The public health emergency (PHE) for mpox officially ended on Tuesday, positive COVID-19 tests are no longer required for Paxlovid or Lagevrio prescriptions, and more in this week's roundup of mpox and COVID-19 news.

Mpox:

• The PHE for mpox, formerly known as monkeypox, officially ended on Tuesday as the number of reported cases continues to fall. The PHE was first declared in August 2022. "From the outset of the mpox outbreak, the Biden-Harris Administration – working through HHS and many of its agencies – pulled every lever to stop the spread of this virus," said an HHS spokesperson. "Given the low number of cases today, HHS did not renew the emergency declaration. But we won't take our foot off the gas – we will continue to monitor the case trends closely and encourage all at-risk individuals to get a free vaccine." According to data from CDC, the seven-day moving average for mpox was three cases, a significant drop from the over 400 average daily cases during the summer. Overall, more than 30,000 cases and 26 deaths from mpox were reported in the United States during the outbreak. Roughly 1.18 million doses of smallpox vaccines were also administered during this time, largely to high-risk populations such as men who have sex with men. In a statement, the Human Rights Campaign (HRC) commended the LGBTQ community for its efforts to contain the mpox outbreak. "Today, we enter the next phase in the continuing fight to end Mpox and maintain the health and well-being of LGBTQ+ people everywhere," said HRC president Kelley Robinson. (Choi, The Hill, 1/31)

COVID-19:

• FDA on Wednesday amended its emergency use authorizations for Paxlovid and Lagevrio, removing the requirement that a positive COVID-19 test is needed before a provider can prescribe the antiviral treatments. "The agency continues to recommend that providers use direct SARS-CoV-2 viral testing to help diagnose COVID-19," the agency said. However, "in rare instances, individuals with a recent known exposure (e.g., a household contact) who develop signs and symptoms consistent with COVID-19 may be diagnosed by their healthcare provider as having COVID-19" even if they test negative. (Twenter, Becker's Hospital Review, 2/1)

• A booster dose of Moderna's original monovalent vaccine may be associated with an increased risk of new-onset chronic spontaneous urticaria (CSU) or hives that last longer than six weeks, according to a new study published in JAMA Network Open. For the study, researchers in Switzerland estimated the incidence of vaccine-related CSU in the Vaud region and across the country as a whole. There were 3,278,808 individuals nationwide and 298,813 individuals in Vaud alone who received an mRNA booster between Dec. 1, 2021, and Aug. 31, 2022. Overall, the researchers found that the crude incidence rate of CSU following a Moderna booster was 30.8-43.9 per 100,000 doses. In comparison, the incidence rate following a Pfizer-BioNTech booster was 1.9-2.1 per 100,000 doses. This difference translated to a relative risk of 20.8 for those in the Vaud group and 16.1 for those in the overall Swiss group. "These data should not discourage patients from being vaccinated," the researchers wrote. "However, guidelines defining the eligibility and dosing for upcoming mRNA-based boosters are needed for patients with CSU after an mRNA-based COVID-19 vaccine." Notably, Moderna's original vaccine is no longer being used as a booster dose, at least in the United States, after its updated bivalent vaccines were introduced last fall. In addition, the original monovalent vaccines are expected to be phased out after FDA's Vaccines and Related Biological Products Advisory Committee unanimously endorsed a plan to use the bivalent vaccines for both the primary series and boosters going forward. (Short, MedPage Today, 2/1)

• COVID-19 was the eighth leading cause of death among children between August 2021 and July 2022, according to a new study published in JAMA Network Open. For the study, researchers analyzed information from CDC's Wide-Ranging Online Data for Epidemiologic Research database to determine where COVID-19 ranked as the underlying cause of death for individuals aged zero to 19 years. Between August 2021 and July 2022, COVID-19 ranked eighth among all causes of death for children, fifth among disease-related causes, and first among respiratory illnesses. However, despite being one of the leading causes of death among children during this time period, the total number of deaths from COVID-19 remained relatively small. There were 821 COVID-19 deaths among children during this time, making up 2% of all deaths in this age group. "Pediatric deaths are rare by any measure. It's something that we don't expect to happen and it's a tragedy in a unique way. It's a really profound event," said Sean O'Leary, chair of the American Academy of Pediatrics' Committee on Infectious Diseases. "Everyone knows that Covid is the most severe in the elderly and immunocompromised and that it's less severe in children, but that does not mean it's a benign disease in children. Just because the numbers are so much lower in children doesn't mean that they're not impactful." (Archie, NPR, 1/31; McPhillips, CNN, 1/30; Flaxman et al., JAMA Network Open, 1/30)

• According to the International Federation of Red Cross and Red Crescent Societies (IFRC), the world is not prepared for another pandemic. Based on how COVID-19 care was delayed, IFRC said countries need to address health inequities and better support vulnerable communities before another crisis occurs. Some persistent issues include malnutrition, limited access to healthcare, overcrowding, and poor sanitation. "When people trusted safety messages, they were willing to comply with public health measures that sometimes separated them from their loved ones in order to slow the spread of the disease and save lives," IFRC said. "Similarly, it was only possible to vaccinate millions of people in record time when most of them trusted that the vaccines were safe and effective. Those responding to crises cannot wait until the next time to build trust." (Twenter, Becker's Hospital Review, 2/1)