(WASHINGTON) -- For one military family, the consequences of a partial government shutdown would be dire: It could mean not affording treatments and medications for their child who is fighting for her life.

Austin Carrigg and her husband, Master Sgt. Joshua Carrigg, are parents of three -- their youngest, 11-year-old Melanie, has Down syndrome, a congenital heart defect and a metabolic disorder. Melanie recently had a catastrophic stroke.

Carrigg spoke with ABC News Senior Congressional Correspondent Rachel Scott and said her family pays around $300 out of pocket for medication each month. With the government on the brink of a shutdown as soon as Sunday, she said she's had sleepless nights worrying about how they'll be able to afford medications that Melanie needs.

"That's been the conversation -- how will we be able to pay for the medications? Because they're not a choice," she said.

The Alexandria, Virginia, residents are one of many military families whose household budgets could take a hit in a government shutdown. As many as 4 million workers could lose pay as a result of a shutdown -- about half of whom are military troops and personnel.

Congress is just days away from triggering a shutdown. They have until the end of the day on Saturday to reach a deal on funding. If they don't, parts of the government will shut down and members of the military will likely have to work without a paycheck.

While the military would see back pay, that may not lessen the blow to many families living paycheck to paycheck.

Melanie sees a litany of specialists including ones for brain injury and spinal rehabilitation, four eye doctors and three urologists, Carrigg said. Concern about how they can give Melanie the care she needs has her family "stuck in this loop of worry and anxiety," Carrigg said.

"The question has really become, what can we get rid of? Who can we borrow money from in order to do what we need to do in order to keep her alive?"

Carrigg said her husband has been in active duty for 21 years, and this looming government shutdown feels like a slap in the face to the many military families who support the country yet live paycheck to paycheck.

"We're a pawn in a game," she said. "If they supported us, they would make sure we knew where our next meal was coming from."

Now Carrigg is pleading with Congress to act.

"They are literally playing games with our lives. We mean nothing to them ... but they expect my husband to go fight their wars. That's not fair."

Scott asked Rep. Ralph Norman, R-S.C., what he would say to military families like the Carriggs.

"First of all, they do get a paycheck -- it's back pay," he said.

Other lawmakers have dismissed the impact of a shutdown.

"Most of what people will see is not a shutdown. What they will experience is the slowdown," Rep. Matt Rosendale, R-Mont., told Scott.

Carrigg said she wants Congress to know there are "human lives on the line" and that her daughter is one of them.

"She's amazing. She's the bravest, strongest child you will ever meet," Carrigg said. "If she's willing to fight to stay alive … then, as the people who pay my husband to do his job, you have a responsibility to make sure her life is the best that it can be."

Copyright © 2023, ABC Audio. All rights reserved.

(NEW YORK) -- Amid the high cost and rising popularity of drugs used for weight loss like Ozempic, Mounjaro and Wegovy, pharmacists and medical doctors are warning consumers about some websites that sell discounted versions of the drugs.

When a consumer orders a drug online, they have no way of knowing what is in the medication, among other things, according to Dr. Konstantinos Spaniolas, director of the metabolic weight loss center at Stony Brook Medicine.

"Even if you assume that the medication is the correct substance, if this is not processed correctly and it's not sterile, there are infectious concerns," Spaniolas told ABC News' Becky Worley. "People really have to be careful because this leap of faith of ordering something that you are self-injecting at home is a big problem."

He added, "I personally, would not expose myself to that risk."

Ozempic, Mounjaro and Wegovy each require a prescription, and are not sold over the counter.

Ozempic and Mounjaro are approved by the U.S. Food and Drug Administration to treat Type 2 diabetes, but some doctors prescribe the medication "off-label" for weight loss, as is permissible by the FDA. Wegovy, which contains the same main ingredient as Ozempic, is FDA-approved for weight loss.

Insurance coverage for Ozempic and Wegovy varies, depending on everything from a person's medical diagnosis to where they live and their insurance plan.

Without health insurance coverage, the medications can cost over $1,000 per month.

Because of the high demand and high price for the drugs, some websites have started offering the drugs to consumers online.

"There's a huge percent of the population who is looking for these medications with limited access, whether … it's from insurance or availability," Spaniolas said. "Patients are trying to get the medications ordered online, but people have to be very careful."

Dr. Al Carter, executive director of the National Association of Boards of Pharmacy, told ABC News that many of the websites selling drugs like Ozempic and Mounjaro appear to be doing so illegally by operating without a license and by not requiring a prescription for the medications.

"There are around 30 to 35,000 pharmacies that are acting illegally," Carter said. "Our Digital Health team finds, on any given day, around 20 pharmacies, new pharmacies that are operating illegally."

Other unlicensed websites may promise a compounded version of a drug like Ozempic, which the FDA has warned against. Compound versions of drugs are made for individual patients using raw ingredients.

In June, the FDA warned consumers it had received reports of adverse events after people took semaglutide -- the active ingredient in both Ozempic and Wegovy -- that came from a compounding pharmacy. It did not specify the number of reports or what the adverse events were.

The FDA also said in the same warning that some compounding pharmacies claiming to sell semaglutide might instead be selling other formulations of the chemical, like semaglutide sodium and semaglutide acetate. Those haven't been shown to be safe or effective, according to the FDA.

Also in June, Novo Nordisk, the pharmaceutical company that makes Ozempic and Wegovy, filed multiple lawsuits against certain medical spas, weight loss and wellness clinics, and compounding pharmacies for "the unlawful marketing and sales of non-FDA approved counterfeit and compounded semaglutide products claiming to contain semaglutide," including allegations of false advertising, trademark infringement and unlawful sales of non FDA-approved compounded products.

Red flags for consumers

Justin Macy, who leads the National Association of Boards of Pharmacy's Digital Health team, said one red flag for consumers to look for is websites that show photos of the drugs with unique United States-drug identification numbers, but then claim to ship out of Canada, which is illegal.

In other instances, websites posing as pharmacies may promote brand name versions of the drugs.

"The reason ... that this looks so legitimate is because this is the actual Wegovy website," Macy said of one example. "They totally just ripped off the manufacturer's website."

More red flags, according to both Carter and Macy, are websites that do not require a prescription in order to obtain the drugs, and websites that offer the drugs for well below the market price.

The FDA has resources on its website for consumers to use to determine whether an online pharmacy is safe, as well as a tool to search for state-licensed online pharmacies.

The National Association of Boards of Pharmacy also has a website, Safe.Pharmacy/a>, where consumers can verify online websites.

Copyright © 2023, ABC Audio. All rights reserved.

(NEW YORK) -- Over-the-counter agents to treat upper respiratory symptoms like nasal congestion make up a multi-billion-dollar business. But recently, a Food and Drug Administration advisory committee ruled that oral phenylephrine, commonly found in some over-the-counter, or OTC, products like Dayquil, Mucinex, and Sudafed PE, does not work as a decongestant.

The decision has left many consumers confused when searching for relief among all the available products on store shelves.

"It really is stressful for a lot of consumers," board-certified pulmonary critical care and sleep medicine physician Dr. Raj Dasgupta, MD, chief medical advisor at Sleep Advisor, told ABC News.

The Food and Drug Administration said in a public statement that the product will stay on the market while they review the available evidence.

The Consumer Healthcare Products Association, which represents manufacturers of over-the-counter-drugs, called the decision "disappointing" and offered to work with the FDA on the matter.

"We encourage FDA, before making any regulatory determination, to be mindful of the totality of the evidence supporting this long-standing OTC ingredient, as well as the significantly negative unintended consequences associated with any potential change in oral PE's regulatory status," CHPA president and CEO Scott Melville said in the statement.

Dasgupta says that taking oral phenylephrine isn't dangerous and some people may believe it works for them, so those products don't necessarily need to be thrown out due to a safety concern, but better options may be available.

For consumers buying new products, ABC News spoke to two experts to provide four tips to help find the right solution for sinus and cold symptoms this season:

Read the label, be intentional about purchase

Dasgupta explained that many people don't actually know what products they are buying and that many products contain different medications that each treat different symptoms.

"If you are going to the store to pick up over the counter medications, you have to ask the question, 'Why? Why are you going there,'" Dasgupta said.

Cold symptoms may include nasal congestion, but people may also have muscle and body aches or a cough they want to treat and there are specific medications that target these other symptoms like acetaminophen, ibuprofen, or dextromethorphan.

Greg Castelli, Pharm.D., director of academic and clinical pharmacy in the department of family medicine at the University of Pittsburgh School of Medicine, says that sometimes less is more and recommends that people buying new products should consider only buying the one indicated for their symptom.

"When you're walking down those aisles, you'll see that there are products that have three and four medications in combination with each other. And you just may not need to have all those individual medications," Castelli said.

Castelli says that oral pseudoephedrine can be found behind the pharmacy counter without a prescription and nasal sprays that contain phenylephrine are both effective agents for nasal congestion.

Certain medications that can be used to treat common cold symptoms such as diphenhydramine or Benadryl, a type of antihistamine, may also provide an added benefit of helping people fall asleep in addition to treating nasal inflammation, but should not be abused or overused.

Experts warn that all of these medications do have risks and side effects so people who have underlying medical problems should talk to their doctor about which one is right for them, or which ones should be avoided.

Some remedies don't require medication to help

Experts say that rest, relaxation and hydration are undervalued when combating colds, but they do help.

"I think that when you're feeling sick, it's always a good time to re-address some of those sleep hygiene things," Dasgupta said.

Dasgupta recommends putting technology away before bed and making sure the room is cool and dark where you sleep at night, and if congestion is a problem, sleeping with the head of the bed elevated or on pillows can help.

Soup is good for the soul and sinuses

Experts say steam can help the sinuses, which can come from a hot shower or even from some comfort foods like chicken-noodle soup.

"If you're gonna smell something, why not some nice noodles and some chicken? … The steam going up your nose is gonna be wonderful," Dasgupta said. "That's one you could do like just really briefly like maybe in the morning or when you get home from work."

Antibiotics are almost never the answer for the common cold

"We know that a lot almost 90% of these infections are caused by a virus and so antibiotics just aren't what's going to help you here," Castelli said.

The Centers for Disease Control and Prevention says most colds are self-limiting viruses that do not require treatment.

"I cannot emphasize enough that we don't take antibiotics for viruses," Dasgupta said.

Dasgupta says there are circumstances when a cold-like illness does need to be treated with antibiotics if it's due to a bacterial infection, but antibiotics should only be taken if prescribed by a healthcare provider.

Bonus: A little bit of honey can help a cough

Honey is one household product that can relieve cough symptoms and is safe for anyone above age 1, so this is a good option for some kids when cough suppressants aren't recommended for them.

"Anyone over the age of one honey can be a really helpful effective way to help treat that cough," ABC News medical correspondent Dr. Darien Sutton told Good Morning America.

Copyright © 2023, ABC Audio. All rights reserved.

(WASHINGTON) -- The Biden administration this week relaunched the website where Americans can once again order free at-home COVID tests.

The website had been shut down since June but came back online just as updated COVID vaccines rolled out across the country.

Here's how to order the tests and why you should not throw out old ones.

How to order free COVID test kits through USPS

Visit COVID.gov/tests and you will see instructions directing you to a website run by the U.S. Postal Service (USPS) to order a kit that comes with four tests.

You don't have to pay for shipping. Just provide your name and address to place the order.

The Federal Trade Commission sent out an alert that government employees will never call, text or email Americans for information on receiving the tests. Credit card information, bank account information and Social Security number are not required to place an order.

If you live in a building or a multi-unit residence or with roommates, consider putting your apartment number ahead of your street address to avoid receiving an error message that the address has already been used.

How long will it take for the free COVID test kits to arrive?

Tests kits will take about one week from when the order was placed, but could take longer due to shipping delays.

If you would like an email confirmation and USPS delivery updates, you can enter your email address when placing the order.

Why not to throw out if they are past their expiration date

Some of the test boxes may arrive with an expiration date that has passed but the Food and Drug Administration warns against throwing them away.

Earlier in the pandemic, COVID tests kits were rolled out typically with a shelf life of about four to six months due to unknowns about how long they would be effective, experts said.

However, the FDA extended expiration dates based on additional data from manufacturers.

To check for an extended expiration date, visit the FDA webpage for at-home tests, which indicates the brands that have an extended date and provides a PDF for each test with new expiration dates.

You can find the lot number on the package, near the expiration date, and then check the PDF to see if it's among those dates.

Where else can I get free COVID tests?

Since the public health emergency ended on May 11 of this year, access to free testing has dwindled. There are, however, still some avenues to access no-cost testing.

For those who are uninsured -- as long as they are symptomatic or have been exposed to COVID -- they can visit the CDC website, which lists sites for free testing at Increasing Community Access to Testing (ICATT) locations.

Free testing may also differ by geographic location. In New York City, for example, free testing is available at NYC Health + Hospitals locations and community care clinics. Free rapid tests are also available at public libraries.

Copyright © 2023, ABC Audio. All rights reserved.

(NEW YORK) -- Brittany Tichenor remembers her daughter Isabella, whom she called Izzy, as the "sweetest person" she has ever met, someone who was resilient and amazing, a 10-year-old child whose eyes were "big and brown."

Those memories of her daughter as a vibrant fifth-grader make it harder, she says, to reconcile that her daughter died by suicide nearly two years ago, on Nov. 6, 2021.

"I just didn't know how bad it was," Tichenor told "Good Morning America" of Izzy's mental health struggles, which she said were a result of bullying. "I think she made a temporary decision in a moment of hurt, and I'll never forget that."

Tichenor said it was only after her daughter's death that she heard from other kids at her daughter's local public elementary school in their home state of Utah the full extent of the bullying she says Izzy endured.

"I knew part of it, and I kept calling the school. I kept calling the district. But I didn't know the severity of it," she said. "I told her, 'You can tell me anything,' and she normally did, but I kind of feel like she was trying to protect me. I just wish she had told me."

Tichenor said on some days, Izzy, who she said was autistic and was one of the few Black students in her school, would open up to her about the taunts she said she endured from her classmates and even some of her teachers.

"I know one thing, she was just tired of the kids at school," Tichenor said. "That's what she kept telling me. She said, 'They keep me making fun of the dot on my head.'"

Bullying in schools has been on the rise in recent years, according to a survey of over 130,000 kids ages 9 to 18 released in August by the Boys & Girls Clubs of America.

According to the survey, 40% of youth say they were bullied on school property in the past year -- up from 37% in 2022 -- while 18% of youth say they have experienced cyberbullying.

At the same time, data is also showing a growing mental health crisis among young people in the United States.

Approximately 5.8 million children in the U.S. had diagnosed anxiety between 2016 and 2019, and approximately 2.7 million kids had diagnosed depression in that same time period, according to data from the U.S. Centers for Disease Control and Prevention, with recent years showing rising numbers of diagnoses for both mental health conditions.

In 2021, a report from U.S. Surgeon General Dr. Vivek H. Murthy warned of a growing mental health crisis among young people. The report, issued during the coronavirus pandemic, cited statistics including a 51% increase in emergency room visits for suspected suicide attempts among girls and a doubling of anxiety and depression symptoms reported across genders.

That same year, suicide was the second leading cause of death for adolescents ages 10-14 and young adults ages 20-34 in the U.S., according to the CDC.

Tichenor said she was in the process of moving Izzy to a new school when her daughter died.

"I didn't want the next school she went to, to go and get bullied there," Tichenor said. "By the time I thought I found the perfect school, she had already took her life. I can't help but blame myself because I wish I would have gotten to it sooner."

In August, Tichenor and the school district Izzy attended, Davis School District, announced a $2 million settlement amid allegations that Izzy was bullied and that teachers and administrators had not stopped the reported harassment.

"Nobody knows the trauma of a parent who loses a kid," Tichenor said of what she's endured the past two years.

Correlation between bullying and suicide

When it comes to the connection between bullying and suicide, data shows there is a correlation, but experts say more research remains to be done.

The CDC defines bullying as "unwanted, aggressive behavior among school-aged children that involves a real or perceived power imbalance." Bullying, the agency notes, is also a behavior that is repeated or can be repeated over time.

Both young people who report bullying others and those who report being bullied are at increased risk for suicide-related behavior, according to the CDC.

In recent years, the correlation between bullying and suicide has increased in the public eye as several families, including Tichenor, have spoken out publicly after losing a child to suicide.

In July, the parents of a 12-year-old girl who died by suicide after experiencing bullying reached a $9.1 million settlement in a wrongful-death lawsuit against their local New Jersey school district, their lawyer said at the time.

In May, an elite boarding school, also in New Jersey, released a statement publicly admitting its failure to protect a 17-year-old student who died by suicide in 2022 after experiencing bullying.

That student's mother, Elizabeth Reid, told "Good Morning America" at the time, "What we've realized from our situation is that [bullying] can lead to death. This is a very serious issue. And the internet absolutely makes it even much worse for kids today."

In the nearly two years since Izzy's death, Tichenor, a mom of five, has made it her mission to make sure no other parent endures the loss of a child due to bullying or suicide.

She launched a nonprofit organization, Izzy's Village, that she described as a place for young people, particularly young people of color, to find support for bullying and mental health struggles.

Though she said she feels like a piece of her died when Izzy died, Tichenor said she continues to share her family's story also as a way to help educate other parents.

"I want people to know her story because I want other parents to check their kids on bullying," she said. "It's not OK."

Can an app help stop bullying and improve mental health?

In Utah, where Tichenor still lives, health officials are putting their hope into meeting kids where they already are -- on their phones -- to help them cope with mental health struggles.

SafeUT is an app where young people have access 24/7 to chat with a mental health professional and can submit a tip about mental health or bullying concerns regarding their peers.

The app was created by legislators, educators and public health officials in response to data showing that suicide is the leading cause of death for youth and young adults in Utah, according to Rachel Kay Lucynski, director of community crisis services with the Huntsman Mental Health Institute at the University of Utah.

Lucynski said the app now serves more than 885,000 elementary, middle and high school, and college students across the state.

The app saw record usage last year, with more than 1 million messages recorded with mental health professionals and over 9,000 confidential tips submitted, according to Lucynski, who said the tips are triaged and responded to by behavioral health specialists as well.

The most commonly reported tip pertains to suicide, typically a young person reporting hearing a friend talk about hurting themselves. The second most commonly reported tip is general mental health concerns, followed by bullying, according to Lucynski.

"We know that students who even witness bullying, not just experience bullying, can be traumatized by that, and it can increase their level of mental health and behavioral health issues," Lucynski said, adding, "It obviously can have catastrophic impacts on someone's feelings of self worth, feelings of safety at school, and in really, unfortunately, extremely tragic situations can result in a student taking their own life or attempting to take their own life because of the bullying that they're experiencing."

Lucynski noted that parents and educators may also use the SafeUT app to report mental health concerns based on changes in kids' behaviors.

"We also want to remind parents that if they're seeing changes in their student's behavior, if they're seeing that they're withdrawn, that they're not as interested or engaged in social activities, or friends or extracurriculars like they used to be, or they have an extreme aversion to going to school ... there could be something else going on," she said. "So, we want parents to know that it's important that they talk to their students at home about what they're experiencing."

After losing her own daughter, Tichenor is now working with SafeUT to help launch an anti-bullying campaign and a parent advisory council.

"I just want parents to know this is serious," Tichenor said. "If as parents, we don't intervene or step in, this kind of stuff will keep happening, and I don't want it to happen to anybody else."

Tichenor said that looking back on her own experience, she wishes she had followed her parental instinct and sought help sooner.

"If [children] tell you something, that they're getting bullied, do what you need to do to protect them," she said. "And make sure you're there as a support 24/7."

Tichenor said parents should also make an effort to know who their kids' friends are at school, and to talk to their kids at home.

"Talk to them. Talk to them until they're blue in the face," Tichenor said. "Because whether your kid is doing the bullying, or they're the one getting bullied, it needs to be talked about."

Mental health experts say that when it comes to talking about mental health and even suicide with kids, more is better, noting that instead of putting the idea of suicide in a child's mind by talking about it, you're letting your child know that they can open up to you about their feelings.

SafeUT offers resources for parents on its website about ways to talk about mental health, suicide and bullying with kids, including a document with ideas for "conversation starters" on those topics.

Tichenor said that in addition to parents talking with their kids, the willingness of a parent like Tichenor who has lost a child to suicide to speak out and share her story is just as impactful.

"I think it's very easy to read news stories or watch things online and think, 'Gosh, that's horrible, but it won't happen to me,'" Lucynski said. "But we really all need to stay alert and vigilant as a community for those of us who are suffering and how we can be that hope and that light for someone in a dark moment."

She added, "Not everyone who has experienced suicide loss is at a point in their grieving process where they're able to talk about it, so the fact that Brittany is able to share what the impact has been on her and make people more aware of this issue is extremely important ... and definitely has the potential to save lives."

If you or someone you know are experiencing suicidal, substance use or other mental health crises please call or text 988. You will reach a trained crisis counselor for free, 24 hours a day, seven days a week. You can also go to 988lifeline.org.

Copyright © 2023, ABC Audio. All rights reserved.

(NEW YORK) -- Nearly half of all adults in the United States plan to get the newly recommended COVID-19 vaccine, according to results from a survey released Wednesday.

The latest poll conducted by the KFF COVID-19 Vaccine Monitor found that 23% of U.S. adults say they will "definitely" get the updated booster, 23% say they will "probably" get it, while 19% say they will "probably not" get it and 33% say they will "definitely not" get it.

The new shots from Pfizer-BioNTech and Moderna, which are formulated to target newer variants of COVID-19, are recommend for everyone 6 months and older, but the survey found that the majority of U.S. parents say they aren’t planning to get it for their children.

Consistent with prior trends as earlier vaccines were being rolled out during the COVID-19 pandemic, the poll found that Democrats and people at least 65 years old are most likely to say they would "definitely" or "probably" get the updated booster.

The share of the American public who intend to get the new vaccine is higher than those who have received previous shots, but not as much as initial vaccine uptake back in 2020, according to the survey.

The poll results came as COVID-19 hospitalizations in the U.S. surpassed 20,000 for the first time since mid-March. However, recent data has indicated that the updated boosters could offer additional protection against currently circulating variants and especially protect against severe disease and death, particularly for those who are elderly or immune compromised.

Copyright © 2023, ABC Audio. All rights reserved.

(NEW YORK) -- After 371 days in space, NASA astronaut Frank Rubio is returning to Earth Wednesday.

The 47-year-old broke the record for the longest time spent in space by a U.S. astronaut earlier this year after his original six-month mission at the International Space Station was extended by an additional six months.

Rubio told ABC News' Good Morning America in August that he will be examined by a medical team upon his arrival and he may need some time to readapt to Earth's gravity and rebalance his equilibrium for everyday tasks such as walking and standing upright.

Experts say spending a prolonged period in space -- especially one year -- comes with many changes to human physiology and psychology.

One of the biggest changes comes from spending time in microgravity, which allows astronauts to float inside a spacecraft or outside during spacewalks.

During this period, there is a decrease of muscle mass -- due to decreased use and lack of stimulus through exercise equipment -- and bone loss.

Dr. Jennifer Fogarty, chief scientific officer at Baylor College of Medicine's Translational Research Institute for Space Health, told ABC News that the biggest changes with bone and muscles loss occur in the first couple of months of a mission and then level off.

She said one of the areas that she sees crew members struggle with upon returning to Earth is neurovestibular challenges, or how the body maintains a sense of position and balance, as gravity changes.

"How do you coordinate movement like walking, which you haven't done for a long period of time, and then the idea of balance? When you put those two together, it can kind of create a little bit of a precarious situation and something that's very well-monitored with the crew members when they land on Earth," she said.

The longer the mission, the longer it can take to acclimate, Fogarty said. Four- to six-month missions make take two to three days. Longer missions would likely take even longer.

Additionally, because of the weightlessness in microgravity, blood and cerebrospinal fluid often shift upward from the lower extremities to the head and eyes, which is believed to cause eye and brain structural changes.

This is a phenomenon known as Spaceflight Associated Neuro-ocular Syndrome and long-duration astronauts may experience a variety of changes including an upward shift of the brain or eye swelling and blurry vision.

Our veins have valves in them so blood doesn't flow backwards when we stand up, but when we're in a weightless environment, there's a big fluid shift from the body up into the head," explained Dr. Michael Decker, co-director of the Center for Aerospace Physiology at Case Western Reserve University School of Medicine. "Some of this increased intracranial pressure can actually impact the eye and lead to visual impairment. Sometimes when astronauts land, that visual impairment does not necessarily resolve."

"That is one of the most foreign things biologically that the body has to deal with," Fogarty, who is also the former chief scientist of the NASA Human Research Program, added. "I think that is the one where I would say crew members who do extended durations do get much greater monitoring, because we really don't know what to anticipate."

There are also physical and psychological effects that come from being isolated and in a closed environment for a long duration.

Research has shown that this type of environment, regardless of whether someone is in space, can lead to behavioral changes and cause fatigue, stress and sleep loss.

Fogarty said that there are also changes to the immune system during this time, often a result of chronic stress, which is why it's important to create as healthy of an environment as possible for astronauts going on missions.

Scientists will also likely look to see if Rubio has any changes to his genes, including those related to the immune system, as occurred with astronaut Scott Kelley when he spent 340 days in space in 2015 and 2016.

Decker said 90% of these changes were resolved within a few months of Kelley’s return so it will be interesting to see if the same thing occurs with Rubio.

Additionally, "isolation creates a stressor and another sensory deprivation issue," she said. "Anywhere where you don't have the smell of the grass or the rain or colors to look at, look at the water versus the mountains, like when your choices are very limited."

She added that while space is a difficult environment, the changes astronauts experience are not unexpected and that NASA teams make sure they are prepared extensively before going into space.

"We can select people, train them and make sure they're very healthy before they go," Fogarty said. "We do the research to understand where we can make different choices with the environments we build for these people to live and work in, so that we are not tapping into those reserves ... and compromising them."

Copyright © 2023, ABC Audio. All rights reserved.

(NEW YORK) -- More than three million cases of dengue fever have been reported in the Americas this year with over 882 in the United States, according to the Centers for Disease Control and Prevention. This is the second highest annual rate in the Americas since 1980.

Dengue is spread through mosquitoes, which thrive at hotter temperatures and humid conditions. These conditions have become more frequent in the past few years as a result of record heat and extreme weather, which results in more cases of dengue, according to Nature.

Experts say the rise in cases are a "canary in a coal mine" for what is to come as we see changes in rainfall and temperature patterns.

The cases in the U.S. have increased from 814 in 2021 to 2,261 in 2022, and over 50% of these cases have been locally acquired in the United States. The disease has been circulating in California, Florida, Texas and New York, but cases in the U.S. have been growing over the past few years, and are expected to rise with climate change and urbanization.

"This is concerning," says Dr. Krutika Kuppalli, infectious disease physician and chair of the Infectious Disease Society of the Americas Global Health.

The growing number of cases are a signal that public health officials in the U.S. and around the world need to invest more resources into tracking and protecting against dengue, Kuppalli says. Officials have not been tracking as much as they should because resources were allocated to COVID-19 management, she says.

"A lot of people think that the United States is impervious to mosquito-borne illness," says Dr. Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security.

"That’s just not true," she added.

Here is what you need to know about dengue fever including what it is, signs, symptoms, treatment and how to prevent it:

What is dengue fever?

Dengue fever is a virus spread to people through Aedes mosquitos. These mosquitoes also spread Zika, chikungunya and other viruses. A person can be infected with dengue multiple times in their life, according to the CDC.

What are the symptoms?

Most people infected with dengue will have mild or no symptoms. If symptoms occur, they usually appear between 4-10 days after a mosquito bite and last for 2-7 days, according to the World Health Organization. People typically get better in 1-2 weeks. Symptoms include headache, high fever, muscle and joint pain, nausea, vomiting, swollen glands and rash.

Mild symptoms can be confused with other illnesses that can cause fever, aches, pains and/or rash. In rare cases, dengue can be severe.

"People do not realize that it can cause serious infection or lead to death," Kuppalli says.

Severe dengue is a medical emergency and can get worse rapidly. Those who have had an infection before are more likely to develop a severe infection. People with severe dengue may have severe abdominal pain, rapid breathing, increased thirst, blood in vomit or stool, pale and cold skin, persistent vomiting, blood in gums or nose and weakness.

Those who have severe symptoms should seek medical attention right away.

There are no antiviral treatments for dengue, Adalja says.

People are treated with fluids and medications that can control pain and bring down a fever, like acetaminophen. The CDC and WHO recommend avoiding aspirin and ibuprofen, which can increase the risk of bleeding.

Is there a vaccine?

A dengue vaccine is approved for use in children between ages 9-16 with previous laboratory-confirmed dengue infection. They must also be living in areas where dengue occurs frequently or continuously. That includes some areas like the U.S. territories of American Samoa, Puerto Rico and U.S. Virgin Islands.

"It’s really beneficial in those individuals who have had one type of dengue before," says Dr. Adalja.

The vaccine is not approved for Americans who are simply traveling to areas with high levels of dengue.

How do we prevent it?

If you are traveling or living in an area with dengue, the best way to prevent infection is by preventing mosquito bites, according to the CDC. Steps you can take include, wearing protective clothing, applying insect repellent with DEET, Picaridin or IR3535, using mosquito nets and using window screens.

Some regions take steps to control the mosquito population by removing places where mosquitoes lay eggs, killing eggs with larvicides and killing the adult population with adulticides. Others use methods include the use of genetically modified mosquitoes, which have been approved by the Environmental Protection Agency (EPA) for use in some counties in Texas and Florida.

These mosquitoes have a gene that prevents female mosquitoes from living to adulthood, so they can’t continue to reproduce -- which reduces the population.

"Genetically modified mosquitoes are an important tool," Dr. Adalja says.

The EPA says that use of genetically modified mosquitoes poses no risk to people, animals or the environment.

Copyright © 2023, ABC Audio. All rights reserved.

(NEW YORK) -- While there is no specific test to determine if someone is experiencing long COVID, a new study published in Nature used blood tests to find new insight into what biological markers are associated with this collection of mysterious conditions reported by millions of Americans.

Researchers used machine learning to help analyze immune markers and hormone levels in 273 adult participants at Mount Sinai and Yale University and compared those with and without long COVID symptoms at least one year after having COVID-19.

Long COVID, defined in this study as persistent symptoms more than six weeks after infection, was associated with lower levels of a hormone called cortisol and had some distinct differences in certain immune cells and inflammatory markers circulating in the blood.

These levels are identified through blood tests, but this is not a blood test that specifically tests for long COVID.

"[These results] suggests some potential mechanisms leading to long COVID that might be amenable to treatment. It also may help in identifying patients with long COVID," Dr. Alison Morris, division chief of pulmonary, allergy, critical care and sleep medicine at the University of Pittsburgh School of Medicine, told ABC News.

"I think one of the most important findings of the paper is that it validates the symptoms people have by finding biological differences between them and healthy controls," Morris said.

"It is a truly remarkable study," Dr. Shari Barnett Brosnahan, M.D., M.Sc., a COVID-19 researcher who was not involved in the study and assistant professor of the division of pulmonary, critical care and sleep medicine at New York University Langone Health System, told ABC News.

Brosnahan does note that "it's a limited analysis that they did, and I think that there's still more work to be done."

This study was done on relatively few people, so researchers say more studies are needed to better understand the significance of these results more broadly. Still, they say this study helps scientists get one step closer to knowing more about long COVID. If there are biological markers that are specific to long COVID, it could help confirm a diagnosis or help target treatments.

This research joins a large movement to gain more understanding of long COVID conditions and efforts to provide services to those affected, including efforts by the Biden administration which recently announced a new Office of Long Covid Research.

Long COVID is a term used to characterize signs, symptoms and conditions that persist for at least four weeks after getting infected with COVID-19 that may last months to years, according to the working definition developed by the U.S. Department of Health and Human Services.

These symptoms can range in severity and impact multiple organ systems in the body. Common complaints include fatigue, brain fog, sleep problems, difficulty breathing or shortness of breath, dizziness upon standing, and stomach issues, according to the CDC.

In July 2021, long COVID was recognized as a condition that could qualify as a disability under the Americans with Disabilities Act if it "substantially limits major life activities." Research that may help doctors make a diagnosis could be crucial for those most severely impacted to receive these necessary services.

"I also hope that continuing to have these studies that show objective evidence help validate people and understanding [of] their long COVID," Brosnahan said. "And help us as a medical community validate the disease of long COVID a little bit more."

Copyright © 2023, ABC Audio. All rights reserved.

(NEW YORK) -- Millions of Americans say they've had long COVID, and some say they're still battling it, according to new federal data.

Two new reports, published early Tuesday by the Centers for Disease Control and Prevention's National Center for Health Statistics, looked at data from the 2022 National Health Interview Survey.

They found that, in 2022, 6.9% of adults -- equivalent to about 18 million Americans -- reported ever having long COVID while 3.4% -- about 8.8 million -- said they currently had the condition, according to 2022 U.S. Census estimates.

Meanwhile, 1.5% of children -- roughly one million Americans -- ever had long COVID while 0.5% -- about 360,000 -- reported currently having long COVID.

Long COVID is a condition that occurs when patients still have symptoms at least four weeks after they have cleared the infection. In some cases, symptoms can be experienced for months or years.

Symptoms vary and can include fatigue, difficulty breathing, headaches, brain fog, joint and muscle pain and continued loss of taste and smell, according to the CDC.

It's unclear what causes people to develop long COVID but research is ongoing.

In the first report, the NCHS team looked at adults and found women were more likely than men to have ever had or currently have long COVID.

Nearly twice as many women, 4.4%, said they currently had long COVID compared to 2.3% of men, the report found.

When it came to age, adults between ages 35 and 49 were the most likely to have had long COVID at some point or currently have it followed by those between ages 50 and 64. Senior citizens aged 65 and older were the least likely to have it in both categories.

Among racial and ethnic groups, Hispanic adults were the most likely to have had long COVID at 8.3% followed by 7.1% for white adults, 5.4% for Black adults and 2.6% for Asian adults.

However, among those currently experiencing long COVID, white adults slightly edged out Hispanic adults at 3.7% compared to 3.4%.

In the second report, looking at children aged 17 and younger, many of the findings were similar. For example, girls were more likely than boys to have ever had or still have long COVID.

Additionally, Hispanic children had the highest percentage of reporting previous long COVID and white children had the highest reporting of current long COVID.

By age group, children between ages 12 and 17 were the most likely to ever have or still have long COVID at 2.0% and 0.8%, respectively.

Meanwhile, 1.0% of children aged 8 and younger and 0.8% between ages 8 and 11 reported having long COVID at some point, while 0.2% of the youngest group and 0.3% of the middle group reported currently having long COVID.

"While the percentage of children who currently have long COVID was low, the differences observed by age persisted," the authors wrote.

The report cited data from the Nationwide Commercial Laboratory Seroprevalence Survey that found about 92% of children currently have antibodies in blood samples, indicating a previous infection, but that long COVID among children is quite rare.

Earlier this year, the Biden administration announced it was forming a new Office of Long COVID Research and Practice to study the condition and help those who have been diagnosed with it.

The office, which will be under the Department of Health and Human Services, "is charged with on-going coordination of the whole-of-government response to the longer-term effects of COVID-19," according to a news release.

Copyright © 2023, ABC Audio. All rights reserved.

(WASHINGTON) -- The federal government program used for the last two winters to send free COVID tests to Americans' homes started up again Monday.

The government's move comes after the Centers for Disease Control and Prevention recently completed its process to roll out the latest COVID shot, targeted to match the circulating variants, and pharmacies began offering it days later.

At the website, CovidTests.Gov, each household will be able to order four free rapid tests, according to the Administration for Strategic Preparedness and Response (ASPR), a part of the Department of Health and Human Services that handles the federal stockpile of COVID tests.

The website for free at-home tests has had an on-and-off presence since the winter of 2022, when the Omicron variant was driving cases up across the country.

At the time, President Joe Biden pledged to give out one billion free rapid tests to ease soaring demand and an overwhelmed test manufacturing industry.

But the site was temporarily shut down that fall as a political fight dragged on over COVID funding. Administration officials said they had to conserve tests in case they didn't get agreement from Republicans to allocate more money -- which they didn't.

Still, the site relaunched again in December as cases began to climb again, then shut down this past June.

The government is now relaunching CovidTests.Gov again in time for a surge in cases this winter.

"We want them to be able to use those tests during this viral season -- fall, winter, respiratory viral season," Becerra said.

The tests will come from a $600 million investment across 12 different domestic test manufacturers, which will yield around 200 million tests to boost the federal stockpile. Tests ordered from CovidTests.Gov will be pulled from that stockpile.

The funding for the free tests will come from money that was left over from a past supplemental COVID bill. Though the debt ceiling deal reached over the summer between President Joe Biden and Republicans did claw back about $30 billion in unspent COVID relief funds, officials said there was still enough left over to put toward replenishing the testing stockpile this fall.

Officials said they didn't have an estimate yet for how many they expect Americans to order the free tests given the shrinking demand for COVID precautionary measures. Roughly 755 million tests have been distributed through the website over the last two years.

But if there is high demand in the future, the $600 million investment toward test manufacturers will also serve to warm up the supply lines and get the production process underway ahead of a crunch in resources, Assistant Secretary for Preparedness and Response (ASPR) Dawn O’Connell said.

“Manufacturing COVID-19 tests in the United States strengthens our preparedness for the upcoming fall and winter seasons, reduces our reliance on other countries, and provides good jobs to hardworking Americans,” O’Connell said.

“ASPR’s investments in these domestic manufacturers will increase availability of tests in the future,” she said in a statement.

COVID-19 hospitalizations are continuing to climb in the United States, according to data from the Centers for Disease Control and Prevention.

For the week ending Sept. 9, data showed that hospitalizations increased 7.7% from 19,068 to 20,538 weekly hospitalizations -- an estimate that's likely an undercount, due to less available data without the public health emergency still in place.

ABC News' Mary Kekatos contributed to this report.

Copyright © 2023, ABC Audio. All rights reserved.

(LOS ANGELES) -- California's controversial new CARE Court program, meant to address serious mental illness and the state's homelessness crisis, will go into effect next week.

Under CARE -- which stands for Community Assistance, Recovery and Empowerment -- the court, family and others can file a petition in civil court if they believe a loved one is suffering from severe symptoms of an untreated psychotic disorder, such as schizophrenia.

The program, however, does not cover other mental illnesses such as anxiety disorders, depression or post-traumatic stress disorder.

There are also other caveats, such as a person must be aged 18 or older. The petition must also include either an affidavit from a licensed mental health professional stating they examined or attempted to examine the individual within 60 days of the petition's submission or evidence the person was detained for at least two intensive treatments.

A judge can then order a care plan for the person for up to 12 months, with renewal for an additional 12 months. The person will be set up with a team that will prescribe individualized treatment along with supportive services and a housing plan, according to Gov. Gavin Newsom's office.

The counties will be required to provide the services but are receiving additional funding from the state government, including for new housing units, treatment slots and behavioral health services.

The court can order medications, but it cannot be forcibly administered and if a person refuses to take it, they will not receive a penalty.

Seven pilot counties -- Glenn, Orange, Riverside, San Diego, San Francisco, Stanislaus and Tuolumne -- are required to launch CARE Court by Oct. 1. The remaining counties will be required to do so by December 2024.

Newsom championed the program as a way to combat the mental health and homelessness crises plaguing the state and to prevent those in need of help from ending up in jails or shelters.

A report from the Substance Abuse and Mental Health Services Administration found 3.79% of those aged 18 and older in California are suffering from a serious mental illness.

Additionally, the state has the largest homeless population in the nation with more than 170,000 estimated to be unsheltered, according to a 2022 report from the U.S. Department of Housing and Urban Development.

"CARE Court means new hope for thousands of Californians with untreated mental health and substance abuse issues," Newsom said in a statement last year. "Today, our work begins to turn promise into practice. While we watch other places in America move swiftly towards more involuntary hospitalization, in California, we're doing it the right way -- community-based care, a focus on housing, and accountability for everyone involved."

However, the program is not without its critics. Earlier this year, the Western Center on Law & Poverty sued to end CARE Court, arguing that the program is forcing treatment on people and is a violation of their rights.

The participant is required to attend hearings to make sure they are following the CARE Court plan but if they fail to complete their treatment, they can be hospitalized or referred to a conservatorship, according to the governor's office.

"Not only is creating this new court system to round up individuals unconstitutional, it is bad policy subject to pervasive societal biases and disproven methods of treating mental illness," WCLP said in a statement at the time.

The group also says it's unclear how many the program would help and what impact it would have on the community at large.

The California Supreme Court declined to block the program from going into effect and the Center declined to comment on its criticisms to ABC News.

The governor's office also did not immediately reply to ABC News' request for comment.

Copyright © 2023, ABC Audio. All rights reserved.

(NEW YORK) -- The overdose crisis has reached historic levels in New York City, according to new data from the city's Department of Health and Mental Hygiene.

Provisional data shows there were 3,026 overdose deaths in New York City in 2022, the highest total since the department began recording such incidents in 2000.

Newly released data shows that overdose deaths increased by 12% from 2021 to 2022. Fentanyl was detected in 81% of drug overdose deaths in New York City, according to the data. Fentanyl is an opioid that is 50 to 100 times stronger than morphine, the department states.

The report found that Black and Latino New Yorkers had the highest rates of overdose death and the largest increases in rate from 2021 to 2022.

Adults ages 55 to 64 continued to have the highest rate of overdose, followed by adults ages 45 to 54, according to the report.

Across the country, officials are battling deadly drug abuse. The Centers for Disease Control and Prevention predicts that 28 states, including New York, Texas, California, Alabama, Washington, and Oregon, are expected to see a rise in overdose deaths from 2022 to 2023.

NYC Mayor Eric Adams and the Department of Health and Mental Hygiene have said they aim to reduce overdose deaths by 15% by 2025 as part of the “Care, Community, Action: A Mental Health Plan for New York City."

The city recently launched its first public health vending machine, which stocks health and wellness supplies, including naloxone -- a safe medication that can reverse the effects of an opioid overdose -- hygiene kits, and safer sex kits.

New York City has also expanded hours and services at the country's first two recognized overdose prevention centers (OPCs) that opened in late 2021. The centers have intervened in over 1,000 overdoses that could have been fatal.

OPCs are a form of harm reduction, which is a set of strategies to minimize the negative effects and consequences linked to drug use, and "keeping people who use drugs alive and as healthy as possible," according to the U.S. government's Substance Abuse and Mental Health Services Administration.

The city also said it continues to provide support to its syringe service programs, which distribute sterile needles and other supplies to people who inject drugs in order keep them and the larger community safe.

The city has also given out more than 77,000 naloxone kits and hosted 38 naloxone trainings, as well as providing approximately 30,000 fentanyl test strips.

In response to the fatal overdose total, the New York City Health Department issued a Commissioner’s Advisory and is recommending that New Yorkers carry naloxone and know how to use it, talk to their loved ones about substance abuse and the risk, avoid using drugs alone, and keep all medication safely stored.

“This crisis is killing a New Yorker every three hours and is impacting every individual and family in our city and in our nation,” said Health Commissioner Dr. Ashwin Vasan in a statement. “No one is spared, even if you think otherwise."

Copyright © 2023, ABC Audio. All rights reserved.

(NEW YORK) -- Weekly COVID hospitalizations have been ticking up over the past 11 weeks, rising to 20,538 for the week ending Sept. 9, the highest figures seen since March of this year.

Although the majority of U.S. counties are reporting low hospital admissions levels, a growing number are seeing moderate and even high levels, according to data from the Centers for Disease Control and Prevention.

Despite the uptick, doctors and hospital administrators across the country said the number of patients they've seen this summer has been lower than previous years and the lessons they've learned over the course of the pandemic has helped them cope with increasing hospitalization rates.

In Sacramento County, California, hospital admissions have reached medium levels with about 10.1 admissions per 100,000.

Michael Korpiel, president of the Sacramento market for Dignity Health, a nonprofit that operates hospitals in three states, said there have been fewer than 20 people testing positive for COVID at any time in the six hospitals.

"The last three years have been a great learning experience for our system and our hospital, but I think for the Sacramento region, we are better prepared today than we have been in the past," he told ABC News. "We have shored up all of our supply lines, so that we make sure that we have enough equipment and supplies in place if we begin to see a spike in the number of COVID patients."

Similarly, Dr. Rami Zebian, chief medical officer for the Medical University of South Carolina Health Pee Dee Division -- which encompasses three hospitals -- told ABC News there has not been a huge surge in patients over the summer, but lessons learned have helped the division be prepared.

One example he gave was increasing the number of devices for non-invasive ventilation and knowing when to use ventilation on a patient.

"We have that equipment that can be used for both," he said. "We learned that we don't have to put people on the ventilator early on in their disease. If we can delay that, until they really need it, we don't have to do it."

Hospital staff are also kept safe by having enough personal protective equipment when dealing with patients. They're also encouraged to get the annual flu shot and the updated COVID vaccine that targets circulating variants.

None of the hospitals or health systems that ABC News spoke to said they have universal masking in place, but there are discussions about what the threshold would be to reinstate a mandate or if they would follow county health department guidelines.

As the U.S. moves into the colder weather months -- the traditional respiratory virus season -- hospitals also need to prepare for a possible "tripledemic," a mix of COVID, flu and RSV that could overwhelm health systems.

Dr. David Hirschwerk, an infectious disease specialist and the medical director at Northshore University Hospital in New York, said his hospital is in "a constant state of readiness for COVID" as well other viruses.

Nassau County, where NU Hospital is based, is currently in the medium admission category with 10.4 hospital admissions per 100,000, CDC data shows. Hirschwerk said the hospital has not been overwhelmed so far and protocols are in place to prevent it from becoming overwhelmed later in the year.

"Each year as we get into this time of year and as we move deeper into the fall and winter will be impacted by increase in respiratory viruses not only with COVID but also with influenza and other respiratory viruses like RSV," he told ABC News. "With that we have the tools to do testing, we have the space in our hospital, and we always manage and try to keep our environment safe by testing patients when it's indicated by screening visitors."

"It would be great if we don't see all three viruses simultaneously. But we know that we're going to see all three at some point and we'll be prepared regardless of how much there is and what the timing of it is," Hirschwerk added.

Copyright © 2023, ABC Audio. All rights reserved.

(NEW YORK) -- An independent panel of advisers at the Centers for Disease Control and Prevention is recommending that everyone over the age of 6 months get the updated COVID vaccine this fall.

"Even children and adults with no underlying conditions can still experience severe illness due to COVID," said Dr. Sandra Fryhofer, an adjunct associate professor of medicine at the Emory University School of Medicine.

Most infectious disease experts agree with the recommendations made by the federal health agency.

"I agree with the CDC recommendations because it is a simple recommendation to follow, and I believe that the benefit of the vaccine outweighs any risk at every age level," Dr. Todd Ellerin, chief of infectious diseases at South Shore Health, told ABC News.

"It’s consistent and harmonized with the flu shot and I think that really important. We need to emphasize that,” he added.

Dr. Donald Alcendor, a professor of microbiology, immunology and physiology at Vanderbilt University, said the sweeping recommendation "was the right thing to do."

"If you start to restrict recommendations to certain age groups or vulnerabilities and leave younger people out of it, you forget that young people can spread COVID and can get older people sick," he told ABC News.

Some of the CDC’s advisers pointed out that only about 20% of American adults received the COVID bivalent booster last fall. However, around 45% of those over the age of 65 – those most at risk – got the shot.

"It’s clear that the vaccines are most important for the elderly in the extremes of age, those with comorbidities like heart disease, diabetes, and the immune compromised," Ellerin said.

Dr. Pablo Sanchez, a professor of pediatrics at The Ohio State University College of Medicine, was the only member of the CDC advisory panel to vote against the new vaccine recommendation.

"The group that should get it are those who are at the highest risk ... those [who are] are greater than 65 years of age and younger individuals with risk factors," he told ABC News. "The healthy adolescent, the male 20-something year old who's already had COVID, may already have been vaccinated ... I'm not sure if that individual should get one or even needs one."

Over 96% of people over the age of 16 are estimated to have some level of antibodies from either past infections or previous vaccines, offering some degree of protection, according to the CDC. But that protection does not last forever, leaving some potentially at risk for severe illness.

"Immunity wanes after anywhere from three to six months. That will be different for different people. Immunity waning in 5-year-old versus a 75-year-old will be different ... the immune system is weakened with age," Alcendor said.

An updated vaccine may also offer some additional protection against infection.

"You may actually get a bonus effect which is prevention of infection. Some people may think of it as protection for the holiday period, or before taking that big trip, or going to a place where there might be others at risk,” Dr. Peter Chin-Hong, an infectious diseases specialist at the University of California, San Francisco, told ABC News.

A point of contention among the advisers was whether or not children should be recommended to receive the updated vaccine.

"A lot of pediatricians feel strongly about this. It is still one of the top 10 causes of death even though it’s not high numbers. All of these younger kids being born now, it’s why we give childhood immunizations, they haven’t seen the real virus before, so you want to give them priming to give a jumpstart on the rest of their lives,” Chin-Hong said.

One concern with the COVID vaccines is the rare potential for myocarditis, or inflammation of the heart muscle. Most cases get better on their own or respond to care quickly, according to the CDC. And the risk of myocarditis is higher when people get a COVID-19 infection versus a vaccine shot, according to published peer-reviewed studies and the CDC.

"There is a rare risk of vaccine-induced myocarditis, which is more pronounced in young men that are typically in older adolescent years or 20s. But the risk is extremely low, the outcomes are usually very good," Ellerin said.

The risk of myocarditis may be more pronounced if vaccine doses are scheduled closely together. Most studies show the second dose of the primary series, typically three to four weeks after the first, had the highest rates of myocarditis.

"Any sort of inflammatory syndrome from vaccines, you have a bunch of immune cells floating and you stimulate them to make more immune cells. That agitation can cause some of these side effects," Chin-Hong said.

It may help to wait to get an updated vaccine if you recently got one, experts say. The CDC recommends waiting at least two months between vaccines or consider delaying a shot three months after COVID symptoms started or a positive test.

Updated COVID-19 vaccines are now available in pharmacies across the country, with health officials urging the public to get all vaccines they are eligible for ahead of the winter respiratory virus season. Everyone older than 6 months is eligible for COVID and flu shots, and seniors are eligible for newly approved RSV vaccines.

Copyright © 2023, ABC Audio. All rights reserved.