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Doctors at Children's Medical Center Dallas will be allowed to intake and treat transgender youth who seek gender-affirming care for at least another year after a  county judge granted a temporary injunction on Monday, the Dallas Morning News reports.

Why it matters: The move comes after the hospital decided to stop providing certain medical treatments, such as puberty blockers and hormone therapy, to new trans patients. Texas has implemented several anti-trans policies in the past year, including one that allows the state to investigate parents for child abuse if they seek gender-affirming care for their trans kids.

Ximena Lopez, the doctor who led the program for trans youth, had requested the injunction in a bid to restore treatments amid the larger court battle over whether to end the policy for good.

The injunction will remain in place until the court holds a trial to hear arguments for and against the program. The trial is currently slated for April 18, 2023.

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Dallas hospital can continue treating new adolescent trans patients, judge rules

The hospital had opted to stop providing some medical treatments, such as puberty blockers, to new trans patients.

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The Dallas skyline on July 21, 2020. Photo: Valerie Macon/AFP via Getty Images

President Biden has made the COVID-19 crisis and a post-Trump return to national unity and traditional democratic ideals his top priorities. From vaccinations to stimulus to schools, Biden is seeking bipartisan compromise while showing a willingness to use executive authority and bare Democratic majorities in the U.S. House and Senate to implement his policies. Republican leaders are navigating deep party divisions over if and how to move beyond former President Trump.

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The Centers for Disease Control and Prevention (CDC) said Monday officials are in the process of releasing some Jynneos vaccines to help prevent monkeypox, Reuters reports.

Why it matters: Monkeybox is not likely to cause a global pandemic like COVID did, but confirmed cases in at least 12 countries have spurred concern about the spread of infections. 

Monkeypox can be transmitted by droplets and via close contact with infected skin lesions or contaminated materials.

Details: The U.S. has over 1,000 Jynneos doses in its national stockpile, CDC officials said Monday.

Rollout is expected to ramp up quickly in the coming weeks, per Reuters.

Jynneos is licensed in the United States to prevent monkeypox and smallpox.

The big picture: There are currently no specific treatments available for monkeypox, according to the CDC.

What we know about the new monkeypox outbreak

Monkeypox symptoms to watch for as first U.S. outbreak cases reported

CDC to release some Jynneos vaccines for monkeypox

The U.S. has over 1,000 Jynneos doses in its national stockpile, CDC officials said Monday.

Photo of the CDC logo hanging on a wooden wall

A podium with the logo for the Centers for Disease Control and Prevention at the Tom Harkin Global Communications Center on Oct. 5, 2014 in Atlanta, Georgia. Photo: Kevin C. Cox via Getty Images

Monkeypox

Health: Broadway theaters will require masks through June — The pandemic pushed an exodus from public schools — COVID cases rise in almost every state.

Vaccines: Pfizer says COVID vaccine more than 80% effective in kids under 5 — Which age groups are eligible for the different COVID vaccines — CDC director authorizes Pfizer COVID booster for children 5-11. 

Politics: Federal judge blocks Biden from ending COVID border policy — Fauci says he won’t stay if Trump is re-elected — Biden orders flags at half-staff for 1 million deaths.

Global: Total confirmed cases as of 1:00 p.m. ET on Monday: 525,778,539 — Total deaths: 6,277,818 — Total vaccine doses administered: 11,445,077,393.

U.S.: Total confirmed cases as of 1:00 p.m. ET on Monday: 83,194,060 — Total deaths: 1,002,022.

What should I do? Axios asked the experts:

When you can be around others after contracting the coronavirus

Traveling, asthma, dishes, disinfectants and being contagious

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Editor's note: Johns Hopkins University stopped reporting U.S. COVID-19 recoveries on its dashboard on Dec. 15, citing a Coronavirus Tracking Project post that explained the national data is incomplete since several states do not keep records of recovered patients. It stopped reporting global recoveries and began reporting doses administered in May. 

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The latest headlines that you need to know.

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China is becoming the most formidable rival America has faced, and the risk of confrontation with Russia, North Korea or Iran still looms. Authoritarians are rising, the chaotic Afghanistan exit revealed the limits of U.S. power, and the pandemic, climate change and other critical challenges continue to pose grave threats.

After a record economic expansion, the coronavirus pandemic sent the U.S. economy into a recession as unemployment soared to staggering heights. The country now faces urgent questions about how much stimulus is needed for reeling consumers and businesses, and what a recovery might look like.

Economy & Business

More questions about the typical symptoms of monkeypox are emerging as health officials investigate a global uptick of the virus, which is rarely found outside of Africa.

Why it matters: Many cases in the growing monkeypox outbreak have been found in people with no travel links to places where it typically circulates. Health officials have so far detected cases in much of Europe, the U.S., Canada and Australia.

The first official case in the U.S. this year was confirmed in Massachusetts last Wednesday. A New York City resident also tested positive for the virus on Friday.

On Sunday, the CDC and Florida health officials said they were investigating a presumptive case in Broward County, one of the state's largest counties.

What they're saying: President Biden said on Sunday that the recent spread of monkeypox in at least 12 countries is "something that everybody should be concerned about."

"It is a concern in that if it were to spread, it would be consequential," Biden told reporters at Osan Air Base in South Korea, where he met with troops before heading to Japan on the next leg of his Asia trip.

But Daniel Bausch, an infectious disease expert and president of the American Society of Tropical Medicine & Hygiene, told Axios last week: "I don't think there's a reason for panic. I don't think we're going to have tens of thousands of cases."

According to the CDC, the illness begins with these symptoms:

Swollen lymph nodes (also called lymphadenopathy)

Of note: Within one to three days after the fever, patients typically develop a rash, which often begins on the face and then spreads to other parts of the body, the CDC said.

"There is no specific treatment for monkeypox virus infection, although antivirals developed for use in patients with smallpox may prove beneficial," the CDC notes.

Details: Monkeypox, which can be transmitted by droplets and by close contact with infected skin lesions or contaminated materials, usually incubates in people for five to 13 days before symptoms appear.

Transmission can come from animals or human-to-human contact, but "it is generally documented among very close contacts. So family members, people taking care of ill patients. Or health care providers," Andrea McCollum, the poxvirus epidemiology team lead at the CDC, told STAT News.

Children are at higher risk, and monkeypox can cause pregnancy complications or stillbirth, per the WHO.

Doctors should suspect monkeypox if patients have a rash after they've traveled to countries with confirmed cases or if a patient has reported having contact with someone who has been to one of those countries, the CDC said in a health alert.

Officials in the U.K. have identified many of the recent monkeypox cases in gay or bisexual men, possibly stemming from close contact at bars and parties.

Keep in mind: UNAIDS, a joint United Nations program, said in a statement it is concerned that "some public reporting and commentary on Monkeypox has used language and imagery, particularly portrayals of LGBTI and African people, that reinforce homophobic and racist stereotypes and exacerbate stigma."

"Lessons from the AIDS response show that stigma and blame directed at certain groups of people can rapidly undermine outbreak response," per UNAIDS.

WHO concerned monkeypox could accelerate during summer months

Watch for rash and these symptoms as first U.S. monkeypox cases emerge.

Electron microscope image of various virus particles of the monkeypox virus taken from human skin

Electron microscope image of various virus particles of the monkeypox virus taken from human skin. Photo: Smith Collection/Gado/Getty Images

Axios Vitals

The CDC is examining 180 reported cases of hepatitis of unknown origin in kids across 36 states and territories, including six cases that resulted in deaths, officials told reporters in a briefing.

Why it matters: CDC is still trying to tease out whether these are part of a true increase in hepatitis among kids — or if the cases were identified as the result of improved pandemic-era surveillance.

Be smart: The leading hypothesis for a root cause is adenovirus infections, which are common in childhood, officials said.

Another working theory is that the cause "is a rogue immune response" to a COVID infection.

Zoom in: The CDC is scrambling to identify possible exposure history including to drugs, foods, or toxins, as well as scouring medical records for clues.

It's unlikely any increase is associated with COVID vaccination since the median age of kids affected is 2 years old, they said.

The bottom line: "Unfortunately, the illness in many of these patients is severe," Umesh Parashar, chief of the viral gastroenteritis branch at the CDC's Division of Viral Diseases said. "This is clearly a severe disease that we're taking very carefully for that reason."

CDC scrambles for clues on children's hepatitis cases and deaths

The leading hypothesis for a root cause is adenovirus infections, which are common in childhood, officials said.

A girl rubs sunscreen on her liver transplant scar.

Liviah Widders rubs sunscreen on her liver transplant scar in Mason, Ohio, earlier this month. She had viral hepatitis. Photo: Megan Jelinger for The Washington Post via Getty Images

Health care

Three small doses of Pfizer and BioNTech's COVID-19 vaccine proved more than 80% effective at eliciting a strong immune response in children between the ages of 6 months and 5 years old, the companies said in a release this morning.

Why it matters: Pfizer is seeking an emergency use authorization to vaccinate children in this age group — one of the last groups of Americans still largely ineligible to receive a coronavirus shot. The companies said they will submit the trial data to the FDA this week.

How it works: A group of 1,678 children under five received a dose of about one-tenth the dosage given to adults for each injection in the Phase 2/3 study and it was "well-tolerated," the companies said.

The efficacy data from three doses was observed during a time when Omicron was the predominant variant.

What they're saying: "These topline safety, immunogenicity and efficacy data are encouraging, and we look forward to soon completing our submissions to regulators globally with the hope of making this vaccine available to younger children as quickly as possible, subject to regulatory authorization," said Pfizer CEO Albert Bourla said in a statement.

What's next: The FDA has said its key advisory committee will meet in June to consider emergency use authorization requests from both Pfizer and Moderna for kids five and under.

Most recently, the CDC director authorized Pfizer's COVID booster for children 5-11 years old.

Pfizer says COVID vaccine more than 80% effective in kids under 5

Pfizer reported three doses of its vaccine in kids under five produced a strong immune response and was safe.

Photo: Allen J. Schaben/Los Angeles Times via Getty Images

Pfizer

The push for more transparency in health care is fueling a reevaluation of the words doctors and nurses use in medical records.

Why it matters: Medical lingo helps shape the care and treatment patients get. But the language health professional commonly use can belittle or cast doubts on patients and their complaints and is due for an update, an analysis published in the BMJ argues.

Common phrases like "presenting complaint" or "the patient denies" can sound judgmental or doubtful of patients, researchers from The Healthcare Improvement Studies Institute (THIS) in the U.K. said.

"One patient stated: 'I did not deny these things. I said I didn’t feel them. Completely different. Language matters,'" the authors wrote about one person's response shown a doctor's notes of an outpatient visit.

Another patient balked at the phrase “Patient claims pain is 10/10” instead of “patient experiencing 10/10 pain” because it implied a degree of disbelief, the researchers wrote.

One study cited in the analysis looked at language examples such as "not tolerating oxygen mask" versus "refuses oxygen mask" and showed the non-neutral term was linked with negative attitudes toward the patient and less prescribing of pain medications.

What they're saying: "Much of the language highlighted here is deeply ingrained in medical practice and is used unthinkingly by clinicians. However, we believe that it is now outdated," write the University of Cambridge researchers. 

The big picture: This is part of a number of efforts calling attention to how patients are described in medical records.

A study published earlier this year in Health Affairs found Black patients were more than two-and-a-half times as likely as white patients to have negative descriptors such as "resistant," "challenging" or "non-compliant." Those clinical descriptions were likely to be copied into subsequent notes and amplify biases as a case works its way through the medical system, the authors wrote.

At times, the language used in records can belie physician bias that can impact the quality of care they receive, another study published in JAMA Open Network found.

Clinical terminology embedded in medical records can include overtly racist phrases that were in use decades ago.

The American Medical Association published a health equity language guide aimed at encouraging physicians to factor how systemic discrimination and biases contribute to patients' ailments.

Be smart: While medical descriptions have typically been viewed as communication between physicians, patients are increasingly going to have access to them making it important in the physician's communication with patients as well.

For instance, rules stemming from the 21st Century Cures Act that go into effect in October will allow patients to access far more parts of the electronic records for free, said Catherine DesRoches, associate professor at Harvard Medical School.

"The law will apply to everything in your record that an organization is legally required to share under HIPAA," DesRoches said. 

But, but, but: While some clinicians say the goal of eliminating bias is laudable, changing clinical language could actually create more confusion.

Using terms such as "the patient claims," for instance, differentiates information that has been provided versus information that has been validated by the provider.

Requiring clinicians to rethink language will likely "add needless burden" in an already overstretched health care system, one physician wrote in a comment on the BMJ article.

My thought bubble: It'd be easy to dismiss questions around language as political correctness.

But the discussion is factoring in more and more policy discussions, not just  because of transparency but because the health system increasingly relies on artificial intelligence and natural language processing. (Both are being used, for example, to help identify cases of child abuse from pediatric electronic medical records.)

Language in medical records may be due for an update

Common phrases like "presenting complaint" or "the patient denies" can sound judgmental or doubtful of patients.

Florida health officials and the CDC are investigating a presumptive case of monkeypox in Broward County, Florida, according to a statement from the Florida Department of Health in Broward County.

Why it matters: A recent monkeypox outbreak has seen the virus appear in multiple countries, including the U.S., while it had previously rarely been seen outside of Africa.

President Biden on Sunday said that the recent spread of monkeypox is "something that everybody should be concerned about."

The big picture: “This case is related to international travel, and the person remains isolated," Florida Department of Health in Broward County said in the statement, adding that no additional cases have yet been identified.

The department said efforts are being made to notify anyone who might have been exposed. It cautioned that the "risk of exposure remains low."

Go deeper: What we know about the new monkeypox outbreak

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CDC and state officials investigating monkeypox case in Florida

"This case is related to international travel, and the person remains isolated."

 the Centers for Disease Control and Prevention (CDC) headquarters

 The Centers for Disease Control and Prevention (CDC) headquarters in Atlanta, Georgia. Photo: Elijah Nouvelage/Bloomberg via Getty Images

President Biden on Sunday said that the recent spread of monkeypox in at least 12 countries are "something that everybody should be concerned about."

Why it matters: These are the president's first public remarks about the recent outbreaks, which include a confirmed case in Massachusetts, a person who tested positive in New York and roughly a half dozen other cases being monitored by the Centers for Disease Control and Prevention.

“It is a concern in that if it were to spread it would be consequential," Biden told reporters at Osan Air Base in South Korea, where he met with troops before heading to Japan on the next leg of his Asia trip.

The president is receiving regular updates from his health team on the outbreaks, National Security Adviser Jake Sullivan said on Sunday.

Sullivan told the traveling pool that the United States has vaccines "available to be deployed."

Zoom out:  Europe has seen a recent spread of monkeypox, with cases found in Belgium, Italy, London and northern Ireland, Portugal and Spain. Australia and Canada also reported cases.

The spread is not likely to cause a global pandemic like COVID did.

Biden: "Everybody should be concerned" about monkeypox spread

"it is a concern in the sense that if it were to spread, it’s consequential," the president said.

President Joe Biden speaks to media before boarding Air Force One prior to departing Osan Air Base in Pyeongtaek on May 22 as he travels to Japan on the second leg of his visit to Asia. Photo: Saul Loeb/AFP via Getty Images

The J. M. Smucker Co. is recalling select Jif peanut butter products for potential Salmonella contamination. 

Why it matters: The voluntary recall comes amid a multistate outbreak of infections linked to certain Jif peanut butter products produced by the company’s facility in Lexington, Kentucky.

Health officials from the Food and Drug Administration and Centers for Disease Control and Prevention are investigating the ongoing outbreak and say there have been 14 reported cases of Salmonella Senftenberg infections with two hospitalizations. 

Details: The recall is for various peanut butter products including creamy, crunchy and natural varieties packaged in dozens of different sizes and containers that were distributed nationwide.

Recalled products include lot codes between 1274425 through 2140425, only if the first seven digits end with 425, which shows they were manufactured in the Lexington facility. 

The codes are located alongside best-if-used-by date.

Georgia and Texas each had two reported cases of Salmonella Senftenberg, the FDA said in its investigation. States with one case include: Arkansas, Illinois, Massachusetts, Missouri, Ohio, North Carolina, New York, South Carolina, Virginia and Washington.

The big picture: According to a recall notice posted on the FDA website, Salmonella can cause serious and sometimes fatal infections in young children, frail or elderly people, and those with weakened immune systems. In healthy people, it can cause fever, diarrhea, nausea, vomiting and abdominal pain.

What they’re saying: "Consumers, restaurants, and retailers should not eat, sell, or serve any recalled Jif brand peanut butter," the FDA said on its outbreak investigation webpage. 

“If consumers have products matching the above description in their possession, they should dispose of it immediately,” the company said in the recall notice.

Be smart: Find the full list of recalled peanut butter products on both the FDA recall notice or company press release.

Jif peanut butter recalled for possible Salmonella amid outbreak

There have been 14 reported cases of salmonella infections linked to the Jif products, according to the FDA.

Select kinds of Jif peanut butter have been recalled for potential Salmonella contamination. Photo: J.M. Smucker Co.

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