This illustration shows test tubes labeled “Monkeypox virus positive and negative” on May 23, 2022.
Donat Ruvic | Reuters
The Biden administration has distributed 1,200 doses of monkeypox vaccine to people who have had high-risk exposure to the virus, part of a nationwide public health response to eradicate the disease before it causes an outbreak. important.
U.S. health officials, concerned that the virus is spreading faster than previously thought, have said the monkey’s global smallpox outbreak is the largest ever. The World Health Organization said on Wednesday that there are now more than 550 cases in 30 countries. In the United States, at least 20 confirmed or suspected cases have been reported in 11 states, including California, Colorado, Florida, Georgia, Illinois, Massachusetts, New York, Pennsylvania, Virginia, Utah, and Washington State, according to the Centers for Disease Control. to Disease Control. and Prevention.
“An outbreak of smallpox on this scale, which has reached the world, has never been seen before,” said Dr. Raj Panjabi, who heads the White House pandemic preparedness office. , to reporters in a call last week.
However, CDC officials have tried to reassure the public that the arrival of smallpox in the United States is very different from the Covid-19, which blinded the country two years ago. Scientists knew little about Covid when it first emerged, and the U.S. had no vaccines or antiviral treatments to fight the virus by 2020.
Monkeypox, on the other hand, has been known to scientists since 1958, when the virus was first identified during outbreaks between monkeys kept for research purposes, and its transmission in humans. has been studying since the 1970s. World health authorities also have extensive experience successfully fighting smallpox, which the World Health Organization declared eradicated in 1980 after a successful global vaccination effort. Smallpox belongs to the same family of viruses as smallpox, although it is much milder.
Vaccine storage
CDC director Dr. Rochelle Walensky told reporters last week that the United States has been preparing for an outbreak of a virus such as monkeypox for decades. The U.S. has millions of doses of vaccines in the National Strategic Reserve that protect against smallpox and smallpox, as well as antiviral pills to treat disease.
Dawn O’Connell, who heads the Office of Health and Human Services responsible for the national strategic stock, said Friday that the U.S. has enough vaccine on hand to manage the current monkeypox outbreak. However, O’Connell did not disclose how many shots the U.S. has ready.
The U.S. has two vaccines, but the preferred option is a shorter supply. Jynneos is a two-dose vaccine approved by the FDA in 2019 to prevent monkeypox in people 18 years of age and older. The CDC generally recommends Jynneos over the other option, ACAM2000, which is an older generation smallpox vaccine that can have serious side effects.
Last week, CDC official Dr. Jennifer McQuiston said the United States has 1,000 doses of Jynneos available. However, the Danish biotechnology company that makes the injections, Bavarian Nordic, said that the US actually has a supply of more than 1 million frozen doses of Jynneos stored in the US and Denmark under an order made the April 2020. Injections have a shelf life of three years.
The United States has ordered about 30 million doses of Jynneos since 2010, but 28 million of them have expired, the spokesman said. Bavarian Nordic plans to increase production this summer and has the capacity to produce 30 million shots a year, the spokesman said.
The U.S. government also has a stockpile of more than 100 million doses of ACAM2000, made by Emergent BioSolutions, McQuiston told reporters last week. The United States had released 500 doses of Jynneos and 200 doses of ACAM2000 as of Tuesday, according to the CDC. The United States has also sent 100 courses of oral antiviral tecovirimat to states, health officials said Friday.
“We want to ensure that people with high-risk exposures have quick access to vaccines and, if they get sick, can receive the right treatment,” Panjabi said in a call with reporters on Friday. Jynneos and ACAM2000 can be given before or after exposure to the virus. However, patients should receive vaccines within 4 days of exposure to prevent the onset of the disease.
ACAM2000 has been shown to have high levels of protection against monkeypox in animal models and is expected to provide 85% protection against virus disease similar to previous versions of smallpox vaccines, according to Mike Slifka, immunologist at Oregon University of Health and Science who has studied smallpox. . Less is known about Jynneos because the vaccine is newer, but it produced reasonable levels of antibodies in humans and should protect against serious disease, Slifka said.
Secondary effects
The CDC generally recommends Jynneos above ACAM2000 because it is considered safer. ACAM2000 could have serious side effects and distributing the vaccine widely would require serious discussion, McQuiston said in a call with reporters last week. The ACAM2000 uses a strain of a mild virus from the same family as smallpox and smallpox that can still be replicated, which means that there is a risk that the live virus from the vaccine could spread to the human body or to other people. .
ACAM2000 is given with a two-pronged needle that is scratched on the top of the arm and then the virus becomes a localized blister-like infection. The patient can spread the virus to other people or other parts of his body by scratching his blister and then rubbing his eye, for example, which can cause vision damage. The FDA warns that it is very important that people vaccinated with ACAM2000 take proper care of the vaccination site so that they do not transmit the virus to other people or other parts of the body.
CDC notice
The CDC has said that pregnant or lactating women, people with weak immune systems, those with skin conditions such as eczema or atopic dermatitis, and people with heart disease should not receive ACAM2000. In pregnant women, the virus can spread to the fetus and cause death. People with weak immune systems run the risk of the virus growing uncontrollably and causing a dangerous infection, Slifka said. People with skin conditions such as eczema or atopic dermatitis also run the risk of the virus spreading to their skin, which can become a life-threatening infection, he said.
The Jynneos vaccine, on the other hand, is not associated with these risks because it uses a strain of virus that is no longer able to replicate in humans, according to Slifka. It is also given with a regular syringe like other regular injections such as the flu shot.
Given the possible side effects of ACAM2000, the vaccine would probably only be widely used in the context of a major smallpox epidemic because the virus is so deadly, according to Dr. Peter Hotez, an expert in infectious diseases and vaccines. Baylor College of Medicine, Texas. Monkeypox, on the other hand, is a much milder virus and no deaths have been reported in recent cases in Europe and North America.
Mortality rate
Smallpox can have a mortality rate of up to 30%, according to the WHO. The West African monkey smallpox strain that appears to be driving the current outbreak is likely to have a mortality rate of around 1%, although data are scarce because the virus has previously spread mainly to remote parts. of Africa. Most people recover within two to four weeks without specific medical treatment, according to the CDC. There is another strain of monkeypox, Congo Basin, associated with a higher mortality rate of 3% to 10%, according to the WHO.
“We are very fortunate that the right outbreak is the low-virulence strain of West Africa,” said Dr. Rachel Roper, a professor of microbiology and immunology at the University of East Carolina who has studied monkeypox.
While the United States has many more tools and more knowledge to fight monkeypox than they had against Covid in 2020, there are still many unknowns about the current outbreak. It is unclear why the virus is now spreading to countries outside of West and Central Africa where the virus is endemic. Historically, the virus has spread to small towns in Africa by jumping from rodents that carry the virus to humans with very little human-to-human transmission, Slifka said. However, it now appears that the virus is spreading better among people, he said.
“Through intimate contact and skin-to-skin transmission, it is better transmitted than in other circumstances,” Slifka said.
According to McQuiston, most monkeypox patients in the U.S. traveled internationally during the 21 days prior to the onset of symptoms, suggesting they caught the virus abroad. The CDC does not believe the monkeypox is spreading widely in the U.S. at this time, but it is closely following the situation. The United States has so far performed 120 tests for orthopoxvirus, the family that includes monkeypox.
Community broadcast
“There could be community-wide broadcasting, and that’s why we want to really step up our surveillance efforts,” McQuiston told reporters during a call Friday. “We want to really encourage doctors to if they see a rash and worry that it might be the monkey’s smallpox to go ahead and try it,” he said.
WHO officials said on Wednesday that the sudden appearance of monkeypox in several countries in North America and Europe indicates that the virus has probably spread outside of West and Central Africa undetected during some time, though it is unclear for how long. Dr. Rosamund Lewis, WHO’s technical director for smallpox, said the virus may be spreading more now because the human population’s immunity has declined since smallpox vaccination was stopped after eradication of the disease.
Lewis said the WHO does not recommend mass vaccination against monkeypox because the current outbreak can still be contained. Most cases so far have been reported among men who have sex with men, have developed symptoms and sought care at sexual health clinics, according to the WHO. Lewis said it is …