detected in India in 1999. Type 3 was declared eradicated in October 2019, having last been detected in November 2012. Type 1 remains in Afghanistan and Pakistan.

Vaccine development

There are two types of polio vaccines – an inactivated (killed) polio vaccine (IPV) developed by Dr Jonas Salk and first used in 1955, and a live attenuated (weakened) oral polio vaccine (OPV) developed by Dr Albert Sabin and first used in 1961.

IPV is made from inactivated wild-type poliovirus strains of each type; it is an injectable vaccine and in many countries is given with other routine childhood immunisations such as against diphtheria, tetanus and pertussis.

OPV consists of a mixture of live attenuated poliovirus strains of each of the three serotypes. It is safe and effective, however, the use of OPV in areas with poor water and sanitation can occasionally have an unwanted side effect – the live vaccine-virus shed by vaccinated individuals can in very rare cases mutate and spread in communities that are not fully vaccinated against polio.

The lower the population immunity, the longer the vaccine-derived virus can spread. This version of the virus can sometimes regain its ability to damage the nervous system and lead to paralysis – this is called a circulating vaccine-derived poliovirus (cVDPV).

Although IPV is an effective vaccine and valuable in countries with zero incidence of polio, it is better used as a precaution, since it does not trigger the same immune response as OPV and therefore is not as effective in stopping active poliovirus transmission. OPV induces mucosal immunity in the intestine, the primary site where poliovirus replicates – in this way, the vaccine prevents shedding of the virus into the environment and can limit or stop person-to-person transmission. This is critical in communities with poor water and sanitation, where people are more likely to be exposed to water-borne pathogens.

Thus, although IPV has recently been introduced into routine immunisation programs in Gavi supported countries, OPV is still needed in countries where transmission needs to be stopped.

The last mile to eradication

The polio eradication effort was badly hit by the pandemic, but is now regaining ground. One new weapon in the arsenal is a new vaccine – the novel oral polio vaccine (nOPV2) – which has been modified to be more genetically stable than the Sabin strain and less likely to cause cases from vaccine-derived virus.

In November 2020, nOPV2 received a recommendation for use under WHO’s Emergency Use Listing (EUL) procedure to be able to roll it out rapidly. As of June 2022, approximately 370 million doses of nOPV2 have been administered in 20 countries – including Benin, Cameroon, Congo, Djibouti, Egypt, Ethiopia, The Gambia, Guinea-Bissau, Liberia, Mauritania, Mozambique, Niger, Nigeria, Senegal, Sierra Leone, Tajikistan and Uganda.

The high demand for this vaccination, however, is causing a supply constraint that the GPEI is working to ease. The GPEI advises that in situations where there is co-circulation of poliovirus strains, trivalent oral polio vaccine (tOPV) may be the best choice of vaccine.

Considerable challenges remain in eradicating polio in the two endemic countries. In Pakistan, difficulties in accessing high-risk mobile communities remain, and this is exacerbated by people refusing to get their vaccinated children because of misinformation or community fatigue, as well as low routine immunisation coverage in some parts of the country.

Afghanistan shares many of these challenges, including vaccine hesitancy, with the added challenge of decades of conflict and insecurity leading to fragile health systems that are unable to sustain routine immunisations. This has meant that many communities are missed or under-vaccinated, leaving children at risk of polio.

Now that polio vaccination programs have resumed, eradication efforts have stepped up, ramping up vaccine coverage by boosting vaccine supply and engaging the trust of communities to overcome misinformation and awareness of the need for the vaccine, which can mean bringing in community and religious leaders .

The last mile to ending polio has been in sight for years, but the pandemic has thrown progress off course. While the road to eradication remains challenging, the ability of polio to re-emerge unexpectedly proves the need to continue to strive towards ensuring a polio-free world. For now, the disease is endemic in two low-income countries; There is no guarantee it will stay that way.

New global alliance launched to end AIDS in children by 2030


Globally, only half (52%) of children living with HIV are on life-saving treatment, far behind adults where three quarters (76%) are receiving antiretrovirals, according to the data that has just been released in the UNAIDS Global AIDS Update 2022 Concerned by the stalling of progress for children, and the widening gap between children and adults, UNAIDS, UNICEF, WHO and partners have brought together a global alliance to ensure that no child living with HIV is denied treatment by the end of the decade and to prevent new infant HIV infections.

The new Global Alliance for Ending AIDS in Children by 2030 was announced by leading figures at the International AIDS Conference taking place in Montreal, Canada.

In addition to the United Nations agencies, the alliance includes civil society movements, including the Global Network of People living with HIV, national governments in the most affected countries, and international partners, including PEPFAR and the Global Fund. Twelve countries have joined the alliance in the first phase: Angola, Cameroon, Côte d’Ivoire, the Democratic Republic of the Congo (DRC), Kenya, Mozambique, Nigeria, South Africa, Uganda, the United Republic of Tanzania, Zambia, and Zimbabwe.

Consultations by the alliance have identified four pillars for collective action:

  1. the treatment gap for pregnant and breastfeeding closing adolescent girls and women living with HIV and optimizing continuity of treatment;
  2. preventing and detecting new HIV infections among pregnant and breastfeeding adolescent girls and women;
  3. accessible testing, optimized treatment, and comprehensive care for infants, children, and adolescents exposed to and living with HIV; and
  4. addressing rights, gender equality, and the social and structural barriers that hinder access to services.

Addressing the International AIDS Conference, Limpho Nteko from Lesotho shared how she had discovered she was HIV positive at age 21 while pregnant with her first child. This led her on a journey where she now works for the pioneering women-led mothers2mothers programme. Enabling community leadership, she highlighted, is key to an effective response.

“We must all sprint together to end AIDS in children by 2030,” said Ms Nteko. “To succeed, we need a healthy, informed generation of young people who feel free to talk about HIV, and to get the services and support they need to protect themselves and their children from HIV. mothers2mothers has achieved virtual elimination of mother-to-child transmission of HIV for our enrolled clients for eight consecutive years—showing what is possible when we let women and communities create solutions tailored to their realities.”

The alliance will run for the next eight years until 2030, aiming to fix one of the most glaring disparities in the AIDS response. Alliance members are united in the assessment that the challenge is surmountable through partnership.

“The wide gap in treatment coverage between children and adults is an outrage,” said UNAIDS Executive Director Winnie Byanyima. “Through this alliance, we will channel that outrage into action. By bringing together new improved medicines, new political commitment, and the determined activism of communities, we can be the generation who end AIDS in children. We can win this – but we can only win together.”

“Despite progress to reduce vertical transmission, increase testing and treatment, and expand access to information, children around the world are still far less likely than adults to have access to HIV prevention, care, and treatment services,” said UNICEF Executive Director Catherine Russell. . “The launch of the Global Alliance to End AIDS in Children is an important step forwardand UNICEF is committed to working alongside all of our partners to achieve an AIDS-free future.”

“No child should be born with or grow up with HIV, and no child with HIV should go without treatment,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “The fact that only half of children with HIV receive antiretrovirals is a scandal, and a stain on our collective conscience. The Global Alliance to End AIDS in Children is an opportunity to renew our commitment to children and their families to unite, to speak and to act with purpose and in solidarity with all mothers, children and adolescents.”

Dr Osagie Ehanire, Minister of Health of Nigeria, pledged to “change the lives of children left behind” by putting in place the systems needed to ensure that health services meet the needs of children living with HIV.

Nigeria, Dr Ehanire announced, will host the alliance’s political launch in Africa at a Ministerial meeting in October 2022.


The Joint United Nations Program on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, TwitterInstagram and YouTube.


UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. Across more than 190 countries and territories, we work for every child, everywhere, to build a better world for everyone. Follow UNICEF on Twitter and Facebook.

About WHO

Dedicated to the well-being of all people and guided by science, the World Health Organization leads and champions global efforts to give everyone, everywhere an equal chance at a safe and healthy life. We are the UN agency for health that connects nations, partners emerging and people on the front lines in 150+ locations – leading the world’s response to healthncies, preventing disease, addressing the root causes of health issues, and expanding access to medicines and health care . Our mission is to promote health, keep the world safe and serve the vulnerable. Learn more at www.who.int and follow WHO on TwitterFacebook, Instagram, LinkedIn, TikTok, Pinterest, Snapchat, YouTube, and Twitch.

GOP Reversal Imperils Burn Pits Bill to Treat Veterans


WASHINGTON — A broadly supported bill to expand medical care eligibility for millions of veterans who may have been exposed to toxins from burning pits of trash on US military bases has become ensnared in a partisan fight over spending, leaving its uncertain fate after a large group of Republicans pulled their support.

The legislation, which would be one of the largest expansions of veterans benefits in history, had been expected to easily pass the Senate last week after receiving an overwhelming bipartisan vote in the House. An earlier version passed the Senate in June on a lopsided vote, with 34 Republicans voting in favor.

But Republicans abruptly withdrew their backing, with all but eight opposed to moving forward on it last week. They did so after Senator Patrick J. Toomey, Republican of Pennsylvania, raised concerns that the measure — which would create a new entitlement program within the Department of Veterans Affairs to finance treatment for veterans exposed to toxins — could lead to vast increases spending.

The reversal also came after Democrats struck a surprise deal to push through a sweeping climate, energy and tax plan this month over unified Republican opposition — a central piece of their domestic agenda that Republicans have derided as a spending spree.

Senator Chuck Schumer, Democrat of New York and the majority leader, said on Sunday that he planned to schedule another vote on the veterans bill this week.

Republicans’ turnabout has stunned proponents in Congress and veteran groups who had seen the burn pits legislation, a top priority of President Biden, as a done deal.

In the days since, veterans have gathered at the Capitol on the steps leading to the Senate, holding signs, photographs of lost loved ones and flags protesting the delay and vigil, even during rain over the weekend. The comedian Jon Stewart, a leading activist on the bill, said at a news conference last week that the veterans were not planning to leave until lawmakers took action.

Exposure from trash fires is believed to have led to a number of ailments and respiratory illnesses among veterans such as bronchial asthma, allergic rhinitis, sleep apnea, bronchitis and sinusitis, as well as different kinds of cancer. The issue has been especially poignant for Mr. Biden, who has speculated that toxic exposure contributed to the death of his son Beau Biden, who died in 2015 several years after serving in Iraq.

The measure would create a new, guaranteed funding stream — not subject to congressional appropriations — for treating veterans exposed to toxins. Republicans warned that could lead to vast, unchecked spending by the Department of Veterans Affairs.

“We want to make sure the PACT Act is not used as a vehicle to increase spending outside of the objective of the bill, which is to cover specific health care and benefits for veterans,” Mr. Toomey said last week.

He proposed imposing an annual cap and ending the entitlement after 10 years, meaning the funding to care fors exposed to toxins would not be guaranteed unless Congress voted to provide it.

Denis McDonough, secretary of the VA, said on CNN’s “State of the Union” on Sunday that the proposal would lead to the “rationing of care for vets.”

Senator Jon Tester, Democrat of Montana and the chairman of the Veterans Affairs Committee, decried Republicans’ reversal, saying that by blocking the bill’s enactment benefits, they essentially “took away from the people who have been impacted by a war that we set off.” ”

Mr. Tester and some other Democrats said they plan to apply pressure on Republicans to get them to switch positions again and support the bill. Mr. Schumer has said he will allow Republicans a chance to offer their own proposal for funding the measure.

At issue is legislation that would affect an estimated 3.5 million veterans and rival the Agent Orange Act that increased access to care for Vietnam War veterans exposed to the toxic substance that was used as an herbicide and endangered generations of Vietnamese, Laotians and Cambodians.

The bill would make it easier for American service members stationed in a combat zone for the past 32 years to be eligible for VA medical care and allocate a projected $280 billion over the next decade to treat ailments tied to those exposures.

It also orders the department to recognize dozens of cancers and illnesses that could be linked to toxic exposure and include such exposures in patient questionnaires to reach patients who might be unaware that their condition could be linked to burn pits. Benefits would be phased in over time, meaning veterans discharged more recently would have to wait more than a decade to receive care.

As of July, more than a third of all veterans to Southwest Asia since Sept. 11, 2001, have submitted a disability claim for compensation related to respiratory conditions, making them the most common ailments, according to the agency. Of those who filed a claim, only 64 percent were granted.

Advocacy groups that have been tracking the legislation said they had been heartened by reports that the measure could soon be back on track.

Sarah Verardo, CEO of The Independence Fund, a nonprofit organization dedicated to helping wounded veterans, said the group has “been monitoring congressional movement over the weekend” and is “very optimism in leadership tone shift.”

When prescription costs add up, MedAssist helps county residents pay for insulin, inhalers and EpiPens | News


Santa Clara County resident Henry has been diabetic for nearly his entire adult life, and he started taking insulin about three years ago to treat his illness. But between him and his wife, Mary, who together battle a number of chronic illnesses, the medical expenses started to pile up.

The couple heard about MedAssist, a Santa Clara County program that helps county residents with the cost of a few specific types of medications: insulin, asthma inhalers and epinephrine auto-injectors, also known by the brand name EpiPens, which delivers life-saving medication in the event of a severe allergic reaction.

According to county data, 118,900 adults have diabetes mellitus in Santa Clara County, 257,000 adults and children have asthma and 21,600 individuals are prescribed epinephrine auto-injectors.

“So we thought, well, let’s see if we qualify,” said Mary. This news organization agreed to identify her and her husband by their middle names to protect their privacy. “We were, I think, among the early enrollees, so the process was very, very quick.”

Henry was accepted into the inaugural 2021-22 program year, and has just re-enrolled for 2022-23, for which the county is currently accepting applications. Patients can apply until April 30, while funding lasts. Once funding is exhausted, the county will open a waitlist.

Qualification and the amount of financial assistance for the program is based on the patient’s income level and the health care expenditures, according to Joy Alexiou, Santa Clara Valley Health and Hospital System communications officer.

“People with high out-of-pocket expenditures receive monthly grants that inversely correlate to their income levels,” Alexiou said, meaning that the lower someone’s income is, the higher the grant.

Mary said the enrollment process was simple: The couple had to upload a tax return, proof of purchase of Henry’s insulin and proof of residency in the county.

“That’s really all there was,” Mary said. “They got back to us within 24 hours. We just enrolled for the second year, and the process was slower, but I think that there are probably many more people now queued up in front of their door. Once we were approved, the process was quick.”

Each month, Mary said, she and Henry submit proof of purchase of his insulin to the program.

“His use of insulin is variable, so we have to give a little bit of thought to trying to make sure that we make a purchase every month,” Mary said. “Or, alternatively, there are times where the pharmacy dispensed a lot more to us than we were expecting. It turns out we can upload that, and if when we uploaded it we marked it as a three-month supply, then they would credit the three months.”

The rising cost of medications in the United States is a major barrier to access, causing some people to take their medications less frequently than prescribed, Alexiou said. Insufficient treatment of diabetes can accelerate vision loss, end-stage renal disease and death. To help county residents with the cost of these vital medications, Supervisor Joe Simitian proposed the program, which the county Board of Supervisors approved and then soft-launched in October 2021.

“The program is specifically designed to support the ‘missing middle’ population who reside in Santa Clara County,” Alexiou said. “These are the individuals who may be enrolled in a health insurance program, however, (they) are forced to pay high out-of-pocket costs for life-saving medications such as insulin, asthma inhalers and/or epinephrine auto-injectors. “

For Mary and Henry, being MedAssist recipients means more peace of mind and one less medical expense to fret over.

“It’s just lovely to have this benefit, given we have such a huge amount of out-of-pocket medical expenses,” Mary said. “This is just a nice thing to have. It’s very easy, and they are absolutely lovely over there. … You get the sense that they are delighted to be helping you.”

To apply for MedAssist, recipients must be 18 years or older, reside in Santa Clara County, have a valid prescription for an asthma inhaler, insulin or epinephrine auto-injector and meet household out-of-pocket health care spending and annual gross household income requirements. More information and a link to apply can be found at scvmc.org.

Vaccines for Monkeypox Prevention: Jynneos and ACAM2000


Jynneos ACAM2000 Company Bavarian Nordic, Inc. Emergent BioSolutions Inc. Generic Name and Formulation Smallpox and monkeypox vaccine, live, non-replicating; contains 0.5–3.95×108 infectious units of MVA-BN live virus; per 0.5mL dose; suspension for subcutaneous (SC) injection; preservative-free. Smallpox (vaccinia) vaccine, live; contains 2.5–12.5×105 plaque forming units; per 0.0025mL dose; lyophilized powder for percutaneous scarification after reconstitution; contains trace amounts of neomycin, polymyxin B. Pharmacological Class Vaccine. Vaccine. Indication Prevention of smallpox and monkeypox disease in adults determined to be at high risk for smallpox or monkeypox infection.

Active immunization against smallpox disease for persons determined to be at high risk for smallpox infection.


Allowed for use against monkeypox under an Expanded Access IND.


≥18yrs: Give by SC injection, preferably into the upper arm (deltoid).


Administer 2 doses (0.5mL each) 4 weeks apart.


Immune response takes 2 weeks after the second dose for maximum development.


<18yrs: not established.

See full labeling for instructions on vaccine preparation, administration, site care, and interpretation of response to vaccination.


≥17yrs: Give by percutaneous route (scarification) into the upper arm (deltoid) only after proper training.


Clean the injection site area using an alcohol swab(s), if necessary. Allow skin to dry thoroughly to prevent inactivation of the live vaccine virus by the alcohol.


Pick up a droplet (0.0025mL) of reconstituted vaccine solution using a bifurcated needle and deposit onto the vaccination site. Rapidly make 15 jabs of the needle perpendicular to the skin through the droplet to puncture skin, within a diameter of about 5mm.


Vaccination site may be covered with loose gauze bandage or semipermeable dressing.


Immune response takes 4 weeks for maximum development.


Repeat vaccination every 3 years in those at continued high risk of exposure.


<17yrs: not established.

Contraindications None. Severe immunodeficiency, including those who are undergoing bone marrow transplantation or those with primary or acquired immunodeficiency who require isolation. Boxed Warning None.

Risk for serious complications including: myocarditis and/or pericarditis in healthy adults; encephalitis, encephalomyelitis, encephalopathy, progressive vaccinia, generalized vaccinia, severe vaccinial skin infections, erythema multiforme major (including Stevens-Johnson Syndrome), eczema vaccinatum resulting in permanent sequelae or death, ocular complications, blindness, and fetal death following either primary revaccination.


Increased risk of these complications, which may result in severe disability, permanent neurological sequelae and/or death, with the following conditions: cardiac disease or history of, eye disease treated with topical steroids, congenital or acquired immune deficiency disorders (including those taking immunosuppressants ), eczema or history of, other exfoliative skin conditions, infants <12mos of age, pregnancy.


Risk of transmitting live vaccinia virus to persons who have close contact with the recipient; The risks in close contacts are the same as the recipient. Weigh risk of serious vaccination complications against the risk of a potentially fatal smallpox infection

Warnings and Precautions

Have appropriate medical treatment available to manage possible anaphylactic reactions.


Immunocompromised: may have diminished immune response.


Vaccination may not protect all recipients.

Pregnancy: available data in sufficient to inform vaccine-associated risks.


Nursing mothers: data not available to assess effects in breastfed infant or on milk production; consider clinical need vs potential adverse effects.


Elderly: studies did not include sufficient number to determine a difference in response compared with younger patients.

See Boxed Warning.


Known cardiac disease (eg, previous MI, angina, CHF, cardiomyopathy, chest pain, shortness of breath with activity, stroke or TIA, other heart conditions).


Diagnosed with ≥3 risk factors for ischemic coronary disease (eg, high BP, elevated blood cholesterol, diabetes, family history of heart condition <50yrs of age, smokers).


Accidental infection of the eye may result in ocular complications (eg, keratitis, corneal scarring, blindness).


Do not inject by the intradermal, SC, IM, or IV route.


Avoid contact with skin, eyes, or mucous membranes.


Avoid blood and organ donation for at least 30 days after vaccination.


Vaccination may not protect all recipients.


Children: may be associated with increased risk of serious complications, especially in infants <12 months old.


Elderly (>65yrs): not studied.


Pregnancy: may cause fetal infection, resulting in stillbirth or death.


Nursing mothers: can be transmitted to infants.

Drug Interactions None.

Concomitant use with corticosteroid eye drops may increase risk of ocular complications.


May induce false (+) tests for syphilis.


May induce false (–) results for tuberculin skin test, and possibly, blood tests for tuberculosis; if possible, delay tuberculin test for 1 month after vaccination.


Do not put salves or ointments on the vaccination site.

Adverse reactions

Most common in vaccine-naïve healthy adults: Injection site reactions (eg, pain, swelling, redness, induration, itching), muscle pain, headache, fatigue, nausea, and chills.


Most common in previously vaccinated healthy adults: Injection site reactions (eg, redness, pain, induration, swelling, itching), fatigue, headache, and muscle pain.

Common: Inoculation site signs/symptoms, lymphadenitis, and constitutional symptoms (eg, malaise, fatigue, fever, myalgia, headache).


Inadvertent inoculation at other sites is the most frequent complication. Most common sites: face, nose, mouth, lips, genitalia and anus.


Self-limited skin rashes not associated with vaccinia replication: urticaria and folliculitis.

How Supplied Single-dose vials—20.

Multiple-dose vial (3mL)—1 (w. bifurcated needles, tuberculin syringes).


After reconstitution with 0.3mL of diluent, the vial contains approximately 100 nominal doses of 0.20025mL of vaccinia virus (live).

How to tell if you have chickenpox or monkeypox


With all the furore about monkeypox recently, I have gotten confused over all the pox diseases. First of all, what is box?

A pox disease simply means any sort of viral disease characterised by pustules or eruptions ie pus-filled bumps on your skin.

In medieval times, the term box was synonymous with syphilis, as it was rampant then. (“You’ve got the pox!” says a medieval doctor to a medieval sailor.)

There are plenty of viruses that can cause pox-like diseases in both humans and animals.

What sort of viruses cause pox?

The first outbreak of monkeypox outside Africa was found in the United States in 2003 and linked to contact with infected pet prairie dogs. — AFPSome of the more famous ones are:

  • variola virus: smallpox
  • vaccinia virus: cowpox, which was used to make the first vaccine to eradicate smallpox
  • molluscum contagiosum: a benign, mild skin disease that resolves slowly which has small, raised lesions with a dimple or pit in the centre. May be be spread though sharing towels at a public swimming pool area or a sauna.
  • Chickenbox
  • Smallbox
  • Monkeybox.

Let’s talk about monkeypox. Does it come from monkeys?

The natural hosts of the monkeypox virus are many types of animals, not just monkeys. They include rope squirrels, tree squirrels, Gambian pouched rats, dormice and primates – which include monkeys and apes.

The monkeypox virus itself is a DNA virus that belongs to one of the poxvirus families.

Did monkey pox originate in Africa?

It is likely. It was identified in humans in 1970 in the Democratic Republic of the Congo.

Everyone thought smallpox had been eradicated, and then, suddenly, a baby manifested a pox-like disease. It began to spread in the Congo basin and West Africa.

There have been many outbreaks since, but mostly contained in Africa. Then in 2003, the first monkeypox outbreak outside Africa was documented in the United States.

It was associated with contact to infected pet prairie dogs, which had been housed with Gambian pouched rats and dormice that had been imported from Ghana.

The 2003 outbreak led to over 70 cases of monkeypox in the US alone. Then in 2018, monkeypox was found in travelers from Nigeria to Israel, and the United Kingdom. Between 2019 and 2021, it was also found in Singapore and the US.

How will I get monkeypox?

It can jump from an animal to human first via blood, body fluids or fluid from the lesion itself. This is called a zoonotic transmission.

Then it can spread from human to human via respiratory secretions, skin lesions or even contaminated objects like used forks and towels.

So how do I know I have monkeypox as opposed to chickenpox or smallpox?

This picture shows the chickenpox rashes at various stages of development.  — FilepicThis picture shows the chickenpox rashes at various stages of development. — FilepicYou are not likely to have smallpox as it has been largely eradicated around the world.

It can be very difficult to tell whether you have monkeypox or chickenpox since the pests look the same. Only a diagnostic test will be able to tell you.

Monkeypox is caused by the monkeypox virus, a member of the orthopoxvirus family.

Chickenpox is caused by varicella zoster virus, and smallpox by variola, which is also a member of the monkeypox family.

For monkeypox, the fever occurs one to five days before the pox rash appears.

For chickenpox, the fever comes quite swiftly, a mere one to two days before the rash.

For smallpox, it is two to four days.

During the fever period, you can have headache, back pain, muscle ache and fatigue which are characteristic of most viral diseases.

Do the rashes between monkeypox and chickenpox appear on the same body parts?

For monkeypox, the rash often starts on your face, then spreads to other body parts, such as your palms and soles. It can also affect your lips, genitals and eyes.

The rash starts off as a red lesion, called a macule. Then it gets raised and firm, which is called a papule. (This is termed as a maculopapular rash, and both macules and papules can appear at the same time.)

Then later, they become vesicles, which are lesions filled with clear fluid.

After that, the vesicles become pustules, which are filled with yellowish cloudy fluid. These eventually form a scab, which then falls off.

For chickenpox, you first get the itchy, blister-like rashes on your chest, back and face. Then it spreads to your entire body. Chickenpox never appears on your palms and soles.

Unlike chickenpox or smallpox, monkeypox can give you swollen lymph nodes.

Monkeybox typically is mild and can last between two to four weeks. It is fatal only in 3% to 6% of cases, and mostly in children. This is unlike smallpox, which is used to be fatal in one third of cases.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, email [email protected] The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.


Management of February Seizures in Pediatrics: Is a Lumbar Puncture Necessary?


Children with simple febrile seizures (SFS) can be managed without lumbar puncture (LP) testing, according to findings published in Pediatrics.

With Haemophilus influenzae and conjugated pneumococcal vaccines, the prevalence of bacterial meningitis has decreased in pediatric patients. In 2011, the American Academy of Pediatrics (AAP) began advising doctors not to conduct a routine LP in children under 1 year old and only use it for children with signs and symptoms of meningitis, if they are not fully vaccinated, or have been pretreated with antibiotics. The AAP also advised against routine hematologic testing, neuroimaging, or electroencephalography (EEG).

The objective of the current study was to analyze the impact of this change in practice guidelines as it relates to the clinical management of children SFSs at emergency departments at children’s hospitals in the US.

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The researchers analyzed data from the Pediatric Health Information System (PHIS) of data from 49 not-for-profit, tertiary care pediatric hospitals affiliated with the Children’s Hospital Association. They included first emergency department visits between 2015 and 2019 of children aged 6 to 60 months diagnosed with SFS. They excluded patients who died during the ED encounter and those with preexisting complex chronic conditions. Delayed diagnosis of bacterial meningitis was defined as diagnosis at a revisit within 3 days of an index encounter that did not include LP.

The researchers identified 49,668 visits before and 92,453 visits after publication of the AAP guidelines. Patients’ (42.4% females) median age at presentation was 20.8 months.

The of children who underwent LP decreased from 11.6% in 2005 to 0.6% in 2019 (P <.001), particularly among children aged 6 to less than 12 months (28.3% to 1.0%). The percentage of children aged 1 year to 5 years who received the procedure dropped from 9.4% in 2005 to 0.6% in 2019.

While 3-day revisits increased from 0.5% in 2005 to 1.4% in 2019, decreases in head computed tomography (CT) (10.6% in 2005; 1.6% in 2019), complete blood counts (38.8% in 2005; 10.9% in 2019 ), serum chemistries (27.5% in 2005; 11.0% in 2019), and urinalysis (31.4% in 2005; 22.3% in 2019), intravenous antibiotics (17.7% in 2005; 3.3% in 2019), and SFSs (19.2% in 2019). 2005; 5.2% in 2019 (over the period)P <.001 for all) did not reverse with the 2011 AAP guideline change.

Adjusting for health care inflation, the researchers found that mean inflation-adjusted decreased costs from $1,523 in 2005 to $605 in 2019 (P <.001).

Declines in hospital admissions and costs plateaued after the 2011 AAP guidelines. The rate of delayed diagnosis of bacterial meningitis did not significantly decrease during the period.

Study limitations included lack of knowledge of presenting signs and symptoms, inability to exclude underimmunized children, uncertainty of whether the patients had previous February seizures outside the facilities or the time period, and identification by SFS code.

“Diagnostic testing, hospital admission, and decreased costs over the study period, without a concomitant increase in delayed diagnosis of bacterial meningitis. These data suggest most children with SFSs can be safely managed without lumber puncture or other diagnostic testing,” the researchers concluded.


Raghavan VR, Porter JJ, Neuman MI, et al. Trends in management of simple febrile seizures at US children’s hospitals. Pediatrics. November 1, 2021. doi: 10.1542/peds.2021-051517

Comparing gastroenteritis and colitis: What are the differences?


Gastroenteritis and colitis are two conditions that involve inflammation of the digestive tract. Although both can cause abdominal pain and diarrhea, they often have different causes and may require different treatment approaches.

Gastroenteritis is inflammation of the stomach and intestines that typically occurs due to a viral or bacterial infection. Diarrhea ranging from mild to severe is the most common symptom. Other symptoms people typically experience are nausea and vomiting. People can usually recover without treatment, although hydration is important in the healing process.

Most cases of colitis are chronic, and risk factors can include genetics and medications. However, some cases can be acute and occur due to infections, such as Clostridioides difficile (C. difficile).

Keep reading to learn more about the link between gastroenteritis and colitis, including how the symptoms and treatment for both conditions compare.

Colitis and gastroenteritis share some similarities. For example, both conditions:

However, there are some key differences between the two conditions. These include:

  • The location of inflammation: Gastroenteritis involves the stomach and intestines, whereas colitis only involves the colon.
  • Symptoms: People with gastroenteritis might experience nausea and vomiting, whereas people with colitis may experience bloody diarrhea.
  • Chronicity: Colitis is more of a chronic condition.
  • Causes: In the case of gastroenteritis, an infection may be the cause.
  • Resolution: Gastroenteritis will likely resolve on its own, whereas colitis may require medical attention.

Dehydration is a complication that commonly occurs in people with viral gastroenteritis. This happens when a person loses too much fluid and electrolytes through vomiting and diarrhea.

If someone has colitis, it means there is inflammation in the lining of their colon.

The most common type of colitis is ulcerative colitis, which causes ulcers or sores. The can inflammation extend from the rectum to the inner lining of the colon.

Other types of colitis include:

  • Crohn’s colitis, a type of Crohn’s disease
  • microscopic colitis, which has two types: lymphocytic and collagenous
  • ischemic colitis, which due to . occurs reduced blood flow to the colon
  • pseudomembranous colitis, which is often the result of an infection with C. difficile bacteria

Cytomegalovirus, a common strain of the herpes virus, can also cause colitis.

Learn more about colitis, including the different types.

People may refer to gastroenteritis as stomach flu. It is not a type of flu that affects the respiratory system. In a person with gastroenteritis, the lining of the intestines has become inflamed. Viruses, bacteria, or parasites can cause the condition.

Viral gastroenteritis is the second most common illness in the United States. Often a norovirus infection is the cause of this condition. The virus spreads through contaminated food or water or contact with a person who has the infection.

Learn more about bacterial gastroenteritis.

Some symptoms of colitis and gastroenteritis might overlap.


Colitis symptoms vary between the different types and from person to person.

Common symptoms of ulcerative colitis include:

Additionally, an individual may experience an urge to move the bowels even though they are empty or sudden urgency to move the bowels.


Symptoms of viral gastroenteritis may include:

The causes of colitis and gastroenteritis might also overlap. For example, infections can cause both conditions. Other causes can include the following:


Various conditions can cause colitis. These include infection, inflammatory bowel disease, ischemia, radiation, certain drugs, and abnormal reactions of the immune system. Doctors refer to colitis that results from an immune reaction as microscopic colitis. Colitis can also occur in some people who have immune deficiency disorders.

Doctors are not entirely sure of the causes of ulcerative colitis but think it could involve:

  • genetics
  • an altered gut microbiome
  • abnormal immune reactions
  • environmental causes

Other types of colitis may have specific causes. For example, in pseudomembranous colitis, C difficile infection is usually the cause. However, inflammatory conditions, disruption to blood flow, and certain medications can contribute.


Gastroenteritis is an infectious illness that viruses, bacteria, or parasites can cause. Norovirus is usually the cause, but other viruses could be involved, including:

Doctors may recommend specific treatments for people with colitis and gastroenteritis.


Doctors treat colitis according to the cause. For example, ulcerative colitis may require Medications to reduce inflammation, such as corticosteroids or immunosuppressants. However, if these medications do not successfully ease symptoms or the individual has complications, a doctor may recommend surgery to remove the colon and rectum.

Likewise, if someone has Crohn’s disease, doctors may prescribe medications to suppress their immune response. They may also recommend dietary changes, and surgery may become necessary if medications cannot control the symptoms.

If an individual has pseudomembranous colitis because of a C. difficile infection, doctors may prescribe antibiotics such as metronidazole, vancomycin, or fidaxomicin.


Treatment of viral gastroenteritis is much more straightforward, and many people recover without medical treatments. However, it is important to replace lost fluids and electrolytes if a person has severe diarrhea.

In some cases, adults may take some over-the-counter medicines to treat diarrhea due to viral gastroenteritis. People should speak with a doctor before taking these medications, especially if they are experiencing bloody diarrhea or fever.

Sometimes it is not possible to prevent a person from developing colitis.

However, people can help Prevent infectious forms of colitis and viral gastroenteritis by following basic hygiene practices, including:

  • washing the hands thoroughly with soap and water after using the bathroom or changing diapers and before handling food or visiting a healthcare facility
  • Disinfecting bathroom and kitchen surfaces
  • using disposable gloves and washing hands after contact with someone who is ill
  • washing clothing or bedding of an ill person with soap and chlorine bleach

Any individual who develops diarrhea and has dehydration symptoms should seek medical attention immediately, as severe dehydration may require hospital treatment.

People with the following symptoms should also contact a doctor immediately:

  • diarrhea lasting more than 2 days
  • frequent vomiting
  • high fever
  • severe pain in the abdomen or rectum
  • black tarry stools
  • stools with bright red blood or mucus
  • weakness or excessive fatigue

Older adults, pregnant people, and those with a weakened immune system or other health conditions should also seek their doctor’s advice if they have symptoms of colitis, gastroenteritis, or dehydration.

Gastroenteritis and colitis are two gastrointestinal disorders that can cause abdominal pain, diarrhea, and other symptoms. While these conditions share some similarities, they are not the same.

Gastroenteritis, or stomach flu, is an inflammation of the stomach and intestines that usually results from a viral or bacterial infection. It is typically an acute, short-lived problem. Prevention of gastroenteritis usually involves good hygiene practices.

Colitis refers to a group of conditions that involve inflammation of the colon and are usually chronic. Examples include ulcerative colitis and Crohn’s disease.

If a person experiences severe symptoms of either condition, it is important to contact a doctor right away.


How Long Does Bronchitis Last: Treatment and Recovery Time


If you think you have bronchitis, it’s normal to wonder how long it takes to get over it. In many cases, a doctor won’t prescribe anything except rest and over-the-counter treatments. So how long will you have to endure this hacking, productive cough?

Figuring out how long your bronchitis will last is a complicated question. There are two different types of bronchitis, acute (short-term) and chronic (long-term). Within each type, there can be multiple causes. Individual causes have unique treatments and recovery times.

Generally, acute bronchitis caused by an infection will last a few weeks, but chronic bronchitis caused by pollution or smoking can last months and come back yearly. Either way, you’ll probably have a worn-out, bronchitis-fatigue feeling for several weeks.

This article will review the types of bronchitis, their causes, and how long they last.

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Chronic vs. Acute Bronchitis

There are two main kinds of bronchitis—acute and chronic. During bronchitis, the tubes that lead from your windpipe into your lungs (called the bronchi) swell up and produce protective mucus that triggers coughing.

The more common and less severe type of bronchitis is acute bronchitis. An infection like the common cold or flu triggers acute bronchitis. This infection can be a virus or (less often) bacteria or fungi. With acute bronchitis, sometimes called a chest cold, you may still be contagious.

Without complications, acute bronchitis lasts less than three weeks. You should be able to recover on your own, without prescription medication. Rest and over-the-counter medications to treat your cough, loosen mucus, and ease pain and fever should be enough to treat your symptoms.

The second trigger for bronchitis is environmental and causes chronic bronchitis. Long-term exposure to pollutants or tobacco smoke irritates the bronchi and causes the buildup of mucus.

Chronic bronchitis is a type of chronic obstructive pulmonary disease (COPD), a kind of illness that makes it hard to breathe. It lasts at least three months and comes back year after year. You should get long-term treatment for it.

Symptoms of bronchitis

Though the causes of bronchitis differ, acute and chronic bronchitis have similar symptoms.

Acute bronchitis will have initial symptoms similar to a cold or respiratory infection, including:

  • A stuffy runny nose
  • Sneezing
  • Scratchy or painful throat
  • Cough
  • Headache
  • Muscle aches
  • Decreased appetite

Lingering symptoms of both acute and chronic bronchitis include:

How Long Each Lasts

Chronic Bronchitis

Chronic bronchitis lasts at least three months out of the year and recurs each year for at least two years. It can be a persistent problem that lasts for the rest of your life.

A medical professional can help treat the symptoms of bronchitis with inhalers, drugs, and other therapies. Quitting smoking can also help improve symptoms of chronic bronchitis.

While chronic bronchitis itself isn’t contagious, it can lead to frequent colds, flu, and other respiratory illnesses that can spread to other people.

Acute Bronchitis

Generally, you should be feeling better from acute bronchitis within a week or two, though you may have a lingering cough and fatigue for three weeks or more.

The types of viruses and bacteria that cause bronchitis will usually have been in your system from two to six days before you start feeling cold symptoms. Once you start feeling sick, you’ll feel like you have a cold or flu that lasts a few days to up to 10. Other symptoms may resolve, but you can develop a lingering cough for potentially a few weeks.

Bronchitis, especially if it’s viral, can be passed on to others just hours after you come into contact with it, long before you develop symptoms. You’ll be contagious through the cold or flu sickness phase—at least a few days, maybe even a week.


A doctor will only prescribe antibiotics for bronchitis if they think bacteria are causing your symptoms and you’re at high risk of the infection not resolving on its own. This may apply to you if you are older, frail, or have other conditions that may make bronchitis worse. Antibiotics won’t heal your viral bronchitis any faster.


The prolonged coughing and irritation from bronchitis can cause some complications. Extended or aggressive coughing fits can irritate or injure the tissues in the throat, causing bleeding and injury.

The irritation of the airways can allow bacteria to move in and set up shop, creating a new “secondary” infection that’s different from what initially caused your bronchitis.

Bronchitis can also turn into pneumonia, a more severe and potentially deadly infection of your lungs. The lungs fill up with fluid, which makes it difficult to breathe. You may also have a fever, chills, and chest pain.

You’ll need to see a doctor for your pneumonia. If a bacteria caused your pneumonia, you’ll likely be prescribed antibiotics to treat it. Viral pneumonia will often go away on its own in a few weeks. But it may be treated with antiviral drugs if it’s severe or the patient is at risk of being hospitalized.

It may take a while to recover from pneumonia. Some feel better in a week or so. In others, the illness lingers for a month or more.

When To See a Doctor

Chronic bronchitis can get worse over time, and so it needs to be treated. You should see a doctor as soon as possible if you suspect you may have chronic bronchitis.

Most of the time, acute bronchitis should resolve on its own. But contact a medical professional if you have:

  • A temperature above 100.4 degrees Farenheit
  • Bloody mucus from too much coughing
  • Whizing and trouble breathing
  • Symptoms that persist for longer than three weeks
  • Bronchitis that goes away and comes back

If you think your bronchitis has into a secondary infection or moved into your lungs and caused pneumonia, contact a doctor.


Acute bronchitis is typically caused by an infection. It will usually begin to clear up in a week or two, but you may have a cough for three weeks. Chronic bronchitis is caused by environmental irritants. It lasts for at least three months and recurs yearly. It is a long-term condition that needs ongoing treatment.

A Word From Verywell

Chronic bronchitis is a life-long condition, but you can manage it with the help of a health professional. If you’ve been diagnosed with chronic bronchitis, it’s essential to maintain a relationship with your provider and manage your condition appropriately.

Lifestyle changes can reduce the symptoms of chronic bronchitis and prevent it from getting worse. Ask a medical professional for help quitting smoking and work on reducing your exposure to other irritants. Physical activity can help strengthen your lungs, so ask about your options. You can prevent future infections by getting vaccines for the flu and pneumonia.

Frequently Asked Questions

  • How long does a cough from bronchitis last?

    A typical case of bronchitis caused by a viral or bacterial infection lasts about a week to 10 days. If your cough does not seem to be improving or worsening after 10 days, see your doctor. If the cough lingers beyond three weeks, call your doctor.

  • How do you know when bronchitis is getting better?

    Bronchitis can make you feel miserable and not able to do much for about a week or more. The cough can keep you up at night, and you may tire quickly. You will know you are turning a corner when your chest congestion loosens and you have more energy. Your cough will likely be more productive and may sound worse, but you will start to feel better.

  • How do you know if bronchitis is turning into pneumonia?

    Bronchitis can worsen and become pneumonia. Pneumonia is a serious condition where the lungs fill with fluid and breathing becomes more difficult. Symptoms of pneumonia include:

    • Chest pain upon breathing or coughing
    • Chills
    • Diarrhea
    • Fever
    • Nausea or vomiting
    • Productive cough

    If you experience these symptoms, see your doctor.

‘Watch the quality of filtered water to prevent gut infection’


While the rains bring relief from the high heat of summer, they also bring a host of diseases, including bacterial infections. Humidity slows down the digestive system a great deal and moisture being a fertile ground for microbial growth, bacteria, parasites and the resultant toxins fuel gastric problems such as acidity, bloating, indigestion, gastroenteritis, ulcers, and Gastroesophageal Reflux Disease (GERD).

Many patients complain of vomiting, nausea, gases, chronic constipation, ulcerative colitis, gastritis, and gut sensitivity issues. “GI issues are significantly high during the season and we can take easy preventive steps,” says Dr Shanti Swaroop Dhar of Max Hospital, Panchsheel.

Why does the digestive system become sluggish during the monsoon and why do we need to be particularly careful?

Monsoon is a time of atmospheric humidity, and droplets of moisture host microbes. Therefore with increased humidity, there is an overgrowth of bacteria and the chances of infections grow multi-fold. At some times, these infections might cause a significant clinical disease and at other times, they might lead to bloating and discomfort. Another reason could be reduced physical activity as incessant rains restrict people to their homes. Finally, rains are associated with eating fatty, oily foods and that slows down the functioning of the digestive system.

How do those with already existing gastrointestinal diseases get affected? Is there a trigger and do they need to be extra careful about the same?

A lot of gastrointestinal diseases are chronic. These include inflammatory bowel disease (IBD), chronic dysepsia and ulcerative colitis. In ulcerative colitis, there can be infective relapses and in chronic dyspepsia, slight infections can trigger elevated symptoms.

Can I self-diagnose the seriousness of my gastro-intestinal condition?

If you are able to deal with uneasiness in your stomach by popping in a regular egg pill, then it is fine. But if you are unable to deal with it even after that, we recommend you seek clinical advice. This is because a lot of diseases mimic each other, for instance a heart disease could appear and feel like a gastric disease. Which is why I would suggest that an individual not go for self-management.

Can the monsoon aggravate constipation?

The monsoon does not necessarily trigger constipation but low fluid intake and exercise could expand it. Lifestyle plays a very important role in the occurrence of constipation. It also means different things for different people. For some it means not having a bowel movement, for others it is the inadequacy of bowel movement or incomplete evacuation. Thus, constipation depends upon the subset an individual has.

How does monsoon affect those with Irritable Bowel Syndrome?

Irritable Bowel Syndrome (IBS) is basically a syndromic diagnosis. It is a chronic condition in which people will have ups and downs. There are various triggers, an important one being food. If you are overloading fatty, oily, fried and savory foods, they could trigger an IBS episode. Other triggers could include infections and lack of exercise that could enhance already existing symptoms. Interestingly, some people also react to the absence of sunlight for prolonged periods on cloudy days.

Are Indians more genetically prone to GI infections?

I don’t think there is a genetic predisposition but Indians are more prone to GI infections because the hygiene levels are not top notch. Watch out as most jaundices are food and water-borne, like Hepatitis A and B.

Why are cholera, dysentery and diarrhoea emerging with greater intensity today?

This, in my understanding, is primarily a consequence of an increase in the size of cities and lack of infrastructure to accommodate people. If we do not have adequate water supply and sewage facilities for the population, then water-borne diseases will go up. Another reason is that antibiotics are used indiscriminately and an increase in antibiotic resistance among individuals is heightening the intensity of these diseases.

What diet should be followed during the monsoon? Are there particular changes that one should make?

There is no perfect diet per se, but eat healthy, do not consume food that could possibly cause infections like street food, eat at regular intervals, do not overindulge and keep a good exercise routine. It is important to highlight the importance of drinking clean water during the monsoon and be mindful of where the water is coming from.

Sometimes even drinking filtered water doesn’t protect us from GI infection. What should be done?

It is more important than ever to consume fluids during the monsoon because the body tends to lose a lot of water in the form of sweat. In case you are not suffering from diabetes or hypertension, it is also a good idea to consume some hydrating solutions everyday. Talking about filtered water, it depends upon the kind of filter that is being used, since different filters have different porosities. So choose the kind that’s most effective and trusted. An infection depends on the kind of organisms that pass through the filter. An individual cannot and should not consume water supplied in taps because it does not meet drinking standards. Some amount of filtration and water treatment is crucial to prevent infections.

What lifestyle changes shall one make to ensure effective metabolic functioning during the monsoon?

Exercise regularly, have enough fluids, drink and eat mindfully. Do not overindulge, avoid fatty and oily food and cut down on alcohol and smoking.