Monkeypox: what we know about the epidemic, vaccines and treatments

Health officials around the world are racing to curb an outbreak of monkeypox cases that has swelled into the thousands, rolling out both vaccines and treatments for a disease that can lead to weeks of rashes and painful lesions for infected people.

While monkeypox infections have already been seen in the United States – in two travelers from Nigeria last year and in 47 cases linked to imported animals in 2003 – the current outbreak is by far the largest recorded in American history.

Here is what is known about the monkeypox outbreak and the response:

How many cases have there been this year in the United States?

At least 1,972 cases were tallied by the Centers for Disease Control and Prevention in 43 states on July 18, as well as the District of Columbia and Puerto Rico.

New York is the state with the highest total number of reported cases, accounting for more than a quarter of the country’s overall tally.

How does it spread?

Officials say the ‘vast majority’ of cases in the current outbreak have so far spread among men who have sex with men, usually through intimate skin-to-skin contact or sharing towels and bedding contaminated.

However, the CDC says it has demographic data on less than half of the reported cases. Unlike its overseas counterparts in places like the UK and Europe, the agency has to rely on details collected and ‘voluntarily’ reported to the agency by local health departments.

Either way, the CDC is now urging everyone to take steps to reduce their risk of catching and spreading the disease.

How serious is a monkeypox infection?

No deaths have been reported in the outbreak so far in the United States among the hundreds of people infected with monkeypox. Three deaths had been recorded worldwide this year until July 4.

Compared to its deadlier cousin, smallpox, officials said cases often resolve after a few weeks without further treatment. The variant linked to the current outbreak has been spreading in Nigeria since 2017, where around 3% of people who contracted monkeypox died.

After an incubation period, which the CDC estimates at just over a week on average, between exposure to an infected person and the first visible signs of infection, patients typically have to endure painful lesions as well as other symptoms – such as fever and swollen lymph nodes – until their rashes heal and heal.

However, authorities were careful not to downplay the danger monkeypox complications could pose beyond his physical pain.

For example, in the UK, authorities have reported that some hospital patients are experiencing “severe swelling” that could choke off circulation to the penis. In Spain, some patients have been hospitalized due to bacterial infections of their wounds.

The CDC says patients who are at “particularly increased risk” for severe illness from monkeypox include:

  • Young children under 8 years old
  • People who are pregnant or have a weakened immune system
  • People with a history of eczema or atopic dermatitis

The agency also says people living with HIV who have caught monkeypox during the current epidemic do not get a more serious illness, as long as they are on treatment that suppresses HIV.

What tests are available for monkeypox cases?

Monkeypox cases to date in the United States have been diagnosed using the CDC’s lab test, which can tell if someone is infected with orthopoxvirus – the family of microbes that includes both monkeypox and others like smallpox.

These tests rely on doctors “vigorously” swabbing suspicious lesions to obtain samples that can be sent to their state’s public health labs that launched the agency’s test, as well as a growing number of commercial labs. .

Some labs have also rushed to develop their own tests for suspected cases of monkeypox, including via saliva or blood samples, though the Food and Drug Administration currently warns that these methods “may lead to false test results.” “.

“We are actively conducting studies to assess what other types of tests might be available, whether it is saliva tests, throat swabs, blood tests, but at the moment we do not have the data for recommend the use of such tests,” CDC Director Dr. Rochelle Walensky told reporters on July 15.

What vaccines are available for cases of monkeypox?

The Biden administration has deployed two vaccines, initially stockpiled by the country to prepare for a possible smallpox emergency, known as Jynneos and ACAM2000.

Both rely on less-lethal parent versions of smallpox to immunize their recipients. But unlike ACAM2000, Bavarian Nordic’s Jynneos vaccine – which was approved by the FDA in 2019 to specifically fight monkeypox as well – carries far fewer risks because it relies on a modified version of the virus to prevent it from spreading. replicate and reduce its severity.

Prior to the current outbreak, the United States contracted Bavarian Nordic to manufacture a “bulk vaccine” worth about 13 million doses of the company’s Jynneos vaccines. The administration has now ordered some 7 million doses of this vaccine to be filled into vials and shipped to them from Bavarian Nordic through mid-2023.

For now, federal officials have acknowledged that the demand for the Jynneos far outstrips the supply for the snaps. Doses are rationed for vaccinees, either known close contacts of cases, or others “presumed” to be at risk of having been in contact with a case, such as having multiple recent sexual partners in a jurisdiction facing an outbreak.

Some 786,000 more doses are expected to arrive over the next few weeks, officials say said on July 15once the FDA approved new batches of vaccines that Bavarian Nordic had put into vials on a new production line.

Can children be vaccinated against monkeypox?

Children are not currently approved by the FDA to be vaccinated with Jynneos, although CDC officials revealed to a panel of its outside vaccine advisers earlier this year that at least one pediatric patient had been seen. offer an injection – and that the agency was working on an “expanded access” protocol to allow for wider vaccination of children, if needed.

Monkeypox cases set to climb across the country as long lines form for vaccines


Are people vaccinated against smallpox protected against monkeypox?

While people in the current outbreak are now being vaccinated with vaccines originally designed to fight smallpox, such as ACAM200 or Jynneos, officials have warned that Americans who were vaccinated against smallpox decades ago are likely only not protected against monkeypox infection.

Although the United States stopped mass vaccination against smallpox in 1972, the CDC still recommends that scientists who are at risk of exposure because they work with orthopoxviruses – including monkeypox – in the laboratory be revaccinated all the three years.

In the current outbreak, the CDC says some cases had been vaccinated against smallpox “decades earlier.” And in the 2003 outbreak, CDC researchers found no evidence that previous smallpox vaccination — among those infected — reduced the chances of patients facing serious illness or being hospitalized.

“We expect people who have had the vaccine, even as children, to retain some immunity. But that’s something that we’re very interested in looking at, watching closely during this outbreak, to really define exactly how long this protection lasts and how much people who were vaccinated decades ago can still benefit from it,” the CDC’s Brett Petersen said June 30, during a webinar with clinicians.

How are cases of monkeypox treated?

While many cases of monkeypox eventually resolve without medication other than painkillers, the Biden administration has allowed doctors to request stockpiled doses of the antiviral Tecovimat or TPOXX for some cases.

Developed from federal research launched in 2002 to prevent a possible bioterrorism attack, the FDA approved tecovirimat in 2018 to treat smallpox cases. However, that approval was largely based on studies in animals infected with monkeypox and rabbitpox, with the regulator deeming it “impossible or ethical to conduct efficacy trials in humans” for smallpox.

Physicians seeking courses of tecovirimat for their monkeypox patients must request them from the CDC under an “expanded access” protocol. The agency says the drug is being considered for use in people who have a serious illness or who have an additional risk factor such as a weakened immune system or damage to any part of the body that “could pose a danger particular” as on the genitals. .

It’s hard for doctors to get antivirals for monkeypox

Some doctors have complained about the “labour-intensive” requirements of obtaining tecovirimat courses for monkeypox cases, which require documents and data to be submitted to the agency, such as for enroll in a clinical trial.

The CDC says it is also working to develop a protocol to make another antiviral, known as brincidofovir, available for patients with monkeypox.

Can it be contained?

While health officials expect the number of monkeypox cases to continue to rise until at least August, authorities say they still hope to control the current outbreak.

“There is community spread. And while public health officials are working around the clock to contain the outbreak, it’s important to say that I think we expect these numbers to continue to rise” , said the CDC’s Jennifer McQuiston during a webinar hosted by the American Medical Association on July 14.

However, with more than 13,000 cases of the outbreak worldwide as of July 18, some experts doubt public health authorities will be able to stem the spread of the virus.

“I think at this point we have failed to contain this. We are now on the verge of becoming an endemic virus, where it now becomes something persistent that we have to continue to manage,” said the Former FDA Commissioner Scott. Gottlieb said “Face the Nation” July 17.

“It’s spread more widely in the community. I wouldn’t be surprised if there were thousands of cases right now,” Gottlieb added later.

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