Although the number of mpox cases in the United States has fallen sharply since its peak in early August 2022, the virus remains widespread. The Chicago Department of Health reported 12 confirmed cases and one probable case between April 17 and May 5. With the summer festivals reopening, public health experts are reiterating calls for vaccination and prevention efforts. Medscape Medical News To help prepare the clinician community, we spoke with Christopher Braden, M.D., Associate Director of the National Center for Emerging and Zoonotic Diseases at the US Centers for Disease Control and Prevention (CDC).
How big of an issue is mpox now?
Since the height of the epidemic, when there were over 450 cases per day, totaling over 30,000 cases, the number of cases has dropped significantly. What we are seeing now is a very long tail of small numbers of reported cases across the country. We are seeing incidents reported from jurisdictions that have experienced numerous incidents in the past. In other words, the spread of infection is not over yet.
There could be more cases linked to that cluster in Chicago, which could bode well for other places. Worryingly, Chicago is experiencing a high number of infections among vaccine recipients. We will be working with public health departments in Chicago and Illinois to investigate what is going on there.
Has the CDC changed its vaccine recommendations because some mpox cases have occurred in vaccinated people?
Most worrisome is whether our estimates of vaccine efficacy are somehow wrong. Are you estimating that too high? [Editor’s note: Full vaccination with JYNNEOS is estimated to be 69% effective at preventing mpox disease, according to the most recent published data.] However, there are some upcoming publications showing that the efficacy of the vaccine is similar to that previously estimated.
A second concern we have is whether vaccine-induced immunity may wane over time, as we have seen with the COVID-19 vaccine. We have ongoing research focused on this very issue, not only in areas where mpox has been occurring for a very long time, such as the Democratic Republic of the Congo, but also in communities like Washington DC and Los Angeles in the United States. At this time, we do not believe there is a need to change vaccination recommendations.
How concerned are experts about a return of mpox cases this summer?
We know the levels of the virus circulating in the country are low, and vaccination coverage is very low in many of those areas, and there is still a substantial risk of outbreaks and large future outbreaks. low. It’s great that we were able to vaccinate more than 1.2 million people at high risk in this country, but that’s only a fraction of the population at risk.if you take it The entire population of this country is at risk, which is probably about 23% coverage of full vaccination. It may be a little more than that considering someone who only received one dose of JYNNEOS, but I highly recommend taking both doses to get as much protection as possible.
Did it modeling Risk of future outbreaks in some areas with low vaccination coverage (e.g. 15%) versus risk of outbreaks occurring in other jurisdictions with very high vaccination coverage (e.g. Washington DC) . Risks therefore vary by jurisdiction based on vaccination coverage. In jurisdictions with vaccination coverage greater than 75%, the risk of new outbreaks over the next five years is estimated to be 5% to 12% annually if mpox is reintroduced. Areas with low vaccination coverage (<35%) are more likely to have recurrent epidemics.
Who should clinicians be most concerned about being vulnerable to mpox infections?
Gay and bisexual men and other men who have sex with men have the highest infection rates in the country so far. A small number of cisgender women and young children have been infected, but these infections tend to occur within households, that is, when they live with someone who is infected. Transgender, non-binary, or gender-diverse people who have had multiple sex partners or sexually transmitted infections (STIs) within the past 6 months are also at increased risk of contracting mpox. People who have had sex in a commercial sex venue, in connection with a large commercial event, or in exchange for money or other goods in the past six months are also considered at risk. Secondly, people with uncontrolled HIV or other immunosuppressive conditions are at increased risk of severe MPOX disease and death. We focus our recommendations on these groups and target them for vaccination.
Who else is eligible for the vaccine?
Postexposure prophylaxis with the mpox vaccine is recommended for people who have been exposed to the mpox virus or who are at high risk of exposure to the virus. This includes those who had a sex partner diagnosed with mpx in the last two weeks. It is best to get her vaccinated within the first 4 days after exposure, but vaccination within 14 days of exposure may still have some benefit.
What signs and symptoms should a clinician look for to diagnose an mpox case?
Clinicians should seriously consider mpox when considering other infections in the same differential diagnosis. Other infections include herpes simplex virus, syphilis, shingles, disseminated varicella-zoster virus infection, molluscum contagiosum, scabies, genital lymphogranuloma, allergic skin rash, and other drug eruptions. will be Fever and swollen lymph nodes may also indicate an infection, and people with mucosal infections may experience oropharyngeal and rectal pain.
As part of a patient workup, clinicians should conduct a thorough history of sexual exposure. Mpox is transmitted by close and sustained physical contact and is almost exclusively associated with sexual contact in these outbreaks. A physical examination should include a thorough skin and mucosal examination of the oral, genital, and anal areas for the characteristic pustular vesicular rash of mpox. This allows clinicians to detect lesions that patients are unaware of.
What can clinicians tell their patients about mpox prevention, including vaccination?
They should urge their patients to be wary of mpox, especially now that the spring and summer festivals are approaching. Individuals may also need to temporarily alter their sexual behavior in some way to prevent mpox exposure or infection.
People at risk should be advised and encouraged to get vaccinated. It can be given intradermally, but it does not have to be given only to the arm. If you don’t want to be noticed with an intradermal injection, you can also inject it into your back, for example. Subcutaneous administration is also possible. Two doses are required for maximal protection against mpox, and it takes him two weeks after the second dose for the vaccine to take full effect. Therefore, people should plan preventive activities especially during the festival season.
There was a problem with the vaccine supply last summer. Has that issue been resolved?
We have sufficient supplies to ship to jurisdictions requesting the vaccine. We hope that more people will be vaccinated.
Will there be additional data on vaccine efficacy after December 2022?
We are planning to publish 3 publications MMWR and one is New England Journal of Medicine Vaccine efficacy is tested in a variety of ways. Estimates may vary from study to study, but all fall within established ranges for vaccine efficacy. This is good news. The efficacy of the vaccine has been considerable and further research continues. We also examined the efficacy of intradermal and subcutaneous vaccines, and both methods appear to be equally effective, although these analyses, although the numbers of patients are small.
I don’t want this observation of many confirmed cases among vaccinated people to somehow dampen enthusiasm for vaccination. We know we can limit the infection, but it’s not 100%. Looking at vaccine efficacy, the time point estimate is 69%. However, vaccines can not only prevent infection, but also reduce the severity of the disease, the risk of hospitalization, and even death in people with significantly weakened immune systems.
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