Good morning. Today we're covering monkeypox developments, from stretching vaccine doses to preparing for campus cases to untangling how it's spreading in the current outbreak. But also Alzheimer's and hepatitis C. And salt.

U.S. acts to stretch doses of monkeypox vaccine

In a move to stretch monkeypox vaccine, the U.S. will permit fractional doses, multiplying by five the number of people it can reach. Yesterday’s decision allows the Jynneos monkeypox vaccine to be administered into, not under, the skin, which can generate strong immune responses with smaller amounts of vaccine than under the skin or into a muscle. STAT's Helen Branswell has more.

NIAID is designing a clinical trial to test this approach, STAT reported last week, and experts writing in an opinion piece in STAT yesterday expressed concern about the approach and the ability of health professionals to carry it out. “A hasty decision to try an unproven and risky strategy to stretch the existing vaccine supply may interfere with developing a national plan to quell this outbreak,” Philip Krause, formerly of the FDA, and Luciana Borio of the Council on Foreign Relations warned.

Universities brace for monkeypox outbreak

Colleges and universities still dealing with the reality of Covid-19 now have to prepare for the arrival of monkeypox as students stream back to campus for the fall semester. Five campuses — Georgetown University, George Washington University, the University of Texas at Austin, Bucknell University, and West Chester University — have already confirmed monkeypox cases this summer, even with most students away. The viral infection is primarily spread through close skin-to-skin contact, so public health experts like Lawrence Gostin of Georgetown worry about contact sports, locker rooms, and sex in dormitories.

“I think that CDC and local health departments should develop a specific set of guidance for higher education,” he told STAT’s Akila Muthukumar. “They did that with Covid-19 and I think it’s critically important, particularly because this academic year is just around the corner. We really needed the guidance yesterday.” Read more.

There’s a cure for hepatitis C, but less than a third of infected people get it

Nearly a decade after an oral medication that can cure hepatitis C was approved, fewer than one-third of people with insurance who are infected with the virus are getting the treatment, a new CDC analysis says. That drops to 1 in 4 people with Medicaid, and it's worse for Black people and for people living in states that restrict access to hepatitis C treatment: Those Medicaid recipients are 23% less likely to receive it than Medicaid recipients in states without restrictions.

Many people don’t know they have the disease, which can cause liver disease, liver cancer, and death when untreated, so one-time screening is recommend for all adults and regular testing for those at risk. The highest infection rate is in adults under 40, who have the lowest treatment rates and the most common spread through injection drug use. The report’s authors call for removing preauthorization requirements and eligibility restrictions for insurance coverage, which include liver scarring, sobriety, or medical specialist prescribing. "Restricting access to hepatitis C treatment turns an infectious disease into a health injustice," CDC's Jonathan Mermin said on a call with reporters yesterday.

Closer look: How does monkeypox spread?

(NIAID)

As monkeypox cases mount around the world, scientists are puzzling over a known virus that seems to be acting in unknown ways since the current outbreak cropped up in the U.K. Unlike the novel coronavirus, monkeypox has been tracked for decades in self-limiting outbreaks in West and Central Africa. Now public health experts tell STAT’s Megan Molteni that it’s not the virus that has changed, nor how it spreads, but the environment and the social networks monkeypox now finds itself in.

The current monkeypox epidemic is being driven overwhelmingly by direct skin-to-skin contact with the lesions caused by the virus, including close intimate contact between sexual partners. What’s less clear is whether bodily fluids can spread the virus, whether people without symptoms can infect others, and how much of a role inhaled respiratory particles play. Read more questions and answers.

The next big Alzheimer's readout is coming next month. What will it mean?

Let’s start with telling lines from STAT’s Adam Feuerstein and Damian Garde in their preview of the next big readout on an Alzheimer’s trial: “Failed studies, like the unhappy families of Russian literature, come in almost infinite variety. And in Alzheimer’s research, where the vast majority of clinical trials don’t meet their goals, parsing failure has become a discipline unto itself.” If you think that’s too dark a view, consider the millions of patients awaiting a medicine that can meaningfully impact their disease, and decades of disappointment in targeting toxic brain plaques called amyloid.

Biotech partners Biogen and Eisai, which developed the polarizing Aduhelm, hope lecanemab, also aimed at amyloid, can significantly slow the cognitive decline that characterizes Alzheimer’s. Read how success might be measured, and what failure might mean for the companies, the FDA, and the amyloid hypothesis.

Dietary salt substitutes gain stronger link to lower blood pressure and cardiovascular disease

Dietary salt substitutes could play a role in reducing the risk of heart attack, stroke, and death from cardiovascular disease, a new analysis in Heart says. A review of 19 studies in nearly 30,000 people in Europe, the Western Pacific, the Americas, and Southeast Asia confirms findings from a large study in China that said salt substitutes low in sodium chloride but high in potassium helped lower blood pressure and the risk of cardiovascular disease and death.

Pooled data from five of the trials linked salt substitutes to an 11% lower risk of heart attack or stroke and a 13% lower risk of early death from cardiovascular disease. The reductions in blood pressure held true across age, sex, history of high blood pressure, weight, baseline blood pressure, and baseline levels of urinary sodium and potassium, as well as geography.

What to read around the web today

This is the data Facebook gave police to prosecute a teenager for abortion, Vice
Long Covid treatments: why the world is still waiting, Nature
Opinion: Implant recipients shouldn’t be left in the dark when a device maker cuts off support, STAT
America has a maternal mortality crisis. Biden push aims to change that, Washington Post
Adam's take: With Pfizer deal, Global Blood CEO sees opportunity to reach sickle cell patients globally, STAT