21 Americans infected with monkeypox, CDC report

The Centers for Disease Control and Prevention has identified 21 cases of monkeypox in 11 states, and the number is expected to increase, officials reported Friday.

Genetic analysis shows that most cases appear to be closely associated with outbreaks in Europe, but two patients have a version of the virus that appears to have evolved from the monkeypox case identified in Texas last year. It became clear that I had it.

Of the 17 patients targeted by the agency There is more informationAll but one were among the men who had sex with men. Fourteen had traveled to other countries three weeks before the onset of symptoms. Three patients were immune vulnerable.

Researchers at the CDC have not been able to determine how a single unnamed patient acquired the virus. It suggests that there is ongoing community communication at least in that state and perhaps in other states, CDC Dr. Jennifer McQuiston told reporters.

“We really want to increase our surveillance efforts,” she said.

Health officials have identified contacts for a total of about 400 people in 13 patients who are also at risk of developing monkeypox. Identifying at-risk contacts helps authorities determine the resources needed to contain the outbreak.

So far, health authorities have provided approximately 1,200 vaccinations and 100 treatment courses to eight states, according to Dr. Raj Panjabi, Senior Director of Global Health Security and Biodefense at the White House.

The number of monkeypox casualties worldwide surged this week, reaching nearly 800 as of Friday. The spread of the virus in at least 31 countries outside Africa, where the virus is endemic, raises alerts among scientists and public health officials.

Health officials in some countries require that anyone who tests positive for monkeypox be quarantined at home. The UK, which records the most cases, Prompted patient Refrain from having sex until the symptoms subside, then use a condom for 8 weeks, Limit interactions With pets and other animals that can become infected.

As the outbreak spreads, health authorities around the world are rushing to collect vaccines and treatments to protect infected people and their close contact. Options are severely limited.

The United States is one of the few countries to stockpile millions of vaccines and medicines for smallpox as a preventative measure against the recurrence of smallpox. Monkeypox is closely associated with smallpox, and vaccines and medicines are expected to be about as effective.

Theoretically, at least two drugs and two vaccines are available to combat the development of monkeypox, but most of these have been tested primarily in animals.

of Recent research Of the two medications in the seven patients, only one appeared to have some benefit and the other caused toxic side effects.

The older of the two vaccine options is used to eradicate smallpox and can cause severe side effects such as heart problems and death. Most doses have been stored for decades and may have lost their effectiveness.

The second vaccine option made by the Danish company Bavarian Nordic has been approved by the Food and Drug Administration. 2019 To prevent smallpox and monkeypox. Called Jynneos in the United States, it is safer than previous vaccines, but its supply is even more limited.

Several countries including Canada, UK When FranceHas already started vaccination of close contacts of infected people, Many others Have placed order To Bavarian Scandinavia for additional supply.

Some experts say that African countries that have been fighting monkeypox for years have had little or no access to these vaccines and treatments.So far this year, 44 cases Recorded in Nigeria When 6 other African countries If the viruses are endemic, but their numbers are likely to be underestimated.

Some experts fear that the outbreak of monkeypox in Western countries may further limit access to vaccines and treatments in poor countries. “Vaccines and treatments stored elsewhere are not always shared,” said Dr. Ifedayo Adettifa, director of the Centers for Disease Control and Prevention in Nigeria.

In Switzerland, the World Health Organization maintain About 2.4 million doses of vaccine used to eradicate smallpox, and it Stockpile An additional 31 million doses in 5 donor countries that may be released to the country in need.

However, WHO previously recommended the vaccine only to people at high risk of exposure, said organization spokesman Tarik Jašarević. Experts convened by WHO were to be reviewed guidance In October, however, “the timeline will need to be speeded up,” he said.

WHO is also evaluating pre-certification of the new Jynneos vaccine. This is a necessary step for use in many countries.

CDC Scientific Advisor voted in November Recommend Jynneos to immunize researchers and healthcare professionals People at risk of exposure to smallpox or monkeypox.

The US emergency stockpile has been vaccinated with an old smallpox vaccine called ACAM2000 100 million times. However, the vaccine contains a live vaccinia virus, About 6 cases of myocardial pericarditis — Myocardial inflammation — For every 1,000 people who receive it.

ACAM2000 cannot be used by pregnant women, babies, or people with weakened immunity, that is, those who most need protection from the monkeypox virus.

In contrast, Jynneos senior citizen, Man When HIV Also AIDS And those who received bone marrow Transplant Therefore, the immune system is weakened.

U.S. stockpiles once held 28 million doses of Jynneos, but these doses include everything ExpiredAccording to Paul Chaplin, Chief Executive Officer of Bayern Nordic. According to Dr. Chaplin, federal health officials say about 1,000 doses of Jynneos are available, but Bavarian Scandinavia has given thousands more doses in the past few weeks.

In total, he said, the United States has access to about one million doses.

People infected with monkeypox can be vaccinated even days after exposure. They can also be treated with one of two drugs approved for the treatment of smallpox, tecobilimat and brinsidefovir.

FDA approved The oral form of tecobilimat, also known as Tpoxx, treats smallpox in adults and children weighing at least 13 kilograms (28.6 pounds), but the drug has never been tested in children.

Manufactured by New York-based Siga Technologies, the drug was taken twice daily for 14 days, and safety studies showed no serious side effects other than stomach symptoms.

The US stockpile has 1.7 million courses of tecovirimat... Pentagon on May 12, before the outbreak of monkeypox Procurement There was an additional $ 7.5 million drug course, about half of which was to be offered this year.

Dennis Hruby, Siga’s chief scientist, states that “a significant number of countries” have been demanding a course of this drug since the outbreak began. He said the company plans to distribute up to 190,000 treatment courses by the end of June.

FDA working with Siga Intravenous preparation This version can be used for patients who cannot take oral medications due to blisters in the mouth.

According to Dr. Hruby, Health Canada, the national health ministry, approved tecovirimat in 2020 and purchased a dose worth $ 13 million. The European Medicines Agency also approved the drug in January to treat all orthopoxviruses, a family of viruses including both smallpox and monkeypox, but still negotiated with the company when the outbreak occurred. It was inside.

Both Tecovirimat and brincidofovir have been approved under the FDA’s Animal Regulations. This allows the FDA to rely on data from rodents or monkeys when testing people’s drugs is unethical.

The second drug, brinkidofovir, is manufactured by Chimerix and appears to have more side effects, including the risk of death, to the agency. So-called black box warning — Its most severe warning — about drug use.

In recent studies of both drugs, researchers reported that brincidofovir was “not observed to provide compelling clinical benefits.” However, the study was too small and the treatment plans offered to patients were so diverse that it was not possible to draw conclusions about the efficacy of the drug, David, a virologist at the University of Alberta, consulting with Chimerax.・ Evans said.

People who cannot safely take either Tecobilimat or Brynsidefovir, such as those with weakened immunity, can receive an immunotherapy called vaccinia immunoglobulin, but in limited doses.

U.S. is supporting development Monoclonal antibody cocktail You can block the monkeypox virus. Some vaccines are also in the early stages of development. A few that Depends on horsepox..

In the long run, it makes sense for the United States to stockpile enough vaccines and medicines to protect the entire population, including those who may have been vaccinated against smallpox in childhood. Said Dr. Seth Raderman, Chief Executive Officer of Tonics. Development of smallpox-based vaccines.

Studies suggest that people vaccinated against smallpox may be protected from serious illness, if not infection. But even the slightest lesions are enough to spread the virus to others, Dr. Lederman said.

“I think the goal is to keep people from getting lesions, like monkeypox,” he added.

The Tonix vaccine is not available in the current outbreak. “Our approach is to go slowly and steadily,” he said. “These issues have not been resolved.”