Monkeypox: the known and the unknown

In early July, the number of monkeypox cases in the United States fell below 100. Last week, the number of confirmed cases surpassed her 14,000, and he affected more than 41,000 people worldwide.

Say ‘It’s not the explosive spread we’ve seen with COVID’ Stuart IsaacsAssociate Professor of Medicine Perelman College of Medicine“But that’s a concern, and with more testing going on, I think we’ll continue to find cases. Perhaps many cases and infections will remain undetected.”

August 4, President Biden declared to occur Following the public health emergency, state of emergency declaration It was announced by the World Health Organization on July 23rd. Some cities, such as San Francisco and New York, have declared their own states of emergency.

But the public health response has failed to contain the disease, and vaccines, although effective and approved, are in short supply.As the spread continues, so does misinformation and concern. Although fatalities from this outbreak have been minimal, not recorded in the United States, and about a dozen cases have been reported worldwide, the disease causes persistent painful lesions and sometimes severe fever. and may cause fatigue. Vulnerable groups such as children, the elderly and the immunocompromised may be at particular risk of severe consequences.

Isaacs, an expert on poxviridae, which includes not only smallpox but also monkeypox, and vaccinia virus, the virus used to make available vaccines, said: pen of the day about seizures. He will share key insights into what is known about the disease, including symptoms, prevention, and treatments, as well as thoughts on what to look for as the outbreak evolves.

Unlike previous outbreaks, human-to-human transmission is driving the recent monkeypox epidemic

Monkeypox is a disease endemic to Africa and is considered a zoonotic disease transmitted from animals to humans. Isaacs said, historically, many people who got sick were infected directly from animals, such as being exposed while hunting. It was limited to contact, and long human-to-human chains were rare.

Outbreaks outside Africa have occurred before, with animals playing a direct role in spreading. For example, in 2003, 72 of her people in the United States contracted monkeypox after being exposed to pet prairie dogs kept with infected rodents imported from Ghana. The outbreak lasted approximately two months with no evidence of human-to-human transmission.

Today’s situation is a far cry from those previous scenarios. With tens of thousands of people affected in 94 countries, there is apparently “widespread community spread,” Isaacs said.

A striking feature of this outbreak is that men who have sex with men (MSM) are primarily affected. Monkeypox was not traditionally thought of as a sexually transmitted infection (STI), but Isaacs said it clearly is. communicable This is because it can be transmitted through sexual intercourse and other types of intimate contact.

“Whether to call it STI is a bit of a semantic debate,” says Isaacs. “It is not yet known whether persons without lesions can transmit the disease through semen or vaginal or rectal contact. Isaacs also noted that epidemics most commonly occur in MSM social networks, and while the focus is on educating and vaccinating this population, under the right circumstances Emphasized that everyone is susceptible to the monkeypox virus.

The symptoms of the disease are also different from previously known cases

Not only does the spread of the disease appear different in this outbreak, but the symptoms of the disease have also changed slightly from what was previously considered the norm.

“People infected with the more classic monkeypox present with a prodrome, a series of symptoms at the onset of the disease, including fever, muscle aches and headaches,” Isaacs said. “Then I started having a rash that was diffuse and often mistaken for smallpox. The lesions all appeared at the same time and had the same progression around the body.”

In contrast, people affected by the current outbreak “may present without warning,” says Isaacs. Some people develop fever and pain, and sometimes more lesions develop later in other parts of the body.”

Scientists are currently uncertain whether these phenotypic differences may be due in part to genetic alterations in the virus. One thing has been confirmed. Formerly known as the West African Clade, a group with common genetic features. This clade he divided into two subtypes and the new virus is called clade IIb.

Monkeypox patients are generally considered most contagious when a rash is present. However, Isaacs said asymptomatic or presymptomatic individuals can infect others, as has been seen with COVID-19. Scientists will know if that’s the case during this outbreak, he notes.

A vaccine is available, but there are hurdles to access

More than 600,000 doses of the vaccine have been distributed statewide and allocated to close contacts of people with confirmed monkeypox infection and to individuals considered at high risk of infection. Biden administration announced We plan to provide an additional 1.8 million doses of the vaccine.

The vaccine to be inoculated is a Gineos vaccine containing live vaccinia virus that cannot multiply in the body. Based on historical smallpox vaccine data from Africa, a two-dose regimen is believed to be 85% effective in preventing infection.

A second vaccine, the ACAM2000 vaccine, exists that can prevent monkeypox. ACAM2000, which is approved for prevention of smallpox, contains live vaccinia virus that replicates after vaccination. About 100 million doses are stored in the US Strategic National Reserve. But the reason this vaccine has not been distributed is its side effects.

“That vaccine is known to have many minor and serious adverse events and even death if given to the wrong person,” Isaacs said. People with compromised immune systems or skin conditions, such as psoriasis or atopic dermatitis, should not receive the vaccine. And those who receive it can shed live vaccinia virus, potentially endangering immunocompromised people around them.

Using such a vaccine could make sense if the outbreak was smallpox, which has a high mortality rate and is highly contagious, Isaacs said. However, the calculation of risk and benefit differs in this clade of monkeypox, which is much less deadly and much less contagious than smallpox.

Unfortunately, Jynneos’ vaccine is far less readily available, with doses close to 1 million doses, and has been slow to roll out to at-risk populations, with many people never receiving the vaccine and others. Because people don’t know when they can be vaccinated. The second in the two-shot series.

recently, FDA Issues Emergency Use Authorization (EUA) has made the Jynneos vaccine available for intradermal injection. It is as effective as subcutaneous delivery while using only one fifth of the vaccine material. While this could expand the supply of vaccines, “the intradermal approach is prone to local reactions and causes inflammation. In addition, it requires a fairly complete injection to deliver an adequate dose.” There is,” he says Isaacs. “It creates a lot of hesitation about moving forward. You have to think about meaning.”

Even with increased distribution of the vaccine, vaccines alone won’t guarantee that those most at risk of monkeypox will return to normal life, Isaacs said.

“All public health responses must work together,” he says. “We need to target at-risk populations and educate them about the disease, including how to recognize and isolate it to prevent further spread. Vaccines alone will not eliminate epidemics.”

Redundant paperwork impedes widespread use of available therapies

Tecovirimat (TPOXX) is an FDA-approved antiviral therapy for the treatment of smallpox, but not monkeypox. Its use on monkeypox is still considered and is permitted under what is known as the Extended Access Protocol. This means a face page and a page of paperwork by doctors who want to prescribe it for their patients. you can’t.

“This creates barriers from both the donor and patient side, because as a doctor, you have to be able to get written consent from the person you want to treat with the drug,” says Isaacs. “We all hope to have emergency use authorization at some point, so providers can simply tell patients about side effects and distribute information sheets. We need data demonstrating efficacy against the occurrence of

Fall Season May Present Additional Outbreak Challenges

As the outbreak continues, Isaacs hopes to clear up some questions about the infection, including: What are the most common routes of transmission? How effective are vaccines and antivirals and do they reduce transmission, or do they simply protect the individual to whom they are administered? Will I be able to return to work or school while minimizing the risk of

But he foresees the challenges ahead. With the arrival of the new school year, students flock to college campuses to participate in social networks and activities. Younger students may also be at risk, especially those in preschools and kindergartens who have close contact with caregivers. “I think it creates anxiety and problems,” says Isaacs.