About Betsy Todd, MPH, RN

Former clinical editor, American Journal of Nursing (AJN), and nurse epidemiologist

Monkeypox: The Basics for Nurses

In the past, cases of monkeypox only occasionally occurred outside of central and western Africa, where the disease is endemic, and it was virtually always related to travel or to the inappropriate relocation of wild animals. (In the US in 2003, 71 cases of monkeypox in six states were traced to pet prairie dogs that had been imported in the “exotic animals” trade.) What should we make of the outbreaks this year in 23 countries where the disease is rarely seen?

Current cases of monkeypox are occurring in people without a history of travel to endemic areas, and in some cases without obvious contact to known cases. Most of these people have had mild disease, though monkeypox can cause severe disease in young children, pregnant women, and immunosuppressed individuals. While monkeypox usually is not highly transmissible nor deadly, it has never spread to so many countries seemingly simultaneously.

A close relative of smallpox.

Monkeypox is a close relative of smallpox, and the smallpox vaccine also prevents monkeypox infection.  Many experts point to the end of mass smallpox vaccination campaigns as a factor in the emergence of cases at this time. Forty years ago, about 80% of the population was vaccinated against smallpox; today that figure is only about 30%. Monkeypox cases have been on the rise since smallpox was declared to be eradicated in 1980. In one monkeypox-endemic region, cases had increased twentyfold in recent decades. At the same […]

2022-06-02T10:14:45-04:00June 2nd, 2022|infectious diseases, Public health|1 Comment
Read More

Delta, Mu, and Others: What to Know About Covid Variants

Daily Trends in COVID-19 Cases in the U.S. Reported to CDC (9-21-21): red line shows 7-day moving average. Click image to enlarge.

According to the CDC, the delta variant now makes up more than 99% of COVID-19 cases across the U.S. Recently, though, the media has been drawing attention to the mu variant. Should we worry?

How serious are variants?

Viruses constantly change. Mutations might make a virus easier to spread or more virulent, change its clinical presentation, or alter its response to tests, vaccines, or treatment. Or there may be no observable change in its characteristics at all. Some variants simply fade away; others stick around, but can’t compete with more dominant variants and never really get a “foothold” in a particular population. At this time—and this is a pretty big caveat—the COVID-19 mu variant seems stuck in this last category, at least in the U.S.

What about mu?

Although the mu variant has been identified in more than 39 countries, including the U.S., there have been only about 2,000 cases here, mostly in California, Florida, Texas, and New York. The World Health Organization (WHO) calls mu a “variant of […]

2021-09-14T14:36:42-04:00September 14th, 2021|COVID-19, infectious diseases, Nursing|1 Comment
Read More

Johnson and Johnson Vaccine a Valuable Addition to the COVID-19 Toolbox

With the emergency use authorization (EUA) of the Janssen Pharmaceuticals/Johnson & Johnson COVID-19 vaccine, three vaccines are now available in the U.S. to prevent SARS-CoV-2 hospitalizations and death. The newest vaccine, given as a single dose and stable at refrigeration temperatures for at least three months, presents far fewer logistical challenges in getting doses to consumers.

All of the three current U.S. vaccines use a single protein from SARS-CoV-2 to enable the body to react to the whole virus. The Pfizer/BioNTech and Moderna vaccines are messenger RNA vaccines that use a synthetic version of part of the SARS-CoV-2 genome to teach our cells to replicate the spike protein found on the surface of the virus. This copy of the protein then stimulates the immune system to produce antibodies and other cells that will recognize the actual virus if it is encountered in the future.

The new vaccine employs a different mechanism to produce the same result. A human adenovirus, modified to disable its ability to multiply and infect, acts as a “vector” to carry a gene from the spike protein into our own cells, where the protein is replicated and activates the immune system as above.

(The Oxford/AstraZeneca COVID-19 vaccine, currently in use in the UK, Canada, and Australia, is also a vector vaccine. Granted emergency use listing by the World Health […]

2021-03-08T12:31:39-05:00March 8th, 2021|COVID-19, infection control, infectious diseases, Nursing, Public health|0 Comments
Read More

COVID-19 Vaccines Explained

As we in the U.S. struggle to set up systems for the rapid administration of SARS-CoV-2 vaccinations, what do nurses need to know about these vaccines?

Two vaccines have received emergency use authorization (EUA) in the U.S.—one manufactured by Pfizer/BioNTech, the other by Moderna. (A third, manufactured by AstraZeneca, is likely to receive EUA by April.) New, more efficient vaccine technologies along with a huge financial investment by the U.S. government have produced these products in a much shorter time frame than has been typical for other vaccines.

Currently available vaccines.

The two vaccines that are available now are messenger RNA, or mRNA, vaccines. This type of vaccine has been developed and studied for decades for possible use in preventing influenza, Zika, and other infectious diseases. Human mRNA is a strand of genetic material used for cell building and maintenance. For SARS-CoV-2 vaccines, mRNA based on part of the SARS-CoV-2 genome is synthesized and standardized in a lab.

When administered in a vaccine, this mRNA delivers to our cells the instructions  to replicate a “spike protein” found on the surface of the SARS-CoV-2 virus. (Important to know and tell patients: The mRNA never enters the nuclei of our cells, and can’t be incorporated into our own DNA.) After a cell follows these instructions and “posts” the spike protein replica on its surface, the immune system recognizes it as foreign […]

2021-01-19T11:08:24-05:00January 19th, 2021|infectious diseases, Nursing, Public health|0 Comments
Read More

Community-Acquired Pneumonia: New Antibiotic Guidelines, Essential Nursing Management

“Pneumonia is an excellent example of an illness in which nursing measures (and not simply drug treatments) are very clearly central to a patient’s rapid and full recovery.”

In these pandemic times, a patient with signs and symptoms of pneumonia is assumed to have COVID-19. But of course other types of pneumonia continue to occur both in the hospital and in the community, and people with COVID-19 can develop secondary bacterial pneumonias as well.

Abandoning old pneumonia categories in determining antibiotic use.

click to enlarge

Until recently, pneumonia was routinely classified as either community-acquired or health care–associated, and the category determined treatment. Health care–associated pneumonias were more often caused by resistant organisms, while someone with no recent exposure to hospitals or nursing homes was thought likely to have a more “benign” infection. But now, a 2019 guideline developed jointly by the American Thoracic Society and the Infectious Diseases Society of America offers new recommendations for the initial treatment of pneumonia.

As described in a CE article “Community-Acquired Pneumonia:  A Review of Current Diagnostic Criteria and Management” in the December issue of AJN, the new guidelines recommend abandoning the use of categories of pneumonia to determine antibiotic coverage.

Instead, treatment decisions should be based on local epidemiology (what […]

2020-12-08T09:54:11-05:00December 8th, 2020|Nursing|0 Comments
Read More

Comment ground rules

1. Please be respectful.
2. We moderate all comments.

Content disclaimer

Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
Go to Top