Monkeypox rising in the United States: Can it become endemic?

Pena: It probably started with travelers to Europe and turned out to be widespread in the men’s community of having sex with men at rave and parties. It is contagious when it comes into close contact.

Smith: The monkeypox peculiar to Africa is spreading all over the world through a network of men who have sex with men. Prodromal symptoms (early signs) include fever, lymphadenopathy (swelling of the glands), headache, muscle pain, and rash.

The rash usually begins in the face and mouth and progresses through a concentrated, synchronized stage in the face and limbs.

Infection is generally mild and self-limited, with no deaths reported to date.

However, some patients report a more severe course.

The virus is transmitted by close physical contact with infected individuals, primarily through skin-to-skin contact from individuals with active skin lesions, but respiratory droplets or oral fluids are potential sources of diffusion. is.

Nara Simhan: Monkeypox surprised us.

Previously, only close family members or animal-to-human transmissions were noted, but current outbreaks are predominantly transmitted through infections. [men who have sex with men] MSM by close sexual contact.

Due to this transmission pattern, most patients have painful genital lesions, including penile lesions, Perineal lesionsWhen Proctitis.. Most cases were mild and self-limited and did not require hospitalization.

Pena: I’ve been frustrated. The test is not widely available. Vaccination against close contacts and people with risk factors took time to increase.

Smith: The NYC Ministry of Health has responded differently to this outbreak.

Some members of the health department have warned endangered individuals to temporarily reduce sexual activity. Other members of DOH are concerned about stigmatizing individuals who are potentially at risk for sexual behavior.

Antivirals and vaccines are becoming more readily available.

Nara Simhan: I think there is room for improvement in the reaction of monkeypox.

First, it’s mainly sent as a sexually transmitted disease, but it’s important for the general public to know that everyone can get it. Close your personal contacts.

Second, vaccine distribution for post-exposure prophylaxis to sexual contact in known cases and pre-exposure prophylaxis in high-risk individuals needs to be increased in a very short time frame to reduce this outbreak.

The monkeypox test is only available in some laboratories and the provider must fill out multiple forms. Tests are now available in commercial laboratories, but they need to be easy to use and short-lived for rapid diagnosis, isolation, and treatment.

Finally, the treatment of monkeypox is currently a new drug under investigation called tecovirimat Or TPOXX. Currently listed as an IND (Investigative Drug), it is cumbersome to obtain and prescribe and requires filling out multiple forms.

Significantly simplifying this process will help providers as the number of cases grows.

Pena: Financial resources. This is much easier to contain than COVID. The test needs to be strengthened and should be wiped out.

Smith: It is very important to have a unified evidence-based message from DOH to at-risk individuals and information to be disseminated to practitioners.

At this time, patients with suspected monkeypox have been reported by health care providers to the local Ministry of Health. Specimens for virus testing may be sent to a designated laboratory and confirmed by the CDC. All of these are time consuming but essential for diagnosis and management.

Nara Simhan: Availability of appropriate vaccines and treatments, access to tests, public awareness and concerns, [and] Deal with stigma because the transmission is primarily due to close contact during sex.

Pena: It is not effective due to limited doses of vaccine, limited points of vaccination, and inadequate contact tracing.

Smith: Awareness of the mode of infection and increased availability of vaccines and treatments should help reduce the spread of the infection.

Nara Simhan: Ring vaccination Efforts to prevent the spread (vaccines are given to people exposed to monkeypox) because some patients encounter sexual contacts through dating apps and it is very difficult to track these contacts Was difficult.

Immunization efforts in Santa Clara County are just beginning to increase. [but] Vaccine supply is very limited at this point, which is the speed limiting factor.

We thank the CDC for its efforts to increase both vaccine supply and distribution.

Pena: This should end. If it becomes endemic, it is a public health failure.

Smith: I don’t know at this point if this will end or if it will be endemic. Alertness, identification of infected individuals, and prevention or treatment are the impetus to reduce the spread of this virus.

Nara Simhan: It’s too early to say at this point. I think it depends heavily on the ability to enhance testing, treatment and vaccination.

Pena: Vaccination, symptom knowledge, prompt presentation and quarantine.

Smith: Avoid close contact with individuals diagnosed with this virus and consider vaccination of individuals at risk. [and] We will continue to track this outbreak, paying attention to personal identification and reduction of epidemics.

Nara Simhan: Aerosolated secretions can also cause droplet / airborne transmission, but this is a disease that spreads primarily through close contact.

Hand hygiene is very important to prevent the spread of the disease. It is advisable to avoid crowded settings such as rave or party in closed areas with minimal clothing and direct, personal, often skin-to-skin contact with others. Patients suspected of having monkeypox should avoid close contact, including sexual contact, and seek medical care. Wearing a mask can also help minimize the spread of the disease.