The World Health Organization (WHO) recommends new COVID-19 boosters to target the dominant XBB variants, patients with sleep apnea may be more likely to develop long COVID, and more in this week's roundup of virus news.

Mpox:

• Earlier this month, WHO lifted the mpox public health emergency, citing sustained decline in cases worldwide. However, CDC officials recently released an alert warning people of the potential of a new mpox outbreak after several new cases were reported across the United States. In Chicago, health officials are currently investigating a cluster of 21 new cases, including those among fully vaccinated individuals. Aside from Chicago, there have also been at least 31 new cases in Texas and a handful of cases in Alabama, California, Florida, Louisiana, New York, and Oregon. Currently, CDC recommends all at-risk individuals to get two doses of the Jynneos vaccine to protect themselves against mpox. Doctors are also recommended to test all patients with symptoms regardless of vaccination status. "Even though no vaccine is perfect, even imperfect immunity in many people still leads to a lot of immunity in the population, and … with that increased immunity we are less likely to have any outbreaks at all or have smaller outbreaks," said Demetre Daskalakis, the White House's national mpox response deputy coordinator. "However, it is important to say that without renewed prevention efforts, especially vaccination, we are definitely at risk of a resurgence, in fact a substantial risk of resurgence." (Mandavilli, New York Times, 5/11; Ingram, MedPage Today, 5/15; Tin, CBS News, 5/15; Mast, STAT+ [subscription required], 5/18)

COVID-19:

• The American Academy of Physical Medicine and Rehabilitation (AAPM&R) last week released new guidance on how clinicians should evaluate and treat new or worsening neurologic symptoms among patients with long COVID. According to AAPM&R, clinicians should make sure they're pursuing appropriate diagnostic workups and collaborate with multidisciplinary teams to address neurologic symptoms, which can include headache, weakness, pain, and palsy, in long COVID patients. They should also work with other providers or specialists to treat any underlying medical conditions that could be worsening neurologic symptoms, including psychiatric, pain, cardiovascular, or other conditions. The group also identified red flags that clinicians should address with immediate interventions, such as sudden or progressive weakness, bowel or bladder incontinence, and acute neuropsychiatric symptoms or psychosis. "What we know is that many people with mild or moderate COVID infections end up with neurologic sequelae that lasts longer than 4 weeks, and we see a very wide variety of neurologic symptoms," said Leslie Rydberg, one of the guidance's authors from the Northwestern University Feinberg School of Medicine. "Whether these patients were hospitalized or not, they continue to have these neurologic symptoms that are persistent and prevalent." (DePeau-Wilson, MedPage Today, 5/18)
• WHO last week recommended that COVID-19 boosters be updated to target either the XBB.1.5 or XBB.1.16 variants, which are currently the dominant coronavirus variants worldwide. In addition, the organization said that that future vaccines should not include the original coronavirus strain, which is no longer circulating in humans and whose shots produce "undetectable or very low levels of neutralizing antibodies." According to Reuters, FDA is scheduled to hold a meeting of outside experts in June to discuss which variants updated COVID-19 vaccines should target for this year. Currently, several vaccine makers, including Pfizer-BioNTech, Moderna, and Novavax, are working to update their shots to target XBB.1.5 and other currently circulating variants. The final composition of these vaccines will likely depend on the variants FDA's advisors recommend. (Reuters, 5/19)
• According to a new  study  published in Neurology: Neuroimmunology and Neuroinflammation, long COVID patients with neurologic symptoms may also experience broad immune dysregulation. For the study, researchers evaluated 12 patients with persistent neurological symptoms after being diagnosed with COVID-19 between March and December 2020. Of the participants, 11 had mild infections, and one had a moderate infection. The patients were evaluated a median of nine months after their infection, and at the time of evaluation, only one patient had been vaccinated. Overall, the researchers found that the patients with long-term neurologic symptoms had lower levels of CD4+ and CD8+ T cells than healthy controls. These patients also had increased levels of B cells and other types of immune cells, which suggests that immune dysregulation could play a role in long COVID. According to the researchers, further investigation is needed to confirm these findings and evaluate the potential role of immunomodulatory agents in clinical trials. (George, MedPage Today, 5/8)
• Patients with obstructive sleep apnea (OSA) had an up to 75% increased risk of developing long COVID, according to a new analysis from the NIH RECOVER collaborative study. For the study, researchers used EHR data from three research networks to identify long COVID patients with OSA prior to their infection. Patients were divided into three cohorts: the National COVID Cohort Collaborative (N3C), the National Patient-Centered Clinical Research Network (PCORnet), and PEDSnet, which only included children. After adjusting for several factors, including hospitalization, obesity, and comorbidities, researchers found that adults who had OSA before their COVID-19 diagnosis were more likely to develop long COVID than adults who did not have OSA. There were also gender differences in risk. In the N3C cohort, women with OSA had an 89% increased risk of developing long COVID compared to 59% for men with OSA. "There's still so much to uncover about long COVID, but this study will inform clinical care by identifying patients that should be watched more closely," said Hannah Mandel, a senior data scientist at the New York University Grossman School of Medicine and one of the study's authors. "People with sleep apnea who get infected with COVID should seek early treatment, pay attention to their symptoms, and keep up with their vaccines to lower the risk of infection in the first place." (Short, MedPage Today, 5/12)