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Proposed changes to school lunches aim to reduce sugar and sodium, but flavored milk stays | CNN

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CNN
—

If new US Department of Agriculture school food guidelines stand as proposed, chocolate milk is in, but for the first time ever, at least some added sugars will be out – and sodium levels will be reduced gradually.

Agriculture Secretary Tom Vilsack publicly announced the changes on Friday.

“The purpose of this is to improve the health and welfare of our children. And I think everybody who comes to this issue shares that goal and hopefully, collectively, we can make sure it happens,” Vilsack told CNN in an interview Thursday ahead of the announcement.

The federally assisted school meal program provides nutritionally balanced meals at school at low or no-cost.

More than 15.3 million kids every day get breakfast at school in the US and 29.6 million get a school lunch, Vilsack said. The numbers were higher earlier in the pandemic, when meals were offered free to all children regardless of their family’s income, but in June, Congress did not extend the Covid-19 pandemic waivers that had expanded the program.

While school meals are paid for by local and federal funding, the standards for what goes on a kids’ cafeteria tray are set by the USDA. The agency’s job is to make sure any meal served at school is nutritious and falls in line with the US Dietary Guidelines.

Flavored milk with “reasonable limits on added sugars” would be allowed under the proposal. Vilsack said school meal administrators tell the USDA that kids just won’t drink much no-fat skim milk or unflavored milk. “That’s not what they get at home,” Vilsack said. “We want to encourage kids to drink milk because there are there’s tremendous nutritional value in milk.”

However, the proposed standards would limit added sugar in certain high-sugar products like prepackaged muffins, yogurt, and cereal. Eventually, the guidelines would then limit added sugars across the weekly menu.

The standards would reduce sodium limits, but that would happen gradually over several school years.

“The [US Food and Drug Administration] provided some insight and direction by suggesting that it is easier for people to accept and adopt to reduced sodium if you do it over a period of time in small increments,” Vilsack said.

A gradual reduction would also give industry time to reformulate their products, said Dr. Lauren Au, an assistant professor at UC Davis’ Department of Nutrition who studies the effectiveness of school nutrition programs.

The guidelines would also place a bigger emphasis on whole grains, but still leave options open for an occasional non-whole grain product.

“Maybe a biscuit can be instituted for a little variety, or grits can be provided where that may make sense from a geographic standpoint. You are sensitive to cultural demands and needs,” Vilsack said.

The proposed rule would also strengthen the Buy American requirements encouraging schools to use more locally grown food.

The USDA will invest $100 million in the Healthy Meals Incentives initiative which offers farm-to-school grants and grants to buy equipment. In the 1980s, schools around the country tore out kitchens and bought prepackaged processed food. To make more nutritious meals, schools have had to rebuild or update kitchens.

“A lot of schools have outdated ovens, freezers, fridges, and that puts limitations on how they can prepare food, so grants that have helped with equipment have been really successful,” Au said.

The money would also reward schools that do a good job providing nutritious meals. Grants would also be aimed at small and rural districts and training.

Vilsack said the USDA created these proposed standards after the USDA received thousands of comments and held 50 listening sessions with parents, school food administrators, the food industry, public health and nutrition experts.

“Establishing these standards are difficult because you have to follow the science you have to follow the dietary guidelines, but you also have to understand that they need to be implemented in the real world which is which is which is tough,” Vilsack said in an interview with CNN.

Real world circumstances are tough already with the higher cost of food, staff shortages and supply chain problems.

Au hasn’t seen all of the proposed policies, but she said what she has seen look good.

“It’s a step forward in terms of promoting healthy nutrition in schools,” Au said. The reduction of added sugar, she added is a big deal.

“Reducing added sugars for this age range is so important,” AU said.

Megan Lott, deputy director for the Robert Wood Johnson Foundation program Healthy Eating Research, said that the policies seem to be heading in the right direction.

“There are a couple of things we would probably like to see strengthened, but it also seems like there are plans to do that over time,” Lott said.

The sugar standard is a good start, she said, but she’d prefer the proposal instead say that no more than 10% of calories should come from added sugars across the meal plan.

“But we recognize that schools might need a little bit of time for implementation,” Lott said.

Lott had also hoped they would take flavored milk off the menu. Research shows that schools that have gotten rid of flavored milk show a drop in milk consumption for a year or two, but milk sales eventually rebound.

School food has become a proverbial hot potato.

After decades of bipartisan support for school meals, the program has been politicized in about the last 10 years Lott says, meaning there is bound to be some pushback.

Friday’s proposed changes would be the first large scale reform of school meal standards since President Barack Obama signed the 2010 Healthy, Hunger-Free Kids Act into law.

The law that went into effect in 2012, championed by first lady Michelle Obama, really did improve US kids’ diet, studies show. The law raised the minimum standards and required schools to serve more whole grains, fruit, vegetables, and fat-free and/or low-fat milk more frequently and serve fewer starchy vegetables and foods high in trans fat and sodium.

Meals that were eaten by students – not just served to students and then tossed into garbage cans – were much healthier and had better overall nutritional quality, the study showed. Students who didn’t participate in the national program did not see an improvement in their diets.

Despite the program’s success, in 2018, the Trump administration announced a proposal to roll back many of the policies in the name of “flexibility,” including ones that involved sodium and whole grains. Trump’s policy would essentially create a loophole letting schools sell more burgers, pizza and french fries and reduce the fruit and vegetables sold. A federal court struck down the rule in April 2020.

During the pandemic, some of the polices were relaxed, like for whole grains, because it was difficult to find products, Lott said.

Studies show kids who eat meals at school ate more fruits, vegetables, whole grains and dairy, compared with those who ate at school less frequently.

Better nutrition can help prevent obesity. About 20% of the US population ages 2 to 19 live with obesity, which can cause kids to have high blood pressure, breathing problems and type 2 diabetes, and lead to lifelong health problems, according to the US Centers for Disease Control and Prevention.

Hungry kids have a hard time paying attention in class. Students who ate healthy meals at school scored better on end-of-year academic tests, studies have shown.

The new standards are just a proposal. The USDA will ask for additional feedback.

Vilsack is hopeful the standards will incentivize more schools to offer more healthy options.

“In terms of future of this program,” Vilsack said, “we want to see more and more school districts push themselves not only to meet the standards, but in some cases to exceed them.”

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Mpox is almost gone in the US, leaving lessons and mysteries in its wake | CNN

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CNN
—

The US public health emergency declaration for mpox, formerly known as monkeypox, ends Tuesday.

The outbreak, which once seemed to be spiraling out of control, has quietly wound down. The virus isn’t completely gone, but for more than a month, the average number of daily new cases reported to the US Centers for Disease Control and Prevention has hovered in the single digits, plummeting from an August peak of about 450 cases a day.

Still, the US led the world in cases during the 2022-23 outbreak. More than 30,000 people in the US have been diagnosed with mpox, including 23 who died.

Cases are also down across Europe, the Western Pacific and Asia but still rising in some South American countries, according to the latest data from the World Health Organization.

It wasn’t always a given that we’d get here. When mpox went global in 2022, doctors had too few doses of a new and unproven vaccine, an untested treatment, a dearth of diagnostic testing and a difficult line to walk in their messaging, which needed to be geared to an at-risk population that has been stigmatized and ignored in public health crises before.

Experts say the outbreak has taught the world a lot about this infection, which had only occasionally been seen outside Africa.

But even with so much learned, there are lingering mysteries too – like where this virus comes from and why it suddenly began to spread from the Central and West African countries where it’s usually found to more than 100 other nations.

Before May 2022, when clusters of people with unusual rashes began appearing in clinics in the UK and Europe, the country reporting the most cases of mpox was the Democratic Republic of Congo, or DRC.

There, cases have been steadily building since the 1970s, according to a study in the CDC’s Morbidity and Mortality Weekly Report.

In the DRC, people in rural villages depend on wild animals for meat. Many mpox infections there are thought to be the result of contact with an animal to which the virus has adapted; this animal host is not known but is assumed to be a rodent.

For years, experts who studied African outbreaks observed a phenomenon known as stuttering chains of transmission: “infections that managed to transmit themselves or be transmitted from person to person to a limited degree, a certain number of links in that chain of transmission, and then suddenly just aren’t able to sustain themselves in humans,” said Stephen Morse, an epidemiologist at Columbia University’s Mailman School of Public Health.

Informally, scientists kept track, and Morse says that for years, the record for links in a mpox chain was about four.

“Traditionally, it always burned itself out,” he said.

Then the chains started getting longer.

In 2017, Nigeria – which hadn’t had a confirmed case of mpox in more than four decades – suddenly saw a resurgence of the virus, with more than 200 cases reported that year.

“People have speculated maybe it was a change in the virus that allowed it to be made better-adapted to humans,” Morse said.

From 2018 through 2021, eight cases of mpox were reported outside Africa. All were in men ages 30 to 50, and all had traveled from Nigeria. Three reported that the rashes had started in their groin area. One went on to infect a health care provider. Another infected two family members.

This Nigerian outbreak helped experts realize that mpox could efficiently spread between people.

It also hinted that the infection could be sexually transmitted, but investigators couldn’t confirm this route of spread, possibly because of the stigma involved in sharing information about sexual contact.

In early May 2022, health officials in the UK began reporting confirmed cases of mpox. One of the people had recently traveled to Nigeria, but others had not, indicating that it was spreading in the community.

Later, other countries would report cases that had started even earlier, in April.

Investigators concluded that mpox had been silently spreading before they caught up to it.

In early summer, as US case numbers began to grow, the public health response bore some uncomfortable similarities to the early days of Covid-19. People with suspicious rashes complained that it was too hard to get tested because a limited supply was being rationed. Because the virus had so rarely appeared outside certain countries in Africa, most doctors weren’t sure how to recognize mpox or how to test for it and didn’t understand all its routes of spread.

A new vaccine was available, and the government had placed orders for it, but most of those doses weren’t in the United States. Beyond that, its efficacy against mpox had been studied only in animals, so no one knew whether it would actually work in humans.

There was an experimental treatment, Tpoxx, but it too was unproven, and doctors could get it only after filling out reams of paperwork required by the government for compassionate use.

Some just gave up.

“Tpoxx was hard to get,” said Dr. Jeffrey Klausner, a clinical professor of public health at the University of Southern California’s Keck School of Medicine.

“I was scrambling to find places that could prescribe it because my own institution just became a bureaucratic nightmare. So I basically would be referring people for treatment outside my own institution to be able to get monkeypox treatment,” he said.

Finally, in August, the federal government declared a public health emergency. This allowed federal agencies to access pots of money set aside for emergencies. It also allows the government to shift funds from one purpose to another to help cover costs of the response – and it helped raise awareness among doctors that mpox was something to watch for.

The government also set up a task force led by Robert Fenton, a logistics expert from the Federal Emergency Management Agency, and Dr. Demetre Daskalakis, director of the CDC’s Division of HIV and AIDS Research.

Daskalakis is openly gay and sex-positive, right down to his Instagram account, which mixes suit-and-tie shots from White House briefings with photos revealing his many tattoos.

“Dr. Daskalakis … really walks on water in most of the gay community, and then [Fenton is] a logistics expert, and I think that combination of leadership was the right answer,” Klausner said.

Early on, after the CDC identified men who have sex with men as being at highest risk of infection, officials warned of close physical contact, the kind that often happens with sexual activity. They also noted that people could be infected through contact with contaminated surfaces like sheets or towels.

But they stopped short of calling it a sexually transmitted infection, a move that some saw as calculated.

“In this outbreak, in this time and context to Europe, United States and Australia, was definitely sexually transmitted,” said Klausner, who points out that many men got rashes on their genitals and that infectious virus was cultured in semen.

Klausner believes vague descriptions about how the virus spread were intentional, in order to garner resources needed for the response.

“People felt that if they called it an STD from the get-go, it was going to create stigma, and because of the stigma of the type of sex that was occurring – oral sex, anal sex, anal sex between same-sex male partners – there may not have been the same kind of federal response,” Klausner said. “So it was actually a political calculation to garner the resources necessary to have a substantial response to be vague about how it spread.”

This ambiguity created room for misinformation and confusion, said Tony Hoang, executive director of Equality California, a nonprofit advocacy group for LGBTQ civil rights.

“I think there was a balancing dance of not wanting to create stigma, in terms of who is actually the highest rates of transmission without being forthright,” Hoang said.

Hoang’s group launched its own public information campaign, combining information from the CDC on HIV and mpox. The messaging stressed that sex was the risky behavior and made sure to explain that light brushes or touches weren’t likely to pass the infection, he said.

Klausner thinks the CDC could have done better on messaging.

“By giving vague, nonspecific information and making comments like ‘everyone’s potentially at risk’ or ‘there’s possible spread through sharing a bed, clothing or close dancing’ … that kind of dilutes the message, and people who engage in risk behavior that does put them at risk get confused, and they say ‘well, maybe this isn’t really a route of spread,’ ” he said.

In July and August, when the US was reporting hundreds of new mpox cases each day, health officials were worried that the virus might be here to stay.

“There were concerns that there would be ongoing transmission and that ongoing transmission would become endemic in the United States like other STIs: gonorrhea, chlamydia, syphilis. We have not seen that occur,” said Dr. Jonathan Mermin, director of the CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention.

“We are now seeing three to four cases a day in the United States, and it continues to decline. And we see the possibility of getting to zero as real,” he said.

At the peak of the outbreak, officials scrambled to vaccinate the population at highest risk – men who have sex with men – in the hopes of limiting both severity of infections and transmission. But no one was sure whether this strategy would work.

The Jynneos vaccine was approved by the US Food and Drug Administration in 2019 to prevent monkeypox and smallpox in people at high risk of those infections.

At that time, the plan was to bank it in the Strategic National Stockpile as a countermeasure in case smallpox was weaponized. The approval for mpox, a virus closely related to smallpox, was tacked on because the US had seen a limited outbreak of these infections in 2003, tied to the importation of exotic rodents as pets.

Jynneos had passed safety tests in humans. In lab studies, it protected primates and mice from mpox infections. But researchers only learn how effective vaccines are during infectious disease outbreaks, and Jynneos has never been put through its paces during an outbreak.

“We were left, when this started, with that great unknown: Does this vaccine work? And is it safe in large numbers?” Mermin said.

Beyond those uncertainties, there wasn’t enough to go around, and infectious disease experts feared that a shortage of the vaccine might thwart any effort to stop the outbreak.

So public health officials announced a change in strategy: Instead of injecting a full dose under the skin, or subcutaneously, they would inject just one-fifth of that dose between the skin’s upper layers, or intradermally.

An early study in the trials of the vaccine had suggested that intradermal dosing could be effective, but it was a risk. Again, no one was sure this dose-sparing strategy would work.

Ultimately, all of these gambles appear to have paid off.

Early studies of vaccine effectiveness show that the Jynneos vaccine protected men from mpox infections. According to CDC data, people who were unvaccinated were almost 10 times as likely to be diagnosed with the infection as those who got the recommended two doses.

Men who had two doses were about 69% less likely, and men with a single dose were about 37% less likely, to have an mpox infection that needed medical attention compared with those who were unvaccinated, according to the CDC.

Mermin says studies have since showed that the vaccine worked well no matter if was given into the skin or under the skin – another win.

Still, the vaccine is almost certainly not the entire reason cases have plunged, simply because not enough people have gotten it. The CDC estimates that 2 million people in the United States are eligible for mpox vaccination. Mermin says that about 700,000 have had a first dose – about 36% of the eligible population.

So it’s unlikely that vaccination was the only reason for the steep decline in cases. CDC modeling suggests that behavior change may have played a substantial role, too.

In an online survey of men who have sex with men conducted in August, half of participants indicated that they had reduced their number of partners and one-time sexual encounters, behaviors that could cut the growth of new infections by 20% to 30%.

If that’s the case, some experts worry that the US could see monkeypox flare up again as the weather warms.

“The party season was during the summer, during the height of the outbreak, and we’re in the dead of winter. So there’s a possibility that behavior change may not able to be sustained,” said Gregg Gonsalves, an epidemiologist at the Yale School of Public Health.

Although we’re clearly in a much better position than we were last summer, he says, public health officials shouldn’t make this a “mission accomplished” moment.

“Now, put your foot on the accelerator. Let’s get the rest of these cases,” Gonsalves said.

Mermin says that’s exactly what the CDC intends to do. It isn’t finished with the response but intends to switch to “a ground game.”

“So much of our work in the next few months will be setting up structures so that getting vaccinated is easy,” he said.

Nearly 40% of mpox cases in the United States were diagnosed in people who also had HIV, Mermin said. So the CDC is going to make sure Jynneos vaccines are available as a routine part of care at HIV clinics and STI clinics that offer pre-exposure prophylaxis, or PrEP, for HIV.

Mermin said officials are also going to continue to go to LGBTQ festivals and events to offer on-site vaccinations.

Additionally, they’re going to study people who’ve been vaccinated and infected to see whether they remain immune – something else that’s still a big unknown.

Experts say that’s just one of many questions that need a closer look. Another is just how long the virus had been spreading outside Africa before the world noticed.

“We’re starting to see some data that suggests that asymptomatic infection and transmission is possible, and that certainly will change how we how we think about this virus and and risk,” said Anne Rimoin, an epidemiologist at the Fielding School of Public Health at UCLA.

When researchers at a sexual health clinic in Belgium rescreened more than 200 nasal and oral swabs they had taken in May 2022 to test for the STIs chlamydia and gonorrhea, they found positive mpox cases that had gone undiagnosed. Three of the people reported no symptoms, while another reported a painful rash, which was misdiagnosed as herpes. Their study was published in the journal Nature Medicine.

“Mild and asymptomatic infections may have indeed delayed the detection of the outbreak,” study author Christophe Van Dijck of the Laboratory of Medical Microbiology at the University of Antwerp in Belgium said in an email to CNN.

While researchers tackle those pursuits, advocacy groups say they aren’t ready to relax.

Hoang says Equality California is pushing the CDC to address continuing racial disparities in mpox vaccination and treatment, particularly in rural areas.

He’s not worried that gay men will drop their guard now that the emergency has expired..

“We’ve learned that we have to take health into our own hands, and I do think that we will remain vigilant as a community for this outbreak and future outbreaks,” Hoang said.

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FDA vaccine advisers vote to harmonize Covid-19 vaccines in the United States | CNN

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CNN
—

A panel of independent experts that advises the US Food and Drug Administration on its vaccine decisions voted unanimously Thursday to update all Covid-19 vaccines so they contain the same ingredients as the two-strain shots that are now used as booster doses.

The vote means young children and others who haven’t been vaccinated may soon be eligible to receive two-strain vaccines that more closely match the circulating viruses as their primary series.

The FDA must sign off on the committee’s recommendation, which it is likely to do, before it goes into effect.

Currently, the US offers two types of Covid-19 vaccines. The first shots people get – also called the primary series – contain a single set of instructions that teach the immune system to fight off the original version of the virus, which emerged in 2019.

This index strain is no longer circulating. It was overrun months ago by an ever-evolving parade of new variants.

Last year, in consultation with its advisers, the FDA decided that it was time to update the vaccines. These two-strain, or bivalent, shots contain two sets of instructions; one set reminds the immune system about the original version of the coronavirus, and the second set teaches the immune system to recognize and fight off Omicron’s BA.4 and BA.5 subvariants, which emerged in the US last year.

People who have had their primary series – nearly 70% of all Americans – were advised to get the new two-strain booster late last year in an effort to upgrade their protection against the latest variants.

The advisory committee heard testimony and data suggesting that the complexity of having two types of Covid-19 vaccines and schedules for different age groups may be one of the reasons for low vaccine uptake in the US.

Currently, only about two-thirds of Americans have had the full primary series of shots. Only 15% of the population has gotten an updated bivalent booster.

Data presented to the committee shows that Covid-19 hospitalizations have been rising for children under the age of 2 over the past year, as Omicron and its many subvariants have circulated. Only 5% of this age group, which is eligible for Covid-19 vaccination at 6 months of age, has been fully vaccinated. Ninety percent of children under the age of 4 are still unvaccinated.

“The most concerning data point that I saw this whole day was that extremely low vaccination coverage in 6 months to 2 years of age and also 2 years to 4 years of age,” said Dr. Amanda Cohn, director of the US Centers for Disease Control and Prevention’s Division of Birth Defects and Infant Disorders. “We have to do much, much better.”

Cohn says that having a single vaccine against Covid-19 in the US for both primary and booster doses would go a long way toward making the process less complicated and would help get more children vaccinated.

Others feel that convenience is important but also stressed that data supported the switch.

“This isn’t only a convenience thing, to increase the number of people who are vaccinated, which I agree with my colleagues is extremely important for all the evidence that was related, but I also think moving towards the strains that are circulating is very important, so I would also say the science supports this move,” said Dr. Hayley Gans, a pediatric infectious disease specialist at Stanford University.

Many others on the committee were similarly satisfied after seeing new data on the vaccine effectiveness of the bivalent boosters, which are cutting the risk of getting sick, being hospitalized or dying from a Covid-19 infection.

“I’m totally convinced that the bivalent vaccine is beneficial as a primary series and as a booster series. Furthermore, the updated vaccine safety data are really encouraging so far,” said Dr. David Kim, director of the the US Department of Health and Human Services’ National Vaccine Program, in public discussion after the vote.

Thursday’s vote is part of a larger plan by the FDA to simplify and improve the way Covid-19 vaccines are given in the US.

The agency has proposed a plan to convene its vaccine advisers – called the Vaccines and Related Biological Products Advisory Committee, or VRBPAC – each year in May or June to assess whether the instructions in the Covid-19 vaccines should be changed to more closely match circulating strains of the virus.

The time frame was chosen to give manufacturers about three months to redesign their shots and get new doses to pharmacies in time for fall.

“The object, of course – before anyone says anything – is not to chase variants. None of us think that’s realistic,” said Jerry Weir, director of the Division of Viral Products in the FDA’s Office of Vaccines Research and Review.

“But I think our experience so far, with the bivalent vaccines that we have, does indicate that we can continue to make improvements to the vaccine, and that would be the goal of these meetings,” Weir said.

In discussions after the vote, committee members were supportive of this plan but pointed out many of the things we still don’t understand about Covid-19 and vaccination that are likely to complicate the task of updating the vaccines.

For example, we now seem to have Covid-19 surges in the summer as well as the winter, noted Dr. Michael Nelson, an allergist and immunologist at the University of Virginia. Are the surges related? And if so, is fall the best time to being a vaccination campaign?

The CDC’s Dr. Jefferson Jones said that with only three years of experience with the virus, it’s really too early to understand its seasonality.

Other important questions related to the durability of the mRNA vaccines and whether other platforms might offer longer protection.

“We can’t keep doing what we’re doing,” said Dr. Bruce Gellin, chief of global public health strategy at the Rockefeller Foundation. “It’s been articulated in every one of these meetings despite how good these vaccines are. We need better vaccines.”

The committee also encouraged both government and industry scientists to provide a fuller picture of how vaccination and infection affect immunity.

One of the main ways researchers measure the effectiveness of the vaccines is by looking at how much they increase front-line defenders called neutralizing antibodies.

Neutralizing antibodies are like firefighters that rush to the scene of an infection to contain it and put it out. They’re great in a crisis, but they tend to diminish in numbers over time if they’re not needed. Other components of the immune system like B-cells and T-cells hang on to the memory of a virus and stand ready to respond if the body encounters it again.

Scientists don’t understand much about how well Covid-19 vaccination boosts these responses and how long that protection lasts.

Another puzzle will be how to pick the strains that are in the vaccines.

The process of selecting strains for influenza vaccines is a global effort that relies on surveillance data from other countries. This works because influenza strains tend to become dominant and sweep around the world. But Covid-19 strains haven’t worked in quite the same way. Some that have driven large waves in other countries have barely made it into the US variant mix.

“Going forward, it is still challenging. Variants don’t sweep across the world quite as uniform, like they seem to with influenza,” the FDA’s Weir said. “But our primary responsibility is what’s best for the US market, and that’s where our focus will be.”

Eventually, the FDA hopes that Americans would be able to get an updated Covid-19 shot once a year, the same way they do for the flu. People who are unlikely to have an adequate response to a single dose of the vaccine – such as the elderly or those with a weakened immune system – may need more doses, as would people who are getting Covid-19 vaccines for the first time.

At Thursday’s meeting, the advisory committee also heard more about a safety signal flagged by a government surveillance system called the Vaccine Safety Datalink.

The CDC and the FDA reported January 13 that this system, which relies on health records from a network of large hospital systems in the US, had detected a potential safety issue with Pfizer’s bivalent boosters.

In this database, people 65 and older who got a Pfizer bivalent booster were slightly more likely to have a stroke caused by a blood clot within three weeks of their vaccination than people who had gotten a bivalent booster but were 22 to 42 days after their shot.

After a thorough review of other vaccine safety data in the US and in other countries that use Pfizer bivalent boosters, the agencies concluded that the stroke risk was probably a statistical fluke and said no changes to vaccination schedules were recommended.

At Thursday’s meeting, Dr. Nicola Klein, a senior research scientist with Kaiser Permanente of Northern California, explained how they found the signal.

The researchers compared people who’d gotten a vaccine within the past three weeks against people who were 22 to 42 days away from their shots because this helps eliminate bias in the data.

When they looked to see how many people had strokes around the time of their vaccination, they found an imbalance in the data.

Of 550,000 people over 65 who’d received a Pfizer bivalent booster, 130 had a stroke caused by a blood clot within three weeks of vaccination, compared with 92 people in the group farther out from their shots.

The researchers spotted the signal the week of November 27, and it continued for about seven weeks. The signal has diminished over time, falling from an almost two-fold risk in November to a 47% risk in early January, Klein said. In the past few days, it hasn’t been showing up at all.

Klein said they didn’t see the signal in any of the other age groups or with the group that got Moderna boosters. They also didn’t see a difference when they compared Pfizer-boosted seniors with those who were eligible for a bivalent booster but hadn’t gotten one.

Further analyses have suggested that the signal might be happening not because people who are within three weeks of a Pfizer booster are having more strokes, but because people who are within 22 to 42 days of their Pfizer boosters are actually having fewer strokes.

Overall, Klein said, they were seeing fewer strokes than expected in this population over that period of time, suggesting a statistical fluke.

Another interesting thing that popped out of this data, however, was a possible association between strokes and high-dose flu vaccination. Seniors who got both shots on the same day and were within three weeks of those shots had twice the rate of stroke compared with those who were 22 to 42 days away from their shots.

What’s more, Klein said, the researchers didn’t see the same association between stroke and time since vaccination in people who didn’t get their flu vaccine on the same day.

The total number of strokes in the population of people who got flu shots and Covid-19 boosters on the same day is small, however, which makes the association a shaky one.

“I don’t think that the evidence are sufficient to conclude that there’s an association there,” said Dr. Tom Shimabukuro, director of the CDC’s Immunization Safety Office.

Nonetheless, Richard Forshee, deputy director of the FDA’s Office of Biostatistics and Pharmacovigilance, said the FDA is planning to look at these safety questions further using data collected by Medicare.

The FDA confirmed that the agency is taking a closer look.

“The purpose of the study is 1) to evaluate the preliminary ischemic stroke signal reported by CDC using an independent data set and more robust epidemiological methods; and 2) to evaluate whether there is an elevated risk of ischemic stroke with the COVID-19 bivalent vaccine if it is given on the same day as a high-dose or adjuvanted seasonal influenza vaccine,” a spokesperson said in a statement.

The FDA did not give a time frame for when these studies might have results.

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Pediatricians are giving out free gun locks to approach the gun violence epidemic as a public health crisis | CNN

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CNN
—

In a triage waiting room of St. Louis Children’s Hospital in Missouri, a clear basket filled with gun locks sits near the walkway, just noticeable enough to those passing by.

The hospital staff calls it the “No Questions Asked” basket, to encourage gun safety without having to confront gun owners about what can be a sensitive and divisive topic. It holds an assortment of cable gun locks free of charge, available to those who need them, alongside pamphlets explaining how to properly and safely store firearms.

The initiative, aimed at reducing the stigma of addressing gun safety, is part of a growing effort by medical professionals who are treating the country’s gun violence epidemic as a public health crisis.

“It takes standing at the bedside of one child who has been shot to realize that we all have to do more and as the leading cause of death for children in this country, pediatricians need to be front and center of the solution, of all the solutions,” said Dr. Annie Andrews, a professor of pediatrics at the Medical University of South Carolina and an expert on gun violence prevention.

Over the course of two years, thousands of gun locks have been taken from the basket, according to Dr. Lindsay Clukies, a pediatric emergency medicine physician at the hospital.

In the coming weeks, baskets filled with free gun locks will be available at more than 17 locations operated by BJC HealthCare, an organization serving metro St. Louis, mid-Missouri and Southern Illinois, Clukies said. It’s a low-cost and effective way to easily distribute firearm safety devices.

“We’ve had employees as well as patients take our locks, also their families and even a grandmother who took one for her grandson. It’s for anyone who needs them,” Clukies told CNN. In recent years, a rising number of pediatricians across the country have been engaging with the topic of gun safety in medical settings by focusing on safety and prevention, already a natural aspect of their work.

During patient visits, it’s increasingly common for pediatricians to ask the patient’s parents if there are guns at home, and if so, how they are stored. Some hospitals then offer free gun locks, often sourced from donations or police departments and paired with safe storage education.

Some pediatricians, who bear witness to the effects of gun violence on children in their workplace every day, told CNN they see it as their obligation as medical professionals to be part of the solution to the epidemic.

In 2022, 1,672 children and teenagers under 17 were killed by gun violence and 4,476 were injured, according to the Gun Violence Archive, a nonprofit organization tracking injuries and deaths by gunfire since 2014.

“We have just as an important voice in this conversation as anyone else because we’re the ones who have invested our entire careers to protecting children and ensuring that children can grow up to be the safest healthiest version of themselves,” said Andrews.

“It is only natural that we see these things that we understand that they’re preventable, and we want to get involved in finding the solutions,” she added.

So far in 2023, high-profile incidents of children accessing firearms have heeded calls for stronger, more consistent laws nationwide, requiring adults to safely secure their guns out of the reach of children and others unauthorized to use them. They have also highlighted a lack of public education on the responsibility of gun owners to store their guns unloaded, locked and away from ammunition, CNN previously reported.

In early January, a 6-year-old boy was taken into police custody after he took a gun purchased by his mother from his home, brought it to school and shot his teacher at Richneck Elementary School in Newport News, Virginia, police said. Just over a week later, a man was arrested in Beech Grove, Indiana, after video was shown on live TV of a toddler, reportedly the man’s son, waving and pulling the trigger of a handgun, CNN previously reported.

Hundreds of children in the US every year gain access to firearms and unintentionally shoot themselves or someone else, according to research by Everytown for Gun Safety, a leading non-profit organization focusing on gun violence prevention. In 2022, there were 301 unintentional shootings by children, resulting in 133 deaths and 180 injuries nationally, Everytown data showed.

Firearm injuries are now the leading cause of death among people younger than 24 in the United States, according to the Centers for Disease Control and Prevention. The American Academy of Pediatrics released an updated policy statement in October 2022, stating firearms are now the leading cause of death in children under the age of 24 in the US.

The Academy’s statement urged a “multipronged approach with layers of protection focused on harm reduction, which has been successful in decreasing motor vehicle-related injuries, is essential to decrease firearm injuries and deaths in children and youth.”

The Academy has free educational modules for pediatricians to guide them on how to have what can be challenging or uncomfortable conversations about firearms with families, according to Dr. Lois Kaye Lee, a pediatrician and the chair of the Academy’s Council on Injury, Violence and Poison Prevention.

“This shouldn’t be considered as something extra; it should be considered as part of the work that we do every day around injury prevention, be it around firearms, child passenger safety and suicide prevention,” Lee said.

Dr. Georges Benjamin, executive director of the American Public Health Association, told CNN the public health approach to addressing gun violence removes the politics from the issue and “puts it into a scientific evidence-based framework.”

“Physicians have a unique opportunity to engage their patients, the parents of kids or the parents themselves as individuals to make their homes safer,” Benjamin said. “We already do this for toxins under our kitchen cabinets, razor blades and outlets in the wall.”

In the emergency department at St. Louis Children’s Hospital, all patients are screened for access to firearms and offered free gun locks, as well as safe storage education, Clukies said. Gun locks can also be mailed to families, free of cost, through the hospital’s website.

“Every patient that comes into our emergency department, whether it’s for a fever or a cold or a broken arm, is asked about access to firearms,” said Clukies, adding 5,000 locks have been given out since the initiatives were started in 2021.

In a collaborative effort between trauma nurses, physicians, social workers, violence intervention experts and family partners, the hospital created a “nonjudgmental” script for doctors to follow as they ask patients about access to firearms, Clukies said.

During the screening process, pediatricians will ask parents or caretakers questions such as: Do you have access to a firearm where your child lives or plays? How is it stored? Is it stored unloaded or loaded?

“When I first started doing this, I would say, ‘Are there any guns in the home? Yes, or no?’ But I have found and learned from other experts that if you just say, ‘If there are any guns in the home, do you mind telling me how they’re secured?’ it takes away the judgment,” said Andrews, a pediatrician whose hospital, the Medical University of South Carolina, also offers free gun locks to patients.

An assortment of cable gun locks offered free of charge by the Medical University of South Carolina.

Families are asked about firearms in the “social history” phase of a patient visit, during which pediatricians will ask who lives in the home, what grade the child is in, what activities they engage in and where the child goes to school, according to Andrews. When parents indicate their firearms are not safely stored, like on the top of a shelf or in a nightstand drawer, Andrews said those are important opportunities for intervention and education about storage devices such as keypad lockboxes, fingerprint biometric safes and other types of lock systems.

It’s also important for pediatricians to understand the parents’ or caretakers’ motivation for owning a firearm to “inform the conversation about where they’re willing to meet you as far as storage goes,” she added.

Andrews and Clukies said they were pleasantly surprised by the willingness of families to discuss firearm safety, most of whom recognize it is an effort to protect their children.

“I expected more pushback than we received, which is attributed to us really focusing on how we properly word these questions,” Clukies said. “I think it’s because we turn it into a neutral conversation, and we focus on safety and prevention.”

Andrews added it is uncommon for medical schools or residencies to discuss gun violence prevention, which she says is due to the “politics around the issue.”

“Thankfully, that has evolved, and more and more pediatricians are realizing that we have to be an integral part of the solution to this problem,” Andrews said.

At the St. Louis Children’s Hospital, pediatricians followed up with patients who received a free gun lock in a research study roughly two months after they launched the initiative in the fall of 2021 to see if their storage practices changed.

The study found two-thirds of families reported using the gun lock provided to them by the hospital and there was a “statistically significant decrease” in those who didn’t store their firearms safely, as well as an increase in those who stored their firearms unloaded, according to Clukies.

But there is still much more work to be done in the medical community to fight the gun violence epidemic and scientific research on the issue is “woefully underfunded,” Andrews contended.

According to the American Public Health Association’s Benjamin, a multidisciplinary approach by policymakers, law enforcement and the medical community is essential to fostering a safer environment for children.

“Injury prevention is a core part of every physician’s job,” Benjamin said. “It’s clearly in our lane.”

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Decreasing rates of childhood immunization are a major concern. Our medical analyst explains why | CNN

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CNN
—

Vaccine rates for measles, polio, diphtheria and other diseases are decreasing among US children, according to a new study from the US Centers for Disease Control and Prevention.

The rate of immunizations for required vaccines among kindergarten students declined from 95% to approximately 94% during the 2020-21 school year. It dropped further — to 93% — in the 2021-22 school year.

That’s still a high number, so why is this drop in immunization significant? What accounts for the decline? What might be the consequences if these numbers drop further? If parents are unsure about vaccinating their kids, what should they do? And what can be done on a policy level to increase immunization numbers?

To help us with these questions, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician, public health expert and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also author of “Lifelines: A Doctor’s Journey in the Fight for Public Health.”

CNN: Why is it a problem that childhood immunization rates are declining?

Dr. Leana Wen: The reduction of vaccine-preventable diseases is one of the greatest public health success stories in the last 100 years.

The polio vaccine was introduced in the United States in 1955, for example. In the four years prior, there were an average of over 16,000 cases of paralytic polio and nearly 2,000 deaths from polio each year across the US. Widespread use of the polio vaccine had led to the eradication of polio in the country by 1979, according to the CDC, sparing thousands of deaths and lifelong disability among children each year.

The measles vaccine was licensed in the US in 1963. In the four years before that, there were an average of over 500,000 cases and over 430 measles-associated deaths each year. By 1998, there were just 89 cases recorded — and no measles-associated deaths.

These vaccines are very safe and extremely effective. The polio vaccine, for example, is over 99% effective at preventing paralytic polio. The measles vaccine is 97% effective at preventing infection.

We can do this same analysis for other diseases for which there are routine childhood immunizations.

It’s very concerning that rates of immunization are declining for vaccines that have long been used to prevent disease and reduce death. That means more children are at risk for severe illness — illness that could be averted if they were immunized. Moreover, if the proportion of unvaccinated individuals increases in a community, this also puts others at risk. That includes babies too young to be vaccinated or people for whom the vaccines don’t protect as well — for example, patients on chemotherapy for cancer.

CNN: What accounts for the decline in vaccination numbers?

Wen: There are probably many factors. First, there has been substantial disruption to the US health care system during the Covid-19 pandemic. Many children missed routine visits to the pediatrician during which they would have received vaccines due to pandemic restrictions. In addition, some community health services offered also became disrupted as local health departments focused on Covid-19 services.

Second, disruption to schooling has also played a role. Vaccination requirements are often checked prior to the start of the school year. When schools stopped in-person instruction, that led to some families falling behind on their immunizations.

Third, misinformation and disinformation around Covid-19 vaccines may have seeded doubt in other vaccines. Vaccine hesitancy and misinformation were already major public health concerns before the coronavirus emerged, but the pandemic has exacerbated the issues.

According to a December survey published by the Kaiser Family Foundation, more than one in three American parents said vaccinating children against measles, mumps, and rubella shouldn’t be a requirement for them to attend public schools, even if that may create health risks for others. This was a substantial increase from 2019, when a similar poll from the Pew Research Center found only 23% of parents opposed school vaccine requirements.

CNN: What are some consequences if immunization rates drop further?

Wen: If immunization rates drop further, we could see more widespread outbreaks. Diseases that were virtually eliminated in the US could reemerge, and more people can become severely ill and suffer lasting consequences or even die.

We are already seeing some consequences: Last summer, there was a confirmed case of paralytic polio in an unvaccinated adult in New York. It’s devastating that a disease like polio has been identified again in the US, since we have an extremely effective vaccine to prevent it.

There is an active measles outbreak in Ohio. As of January 17, 85 cases have been reported. Most of the cases involved unvaccinated children, and at least 34 have been hospitalized.

CNN: If parents are unsure of vaccinating their kids, what should they do?

Wen: As parents, we generally trust pediatricians with our children’s health. We consult pediatricians if our kids are diagnosed with asthma and diabetes, or if they have new worrisome symptoms of another illness. We should also consult our pediatricians about childhood immunizations; parents and caregivers with specific questions or concerns should address them.

The national association of pediatricians, the American Academy of Pediatrics, “strongly recommends on-time routine immunization of all children and adolescents according to the Recommended Immunization Schedules for Children and Adolescents.”

CNN: What can be done to increase immunization numbers?

Wen: There needs to be a concerted educational campaign to address why vaccination against measles, mumps, rubella, chickenpox, polio and so forth is so crucial. One of the reasons for vaccine hesitancy, in my experience, is that these diseases have been rarely seen in recent years. Many people who are parents now didn’t experience the devastation of these diseases growing up, so may not realize how terrible it would be for them to return.

Specific interventions should be targeted at the community level. In some places, low immunization levels may be due to access. Vaccination drives at schools, parks, shopping centers, and other places where families gather can help increase numbers. In other places, the low uptake may be because of vaccine hesitancy and misinformation. There will need to be different strategies implemented in that situation.

Overall, increasing immunization rates for vaccine-preventable childhood diseases needs to be a national imperative. I can’t underscore how tragic it would be for kids to suffer the harms of diseases that could be entirely prevented with safe, effective and readily available vaccines that have been routinely given for decades.

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Damar Hamlin could be released from a Buffalo hospital in the next day or two | CNN

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CNN
—

A week after suffering a cardiac arrest while playing the Cincinnati Bengals, doctors are hoping Buffalo Bills safety Damar Hamlin is healthy enough to be released from a Buffalo hospital within 24 to 48 hours, Michael Hughes, senior vice president and chief administrative officer at Kaleida Health, told CNN on Tuesday.

Doctors are finishing tests and are identifying possible causes of the event, including whether there were any pre-existing conditions that played a role in Hamlin’s January 2 cardiac arrest.

“Hamlin is going through a series of testing and evaluation today,” Kaleida Health said in a statement Tuesday. The Buffalo General Medical Center team will also “potentially treat any pathology that may be found, as well as plan for his recovery, discharge and rehabilitation.”

Hamlin himself updated his fans Tuesday afternoon.

“Not home quite just yet,” Hamlin tweeted. “Still doing & passing a bunch of test. Special thank-you to Buffalo General it’s been nothing but love since arrival! Keep me in y’all prayers please!”

Hamlin was transferred from a Cincinnati hospital to the Buffalo hospital on Monday after doctors determined his critical condition had improved to good or fair – surpassing expectations.

“We felt that it was safe and proper to help get him back to the greater Buffalo area,” Dr. Timothy Pritts, chief of surgery at the University of Cincinnati Medical Center, said Monday.

Hamlin’s parents flew from Cincinnati back home to Pittsburgh but then flew to Buffalo. They were en route Tuesday from the Buffalo Bills’ practice facility and were expected to arrive at the hospital to see Hamlin soon.

Hamlin, a second-year NFL player, has been regaining strength over the past several days after his sudden collapse after a tackle against the Bengals in Cincinnati.

“He’s certainly on what we consider a very normal to even accelerated trajectory from the life-threatening event that he underwent,” Pritts said, “but he’s making great progress.”

Normal recovery from a cardiac arrest can be measured in weeks to months, Pritts explained. But Hamlin has been beating that timeline at each stage and is neurologically intact.

Still, Pritts said it’s too early to say when Hamlin could get back to normal life or what caused his heart to stop, saying more testing is needed.

Hamlin was sedated and on a ventilator for days after his cardiac arrest. On Friday morning, the breathing tube was removed, and Hamlin began walking with some help by that afternoon, his doctors said Monday.

The safety’s condition was upgraded Monday because his organ systems were stable and he no longer needed intensive nursing or respiratory therapy, doctors said.

“He walks normally,” said Dr. William Knight, a neurovascular critical care expert who treated Hamlin at UC Health. “He is admittedly a little weak. I don’t think that’s of any real surprise after what he went through, just regaining his strength. And that’s part of his recovery process.”

Hamlin’s release Monday meant he could return to Buffalo, which prompted even more encouragement and eagerness for some of his teammates to see him again.

“Super excited that he’s back in Buffalo and what a job that the team of docs and the medical team did out in Cincinnati, and now he’s in great care here in Buffalo. We’re happy to have him back,” Buffalo Bills head coach Sean McDermott told reporters Monday.

After seeing him Monday, McDermott said Hamlin was “tired” but seemed happy. “Happy to be back in Buffalo and around a familiar area to him. I know he’s taking it just one step at a time.”

The coach also said his team has grown since Hamlin was injured, saying such experiences nurture growth.

“We will all have grown as people, and as men in this case,” McDermott said, noting there’s a plan in place for the players and staff to visit Hamlin “at the proper time.”

“Having him nearby will give us more comfort” and inspire the team as it prepares for the postseason, McDermott said.

Although Hamlin was not with the team when they played Sunday against the New England Patriots, his support was definitely felt.

When his team scored a touchdown, Hamlin set off alarms in the ICU, Pritts said.

“When the opening kickoff was run back, he jumped up and down and got out of his chair and set – I think – every alarm off in the ICU in the process, but he was fine, it was just an appropriate reaction to a very exciting play. He very much enjoyed it,” Pritts said.

Hamlin was “beyond excited” Sunday and felt “very supported by the outpouring of love from across the league, especially from the Buffalo area. We’ve learned this week that the Bills mafia is a very real thing,” Pritts added.

The immediate medical response to Hamlin’s collapse helped save his life, and the Buffalo Bills are now encouraging people to learn how to administer CPR.

Assistant athletic trainer Denny Kellington is credited with performing CPR when Hamlin lost his pulse on the field and needed to be revived through resuscitation and defibrillation.

The medical response was part of an emergency action plan that “involves team, independent medical and athletic training staff, equipment and security personnel, and is reviewed prior to every game,” a Monday statement from the Bills read.

The team pledged support for resources including CPR certifications, automated external defibrillator units and guidance developing cardiac emergency response plans within the Buffalo community, according to the statement.

“We encourage all our fans to continue showing your support and take the next step by obtaining CPR certification,” the Bills said.

Clarification: This story has been updated to clarify Hughes’ remarks about Hamlin’s injury and recovery.

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The year in sport: A fond farewell for some, a glimpse of the future for others | CNN

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CNN
—

An athlete, former jockey AP McCoy said earlier this year, is the only person who dies twice, such is the pain of walking away from the intoxicating, all-consuming nature of professional sport.

McCoy retired from his long, decorated racing career in 2015, and since then has had to learn, in his own words, how to “start again and have another life.”

Based on the past 12 months, there are some notable sports stars who might have been listening extra closely to McCoy’s experience of retirement – or indeed to anyone else who has spoken candidly about the difficulty of ending a successful sporting career.

Among them is Roger Federer, who called time on his trophy-laden tennis career at the Laver Cup in September after years spent trying to recover from two knee surgeries.

In the letter announcing his retirement, Federer, like McCoy, alluded to the heightened emotions of being a professional athlete and how they make saying goodbye so hard.

“I have laughed and cried, felt joy and pain, and most of all I have felt incredibly alive,” Federer wrote. “To the game of tennis,” he signed off the letter, “I love you and will never leave you.”

Those final words were reassuring for fans who have admired Federer’s career for so many years, but also spoke to another issue: namely, of how hard it can be to walk away entirely from professional sport after retirement.

It remains to be seen exactly how Federer will remain involved in tennis moving forward, and the same can be said of Serena Williams, who announced she would “evolve away from tennis” ahead of this year’s US Open – but refused to say she was retiring.

On several occasions over the past three months, the 23-time grand slam champion has even teased fans about a potential return to tennis.

At the 2022 US Open, Serena Williams lost to Australian Ajla Tomlijanovic in the third round.

While Federer and Williams have stepped away from their careers as two of the greatest athletes of all time, other sports stars can’t seem to decide when, or how, to walk away.

Heavyweight boxing champion Tyson Fury has yo-yoed in and out of retirement this year, saying in October that he’s finding it “really hard to let this thing go.”

And earlier this year, Tom Brady announced he would be retiring from the NFL, leaving the sport as a seven-time Super Bowl champion and arguably the greatest quarterback of all time. the 45-year-old then reversed that decision and is still breaking records with the Tampa Bay Buccaneers during his 23rd season in the NFL.

However in September, Brady and Gisele Bündchen announced they were to divorce after 13 years of marriage.

“I think there is a lot of professionals in life that go through things that they deal with at work and they deal with at home,” the Bucs quarterback said on his weekly podcast a few days the couple’s divorce announcement.

“Obviously, the good news is it’s a very amicable situation, and I’m really focused on two things: taking care of my family, and certainly my children, and secondly doing the best job I can to win football games. That’s what professionals do.”

Brady has redefined what most believed to be the average shelf-life of an athlete, and he’s not the only person refusing to let the light dim on his career.

LeBron James is about to turn 38 but is still setting records in the NBA – in February passing Kareem Abdul-Jabbar for the most combined regular season and postseason points in NBA history.

Federer’s rivals Rafael Nadal, 36, and Novak Djokovic, 35, meanwhile, have added to their grand slam tallies this year – the Mallorcan at the Australian Open and French Open, where he became the oldest men’s singles champion, and the Serbian at Wimbledon. Djokovic’s Wimbledon triumph moved him to within one grand slam title of Nadal’s men’s record of 22.

Having been deported from Australia over his vaccination status at the start of the year, Djokovic is set to compete at the Australian Open at the start of 2023 – a tournament he has won on nine previous occasions and is favorite to win again next year off the back of his recent ATP Finals victory.

For Nadal, his future in the sport rests on the amount of strain his injury-ravaged body can continue to withstand.

In golf, Tiger Woods faces similar questions. The 15-time major champion completed a stunning return from serious leg injuries suffered in a car crash at this year’s Masters, scoring a remarkable one-under 71 at Augusta National before making the cut the following day.

Then there’s sprinter Shelly-Ann Fraser-Pryce, who turns 36 later this month but has shown no signs of slowing down. The Jamaican produced a string of consistently fast performances this year, running under 10.7 seconds for the 100 meters a record seven times and claiming her fifth world championship title over the distance in July.

Shelly-Ann Fraser-Pryce celebrates winning the women's 100m final at the World Athletics Championships in Eugene, Oregon, in July.

And it’s not just athletes who have defied the call of retirement this year. In November, 73-year-old Dusty Baker became the oldest ever manager to win the World Series when he guided the Houston Astros to a 4-2 victory against the Philadelphia Phillies.

Many of the athletes who stole the headlines in 2022 have been doing so for years.

No one is sure where an aging Cristiano Ronaldo will play his club football in January after ending his second spell at Manchester United in ignominious fashion, but the 37-year-old still appears to be set on extending his playing career after Portugal’s quarterfinal exit from the World Cup.

His rival Lionel Messi, meanwhile, ended the year on a sensational high, guiding Argentina to a third World Cup trophy. The 35-year-old Messi scored twice in an absorbing final against France and finally got his hands on the World Cup at the fifth time of asking, further staking his claim as the game’s greatest ever player.

That hasn’t been the only recent instance of an established superstar winning silverware. In last season’s NBA Finals, Steph Curry guided the Golden State Warriors to a fourth championship title in eight seasons – in the process picking up his first Finals MVP award as the Warriors beat the Boston Celtics.

In baseball, meanwhile, Aaron Judge enjoyed a season for the ages. The 30-year-old outfielder, who has reportedly just signed a nine-year, $360 million deal with the New York Yankees, hit 62 home runs last season, breaking Roger Maris’ single-season American League (AL) home run record from 1961.

On Wednesday, the Yankees named Judge, the reigning AL MVP, as the 16th captain in the franchise’s history.

Judge (left) hit a record-breaking 62 home runs last season.

But even as familiar faces have continued to shine, the past year has also seen future stars emerge.

The 19-year-old Carlos Alcaraz ends the year as the youngest No. 1 in the history of the men’s tennis having triumphed at the US Open, and in the women’s game, Iga Swiatek, who rose to No. 1 in the world following Ashleigh Barty’s decision to retire after winning the Australian Open, looks set to dominate for years to come.

This year, the 21-year-old Swiatek won her second grand slam title at the French Open – which came in the middle of a 37-match winning streak – and her third at the US Open.

In Formula One, Max Verstappen has cemented his position as the best driver in the sport, comfortably defending his world title with four races to spare, while Erling Haaland, regarded as one of the best strikers in European football, has been scoring goals at a record-breaking rate during his first season at Manchester City.

There was no stopping Max Verstappen this year.

At the Winter Olympics in Beijing, then-18-year-old freestyle skier Eileen Gu stole the headlines, winning two gold medals and a silver for the host nation; she also became the first freestyle skier to earn three medals at a single Olympics.

Another teenager, figure skater Kamila Valieva, had a memorable Games for different reasons. The 16-year-old tested positive for trimetazidine, a heart medication, in December 2021, but the result didn’t come to light until Valieva was already in Beijing and had won gold in the figure skating team event.

In that competition, she became the first woman to land a quadruple jump – which involves four spins in the air – at the Winter Olympics.

The outcome from the positive test remains unresolved, and in November, the World Anti-Doping Agency referred Valieva’s case to the Court of Arbitration for Sport after deeming the Russian Anti-Doping Agency had made no progress.

Eileen Gu performs a trick during the women's freestyle freeski halfpipe final at the Beijing Winter Olympics in February.

Russia’s invasion of Ukraine has cast a shadow over much of this year’s sporting calendar.

Athletes and teams from Russia and Belarus were banned from competitions across various sports, including qualification games for this year’s World Cup and participation at Wimbledon.

The decision from Wimbledon was perhaps the strongest stance taken by a sports organization, resulting in the ATP and WTA Tours removing ranking points from this year’s tournament.

At the start of the war, many Ukrainian athletes – like skeleton racer Vladyslav Heraskevych and MMA fighter Yaroslav Amosov – opted to put their careers on hold and support the country’s military efforts.

Boxer Oleksandr Usyk has also spoken passionately about serving his country, and in the ring has extended his undefeated record, beating Anthony Joshua in August to retain his WBA (Super), IBF, WBO, and IBO heavyweight titles.

Oleksandr Usyk lands a punch on Anthony Joshua during their

Throughout 2022, sport and geopolitics have been closely entwined. This month, WNBA star Brittney Griner returned home to the US having been detained in Russia for nearly 10 months on drug smuggling charges.

Despite her testimony that she had inadvertently packed the cannabis oil that was found in her luggage, Griner was sentenced to nine years in prison in early August and was moved to a penal colony in the Mordovia republic in mid-November after losing her appeal.

The 32-year-old’s arrest in Russia sparked diplomatic drama between the US and the Kremlin which played out alongside Russia’s war in Ukraine.

She was released in a prisoner swap that involved Russian arms dealer Viktor Bout. The exchange, however, did not include another American that the State Department has declared wrongfully detained, Paul Whelan.

Brittney Griner is seen getting off a plane in an undated photo posted to her Instagram.

Perhaps no sport has been as gripped by internal politics this year as much as golf, which was rocked by the launch of the Saudi-backed LIV Golf series in June.

LIV Golf has been criticized by some of the game’s leading players – including Woods and Rory McIlroy – while others – major champions Phil Mickelson and Dustin Johnson – have abandoned the PGA Tour in favor of the lucrative, breakaway series.

It has left the sport divided. Earlier this year, LIV Golf joined an antitrust lawsuit alongside some of its players, alleging that the PGA Tour threatened to place lifetime bans on players who participate in the LIV Golf series.

The suit also alleges that the PGA Tour has threatened sponsors, vendors, and agents to coerce players into abandoning opportunities to play in LIV Golf events.

The PGA Tour filed a countersuit in late September, claiming “tortious interference with the Tour’s contracts with its members.”

The LIV Golf series is backed by Saudi Arabia’s Public Investment Fund (PIF) – a sovereign wealth fund chaired by Mohammed bin Salman, the crown prince of Saudi Arabia and the man who a US intelligence report named as responsible for approving the operation that led to the 2018 murder of journalist Jamal Khashoggi. Bin Salman has denied involvement in Khashoggi’s murder.

LIV Golf’s launch is part of Saudi Arabia’s wider ambition to host and invest in global sports events. This year, it staged the rematch between Usyk and Joshua and even won a bid to host the 2029 Asian Winter Games.

But unquestionably, the most prominent sporting event held in the Gulf region this year has been the World Cup in Qatar.

The four-week-long tournament came to a thrilling conclusion on Sunday as Argentina lifted the trophy, bringing down the curtain on what FIFA president Gianni Infantino argued was the greatest World Cup of all time.

There were upsets, high-scoring games, and brilliant goals throughout – right up to Sunday’s showpiece when Messi reigned supreme and Kylian Mbappé scored a stunning hat-trick in a losing cause.

The match between Argentina and France at Qatar 2022 is being viewed as the greatest ever World Cup final.

It was the first time a country in the Middle East had hosted the World Cup, and Qatar, which has a population of just three million people, invested billions of dollars in building seven new stadiums, as well as new hotels and expansions to the country’s airport, rail networks and highways.

The tournament was also fraught with controversy, particularly when it came to allegations surrounding the country’s poor human rights record and treatment of migrant workers.

Since 2010, many migrant workers in Qatar have faced delayed or unpaid wages, forced labor, long hours in hot weather, employer intimidation, and an inability to leave their jobs because of the country’s sponsorship system, human rights organizations have found.

In the face of such criticism, Qatar has maintained it is an open, tolerant country and has seen the World Cup as a vehicle to accelerate labor reforms.

Elsewhere in international football, England won the Women’s European Championships for the first time in front of a record crowd on home soil, while Senegal claimed the Africa Cup of Nations (AFCON) title in February, also for the first time.

Outside international competitions, Real Madrid won its 14th European crown by defeating Liverpool in the Champions League final – a game that was marred by security issues.

Real Madrid defeated Liverpool in this year's Champions League final in Paris.

The match itself was delayed by more than 35 minutes after Liverpool fans struggled to enter the Stade de France and tear gas was used by French police towards supporters held in tightly packed areas.

Paris police chief Didier Lallement admitted in June that the chaos was “obviously a failure” and said he takes “full responsibility for police management” of the event.

Tragically, football has witnessed multiple serious stadium disasters this year. In October, more than 130 people were killed in a stampede in the Indonesian city of Malang – one of the world’s deadliest stadium disasters of all time.

Indonesia’s President Joko Widodo later said the country would demolish and rebuild the stadium, vowing to “thoroughly transform” the sport in the football-mad nation.

Players and officials from Arema Football Club gather to pray on the pitch for victims of the stampede at Kanjuruhan stadium in Malang.

A stadium crush in the Cameroonian capital of Yaoundé during this year’s AFCON also saw at least eight people killed and 38 injured during the game between Cameroon and Comoros.

Looking ahead to 2023, Australia and New Zealand is scheduled to host the Women’s World Cup in July and August.

The US Women’s National Team (USWNT) could become the first team to win the tournament three times in a row.

This year, the United States Soccer Federation (USSF), the USWNT’s Players Association (USWNTPA) and the United States National Soccer Team Players Association (USNSTPA) forged a landmark equal pay deal – the first federation in the world to equalize prize money awarded to the teams for participating in World Cups.

Next year will be the first time the USWNT has played a major tournament under such a deal.

Among the other major sporting events being held next year are the World Athletics Championshps in Budapest, Hungary, and the Rugby World Cup in France.

In the NFL, Super Bowl LVII in Glendale, Arizona is only weeks away, while the NBA Playoffs begin two months later in April.

With the men’s World Cup over, club football resumes in Europe and tennis’ first grand slam of the year, the Australian Open, begins on January 16.

For sports fans, that will hopefully serve as tonic to stave off the January blues.

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LeBron James and Billie Jean King lead tributes to American journalist Grant Wahl | CNN

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CNN
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The death of prominent journalist Grant Wahl at the World Cup in Qatar has led to an outpouring of shock and grief across the sports world, with NBA star LeBron James and tennis great Billie Jean King leading the tributes to the American.

Prominent American journalist Grant Wahl has died in Qatar after collapsing while covering the World Cup, sparking an outpouring of shock and grief across the sports world. He was 49.

King said Wahl’s death was “heartbreaking.”

“A talented journalist, Grant was an advocate for the LGBTQ community & a prominent voice for women’s soccer,” King tweeted Saturday. “He used his platform to elevate those whose stories needed telling. Prayers for his family.”

On Friday in Philadelphia, basketball star James said he had been “very fond of Grant.” While Wahl was at Sports Illustrated, he did a cover story on James when James was in high school.

“I’ve always kind of watched from a distance even when I moved up in ranks and became a professional, and he went to a different sport,” said James, speaking at a postgame press conference. “Any time his name would come up I’ll always think back to me as a teenager and having Grant in our building … It’s a tragic loss.”

Tyler Adams, the captain of the US men’s national soccer team, which was knocked out of the World Cup by the Netherlands in the last 16, sent his “deepest sympathy” to Wahl’s wife, Celine Gounder, and to those who knew him.

“As players we have a tremendous amount of respect for the work of journalists, & Grant’s was a giant voice in soccer that has tragically fallen silent,” Adams wrote on Twitter.

Qatar’s World Cup organizers said on Saturday that Wahl “fell ill” in the press area, where he received “immediate medical treatment on site.”

He was then transferred to Hamad General Hospital, said a spokesperson for the Supreme Court Committee for Delivery and Legacy, the body responsible for planning the tournament.

Wahl was treated in the stadium “for about 20-25 minutes” before he was moved to the hospital, Keir Radnedge, a columnist at World Soccer Magazine, told CNN Saturday.

“This was towards the end of extra time in the match. Suddenly, colleagues up to my left started shouting for medical assistance. Obviously, someone had collapsed. Because the chairs are freestanding, people were able to move the chairs, so it’s possible to create a little bit of space around him,” Radnedge said.

He added that the medical team were there “pretty quickly and were able to, as best they could, give treatment.”

White House Press Secretary Karine Jean-Pierre reacted to Wahl’s death on Saturday, adding that senior State Department officials were in touch with Qatari officials and Grant’s family.

“Grant Wahl was an inspiration to many. Our thoughts are with his wife Dr. Céline Gounder and all those who loved him. State Department officials are in touch with Grant’s family and with senior officials in the government of Qatar to ensure his family gets the support they need,” Jean-Pierre wrote on Twitter.

“Only some days ago, Grant was recognized by FIFA and AIPS (the International Sports Press Association) for his contribution to reporting on eight consecutive FIFA World Cups,” said FIFA President Gianni Infantino in a statement.

Infantino and FIFA media director Bryan Swanson were at the hospital on Saturday to offer any kind of support needed for the family, friends, and the journalists who were also his housemates in Qatar.

The co-editors in chief of Sports Illustrated, the publication where Wahl spent the majority of his career, said in a joint statement they were “shocked and devastated at the news of Grant’s passing.”

“We were proud to call him a colleague and friend for two decades – no writer in the history of (Sports Illustrated) has been more passionate about the sport he loved and the stories he wanted to tell,” said the statement.

It added that Wahl had first joined the publication in November 1996. He had volunteered to cover the sport as a junior reporter – back before it reached the heights of global popularity it now enjoys – eventually becoming “one of the most respected soccer authorities in the world,” it said.

The statement said that Wahl also worked with other media outlets including Fox Sports. After leaving Sports Illustrated in 2020, he began publishing his podcast and newsletter.

Other current and former US soccer players, including Ali Krieger and Tony Meola, shared their condolences, as did sporting bodies such as Major League Soccer and the National Women’s Soccer League.

Wittyngham, Wahl’s podcast co-host, told CNN on Saturday the news of his death had been hard to fathom.

“For Americans, Grant Wahl is the first person you read covering soccer. He was kind of the only person for a while … Grant was the first person who really paid genuine attention to this sport in a meaningful way,” Wittyngham said.

Several journalists shared stories of reporting alongside Wahl, and having encountered him at multiple World Cups over the years.

“Before he became the best covering soccer he did hoops and was so kind to me,” wrote famed broadcaster Dick Vitale.

Timmy T. Davis, the US Ambassador to Qatar, tweeted that Wahl was “a well known and greatly respected reporter who focused on the beautiful game.”

“The entire US Soccer family is heartbroken to learn that we have lost Grant Wahl,” US Soccer said in a statement on its official Twitter account.

“Grant made soccer his life’s work, and we are devastated that he and his brilliant writing will no longer be with us.”

US Soccer praised Wahl’s passion and “belief in the power of the game to advance human rights,” and shared its condolences with Wahl’s wife, Celine Gounder, and his loved ones.

Gounder also posted the US Soccer statement on Twitter.

“I am so thankful for the support of my husband Grant Wahl’s soccer family and of so many friends who’ve reached out tonight. I’m in complete shock,” wrote Gounder, a former CNN contributor who served on the Biden-Harris transition Covid-19 advisory board.

US State Department spokesperson Ned Price said the department was in “close communication” with Wahl’s family. The World Cup organizers also said they were in touch with the US embassy “to ensure the process of repatriating the body is in accordance with the family’s wishes.”

Wahl wearing a rainbow-colored t-shirt while working at Qatar 2022.

Wahl had covered soccer for more than two decades, including 11 World Cups — six men’s, five women’s – and authored several books on the sport, according to his website.

He had just celebrated his birthday earlier this week with “a great group of media friends at the World Cup,” according to a post on his official Twitter account, which added: “Very thankful for everyone.”

In an episode of the podcast Futbol with Grant Wahl, published days before his death on December 6, he had complained of feeling unwell.

“It had gotten pretty bad in terms of like the tightness in my chest, tightness, pressure. Feeling pretty hairy, bad,” Wahl told co-host Chris Wittyngham in the episode. He added that he sought help at the medical clinic at the World Cup media center, believing he had bronchitis.

He was given cough syrup and ibuprofen, and felt better shortly afterward, he said.

Wahl also said he experienced an “involuntary capitulation by my body and mind” after the US-Netherlands game on December 3.

“This isn’t my first rodeo. I’ve done eight of these on the men’s side,” he said at the time. “And so like, I’ve gotten sick to some extent at every tournament, and it’s just about trying to find a way to like get your work done.”

He further described the incident in a recent newsletter published on December 5, writing that his body had “broke down” after he had little sleep, high stress and a heavy workload. He’d had a cold for 10 days, which “turned into something more severe,” he wrote, adding that he felt better after receiving antibiotics and catching up on sleep.

Wahl had made headlines in November by reporting that he was detained and briefly refused entry to a World Cup match because he was wearing a rainbow t-shirt in support of LGBTQ rights.

He said security staff had told him to change his shirt because “it’s not allowed,” and had taken his phone. Wahl said he was released 25 minutes after being detained and received apologies from a FIFA representative and a senior member of the security team at the stadium.

Afterward, Wahl told CNN he “probably will” wear the shirt again.

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