Good morning. My colleague Rachel Cohrs in Washington is helping to expand D.C. Diagnosis, our newsletter on the politics and policy of medicine, to a second Thursday edition. Read her first dispatch today, and sign up here to get it in your inbox.

U.S. monkeypox case adds to reports in Spain and Portugal in growing outbreak

A case of monkeypox infection was confirmed in Massachusetts yesterday in a man who recently traveled to Canada, state officials said, the same day that two more European countries reported unusual monkeypox cases. The development adds the U.S. and possibly Canada to a growing list of countries reporting monkeypox cases in an outbreak first spotted in the U.K. Spain is investigating eight suspected cases, and Portugal is looking at more than 20. There are many unknowns in Europe: whether the outbreaks are linked to each other or to cases in the U.K.; if so, whether the virus spread from the U.K. to Europe, or the reverse; or how long the virus has been spreading. Still, the quick accumulation of cases is ringing alarm bells. Read more from STAT’s Helen Branswell.

'Pharma bro' leaves federal prison

He’s out. Martin Shkreli, the infamous “pharma bro” sentenced to prison for securities fraud, was transferred to a halfway house operated by the Federal Bureau of Prisons after finishing programs that allowed his jail time to be shortened, according to a statement from his attorney. Shkreli, who’d been serving time in a federal prison in Allenwood, Pa., was expected to be released in September. The unexpected move is the latest twist for Shkreli, a former hedge fund manager who quickly became reviled for his smug responses to criticism that he callously exploited the drug pricing system. His former company purchased an old, lifesaving drug and jacked up the price by 4,000% overnight. STAT’s Ed Silverman has more on how Shkreli became the poster child for pharmaceutical greed.

Study links vaccination after Covid infection to lower odds of long Covid symptoms

Ever since Covid vaccines became available, some people with long Covid have said vaccination eases symptoms that persist weeks and months after their original infection clears. Research has so far been intriguing but inconclusive, in part because of the small numbers of people studied. A new study published yesterday in BMJ solves the size problem, combing through responses from more than 28,000 adults taking part in the U.K.’s Covid-19 Infection Survey. Vaccination after infection was associated with a lower likelihood of long Covid, the researchers report, but more data will be needed to clinch any cause-and-effect connection. “Our results suggest that vaccination of people previously infected may be associated with a reduction in the burden of long Covid on population health, at least in the first few months following vaccination,” study author Daniel Ayoubkhani told me. Read more.

Closer look: Why isn’t there a nasal vaccine for Covid-19 yet?

Yes, current Covid-19 vaccines have turned a dangerous infection into something much less serious for many vaccinated people who contract it. But while these vaccines are great at protecting against severe illness and death, they cannot stop vaccinated people from contracting the virus at all. To do that, and to prevent mild Covid infections, we’re going to need intranasal vaccines that protect us where infections start: in the mucus membranes of the nose, mouth and throat. But as Helen Branswell explains and this video shows, designing them is a real challenge. The vaccine virus has to be potent enough to trigger the start of an infection, to activate the immune system, but not so potent that the person being vaccinated becomes ill. Will the intranasal Covid vaccines currently in development succeed? Watch here.

Polio outbreak declared in Mozambique

Health authorities in Mozambique declared a polio outbreak yesterday after confirming that a child in the country’s northeastern Tete province has been paralyzed by the disease. The case in Mozambique is the second imported case of polio in southern Africa this year, following one discovered in Malawi in mid-February. The child, who was paralyzed in March, is the first case of wild polio in Mozambique since 1992, although cases linked to a mutated virus from the oral vaccine were detected in 2019. Sequencing links the recent case to a strain of polio spreading in Pakistan in 2019, similar to the case reported in Malawi earlier this year. WHO declared Africa free of the wild polio virus in August 2020, even though numerous countries across the continent have reported outbreaks linked to the vaccine in recent years, the Associated Press notes.

CDC is investigating 180 cases of hepatitis in kids from unknown cause

The mystery of unusual hepatitis cases in previously healthy children remains unsolved, the CDC said yesterday, as 36 states and territories now report that 180 children’s cases over the past seven months are under investigation. That’s 71 more cases than the 109 reported on May 5, but the agency said the vast majority of the increase involves “retrospective” patients. “Not all are recent, and some may ultimately wind up not being linked to this current investigation,” CDC said in its statement. No deaths have been reported since February, when five children had died, and patients needing liver transplants have gone down from 15% to 9% since May 5. “We encourage parents and caregivers to be aware of the symptoms of hepatitis — particularly jaundice, which is a yellowing of the skin or eyes — and to contact their child’s healthcare provider with any concern,” the statement says.  

What to read around the web today

The pandemic’s true health cost: How much of our lives has Covid stolen? Nature
A third of US should be considering masks, officials say. Associated Press
Former top Medicare official says Medicare Advantage’s coding industry offers ‘no benefit to society.’ STAT+
Over 75 percent of long Covid patients were not hospitalized for initial illness, study finds. New York Times
Pharma wins a court battle over an HHS rule that would have penalized them for offering copay coupons. STAT+