Monkeypox ... as it develops
October 14, 2022
https://graphics.reuters.com/HEALTH-MONKEYPOX/xmpjomlqqvr/
Sept 20, 2022
... infant case Florida
... China warns against skin to skin contact with foreigners
... Sudan has 5 more cases
... Vaccine slows down cases in Florida
... Monkeypox affecting API & Latinos disproportionately
... Boston public schools has first case
Sept 15, 2022
... China gets first case, imported
... Bahrain gets 1st case
... Monkeypox exposure in Carlsbad, CA
... California colleges strategize to prevent Covid-19 & Monkeypox
... The AIDS Clinical Trials Group (ACTG) is launching a phase 3 trial to evaluate the safety and efficacy of tecovirimat to treat monkeypox in vulnerable residents
... Monkeypox disproportionately impacting Utah Latinos
... Riverside County report first pediatric case of monkeypox
... OSDH records 33 monkeypox cases in Oklahoma [OSDH says there is one case in northeast Oklahoma, two in southwest Oklahoma, three cases in southeast Oklahoma, five cases in central Oklahoma (not Oklahoma Co.), nine in Tulsa County, and 13 cases in Oklahoma County]
Sept 9 - 14, 2022
... 1 death in LA
... 2 cases of brain inflammation - both healthy men in their 30s
.... cases continue to decline; this was great for me to watch ... vaccinations and education in play 👏 took about 4 months.
... numbers remain the same in Africa
... https://fortune.com/well/2022/09/14/why-black-men-have-highest-rate-monkeypox-vaccines-jynneos/
... reinfection probability? Not likely
... I'd like to see this type of outreach for all the at risk groups:
https://time.com/6208357/monkeypox-vaccine-gay-bars-california-pharmacy/
Sept 8, 2022
... Massachusetts 30 new cases
... Honolulu 3 new cases
... The Centers for Disease Control and Prevention has reported 20,733 cases of monkeypox in the United States since May 2022.
Sept 6-7, 2022
Cases surpass 20,000 in US, but as vaccinations increase, cases decrease
Sept 1-5, 2022
... Wastewater surveillance becomes more targeted in search for poliovirus, monkeypox and coronavirus
... Cases still on a downward trend
Aug 31, 2022
... 31 child cases in US
... cases tripled in Florida during the month of August
... Yale Univ preparing for an outbreak.
... San Francisco starting vaccine round 2
... Homeless outbreak strategy varies from city to city
Aug 30, 2022
... case dies in Texas; no details, except the victim suffered with a severe compromised immune system
... data research shows men of color share the burden of cases
Aug 28-29, 2022
... Bavarian Nordic has partnered with Grand River Aseptic Manufacturing to assist in vaccine production.
... new cases slow down
Aug 27, 2022
... cases spread but slow in major U.S. cities where residents are getting vaccinated.
... below, a diagram showing BN plans to efficiently use Mpox vaccine.
Aug 26, 2022
... at almost an 8 week period Mpox peaked and is now on the decline. Rapid vaccination and education have nipped this in the bud. However, there is a possible threat with schools & colleges returning to class. Get vaccinated, live safe & take precautions; flu season begins in October, so washing hands, covering your nose and mouth when sneezing and coughing should be part of your routine.
Aug 25, 2022
... 1st child case Orange Cty
... 3 Georgia cases; 1 in elementary. 2 elsewhere
... Global cases fall 21% but US still leads
Aug 24, 2022
... NY cases are going down. I believe this is due to aggressive outreach awareness & education and a rapid vaccination program.
Aug 22-23, 2022
... all 50 states have Monkeypox cases
... gay bars educating patrons to stop pox spread
Aug 21, 2022
... first juvenile in NY [no details stated]
... Major monkeypox patients in Oregon are Latino men
Aug 19-21, 2022
... Indonesia first case
... Cuba first case
... experts go on record stating crowded events are not safe
... 1st case in NY child
... King County, WA states public health emergency
... Monkeypox disproportionately affecting people of color, data shows
Aug 18, 2022
... cases double in L.A. over 2 week period
... LBGTQ+ events being cancelled
Aug 19, 2022
.... first child case Oregon
Aug 17, 2022
... first case arrives Montana
... three cases human to dog transmission
... Bavaria Nordic to outsource vaccine production in U.S.
... 8th child diagnosed in U.S.
... OC up to 77 cases
... Iran first case; 34 y.o. female
Aug 16, 2022
... check CDC or WHO for info; 28% of social media posts are misleading information
Aug 15, 2022
... Dog infected with monkeypox after sharing bed, licking owners
Aug 14, 2022
... new names will be assigned to replace "Monkeypox" and its variants
Aug 13, 2022
... colleges brace for the worst
Aug 12, 2022
... cases double in U.S. from end of July
Aug 9-11, 2022
U.S. monkeypox cases surpass 10,000 as CDC still aims for "containment"
Aug 8, 2022
... cases increase across the U.S., vaccine shortage remains a concern
Aug 6-7, 2022
... It sounded like a simple solution to the shortage of monkeypox vaccine: Merely by changing the way doses are injected, the federal government could vaccinate five times as many people with the supply it has in hand.
But the approach — injecting one-fifth of the current dose into the skin instead of a full dose into underlying fat — is not actually all that simple, experts say. And some federal officials are concerned about changing the method without more research, even though Dr. Robert M. Califf, the head of the Food and Drug Administration, described the proposal on Thursday as promising.
... a new strain found in India
Aug 5, 2022
... US declares health emergency
Aug 4, 2022
... Texas has the most cases
Aug 3, 2022
Lots of news. Here is the main link: https://www.google.com/search?q=monkeypox&client=ms-android-tmus-us-rvc3&prmd=niv&sxsrf=ALiCzsbJAm9ibWKSeGHBxBX_iar1oVDWOw:1659556856577&source=lnms&tbm=nws&tbs=qdr:d&sa=X&ved=0ahUKEwjIw66Hu6v5AhWYLEQIHe4xBs4Q_AUIGigB&biw=384&bih=718&dpr=2.81
Aug 2, 2022
... 1st child case Long Beach, 2nd in Califormia
... whole lotta emergency declarations being made
Aug 1, 2022
... India reports 1 death, 3rd global death
... The campaign to rename monkeypox gets complicated
... Florida: 442 cases in 22 counties, 169 new cases
July 30-31, 2022
... 1st case Spokane
... 1st case Alaska
... New York declares State of Emergency
... US said not to have enough vaccine
... 1st case Vermont
... 2nd death Spain
... 3rd reported death Africa
July 29, 2022
... South Carolina 5 cases
... Phillipines 1st case
July 28, 2022
... Chicago 326 cases
... San Diego out of vaccines
July 27, 2022
... FYI: https://www.livescience.com/what-is-monkeypox-symptoms-treatment
July 26, 2022
... 1st case Mississippi
... 1st case Ventura Cty
... 13 cases Puerto Rico
July 25, 2022
... Japan gets 1st case
... North Dakota gets 1st case
... Europe gets 'go ahead' for vaccinations
... Singapore not giving vaccines; health ambassador states vaccine risk not worth rhe benefit
July 23, 24 2022
WHO declares Monkeypox global health crisis
July 22, 2022
Imvanex now approved to prevent Monkeypox; by Bavarian Nordic [https://www.the-journal.com/articles/eu-drug-regulator-recommends-clearing-vaccine-for-monkeypox/]
actual virus
Symptoms --
One of the main symptoms associated with monkeypox is a rash of lesions breaking out across the skin.
However, the study has revealed that the most common area for the lesions were genitals and the anus, rather than the rest of the body. The next most common area for the lesions was the trunk, arms, or legs.
A total of 54 patients also had only a single genital ulcer—a symptom not currently widely recognized. The study noted that this presents a risk of misdiagnosis, as single genital ulcers are also common in sexually transmitted infections (STI). The study said these findings should be flagged to health care professionals, so that monkeypox may be easier to diagnose and treat.
Around 61 of those infected reported anorectal pain, proctitis, tenesmus, or diarrhea, "or a combination of these symptoms."
The study also reported oropharyngeal symptoms in 26 people, which included lesions inside the mouth and on the tonsil, as well as sore throat, painful swallowing and an inflamed windpipe. There were also cases of lesions appearing on the eyelids, however this was only recorded in three people.
Other than lesions, the other common symptoms reported included a fever (62 percent), lethargy (41 percent), myalgia (31 percent), and headache (27 percent).
Swollen lymph nodes were also reported in 56 percent of people.
According to the study, some of those impacted by anal and oral symptoms were in so much pain they had to be admitted to hospital. The study noted that "this is why it's so important" to flag these new symptoms to health care authorities, so that they be better equipped to treat the virus.
~
... More than 2,300 cases had been confirmed as of Wednesday afternoon, up from 700 on July 8. Cases have been reported in 43 states and the territory of Puerto Rico. Washington, D.C., leads the nation with about 19 cases per 100,000 residents, followed by the states of New York, Illinois and Georgia.
Nine states recorded their first cases in the last two weeks: Alabama, Delaware, Kansas, Louisiana, New Mexico, South Carolina, South Dakota, Tennessee and West Virginia.
| State | July 20 | June 26 | June 10 |
|---|---|---|---|
| Alabama | 4 | 0 | 0 |
| Alaska | 0 | 0 | 0 |
| Arizona | 22 | 1 | 1 |
| Arkansas | 1 | 0 | 0 |
| California | 356 | 66 | 8 |
| Colorado | 38 | 7 | 3 |
| Connecticut | 15 | 0 | 0 |
| Delaware | 1 | 0 | 0 |
| District of Columbia | 110 | 20 | 2 |
| Florida | 208 | 27 | 4 |
| Georgia | 158 | 7 | 1 |
| Hawaii | 8 | 6 | 2 |
| Idaho | 1 | 0 | 0 |
| Illinois | 208 | 45 | 3 |
| Indiana | 26 | 2 | 0 |
| Iowa | 5 | 0 | 0 |
| Kansas | 1 | 0 | 0 |
| Kentucky | 4 | 1 | 0 |
| Louisiana | 16 | 0 | 0 |
| Maine | 0 | 0 | 0 |
| Maryland | 55 | 5 | 0 |
| Massachusetts | 69 | 13 | 1 |
| Michigan | 19 | 0 | 0 |
| Minnesota | 15 | 2 | 0 |
| Mississippi | 0 | 0 | 0 |
| Missouri | 5 | 2 | 0 |
| Montana | 0 | 0 | 0 |
| Nebraska | 2 | 1 | 0 |
| Nevada | 7 | 2 | 0 |
| New Hampshire | 3 | 0 | 0 |
| New Jersey | 41 | 2 | 0 |
| New Mexico | 6 | 0 | 0 |
| New York | 581 | 63 | 9 |
| North Carolina | 13 | 2 | 0 |
| North Dakota | 0 | 0 | 0 |
| Ohio | 11 | 2 | 0 |
| Oklahoma | 3 | 2 | 0 |
| Oregon | 9 | 1 | 0 |
| Pennsylvania | 58 | 4 | 1 |
| Puerto Rico | 7 | 0 | 0 |
| Rhode Island | 7 | 1 | 0 |
| South Carolina | 6 | 0 | 0 |
| South Dakota | 1 | 0 | 0 |
| Tennessee | 10 | 0 | 0 |
| Texas | 81 | 7 | 1 |
| Utah | 11 | 4 | 2 |
| Vermont | 0 | 0 | 0 |
| Virginia | 56 | 3 | 1 |
| Washington | 55 | 6 | 1 |
| West Virginia | 1 | 0 | 0 |
| Wisconsin | 6 | 0 | 0 |
| Wyoming | 0 | 0 | 0 |
Monkeypox cases per 100,000 people, July 20
Forty-four states and D.C. reported more than 2,300 monkeypox cases
July 21, 2022
... cases are spreading in cluster events across the U.S.
A global outbreak of monkeypox has grown to nearly 14,000 cases, including 5 deaths, the director-general of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, PhD, said today.
Though the outbreak is heavily concentrated in Europe, the five deaths have been reported in African nations. Some countries are beginning to record a decline in cases, but six countries this week reported their first cases.
July 20, 2022
... cases in Michigan reach 14
... cases in North Carolina reach 20
https://www.theatlantic.com/newsletters/archive/2022/07/us-messaging-on-monkeypox-is-deeply-flawed/670573/
July 19, 2022
... 1st case Fresno
... cases increase Oregon
... cases spread to Mobile & Jefferso Cty Alabama
July 18, 2022
... cases grow in So. Florida
... Washington D.C. 122 cases; highest in U.S.
... Vaccines limited in Los Angeles
July 17, 2022
... 200+ DC, Maryland, Virginia
... first case Long Beach
July 16, 2022
CDC expects cases to grow
Demand for vaccine exceeds stock
Gay community being hit hardest
July 15, 2022
No new news
July 14, 2022
... Global cases now 10,000+
... LA County now 66 cases
... India confirms 1st case
... New Jersey 2 cases
... Austin, TX 6 more cases
... Uptick in cases Erie, PA
... Trending vaccine shortage; BN spokesperson says they can keep up
July 13, 2022
... 1 case Erie, PA
... Spreading in Ohio
... Cases increase New Orleans
... Community spread in Austin, TX
"Comunnity spread":
- the spread of an infectious disease within a group of people who have had no known contact with a person infected with or exposed to the disease."we expect we will see community spread in this country"
July 12, 2022
... 9200+ global cases
... 1735+ London cases
... 1st case Russia
... 1st case Delaware
... 2nd case Taiwan
... Pennsylvania in top 10 for US cases
... North Carolina has no testing centers
July 11, 2022
... 2nd case Wisconsin
... > 100 cases Florida
... 3rd case South Africa
... Man positive for Monkeypox, leaves Jamaican hospital on the low
... Cases double in West Midlands, England while the UK deescalates Monkeypox response
... Israel gets 11 new cases
... Madrid and Berlin have most European cases
... 1st case in Australia; Queensland
... South Carolina & Georgia surpass 30 cases
... 3rd case Kentucky
July 10, 2022
... Kern county; 1st case
... West Virginia; 1st case
July 9, 2022
... Michigan up to 3 cases
July 8, 2022
... Club Dallas and DaddyLand Festival Visitors Should Watch for Monkeypox: DCCHS
... First Probable Case of Monkeypox in West Virginia
... DHEC Announces First Confirmed Cases of Monkeypox / South Carolina
... US monkeypox cases top 600 in 34 states
Can you get monkeypox from surfaces? Here's what one study found.
High viral concentrations of monkeypox were found on the surfaces of infected patients' rooms, according to a study published in Eurosurveillance. Do contaminated surfaces increase the risk of transmission?
Monkeypox: The latest on the outbreak
Monkeypox found on surfaces in infected patients' hospital rooms
Monkeypox mainly spreads through direct physical contact with an infected animal or person, but as cases worldwide continue to grow rapidly, scientists are researching other potential routes of transmission.
For the study, researchers swabbed the surfaces of rooms being used by two hospitalized monkeypox patients in Germany, including their bathrooms and the adjacent anterooms where workers would change in and out of personal protective equipment (PPE).
According to the researchers, the surfaces the patients directly touched had the highest loads of viral concentration and were primarily found in their bathrooms, particularly on the toilet seats, washbasin, and levers. The virus was also detected on the patients' chairs, the fabrics in their rooms (towels, shirts, pillowcases), and one patient's mobile phone.
In addition, the virus was found in different areas of the patients' rooms, including on the handles of the cabinets, as well as all contact points in the anterooms. The researchers believe the viral contamination on these surfaces was mainly from medical staff caring for the patients.
Do contaminated surfaces increase the risk of viral transmission?
According to the researchers, there is currently no "definite data" on what amount of viral load is needed to transmit monkeypox, but the necessary amount is believed to be substantially higher than other viruses, such as smallpox. This means that although monkeypox was found on several surfaces in the patients' rooms, infection would not necessarily occur from touching them.
"Despite high contamination with up to 105 cp/cm2 as well as the successful recovery of monkeypox virus from samples with a total of > 106 copies, our findings do not prove that infection can occur from contact with these surfaces," the researchers wrote.
However, they also noted that contaminated surfaces have the potential to be infectious, and "it cannot be ruled out that their contact with especially damaged skin or mucous membranes, could result in transmission."
Although no evidence of secondary transmission through contaminated surfaces was observed in the study, there have been other cases where individuals have been infected after interacting with contaminated materials.
For example, during a previous monkeypox outbreak in Africa, a nurse who was not wearing adequate PPE was infected with the virus after removing a patient's clothes, taking their blood, and checking their temperature. In addition, another case was reported in the United Kingdom where a health care worker became infected after changing "potentially contaminated bed linen" without adequate PPE.
According to Hugh Adler, from the department of clinical sciences at the Liverpool School of Tropical Medicine, the study's findings are "absolutely an expected development" and that "outside of very heavily contaminated areas … surfaces in the community are not likely to be high risk for transmission."
"Patients with extensive skin lesions admitted to hospital are likely to spread the highest amount of virus to the environment," he said. "Patients with milder disease might shed less; we don't know yet."
"Monkeypox viral persistence on surfaces is already well known in public health circles, and current public health guidelines for people self-isolating at home include recommendations for how to do laundry and steps to be taken to prevent transmission to household contacts," Adler said.
Overall, Adler said the study's findings are not a cause for concern, but instead help "reinforce the importance of following public health guidelines."
"This data refers to a hospital room, and may translate to the home environment (e.g., someone's bedroom while they're self-isolating) but this paper does not mean that monkeypox patients shed infectious virus into the wider environment/surfaces around the town," he added. (White, Newsweek, 7/5; European Centre for Disease Prevention and Control, EurekAlert!, 7/1; Nörz et al., Eurosurveillance, 6/30)
[I've counted by accident at least 10 people in front of me wiping their noses then go for their drinks. Tdk, tsk, that's a good way to spread disease. Trying to harass and gaslight me will backfire, trust, when caseloads increase of any diseases. Stop doing what the cops are telling you].
July 7, 2022
... Oregon faces ‘another public health emergency’ as monkeypox begins to spread
... Hawaii receives 357 monkeypox vaccine doses
... Monkeypox has been identified in Louisiana.
~
July 6, 2022
... Hawaii distributing monkeypox vaccine to close contacts, those at highest risk
... BREAKING: Dallas County Reports the First Monkeypox Virus
... First confirmed case of monkeypox in Arkansas puts Mid-South doctors on high alert
... Singapore Confirms Its First Local Case of Monkeypox
... Global monkeypox cases top 6000, WHO says
~
July 5, 2022
... First Case of Monkeypox Detected in Camden County, New Jersey
... Connecticut reports first Monkeypox case as infections rise nationally
... Panama reports country's first monkeypox case
... The US is ordering up more doses of the monkeypox shot
~
July 4, 2022
... Colorado plans 3 more pop-up monkeypox vaccine clinics
... Puerto Rico investigates four additional possible cases
... Number of monkeypox cases in Brazil reportedly reaches 78
... Hamilton [Ontario, CA] confirms 1st case of monkeypox
... Monkeypox is in Iowa
... Number of Probable and Confirmed Cases 47 -- Date as of July 7, 2022 at 9:00 a.m.
July 3, 2022
~
Advocates warn US at risk of losing control on monkeypox
Infectious disease experts and public health advocates are warning that the Biden administration has been too slow to respond to the monkeypox outbreak and that the U.S. is at risk of losing control of the disease.
The response to monkeypox is mirroring the worst parts of the early days of the coronavirus pandemic, they say, with severely limited testing and a sluggish rollout of vaccines leading to a virus that’s spreading undetected.
“Where we have lagged is streamlining testing, making vaccines available, streamlining access to the best therapeutics. All three areas have been bureaucratic and slow, and that means we haven’t contained this outbreak,” said David Harvey, executive director of the National Coalition of STD Directors (NCSD).
Unlike COVID-19, monkeypox is not a novel virus, and the strategies to reduce the spread are well known. Biden administration officials said they are confident in their approach.
“We as a global community have known about it for decades. We know how it spreads. We have tests that help identify people who are infected. We have vaccines that are highly effective against it,” White House coronavirus response coordinator Ashish Jha said during a recent briefing.
According to the Centers for Disease Control and Prevention (CDC), there are 460 cases in 30 states, Puerto Rico and D.C., though experts say that number is almost certainly an undercount, as many people who may be infected don’t yet have access to widespread testing.
The administration is ramping up its response by expanding testing capacity and broadening access to vaccinations, though critics say the efforts may be coming too late.
“We’ve been sort of screaming for a month about how bad the diagnostic situation is for monkeypox. And that really was a clear error, preventable, and it’s very clear that this administration has not learned lessons from early COVID,” said James Krellenstein, co-founder of the HIV treatment advocacy group Prep4All.
Jon Andrus, an adjunct professor of global health at George Washington University’s Milken Institute School of Public Health, said the U.S. is lucky that monkeypox is not as contagious as COVID-19, or as deadly, because the public health system is underfunded and overly fractured.
“I think we’ll continue to repeat these mistakes because that’s been our track record. That’s been our track record. We’ve had, what, more than five or six waves of COVID, and we seem every time to be a little bit caught off guard,” Andrus said. “Stopping transmission requires that we’re all reading from the same page. We all have the same road map.”
The administration expanded testing to commercial labs in late June, so providers will soon be able to order tests directly from the labs where they have established relationships and can jump through fewer hoops.
But it took more than a month for that move to happen, which increased testing capacity from about 8,000 tests a week to 10,000 across the entire system.
Demand is also not evenly spread across the public health laboratory networks; it is concentrated in urban areas such as New York City, leading to backlogs and frustrated patients who wait days for test results.
Biden administration health officials this week touted efforts to expand testing.
“I strongly encourage all health care providers to have a high clinical suspicion for monkeypox among their patients,” CDC Director Rochelle Walensky said during a call with reporters. “Patients presenting with a suspicious rash should be tested.”
Testing for monkeypox is a relatively simple process that involves swabbing a skin lesion. Unlike with COVID-19, the CDC already had a previously developed test, but patients were limited to a narrow set of specific criteria in order to qualify for testing.
“We already had testing available. We already had vaccines available. We should have really been much more aggressive with testing … and I think this speaks to some of the bureaucracy of both FDA [Food and Drug Administration] and CDC,” said Celine Gounder, an infectious disease specialist and editor-at-large for public health at Kaiser Health News.
“Getting the commercial labs on board they could have done sooner. Getting academic medical centers to do testing, hospital labs to develop their own PCR tests. I mean, that’s not a very difficult thing to do,” Gounder said.
The White House is also working to scale up its vaccination program and announced a plan to immediately send out tens of thousands of doses of Jynneos, the only FDA-approved vaccine specifically for monkeypox.
More than a million doses will be made available throughout the year. The CDC is also broadening the eligibility criteria so individuals with confirmed monkeypox exposures and presumed exposures can be vaccinated, rather than only those who have a confirmed case.
But activists and experts say the administration moved too slowly and that the updated vaccination strategy is not nearly sufficient.
“We believe this outbreak is already out of control. So, we have not contained it. Vaccines are not going to contain it at this point. Because we don’t have enough. Getting them into arms is an expensive and intense process,” said NCSD’s Harvey.
New York City and Washington, D.C., began offering the vaccines to men who have sex with other men or may have been exposed to the virus. But both cities ran through their supplies less than a day after launching their local immunization initiatives. D.C. Health had to shut access about 10 minutes after making shots available.
There are about 56,000 Jynneos doses in the Strategic National Stockpile that will be allocated immediately, officials said, and the administration plans to allocate 296,000 doses over the coming weeks.
The U.S. has tens of millions of doses of the smallpox vaccine ACAM2000, but that shot has more dangerous and severe side effects.
According to a spokesman for Jynneos’s Denmark-based manufacturer Bavarian Nordic, 300,000 doses have already been delivered or will be arriving over the next few days.
An additional 1.1 million filled doses are still being inspected by the FDA, which should finish in the next couple weeks.
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The government also owns bulk materials totaling as many as 15 million doses, but they are still frozen, and the administration has not told the company how it wants those doses filled.
“American taxpayers spent money buying and manufacturing these doses precisely so they can be used rapidly in the event of an outbreak,” said Krellenstein of Prep4All.
“Here we have an outbreak, and my friends are literally being turned away from being vaccinated because the Biden administration can’t figure out how to get a million doses out of a freezer in Denmark into the United States,” Krellenstein added.
~
First confirmed monkeypox case found in Suffolk County, health department says
A Brookhaven Town resident tested positive for monkeypox, the first confirmed case in Suffolk County since an outbreak in the United States began of the rare virus that leads to symptoms similar to smallpox.
The Suffolk County Department of Health announced Friday that the person was seen by a local health care provider and is following isolation protocols at home. The New York State Department of Health’s Wadsworth Center Laboratory tested for monkeypox, the virus which belongs to the orthopoxvirus genus.
There have been 96 confirmed cases in New York State and about 400 in the United State to date, the County health department said.
Monkeypox is rarely fatal.
“While the current risk to the general public is low, we urge the public as well as health care providers in Suffolk County to be aware that this rare virus has been found in the region and to know the signs and symptoms and manner of transmission of the monkeypox virus,” Dr. Gregson Pigott, the County health commissioner, said in a statement.
Anyone with a rash that looks like monkeypox should contact a health care provider, the health department says.
On May 18, a Massachusetts resident tested positive for monkeypox after returning to the U.S. from Canada and is the first confirmed case in the current outbreak, according to the Centers for Disease Control and Prevention.
Monkeypox can spread from person-to-person “often through direct and prolonged contact with the infectious rash, scabs, body fluids or respiratory secretions during prolonged, face-to-face contact, or during intimate physical contact, such as kissing, cuddling or sex,” the health department said. “It may also spread by touching items, such as clothing or linens with infectious body fluids.”
A pregnant woman can also spread the virus to their fetus through the placenta.
The health department said recent monkeypox cases in the region have involved a rash that “is often in the genital and peri-anal regions and may include other symptoms such as fever, swollen lymph nodes, and pain when swallowing, before or after the rash appearance.”
Most infections last two to four weeks. Monkeypox is not related to chickenpox.
Scientists at the CDC have been tracking multiple cases of monkeypox that were reported in countries that don’t typically report monkeypox, including the United States. Early data has shown that gay or bisexual men have made up a high number of cases, the CDC said.
“However, anyone who has been in close contact with someone who has monkeypox is at risk,” a statement overview on the outbreak says.
Symptoms of monkeypox can include fever, headache, muscle aches, swollen lymph nodes, chills, exhaustion and a rash that can look like pimples or blisters that appear on the face, inside the mouth and on other parts of the body, according to the CDC. In some cases, the rash appears first, followed by other symptoms. Some people only experience a rash.
Cases have been reported across the county in more than half of the states.
Two vaccines licensed by the U.S. Food and Drug Administration are available to prevent monkeypox infection. However, there is currently a limited supply of the vaccine known as JYNNEOS in the U.S. with more expected in the coming weeks and months, the CDC says.
A second vaccine known as ACAM2000 has ample supply, but should not be used in people who have health conditions such as a weakened immune system, skin conditions or women who are pregnant. The CDC currently does not recommend widespread vaccination against monkeypox. It is recommended for some people who are close personal contacts of people with the virus or have been exposed to it.
Monkeypox was first discovered in 1958 and the first human case was recorded in 1970 and cases have largely been in center and western African countries. Prior to the current outbreak, “nearly all monkeypox cases in people outside Africa were linked to international travel to countries where the disease commonly occurs, or through imported animals,” the CDC says.
There are no treatments specifically for monkeypox virus infections, although antivirals used for smallpox can be used, the CDC says. An outbreak of monkeypox in 2003 in the United States resulted in 47 confirmed cases in six states.
All of the confirmed cases were people who had contact with pet prairie dogs. The pets had gotten infected when housed near imported small mammals from Ghana. It was the time human monkeypox was reported outside Africa, the CDC says.
Joe Werkmeister is the editor of The Riverhead News-Review and The Suffolk Times. A graduate of St. Bonaventure University, he joined the Times Review Media Group Staff as a sports reporter in 2006. He is a three-time New York Press Association Sports Writer of the Year.
~
Monkeypox may be spreading undetected in Colorado. Here’s what that means.
COLORADO — It appears the monkeypox virus may be gaining a foothold in Colorado, prompting health officials to offer vaccination to people in high-risk groups.
On Wednesday, state epidemiologist Dr. Rachel Herlihy said Colorado has seen a potential change in transmission patterns for recent monkeypox cases and the virus could be spreading undetected. As of Thursday afternoon, Colorado has seen eight cases of monkeypox — including two found in the last week.
“What we have seen in some recent cases is more clear evidence of possible community transmission,” she said.
Up until now, Colorado’s monkeypox cases have been tied to either travel to an area with an outbreak or contact with someone in the state who was known to have the virus. But Herlihy said one recent case in the state had neither of those factors. There are two more recent cases where it is also unclear how the person contracted the virus.
“That’s why we want to be proactive,” she said.
~
July 2, 2022
Monkeypox cases increase in Texas, but risk to public remains low
AUSTIN — The Texas Department of State Health Services and local health departments said today they have identified at least 12 cases of monkeypox since the first one was reported in early June.
While the first cases involved international travel, three patients report that they did not travel in the three weeks before becoming sick, meaning they were exposed in Texas, officials said.
The number of confirmed cases has tripled in Texas, where last week the state had four confirmed cases.
“With the sharp increase in monkeypox cases worldwide, it’s not surprising to see the virus spread in Texas,” said Dr. Jennifer Shuford, chief state epidemiologist, in a statement. “We want people to know what the symptoms are, and if they have symptoms, to avoid the types of close contact with other people that can spread the disease.”
Monkeypox is a viral illness that starts with symptoms such as fever, headache, muscle aches, swollen lymph nodes, chills and exhaustion. Soon after, a rash that can look like pimples or blisters appears. The rash often appears first on the face and inside the mouth and then spreads to other parts of the body. People who develop a rash should avoid direct contact with other people and contact their health care provider as soon as possible for next steps, health officials said.
Monkeypox can spread from person to person through direct contact with the rash, scabs or bodily fluids like saliva. It can also be transmitted with prolonged face-to-face contact via respiratory droplets. Many monkeypox cases in the current outbreak have been among men who have sex with men, but anyone who has direct skin contact with or kisses someone who is infectious could contract the virus, they added.
As of Thursday, Texas is one of 27 states and the District of Columbia with confirmed cases. There have been fewer than 350 reported cases nationwide, per Centers for Disease Control and Prevention data.
Despite the rise, TDSHS Senior Press Officer Lara Anton said the risk to the general public remains low at this time.
“Our goal is to stop the spread of the monkeypox virus and the best way to do that is to make people aware of how it is spread and what the symptoms are,” Anton said.
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Twelve African countries report 1,782 cases of monkeypox: Africa CDC
Addis Ababa, Ethiopia | Xinhua | Twelve African countries have so far reported 1,782 cases of monkeypox, the Africa Centers for Disease Control and Prevention (Africa CDC) has disclosed.
Out of the 1,782 cases of monkeypox that have been reported in Africa, some 1,678 of them are being suspected while 104 are confirmed cases, Ahmed Ogwell, acting director of Africa CDC, said during a weekly briefing on Thursday.
He said the cases have been reported both in endemic and non-endemic countries to monkeypox, highlighting that Benin, Morocco and South Africa are the non-endemic African Union (AU) members reporting confirmed cases of the disease.
“Unfortunately, 73 deaths have been reported in the continent as a result of the monkeypox outbreak, bringing the case fatality rate of the disease to 4.1 percent,” said the acting director.
He said the Africa CDC is offering training to 20 health experts drawn from different parts of the continent in Nigeria to help them build the capacity of making a laboratory diagnosis for monkeypox in their respective countries.
“The training is very important because it enhances the capacity of our member states to confirm suspected cases,” Ogwell said, indicating that clinical laboratory confirmation for the disease has been slow across the continent.
He said the Africa CDC’s Institute for Pathogen Genomics is also working on sequencing samples of monkeypox so that it will be able to identify and document any variant that could occur in any AU member.
“We will continue to sequence samples of monkeypox just as we did for COVID-19 to ensure that we understand and know the kind of pathogen that we are dealing with in the continent,” he added.
Ethiopia, Guinea, Liberia, Mozambique, Sierra Leone, Sudan and Uganda — all countries with no previous incidence — have also reported suspected cases, the WHO said in a recent report.
July 1, 2022
First 'probable' case of monkeypox reported in Polk County
Florida health officials are reporting the first probable case of monkeypox in Polk County – this comes weeks after two infections were confirmed in Pinellas County.
According to the state health department, the Polk County case was identified last week, but it's unclear how or where that person may have contracted the disease. Health official said the case is isolated.
People with monkeypox often experience symptoms like fever, body aches and a rash. Most recover within weeks without needing medical care.
Overall, at least 396 monkeypox cases have been confirmed in 30 states and Washington D.C.
In the coming weeks, the federal government plans to deploy nearly 300,000 monkeypox vaccine doses in states with high case-rates.
Earlier this week, the World Health Organization said the escalating monkeypox outbreak in more than 50 countries should be closely monitored but does not warrant being declared a global health emergency.
In a statement Saturday, a WHO emergency committee said many aspects of the outbreak were "unusual" and acknowledged that monkeypox — which is endemic in some African countries — has been neglected for years.
Where is monkeypox spreading?
WHO Director-General Tedros Adhanom Ghebreysus convened the emergency committee on Thursday after expressing concern about the epidemic of monkeypox in countries that haven't previously reported the disease.
"What makes the current outbreak especially concerning is the rapid, continuing spread into new countries and regions and the risk of further, sustained transmission into vulnerable populations including people that are immunocompromised, pregnant women and children," the WHO chief said.
Monkeypox has sickened people for decades in central and west Africa, but until last month, the disease had not been known to cause significant outbreaks in multiple countries at the same time and involving people with no travel links to the continent.
Declaring a global health emergency means that a health crisis is an "extraordinary" event requiring a globally-managed response and that a disease is at high risk of spilling across borders. WHO previously made similar declarations for diseases including COVID-19, Ebola in Congo and West Africa, Zika in Brazil and the ongoing effort to wipe out polio.
The emergency declaration mostly serves as a plea to draw more global resources and attention to an outbreak. Past announcements have had mixed impact, given that WHO is largely powerless when trying to convince countries to act.
WHO said this week it has confirmed more than 3,200 monkeypox infections in about 40 countries that haven’t previously reported the disease. The vast majority of cases are in men who are gay, bisexual or have sex with other men and more than 80% of the cases are in Europe.
What is monkeypox?
A leading WHO adviser said last month the spike in cases in Europe was likely tied to sexual activity by men at two raves in Spain and Belgium, speculating that its appearance in the gay and bisexual community was a "random event." British officials have said most cases in the U.K. involve men who reported having sex with other men in venues such as saunas and sex clubs.
Scientists warn that anyone in close, physical contact with someone infected with monkeypox or their clothing or bedsheets is at risk of catching the disease, regardless of their sexual orientation.
People with monkeypox often experience symptoms like fever, body aches and a rash; most recover within weeks without needing medical care.
Monkeypox in Africa mostly affects people who come into contact with infected wild animals, like rodents or primates. There has been about 1,500 reported cases of monkeypox, including 70 deaths, in Congo, Cameroon and the Central African Republic.
To date, scientists haven’t found any mutations in the monkeypox virus that suggest it’s more transmissible or lethal, although the number of changes detected show the virus has likely been spreading undetected for years.
PREVIOUS COVERAGE: Monkeypox likely spread by sex at 2 raves in Europe, expert says
The version of the disease transmitting beyond Africa typically has a fatality rate of less than 1%, while the version seen in Africa can kill up to 10% of people affected.
WHO is also creating a vaccine-sharing mechanism for monkeypox, which could see vaccines go to rich countries like Britain, which currently has the biggest outbreak beyond Africa.
Some experts warned that could entrench the deep inequities seen between rich and poor countries during the coronavirus pandemic.
"France, Germany, the U.S. and U.K. already have a lot of resources and plenty of vaccines to deal with this and they don’t need vaccines from WHO," said Dr. Irwin Redlener, an expert in disaster preparedness and response at Columbia University.
"What we should be doing is trying to help the countries in Africa where monkeypox has been endemic and largely neglected," he said. "Monkeypox is not COVID, but our attention should not be so distorted that it only becomes a problem when it is seen in rich countries."
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The Wisconsin Department of Health Services Identifies the First Case of Monkeypox in a Wisconsin Resident
Risk to the general public remains low
On June 30, 2022, the Wisconsin Department of Health Services (DHS) identified the first confirmed case of orthopoxvirus, presumed to be monkeypox, in a resident of Dane County. The patient is currently isolating and the risk remains low for the general public. As of June 30, there have been 396 confirmed monkeypox and orthopoxvirus cases in the United States due to this outbreak. DHS, federal, state, and local partners are working closely together to investigate and monitor the current monkeypox outbreak.
“The number of monkeypox cases continues to rise in the U.S., so it is not a surprise that monkeypox has now been detected in Wisconsin,” said Chief Medical Officer Dr. Ryan Westergaard. “While it’s likely that additional cases will be found among Wisconsinites, we are relieved that this disease does not spread easily from person to person. We’d like for all clinicians to remain alert to patients with compatible rashes and encourage them to test for monkeypox. We want the public to know that the risk of widespread transmission remains low.”
Monkeypox is a rare but potentially serious disease caused by the monkeypox virus. It is typically characterized by a new, unexplained rash and skin lesions. Other early symptoms of monkeypox include fever, chills, and swollen lymph nodes. Recently identified cases have developed skin lesions in the genital, groin, and anal regions that might be confused with rashes caused by common diseases such as herpes and syphilis.
Most people with monkeypox recover in two to four weeks without needing treatment. However, vaccinations and antiviral medications can be used to prevent and treat monkeypox. People who had known exposure to someone with monkeypox should talk with a doctor or nurse to learn if they are eligible to receive a vaccine. This includes people who were specifically identified as someone who had close or intimate in-person contact with someone with the characteristic monkeypox rash or someone with a probable or confirmed monkeypox diagnosis.
It is important to know that monkeypox does not spread easily from person to person. The virus is transmitted through respiratory droplets, sustained skin-to-skin contact, and contact with items that have been contaminated with the fluids or sores of a person with monkeypox. Anyone can develop and spread this disease after being exposed to the virus. However, the Centers for Disease Control and Prevention (CDC) reports that most cases of monkeypox in the U.S. have occurred among gay, bisexual, and other men who have sex with men (MSM).
To prevent the spread of monkeypox, DHS encourages all Wisconsinites to be aware of the following:
Know the symptoms and risk factors of monkeypox.
Avoid skin-to-skin contact with people who are showing a rash or skin sores. Don’t touch the rash or scabs, and don’t kiss, hug, cuddle, have sex, or share items such as eating utensils or bedding with someone with monkeypox.
In jurisdictions with known monkeypox spread, participating in activities with close, personal, skin-to-skin contact may pose a higher risk of exposure.
If you were recently exposed to the virus, contact a doctor or nurse to talk about whether you need a vaccine to prevent disease. Monitor your health for fever, chills, swollen lymph nodes and a new, unexplained rash, and contact a health care provider if any of those occur. If you become ill, avoid contact with others until you receive health care.
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New monkeypox cases have tripled in Europe since June 15, the WHO regional chief says
Monkeypox is continuously reaching new parts of Europe, where the number of new cases has tripled since June 15 to more than 4,500 laboratory confirmed cases, the World Health Organization's regional director for Europe, Dr. Hans Kluge, said in a statement on Friday.
Europe accounts for nearly 90% of all confirmed and reported cases worldwide since mid-May, Kluge said, adding that 31 countries and areas in the region have now reported at least one monkeypox case.
The U.K. has reported more than 1,000 monkeypox cases — the most in Europe — followed by Germany (838), Spain (736), Portugal (365), and France (350), according to the latest joint bulletin from the European Centre for Disease Prevention and Control and the WHO's regional office for Europe.
The numbers are smaller in Africa. On Monday, the Africa Centres for Disease Control and Prevention reported that since the start of 2022, 1,715 cases (including 1,636 suspected cases) of monkeypox had been reported in 10 countries. The figures include 73 deaths.
Monkeypox outbreak in U.S. is bigger than the CDC reports. Testing is 'abysmal'
No deaths have been reported from the disease in Europe, Kluge said.
While men still account for most reported infections in Europe, Kluge said, "small numbers of cases have also now been reported among household members, heterosexual contacts, and non-sexual contacts, as well as among children."
Kluge provided details on who's getting the disease in Europe:
- 99% of the cases so far were detected in men;
- The majority are men who have sex with men, among patients whose sexual orientation is known;
- Most cases were people who are between 21 and 40 years old
- Only one patient was admitted to intensive care in Europe, Kluge said.
"The vast majority of cases have presented with a rash," he said, and about three-quarters have reported systemic symptoms such as fever, fatigue, muscle pain, vomiting, diarrhea, chills, sore throat or headache.
Kluge said governments in the region must step up their surveillance efforts, from testing and contact tracing to sequencing.
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What doctors wish patients knew about monkeypox
While the U.S. continues to navigate the ongoing COVID-19 pandemic with a recent rise in cases due to Omicron subvariants, there is now growing concern about another virus: monkeypox. A monkeypox outbreak has continued to grow in countries where the virus is not normally found, which has put global health officials at the Centers for Disease Control and Prevention (CDC) and elsewhere on high alert and left many patients wondering what this means. As the CDC tracks the monkeypox situation, a distinguished physician-scientist helps clear up some confusion.
The AMA’s What Doctors Wish Patients Knew™ series provides physicians with a platform to share what they want patients to understand about today’s health care headlines.
This installment features insight from AMA member Peter Hotez, MD, PhD, dean of the National School of Tropical Medicine, and professor of pediatrics and molecular and virology and microbiology at Baylor College of Medicine and Texas Children’s Hospital in Houston. He took some time to answer some frequently asked questions about monkeypox.
There’s some concern about monkeypox
While Dr. Hotez is concerned, he was glad that the World Health Organization mentioned “the likelihood of this becoming a true pandemic is remote or very low.”
“But I do think we will see an increased number of cases,” he said, noting hundreds of cases of monkeypox have been confirmed in dozens of countries outside the endemic areas of West and Central Africa.
While the numbers in the U.S. are, so far, relatively “low, we need to follow it closely because we do have two different vaccines—one that’s stockpiled and in more abundance.”
It’s not the same as chicken pox
“Monkeypox is an orthopoxvirus. It has some genetic similarities to smallpox, although it produces much less severe disease,” said Dr. Hotez. But “it's not related to chicken pox. A lot of people just hear the word pox and they think it must be all the same.”
“Chicken pox is a herpes virus—like Epstein-Barr virus or cytomegalovirus—and monkeypox is a true pox virus like smallpox,” he said. “And we think there may be two forms. The one in central Africa out of the Democratic Republic of Congo is maybe more severe, with a higher mortality rate around 10%.
“Whereas the one in west Africa—the Nigerian version—is probably closer to 1%, so much less severe,” Dr. Hotez added. “Both are far less severe than smallpox, which can kill up to one-third of individuals.”
Spread occurs through direct contact
“Monkeypox most likely spreads through very close, personal contact,” said Dr. Hotez, noting that is “through an abrasion in the skin or through droplets and possibly through oral contact as well.”
“There is a concern, potentially, that it could be transmitted by aerosolized transmission, although the scientific community is divided about that,” he explained. “Most of us think it probably is not so much transmitted by aerosol, but there are some who think it potentially could be something like if there’s a rupture of one of these pustules or lesions associated with monkeypox and it releases a lot of virus into the atmosphere and you’re close enough, perhaps that could be aerosolized.
“So, most are saying aerosolized transmission is not a major route of transmission, but there are some in the small community of orthopox experts who say, ‘Be careful, don’t jump to that conclusion yet,’” Dr. Hotez added, noting that monkeypox may also spread through respiratory secretions when people have close, face-to-face contact. Contact with fabrics, objects or surfaces contaminated with the monkeypox virus—such as clothing, bedding or towels—can also spread infection.
The virus is not currently sexually transmitted
“It doesn't currently look like this virus is sexually transmitted, meaning it's not being transmitted so much through bodily fluids,” said Dr. Hotez. “If there's a lot of face-to-face, intimate contact with lesions, that's probably the route.”
But the World Health Organization has indicated that they are looking into reports that the monkeypox virus is present in the semen of patients, meaning the virus could potentially be sexually transmitted.
It is also important to note that anyone can get and spread monkeypox. The current cases are primarily spreading among social networks of gay, bisexual and other men who have sex with men, so this community is currently at greater risk of exposure.
“There's no inherent reason why,” Dr. Hotez said. “We've gone down that rabbit hole of stigmatizing gay and bisexual men in the past through HIV/AIDS with devastating public health consequences, not only for them, but for the whole public health community. And we don't want to go there again.”
“It was just by accident that it got into that network in the Canary Islands and then the people who are having contact belong to that demographic and group,” he said.
Contact tracing will be vital
“We have the opportunity to do what's called a ring vaccination, which was so successful to eradicate smallpox,” said Dr. Hotez. “During the smallpox eradication campaign, what you did was if you had an individual with lesions and clearly had a clinical case of smallpox, you traced all of the contacts and then you vaccinated them.
“And that was dose-sparing in terms of vaccinations and progressed far more efficiently than just doing mass vaccinations of whole villages or cities,” he added. “Potentially we could do something along those lines with one of the two vaccines that we have.”
“This is why I don’t have the same level of alarm about a pandemic or a major epidemic in the U.S. as I might with COVID-19,” said Dr. Hotez, noting that SARS-CoV-2 “was just the opposite of monkeypox with aerosolized transmission, which is the easiest mode of transmission.”
“Up to 40% or more were without symptoms of COVID-19 and a very quick incubation period and as the virus evolved to the current BA.2.1.2 variant, the incubation period really truncated down to a couple of days,” he said. “With monkeypox so far, it’s just the opposite of that. If you have monkeypox, typically you’ll have characteristic lesions—so you can identify cases—and the incubation period is maybe a couple of weeks, so you have more time to do that contact tracing and its harder to transmit.”
“I don’t want to be too optimistic because the cases will continue to go up as certain contact tracing falls through the cracks, but it won’t look anything like COVID-19,” Dr. Hotez said.
Concern for kids and immunocompromised
“The two concerns that I have about monkeypox is—one—it becomes more generalized in the population, especially kids,” said Dr. Hotez. That’s “because kids don't handle this virus as well as adults.”
That’s because monkeypox is a “higher, more disseminated illness with higher morbidity and mortality, so we want to keep it out of the kids if we can,” he said. “And, of course, people who are immunocompromised don't handle the virus well either.”
Smallpox vaccines may help
Unlike with the sudden emergence of COVID-19, there are vaccines, treatments and tests that can help curb the spread of monkeypox.
“The vaccine that's stockpiled at the greatest abundance—and I'm hearing tens of millions of doses—is ACAM2000,” said Dr. Hotez. “It’s the old, traditional vaccinia vaccine and is produced by Sanofi Pasteur.
“It’s a great vaccine for eradicating smallpox. The problem is it has a lot of side effects,” he added. “If you have an underlying skin condition such as eczema—atopic dermatitis—the virus finds the places where you have the rash and it creates this very explosive necrotizing, devastating skin illness.”
“So, people with eczema, even if they don’t currently have symptoms—or even potentially psoriasis—you would not want to give them that vaccine,” Dr. Hotez said, noting it is the same for “people who are immunocompromised because they’re receiving cancer chemotherapy or because they’re HIV-positive or potentially on all of the immunosuppressive monoclonal antibodies.”
“But there’s a second vaccine that was authorized or licensed by the Food and Drug Administration in 2019 from Bavarian Nordic,” he said. “Instead of vaccinia, which is a replicating virus, it is modified vaccinia virus Ankara.
“It’s not replicating and has a much better safety profile, so you could probably feel a lot more comfortable using it for monkeypox,” Dr. Hotez added.
There are two antiviral drugs
There is no specific treatment approved for monkeypox virus infections, according to the CDC. But antivirals that were developed for use in patients with smallpox may work.
“We have two antiviral drugs. One is known as brincidofovir. Another one is tecovirimat and those were developed primarily for smallpox, but people believe that it could be used to treat monkeypox as well,” said Dr. Hotez. “CDC has not given firm guidelines yet on whether it would be anybody with lesions or only for individuals who you suspect may go on to develop more disseminated infection.”
“So, people with eczema, even if they don’t currently have symptoms—or even potentially psoriasis—you would not want to give them that vaccine,” Dr. Hotez said, noting it is the same for “people who are immunocompromised because they’re receiving cancer chemotherapy or because they’re HIV-positive or potentially on all of the immunosuppressive monoclonal antibodies.”
“But there’s a second vaccine that was authorized or licensed by the Food and Drug Administration in 2019 from Bavarian Nordic,” he said. “Instead of vaccinia, which is a replicating virus, it is modified vaccinia virus Ankara.
“It’s not replicating and has a much better safety profile, so you could probably feel a lot more comfortable using it for monkeypox,” Dr. Hotez added.
There are two antiviral drugs
There is no specific treatment approved for monkeypox virus infections, according to the CDC. But antivirals that were developed for use in patients with smallpox may work.
“We have two antiviral drugs. One is known as brincidofovir. Another one is tecovirimat and those were developed primarily for smallpox, but people believe that it could be used to treat monkeypox as well,” said Dr. Hotez. “CDC has not given firm guidelines yet on whether it would be anybody with lesions or only for individuals who you suspect may go on to develop more disseminated infection.”
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HHS Orders 2.5 Million More Doses of JYNNEOS Vaccine For Monkeypox Preparedness
Order will bring federal government’s rapidly available supply to more than 4 million vaccines
The U.S. Department of Health and Human Services (HHS) today ordered an additional 2.5 million doses of Bavarian Nordic's JYNNEOS, an FDA-licensed vaccine indicated for prevention of smallpox and monkeypox, for use in responding to current or future monkeypox outbreaks and as part of U.S. smallpox preparedness. Deliveries from this latest order will begin arriving at the Strategic National Stockpile (SNS) later this year and will continue through early 2023.
The additional supply of vaccines is part of the Biden-Harris Administration's broader strategy to combat the monkeypox virus and protect those most at risk, including by accelerating the production and distribution of vaccines, making testing more accessible and convenient, and communicating regularly with health and community leaders about the virus.
"We are working around-the-clock with public health officials in states and large metro areas to provide them with vaccines and treatments to respond to the current monkeypox outbreak," said HHS Secretary Xavier Becerra. "This order of additional JYNNEOS vaccine will help us push out more vaccine quickly, knowing that we have more doses on the way in the coming months – and is only possible because of our longstanding investment in smallpox and monkeypox preparedness."
The order announced today is in addition to the 500,000 doses of government-owned vaccine the company is producing in 2022 for use in the current response to monkeypox in the U.S and brings the total vaccine doses to be delivered in 2022 and 2023 to more than 4 million. The company will produce these doses in liquid frozen form using vaccine already manufactured in bulk under an existing 10-year contract with the Biomedical Advanced Research and Development Authority (BARDA), within the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR); that contract was part of ongoing national preparedness efforts against smallpox.
"The medical countermeasures available to help respond to the current outbreak are the result of years of investment and planning made possible through the ongoing work between HHS and private industry," said Gary Disbrow, director of the Biomedical Advanced Research and Development Authority. "We are pleased that we have been able to work with our partners at Bavarian Nordic to accelerate delivery of vaccines that can help keep people safe and stem the spread of the virus."
BARDA supported the development of JYNNEOS, which is approved by the FDA to prevent smallpox and monkeypox. The U.S. government owns enough smallpox vaccine – JYNNEOS and ACAM2000 – to vaccinate millions of Americans, if needed.
As of June 24, ASPR's SNS held approximately 65,000 doses of JYNNEOS in immediate inventory with delivery of an additional 300,000 doses in the coming days. On June 28, HHS announced that it would immediately make available 56,000 doses and soon after would make available 240,000 additional doses. The SNS also has more than 100 million doses of ACAM2000 which was developed with SNS support and is approved by FDA for use in preventing smallpox. The Centers for Disease Control and Prevention (CDC) currently has an expanded access Investigational New Drug protocol which allows use of ACAM2000 for monkeypox.
In addition, the SNS has over 1.7 million treatment courses of the smallpox antiviral drug TPOXX, which was developed with BARDA support and can be used to treat individuals with monkeypox under an appropriate regulatory mechanism. CDC currently has an expanded access Investigational New Drug protocol which allows its use for monkeypox.
As of June 29, the CDC has received reports of approximately 350 cases of monkeypox in the U.S., primarily among men who have sex with men. To learn more about monkeypox, visit cdc.gov/monkeypox.
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Monkeypox Cases Are Rising.
Here's How to Protect Your Workplace
The Biden administration is expanding access to testing and vaccines against the outbreak. It's not as threatening as Covid-19, but employees need to be wary
People who may have been exposed to the virus will now have access to vaccinations, which will be available through public health outlets, such as health clinics.
The U.S. Department of Health and Human Services will dispense 56,000 doses of the Jynneos vaccine, which helps prevent both smallpox and monkeypox, to regions with high case counts and where more at-risk populations reside. The White House says that it anticipates 1.6 million doses will be accessible this year. Doses are administered four weeks apart and someone is considered to have protection two weeks after their second dose.
The first confirmed case of monkeypox were detected on May 18, the White House says, and data from the Centers for Disease Control and Prevention show more than 300 cases nationwide as of June 29.
Dr. Matthew Hamill of Johns Hopkins Division of Infectious Diseases explains that monkeypox's primary mode of transmission is through skin-to-skin contact-- including sexually -- though he adds that the virus can also be transmitted through unwashed bedding and towels, or sharing normal household equipment like cups and plates.
For workplaces, the protocols around monkeypox are different from Covid-19. Take the case of someone who tests positive for monkeypox and was working in an office two days prior. Hamill explains that if that person normally wears long sleeves, long pants and a mask--and they didn't touch anyone or anything--the risk of spreading monkeypox within that office remains quite low.
But that risk could creep up if, say, that person is sitting in close quarters with their colleagues in a conference room for most of the day. "Transmission depends on what the risk of that situation is, the proximity, the duration, whether people were masked or not, and whether there was skin-to-skin- contact," Hamill says.
Though anyone can get monkeypox, the current outbreak in the U.S. is mostly found among gay men. Some of the symptoms of monkeypox mimic that of other viruses, such as fever, headache, muscle aches and swollen lymph nodes, but one of the more common symptoms of monkeypox is a rash that resembles either pimples or blisters.
Typically, those who contract monkeypox can expect the infection to run its course for two to three weeks. "A person will typically develop a rash, isolate at home, gradually improve and be considered no longer infectious when all of their skin lesions have scabbed over," Hamill says. A fresh layer of intact skin underneath is a signal that a patient can socialize again. Though most people fully recover from the monkeypox virus, it is potentially lethal, although no one has died from the current outbreak in the U.S., according to the Cleveland Clinic.
According to Gavi, the Vaccine Alliance, monkeypox is less transmissible than COVID-19. But the organization emphasizes that monkeypox won't die out on its own. That's why U.S. health officials are acting aggressively now to contain the contagion now.
Monkeypox soars in Europe, with more than 4,000 cases
New data from the European Centre for Disease Prevention and Control and the World Health Organization European regional office shows the monkeypox outbreak in Europe has grown to 4,177 cases in less than 2 months, with the United Kingdom producing 25% of those cases.
Germany has surpassed Spain and Portugal with a national total reaching 838 cases, compared to 736 cases in Spain and 365 in Portugal. France has 350 cases.
One day after the White House pledged more monkeypox vaccines would be deployed to states seeing outbreaks, the United States is also reporting a significant uptick in cases. According to the Centers for Disease Control and Prevention (CDC), the US total now stands at 351 cases from 28 states and Washington, D.C. after 45 more monkeypox cases were confirmed yesterday.
Evidence of community spread in Texas
Today the Texas Department of State Health Services said there was evidence of local, community spread of the virus in the state's 12 cases. While the first cases reported in Texas involved international travel, three recent patients report that they did not travel in the 3 weeks before becoming sick.
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First Monkeypox Case Confirmed in Travis County [Austin, TX]
AUSTIN, Texas – As an update to Austin Public Health’s (APH) initial announcement, the Centers for Disease Control and Prevention (CDC) testing has confirmed Travis County’s first monkeypox case. APH Epidemiologists have completed an investigation and are conducting contact tracing of people who had direct close contact with the resident while contagious.
The resident continues to isolate at home. APH is also investigating five presumptive cases who have symptoms that are consistent with monkeypox. Initial case investigations indicate these persons did not have a history of international travel.
“This spread of monkeypox within our community is concerning. Anyone who believes they may have symptoms of the virus should reach out to a medical provider immediately,” said Dr. Desmar Walkes, Austin-Travis County Health Authority. “This virus is predominantly spread through close, intimate contact with others. You should avoid skin-to-skin contact with anyone showing rashes or sores.”
Monkeypox is rare and does not spread easily between people without close contact. The virus can be transmitted by person-to-person contact including:
- Direct contact with the infectious rash, scabs, or body fluids.
- Respiratory secretions during prolonged, face-to-face contact, or during intimate physical contact, such as kissing, cuddling, or sex.
- Touching items (such as clothing or linens) that previously touched the infectious rash or body fluids.
- Pregnant people can spread the virus to their fetus through the placenta.
Symptoms of monkeypox can include:
- Fever
- Headache
- Muscle aches and backache
- Swollen lymph nodes
- Chills
- Exhaustion
- A rash that can look like pimples or blisters that appears on the face, inside the mouth, and on other parts of the body, like the hands/palms, feet, chest, genitals, or anus.
- The rash goes through different stages before healing completely. The illness typically lasts 2-4 weeks.
There are a number of measures that can be taken to prevent infection with monkeypox:
- Minimize skin-to-skin contact, especially if a person has been exposed to the virus, showing a rash or skin sores.
- Avoid contact with any materials, such as bedding, that have been in contact with monkeypox.
- Practice good hand hygiene. For example, washing your hands with soap and water or using an alcohol-based hand sanitizer.
- Use personal protective equipment (PPE) when caring for people infected with monkeypox.
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Monkeypox spread at two large parties in L.A. County, officials say
Los Angeles County officials have reported limited local transmission of monkeypox, with some recent cases involving people who attended large events here and infected people who haven’t traveled out of state.
“There’s been some what we call ‘community transmission.’ That is, it’s not from travelers or people who went elsewhere and contracted monkeypox somewhere else. It’s actually they got monkeypox here in L.A. County, because it was transmitted from someone else here in L.A. County who had monkeypox,” Public Health Director Barbara Ferrer said at this week’s Board of Supervisors meeting.
Overall, there were 30 presumptive or confirmed monkeypox cases in L.A. County as of Thursday. No one in the county had been hospitalized or died from the disease as of last week.
Meanwhile, the geographic impact of the monkeypox outbreak continues to expand.
Orange County reported its first presumptive case Wednesday. Public health officials in Riverside and Santa Clara counties did likewise last week.
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Illinois Receives Monkeypox Vaccines as State Sees Third Highest Number of Confirmed Cases in US
Illinois health officials is expected to receive doses of a monkeypox vaccine, the Illinois Department of Health announced Thursday, as the state continues to record some of the most cases in the U.S.
As part of the national strategy to combat the virus, IDPH revealed that the state will receive 1,291 doses of the JYNNEOS vaccine, while the Chicago Department of Public Health will get 3,200 shots.
Those amounts are expected to increase over coming months, IDPH noted, as federal health officials start to ramp up testing efforts.
The vaccine will go to Illinois counties that have experienced at least one case of monkeypox and will be "designated for individuals at higher risk of exposure, which includes those who have had close physical contact with someone diagnosed with monkeypox virus or presumed exposure to the virus."
Monkeypox cases across the country continuing to rise, with more than 351 confirmed cases across 28 states as of Thursday, according to the Centers for Disease Control and Prevention.
Overall, Illinois has reported 46 cases of the virus, the CDC reports, with most in Chicago and others in Cook, DuPage, Kane and Lake counties. The state follows New York, with 72 confirmed cases, and California, with 80 confirmed cases.
As the U.S. prepares to deploy nearly 300,000 monkeypox vaccine doses in an effort to stamp out the growing outbreak of the virus, the Chicago Department of Public Health says vaccine events have already begun to take place.
"In Chicago, we have been ordering and receiving vaccine doses we deliver to clinical settings where identified contacts are referred for post-exposure prophylaxis," a statement Wednesday from the CDPH read.
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June 30, 2022
Monkeypox vaccine clinic opening in Denver for high risk individuals
State health officials plan to administer 200 doses of monkeypox vaccines to high-risk individuals in the Denver metro area this weekend to help curb the spread of the disease.
The Colorado Department of Public Health and Environment announced Wednesday that it had secured an “extremely-limited” supply of vaccines from a federal stockpile. It encourages interested individuals to register online for a spot at its pop-up clinic.
“We expect demand may outweigh supply, so we are asking the federal government for more vaccines,” said Scott Bookman, division director of CDPHE’s Disease Control and Public Health Response Division, in a press release. “But for right now, we can’t sit on this valuable tool we have to prevent spread.”
The vaccines are available to men aged 18 years and older who are gay or bisexual. Slots are also open to any men who have had multiple male sexual partners in the past 14 days, according to the release.
Anyone who believes they have been in close contact with someone who had monkeypox in the last 14 days also qualifies, the release said.
The monkeypox virus can spread through skin-to-skin contact with an infected individual. It is rarely deadly, with a fatality rate of less than one percent.
Symptoms can last up to four weeks and include fever, headache, muscle aches, swollen lymph nodes and exhaustion. Typically, a rash or skin bumps develop after the onset of fever, beginning on the face and spreading to other parts of the body.
The disease is endemic in central and west Africa, but has recently been spreading in parts of the United States, Canada, Europe and Australia.
Colorado’s first positive case was detected in Denver in May. In June, CDPHE recorded at least four more cases.
At least two dozen individuals in the state have received post-exposure vaccinations so far. The two-dose vaccine is fully FDA approved, and each dose is given four weeks apart.
“Vaccination following a high-risk exposure is the best way to help prevent infection or reduce the severity of illness if someone contracts monkeypox,” said Dr. Rachel Herlihy, state epidemiologist, in the state’s release. “Our response will continue to evolve, as we expect to receive additional guidance and vaccines from the federal government.”
People hoping to attend weekend’s clinic must receive email confirmation for an appointment. Those who can’t get an appointment and think or know they have been exposed to monkeypox should contact a healthcare provider as soon as possible, according to CDPHE.
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Monkeypox in Texas: State health officials say 12 cases found
AUSTIN (KXAN) — After testing, state health officials said at least 12 monkeypox cases were found in Texas so far. Some of those patients haven’t traveled outside of the state recently.
The Texas Department of State Health Services said Thursday while the first cases were patients who traveled internationally, at least three patients reported they didn’t travel in the three weeks before getting sick. That means they were likely exposed to the virus in the state.
On Tuesday, Austin Public Health said it was monitoring several potential cases in the community. On Thursday, the first monkeypox case was confirmed in Travis County after the presumed case was reported in the area last week.
‘We are having community spread’: Austin health leaders give monkeypox update
DSHS said monkeypox symptoms begin with a fever, headache, muscle aches, swollen lymph nodes, chills and exhaustion. A rash that looks like pimples or blisters may appear soon after the initial symptoms.
Monkeypox can spread from person to person through direct contact with the rash, scabs or bodily fluids like saliva.
DSHS said many of the monkeypox cases in the current outbreak have been among men who have sex with men, but anyone who has direct skin contact with or kisses someone who is infectious could contract the virus.
Doctors should report all potential cases to their local health department, which may help close contacts of the patient get the monkeypox vaccine. The vaccine can prevent people from getting sick with the disease if it’s given within four days of exposure, DSHS said. On Tuesday, the U.S. Department of Health and Human Services announced a plan to provide vaccines across the nation to those who need them.
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1st monkeypox case in Metro Detroit: What you need to know
Monkeypox cases detected in at least 27 states
Michigan health officials confirmed the first probable case of monkeypox in the state on Wednesday.
The case was detected in a person from Oakland County. MDHHS is awaiting confirmation from lab testing at the CDC. The individual is currently isolating and does not pose a risk to the public. MDHHS is working with local health departments to notify any close contacts.
Since the beginning of the current global outbreak, 5,115 cases have been confirmed in 51 countries, including the United States. The CDC reports that there are 306 confirmed cases in 27 states and D.C.
MPV is contagious when a rash is present and up until scabs have fallen off. Symptoms generally appear one to two weeks after exposure and infection, and the rash often lasts two to four weeks.
Related: US officials announce more steps against monkeypox outbreak
There are no treatments specifically for MPV infections. However, MPV and smallpox viruses are genetically similar, which means that antiviral drugs and vaccines developed to protect against smallpox may be used to prevent and treat MPV infections.
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New Hampshire identifies 1st probable monkeypox case
CONCORD, N.H. (WCAX) - New Hampshire has identified its first probable case of monkeypox.
The patient is from Rockingham County which is north of Boston.
Monkeypox is rare and belongs to the same group of viruses as smallpox.
Transmission requires close interaction with a symptomatic person and usually involves close physical or intimate contact, or health care examinations conducted not using appropriate protective equipment.
State health officials are working to identify others who may have been exposed.
They say the general public remains at low risk of exposure.
The CDC identified 224 monkeypox cases in 26 states as of June 27.
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Riverside County Public Health launches monkeypox site
The Riverside County Department of Public Health has launched a new website to share information with the community about monkeypox.
You can visit https://rivcoph.org/Monkeypox to get the latest information on the virus here in Riverside County.
Last week, the county announced its first probable case of monkeypox, a man in his 60s from eastern Riverside County. Health providers in Palm Springs told News Channel 3's Jake Ingrassia that the person was possibly exposed to Monkeypox after attending an LA Pride event.
We learned on Wednesday that the patient was treated in the Coachella Valley.
Local health officials have said that while monkeypox is not yet widespread, the community should take note of precautions that can be taken to prevent its spread. News Channel 3's Peter Daut spoke with Barbara Cole, director of the Riverside County Disease Control, who said the overall risk of transmission is low.
"We want people taking preventive measures. for instance, if they have intimate contact with someone, do they have a rash? Are they ill? so they avoid direct exposure if that's possible," Cole said.
While Cole said the risk of transmission is low, Dr. Phyllis Ritchie, CEO and Founder of PS Test in Palm Springs, strongly suspects there are other undiagnosed cases locally.
"This is about to explode in Palm Springs and elsewhere," she said. "I think it's actually already here beyond just one patient," Ritchie told Jake Ingrassia on Monday.
There are a total of 396 confirmed cases of monkeypox in the United States as of June 30. There are 89 confirmed cases in California. Riverside County has not confirmed a case so far, just the one probable case.
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1st presumed case of monkeypox in Southwest Virginia: Here’s what you should know
(WJHL) — The Virginia Department of Health (VDH) on Wednesday announced that one person presumably has monkeypox in Southwest Virginia.
The VDH did not reveal which health district has the positive case but did describe the patient as a man who is isolated.
Monkeypox: how worried should the Tri-Cities be?
A VDH news release stated that “most, but not all, cases have occurred in persons who identify as gay, bisexual or men who have sex with men.”
In Virginia, the five new cases involve men, and the VDH continues to monitor their conditions and the patients’ close contacts. This includes three new cases in northern Virginia and one in eastern Virginia.
JC parents trust science behind COVID vax for toddlers
Monkeypox is a virus that is characterized by a specific rash, with lesions beginning on the genitals, perianal region or oral cavity. The rash might be the first or only sign of monkeypox and can be transmitted along with sexually transmitted infections.
Other signs and symptoms include fever, headache, muscle aches, exhaustion and/or swelling of the lymph nodes before developing a rash. These generally appear within six to 14 days after exposure to the virus and clear up within two to four weeks.
The virus spreads during close person-to-person contact or through direct contact with bodily fluids and contaminated materials. If you have symptoms consistent with monkeypox, seek medical care. There are no approved treatments for the virus, but there are treatments that can help.
Where can toddlers receive COVID vaccines in Tri-Cities?
Patients who have severe illness or are at high risk for developing severe illness can access treatment through the federal government with VDH coordination. There are also two post-exposure vaccines available.
Those most at risk for the virus include the following:
Have had close contact or skin-to-skin with someone who had a rash that looked like monkeypox or was diagnosed with it
Have traveled to places or attended events where monkeypox cases have been confirmed
Have had contact with items used by a person with known or suspected monkeypox
Have had contact with a live or dead exotic animal from Africa or used a product from such animals (game meat, creams, lotions, powders, etc.)
The VDH urged anyone with symptoms to contact their medical provider, who should notify the VDH of the monkeypox diagnosis.
These new cases of monkeypox bring Virginia’s total reported cases to eight since May. None have been reported yet in Tennessee, according to a map from the CDC. Kentucky and North Carolina have one and two active cases, the map reveals.
Across the country, the CDC has reported 306 cases of monkeypox in the U.S. The outbreak, which involves 4,769 cases worldwide, has seen few hospitalizations and one death, the VDH reported Wednesday.
June 29, 2022
South Korea's Seegene Creates Monkeypox PCR Test With AI
South Korean medical company says it has created a PCR test to detect the monkeypox virus using artificial intelligence.
Seoul-based Seegene, which makes diagnostic products, announced its Novaplex monkeypox virus test on Tuesday.
The test, developed using the company's AI-based automated test development system, can identify a positive case in 90 minutes, Seegene states.
However, for now the product is for research use only and Seegene says it is not for use in clinical diagnostic procedures yet. The company's press release also did not provide any information on how accurate or sensitive the test is.
"The monkeypox virus outbreak shows that endemic viruses can rapidly spread to the rest of the world and it's a warning that new pandemics can emerge and threaten our lives at any time," said Dr. Jong-Yoon Chun, CEO of Seegene, in the press release. "We will continue our efforts to develop products that can accurately diagnose any virus to help prevent new infectious diseases from taking hold and becoming a pandemic."
Monkeypox cases continue to rise around the world as part of an unprecedented outbreak of the viral disease which is normally endemic to West and Central Africa. There had been at least 4,769 cases reported worldwide on June 28 according to the U.S. Centers for Disease Control and Prevention, with 305 of those in the U.S.
That same day, the Biden administration announced the first phase of a national vaccine strategy to control the spread of monkeypox, stating that it would hugely ramp up the number of monkeypox vaccines available to 1.6 million over the coming months.
Up to that point, the number of vaccines deployed was just "over 9,000," the White House said, though it added that 56,000 more would be allocated immediately. Earlier this month, the U.S. ordered 500,000 monkeypox vaccines from smallpox/monkeypox vaccine producer Bavarian Nordic.
Earlier in the week, the vaccine rollout had been criticized as too small by New York City officials, where cases had increased by 60 percent to 48 in just four days. Demand was so high that walk-in centers were closed within hours.
"This is yet another example of a public health failure," New York City council member Erik Bottcher said, according to NBC New York. "And considering what we just went through with COVID-19, we should be much more prepared."
Testing also forms part of the government's strategy. When the outbreak started the U.S. already had a Food and Drug Administration-cleared test capable of detecting monkeypox.
On Tuesday the White House said the CDC had scaled up testing capacity to 78 sites in 48 states. It remains to be seen whether this will be enough to serve demand.
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Who can get a vaccine for monkeypox? Answers from NC health officials.
North Carolinians are not currently able to receive a pre-exposure vaccine for monkeypox virus infection. Only those who have been exposed to monkeypox and determined high-risk by a healthcare professional are able to get a vaccine against smallpox — which the Centers for Disease Control and Prevention says can protect against monkeypox — in North Carolina. New York City began offering a smallpox vaccine at one clinic last week to individuals exposed to monkeypox. As of June 28, 55 people in New York City tested positive for orthopoxvirus, which is presumed to be monkeypox. The first case of monkeypox virus infection was found in a North Carolina resident June 23, the North Carolina Department of Health and Human Services reported. The second was reported in Mecklenburg County on Monday. While vaccinations for monkeypox are available in North Carolina through public health channels, you can only receive the vaccine if you have been exposed to monkeypox and told by a local healthcare provider that you should get it, NC DHHS said through spokesperson Summer Tonizzo. You cannot currently receive this vaccine in North Carolina as a preventative measure, but only to treat exposure in a high-risk situation. “At this time, there is no specific treatment for monkeypox, although antivirals developed for treatment of smallpox may prove beneficial,” Tonizzo said. “We are aware that vaccines are being used more broadly in some jurisdictions that are seeing active outbreaks and/or chains of transmission.” The vaccine is only available through NC DHHS and the CDC, Dr. David Wohl (infectious disease expert with UNC Health) told The N&O: “This vaccine is available only from the state and is not something routinely stocked by hospitals.” Any program here similar to New York City’s would have to be coordinated by NC DHHS, as only they can access the vaccine, he said. “Because the vaccine is currently in short supply, it’s being prioritized for those who have already had known post-exposures, such as health care workers, or those who’ve had a household or sexual contact with an infected person,” Dr. Cameron Wolfe (infectious disease expert with Duke Health) told The N&O.
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Monkeypox case diagnosed in Pittsburgh
A case of monkeypox has been detected in Pittsburgh, the infected patient’s primary care office said Wednesday in a statement.
The individual received testing for monkeypox at Central Outreach Wellness Center on the North Side, according to the statement, and the state Department of Health confirmed the result Tuesday.
The case in Pittsburgh brings the state’s total number of cases to five. There have been just over 300 cases diagnosed in the United States.
Monkeypox is not a new virus, and virologists have indicated that there is no need “to get crazy scared.”
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2 monkeypox cases now confirmed in Minnesota
MINNEAPOLIS -- Another monkeypox case has been confirmed in Minnesota.
According to the Minnesota Department of Health, there are now two confirmed cases of monkeypox as of Tuesday.
The second case, like the first, was identified in a man from the Twin Cities area who appears to have caught the disease while traveling outside Minnesota. However, unlike the first case, the second man was not traveling internationally.
"While we do expect to see some additional cases in the next few days or weeks, it's important to remember that monkeypox is not as infectious and does not spread in the same way as COVID or influenza, but requires skin-to-skin contact or prolonged face-to-face contact, exchange of body fluids, etc.," MDH said.
In the first case, the infected person received outpatient care, and the health department is conducting contact tracing. Officials don't believe he's spread the disease to anyone else.
The disease originated in Africa and since the beginning of May, more than 4,000 cases have been reported in 47 countries around the world. According to the Centers for Disease Control and Prevention, monkeypox has been recently detected "in several countries that don't normally report monkeypox, including the United States." Cases have been found in 26 states besides Minnesota in connection with the latest outbreak.
Symptoms of monkeypox include fever, head and muscle aches, swollen lymph nodes and a rash that looks like pimples or blisters. It's also possible to contract the virus and show no symptoms.
According to the health department, most people recover from the virus in two to four weeks with no treatment, but in rare cases, monkeypox can be fatal. However, Dr. Richard Kennedy with the Mayo Clinic says the mortality rate for the disease is comparatively low.
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NJ Monkeypox Case Count Rises To 4: Report
4 likely cases of monkeypox have been reported in NJ as of Tuesday, according to a NorthJersey.com report. Here's what it means for you.
“As of Tuesday night, New Jersey now has four probable monkeypox cases," NJ Department of Health Nancy Kearney told the publication. It wasn’t immediately clear where in the state the cases were identified.
The first case of monkeypox was announced by the state Department of Health on June 18. The infected person is a Jersey City resident who has been instructed to quarantine until they are no longer contagious — that is, after the infected person's skin has healed.
As of Tuesday night, the total number of monkeypox cases in the U.S. stood at 306. To combat the spread of the disease, a “enhanced nationwide vaccination strategy” will be executed by the U.S. Department of Health and Human Services, with 56,000 doses of vaccine to be shipped immediately to locations with the highest number of cases. 240,000 more doses are also coming in the next few weeks, officials said.
“The Advisory Committee on Immunization Practices currently recommends vaccination for those at high risk following a confirmed monkeypox exposure,” the HHS said in a statement on Tuesday. “Given the large number of contacts and difficulty in identifying all contacts during the current outbreak, vaccine will now be provided to individuals with confirmed and presumed monkeypox exposures. This includes those who had close physical contact with someone diagnosed with monkeypox, those who know their sexual partner was diagnosed with monkeypox, and men who have sex with men who have recently had multiple sex partners in a venue where there was known to be monkeypox or in an area where monkeypox is spreading.”
Per the CDC, California and New York currently have the highest number of patients diagnosed with monkeypox, reporting 66 and 63 respectively. Illinois has 45 cases, followed by Florida with 26, the District of Columbia with 20, and Massachusetts with 13. The first US case in 2022 was reported May 18 in Massachusetts.
The disease has historically been limited to central and west Africa, where people are exposed through bites or scratches from rodents and small mammals, preparing wild game or coming into contact with an infected animal. But the World Health Organization has described the outbreak, now in more than 30 countries beyond Africa, as "unusual," the Associated Press reported.
Monkeypox symptoms are similar but milder than the symptoms of smallpox, with symptoms like fever, headache, muscle aches, and exhaustion 7 to 14 days after infection.
“As a precaution, any New Jersey residents who experience flu-like illness with swelling of lymph nodes and rash occurring on the face and body should contact their healthcare provider,” the New Jersey health department has advised.
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June 28, 2022
Monkeypox case count rises to more than 3,400 globally, WHO says
More than 3,400 confirmed monkeypox cases and one death were reported to the World Health Organisation as of last Wednesday, with a majority of them from Europe, the agency said in an update on Monday.
WHO said that since June 17, 1,310 new cases were reported to the agency, with eight new countries reporting monkeypox cases.
Monkeypox is not yet a global health emergency, WHO ruled last week, although WHO Director-General Tedros Adhanom Ghebreyesus said he was deeply concerned about the outbreak.
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Spain receives more than 5,000 vaccines against monkeypox, 1100 confirmed cases of monkeypox have been reported
Spain has received this Tuesday the first 5,300 doses of the Jynneos vaccine against Monkeypox or monkeypox. The vaccines are part of the purchase carried out by the European Commission through the Health Emergency Preparedness and Response Authority (HERA).
This European initiative has allowed member states to have third-generation vaccines against this disease in an equitable manner based on epidemiological and demographic criteria. Two more shipments are expected in the coming months. The contract signed by HERA made it possible to acquire 110,000 doses for the entire European Union and Spain will receive 10 percent, which places us as the European country with the highest receipt of vaccines against Monkeypox.
Vaccines must be stored deep-frozen to ensure their quality, safety, and efficacy and are made available to public health authorities for control of this outbreak.
These vaccines are added to the 200 doses of INVAMEX that Spain bought from a neighboring country and that are already being inoculated at the request of the Autonomous Communities, following the protocol approved by the Public Health Commission, hand in hand with the Vaccine Report.
In Spain, as of June 28, a total of 1,158 confirmed cases of Monkeypox have been reported, including 773 in Madrid.
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Monkeypox mean incubation period estimated at 8.5 days: Netherlands study
Scabies outbreak affects more than 1000 in Hoima district, Uganda
H5N6 avian influenza case reported in Jiangxi province, China
Monkeypox in Africa: 1,715 cases, 73 deaths in 2022 to date, according to African CDC
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The next epidemic may be here. The U.S. isn’t ready for it
s if dealing with continued waves of Covid-19 isn’t enough, the U.S. is facing a new outbreak — monkeypox — that highlights just how close the U.S. public health system is to its breaking point.
While monkeypox has not technically been categorized as a sexually transmitted infection (STI), it looks and acts like common STIs and shares the same barriers to detection and treatment, including stigma and access to knowledgeable providers.
For people like me who are working inside the broad national response to monkeypox, there are loud echoes of the earliest days of Covid-19 and, longer ago, of AIDS. But understanding the country’s capacity to contain monkeypox requires an examination of the STI epidemic that the nation has ignored for years, which is why these diseases continue to be out of control.
Consider this: More than 2.5 million sexually transmitted infections were diagnosed in 2020, the last year with complete statistics. The ballooning rates touch people of every race, sexual orientation, and even age. Syphilis among newborns has increased 235% since 2016, and STIs like gonorrhea have reached historic highs among teens and adults.
Related: ‘Nobody wants to mess this up’: A WHO official weighs in on the challenges of responding to monkeypox
The lack of accessible testing, combined with stigma, are major factors in the increases. Yet there is no dedicated federal funding to guarantee that communities can provide STI testing.
Most Americans are blissfully unaware of the fractured funding streams that make it possible for public health providers to offer services in their communities. One federal funding stream makes family planning available. Another funds HIV testing. Clinics providing these services also offer community education, treatment, and the capacity to successfully turn health issues around — just look at dropping rates of HIV and teen pregnancy. Without a similar funding stream for the rising outbreaks of syphilis, gonorrhea, chlamydia, and now monkeypox, there is no guaranteed service designed to keep them in check.
It will be difficult for the nation to address monkeypox if it can’t address diseases that have been on the rise for decades.
My colleagues and I in public health know what to do about monkeypox, just as we know what to do about sexually transmitted infections. By taking smart steps during this outbreak, we can stop monkeypox in its tracks, while also driving down STI rates and preparing for future outbreaks. But that can happen only with a serious federal response. Here are three key steps that response should include:
First, the U.S. needs to immediately develop a coordinated outbreak response. It should include investing in testing people with symptoms, which may turn out to be monkeypox but could also be due to something more common and more consequential, like syphilis. It’s essential to develop point-of-care testing technology and outreach to the public and to clinicians so they know what to look for. The response also needs to involve preparation for potential vaccination needs, taking into account bureaucratic hiccups and misinformation.
Related: How the hard lessons of the AIDS crisis are shaping the response to the monkeypox outbreak
Second, permanent, dedicated funding must be established for STI and sexual health clinics to provide the same kinds of services for chlamydia, gonorrhea, syphilis, and other sexually transmitted infections that currently exist for HIV and family planning. This long-needed dedicated network would make it possible for every community to detect the spread of new infections, like monkeypox, and permanently address common sexually transmitted infections that are skyrocketing.
Third, the country must continue to invest in success. When Covid-19 emerged in early 2020, disease intervention specialists used their decades of contact tracing experience for sexually transmitted infections to provide an essential part of the national effort to combat the pandemic. This workforce is now being called upon to respond to monkeypox. Congress must make permanent the investment in disease intervention specialists.
If HIV and Covid-19 were wake-up calls for the government to prioritize public health, monkeypox shows the consequences of hitting the snooze button too many times. HIV showed the importance of creating an infrastructure of health care workers who can provide approachable, competent care for stigmatized infections. Covid-19 revealed the make-or-break nature of coordinated logistics and communications.
The U.S. is at a crossroads regarding sexually transmitted infections. It can mount an effective monkeypox response and provide communities across the country with the infrastructure needed to promote health care for everyone. Or it can continue to play catchup in crisis after crisis and let common infections continue to rage in between.
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As Monkeypox Spreads, U.S. Plans a Vaccination Campaign
States will be given vaccine doses from the federal stockpile, but supplies of the safest type are limited.
Clinics nationwide will begin offering vaccinations against monkeypox to anyone who may have been exposed to the virus, federal health officials announced on Tuesday.
Until now, immunizations were offered only to people with a known exposure.
States will receive doses of a safer and newer monkeypox vaccine called Jynneos from the federal stockpile, based on the number of cases and the proportion of the state’s population at risk for severe disease, the officials said at a news briefing.
State health authorities may also request supplies of an older vaccine developed for smallpox, which is believed to protect against monkeypox, as well.
The Department of Health and Human services will provide 56,000 doses of the Jynneos vaccine immediately and an additional 240,000 doses in the coming weeks. Another 750,000 doses are expected to become available over the summer, and a total of 1.6 million doses by the end of this year.
“This vaccine currently has some limitations on supply, and for this reason the administration’s current vaccine strategy prioritizes making it available to those who need it most urgently,” Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said.
The older smallpox vaccine, called ACAM2000, is associated with harsh side effects, including death, in people who are immunocompromised, pregnant women and older adults.
The new vaccination plan drew quick criticism from experts, who said the campaign was too small and slow to make an impact. The longer it takes to contain the monkeypox outbreak, the greater the chances that the virus will become entrenched in the United States, particularly among men who have sex with men, researchers warned.
“Many of us are concerned that the window is closing for us to be able to eliminate monkeypox,” said Dr. Celine Gounder, an infectious disease expert and editor at large for public health at Kaiser Health News.
“If we don’t start vaccinating more quickly and broadly, we’re going to have a very difficult time containing this,” she said. Ideally, tests and vaccines for monkeypox could have been offered at L.G.B.T.Q. Pride events across the country in order to reach men at high risk of contracting the virus, Dr. Gounder added.
Some experts said the plan was also unfair to men at risk who will not have access to the Jynneos vaccine, especially those who have H.I.V. and cannot safely take the older smallpox vaccine.
“There won’t be enough to meet the need,” said Elizabeth Finley, director of communications for the National Coalition of STD Directors. “Plus, without better testing capacity, a strategy based on contacts with a positive case falls flat.”
It’s also not clear what qualifies as a probable exposure, she added: “Do you need to know someone at the event tested positive, or do you just say, ‘Oh, I went to a rave and I want to be safe’?”
Many clinicians are worried about side effects and scarring from the older smallpox vaccine, as well as the misinformation and vaccine hesitancy they might fuel, Ms. Finley said. “We’ve had clinicians say that there’s no way in hell they would give somebody ACAM2000,” she said.
The Jynneos vaccine, on the other hand, has never been used on this scale, and federal health officials said they would watch for unexpected side effects.
The administration has so far provided more than 9,000 doses of Jynneos vaccine and 300 courses of antiviral treatments to 32 jurisdictions in the country, officials said on Tuesday.
The European Union is adopting a similar plan, sending 5,300 of its 100,000 Jynneos doses to Spain, which has the most cases, followed by Portugal, Germany and Belgium. Other member states will receive doses in July and August.
The number of monkeypox cases has risen sharply in many European countries and in the United States.
What to Know About the Monkeypox Virus
What is monkeypox? Monkeypox is a virus endemic in parts of Central and West Africa. It is similar to smallpox, but less severe. It was discovered in 1958, after outbreaks occurred in monkeys kept for research, according to the Centers for Disease Control and Prevention.
What are the symptoms? Monkeypox creates a rash that starts with flat red marks that become raised and filled with pus. Infected people may also have a fever and body aches. Symptoms typically appear in six to 13 days but can take as long as three weeks after exposure to show, and can last for two to four weeks. Health officials say smallpox vaccines and other treatments can be used to control an outbreak.
How infectious is it? The virus spreads mainly through body fluids, skin contact and respiratory droplets, though some experts suggest that it could occasionally be airborne. Typically it does not lead to major outbreaks, though it has spread in unusual ways this year, and among populations that have not been vulnerable in the past.
Should I be worried? The likelihood of the virus being spread during sexual contact is high, but the risk of transmission in other ways is low. Most people have mild symptoms and recover within weeks, but the virus can be fatal in a small percentage of cases. Experts say that monkeypox is unlikely to create a pandemic scenario similar to that of the coronavirus.
As of June 28, there were 306 cases in 27 states and the District of Columbia, up from 156 cases a week earlier. The C.D.C. has activated its emergency operations center to better monitor and respond to the outbreak, Dr. Walensky said.
The reported numbers are likely to be underestimates, said Dr. Jay Varma, director of the Cornell Center for Pandemic Prevention and Response. “It’s pretty clear to me and I think many others that the epidemic is far larger in magnitude than what our official case counts suggest it is,” he said.
Given the rising numbers, the available doses are not likely to be enough to meet the demand. Washington’s health department offered 300 monkeypox vaccination appointments on Monday; the slots filled up in less than 15 minutes.
New York City, which had identified 55 cases of monkeypox as of Tuesday, had 1,000 doses of the Jynneos vaccine at hand. The city’s health department began administering the vaccines at a single clinic in Chelsea, where the clientele is largely affluent white men who have sex with men.
The city offered the first doses at noon on June 23. Less than two hours later, officials announced that the clinic could no longer accommodate walk-ins and had booked appointments through June 27. As of Tuesday, the city was still waiting for more vaccine doses to become available.
“It started and then it stopped, and it started without anyone being prepared, and I’m not sure when it’s coming back,” said Keletso Makofane, a social network epidemiologist at the FXB Center for Health and Human Rights at Harvard University.
“All of this uncertainty does not help us to cultivate the trust we need to have,” Dr. Makofane said.
Several experts also took issue with the location and said it would have been more equitable to offer the vaccines at clinics frequented by Black men with untreated H.I.V. and limited access to health care.
According to UKHSA, up to June 26, 2022, there were 1,076 laboratory-confirmed cases in Britain. Of these, 27 were in Scotland, five in Northern Ireland, nine in Wales and 1,035 in England. Since the WHO's previous update on June 17, there have been 1,310 new cases reported, with eight new countries reporting cases.
It means almost a third of all cases in the world reported since the current outbreak started have emerged in Britain.
In its latest update issued Monday, the WHO said since Jan. 1, and as of June 22, there have been 3,413 laboratory-confirmed cases and one death reported to WHO from 50 countries and territories in five WHO regions.
WHO said the majority of laboratory-confirmed cases, 2,933 of the 3,413 cases, are in the WHO's European region. This accounts for about 86 per cent of the total.
"The monkeypox outbreak in the UK continues to grow, with over a thousand cases now confirmed nationwide," UKHSA incident director Sophia Makki said, "We expect cases to continue to rise further in the coming days and weeks."
Makki urged people attending large events over the summer, or having sex with new partners, to be alert to any monkeypox symptoms, and get tested rapidly to help avoid passing the infection on."Currently, the majority of cases in Britain have been in men who are gay, bisexual or have sex with men, but UKHSA said anyone who has had close contact with an individual with symptoms is also at increased risk.
With an extensive program of summer music events on the horizon, Makki said if people were concerned they may have monkeypox, they should not go to the events, meet with friends or have sexual contact.
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Nigeria says at current rate, monkeypox infections in 2022 could be highest in five years
LAGOS, June 28 (Reuters) - Confirmed cases of monkeypox in Nigeria could reach their highest level in five years if the current trend of infections is maintained, the head of the country's centre for disease control said on Tuesday.
Nigeria is one of the countries in Africa where monkeypox is endemic. Monkeypox occurs when a person comes in contact with the virus from another person, animal or contaminated materials.
Nigeria, Africa's most populous country, has confirmed 62 cases this year, nearly double the number for the whole of last year. In 2017 Nigeria reported 88 cases, said the Nigeria Centre for Disease Control (NCDC).
Monkeypox re-emerged in Nigeria in 2017 after nearly four decades without any reported cases, Idefayo Adefita, NCDC director general told reporters during a virtual briefing.
"We now know based on the trend that we have seen in the last few weeks that if the current trajectory continues or is sustained we may find ourselves in a situation where we match or exceed the peak number of cases seen in 2017," he said.
More than 40 countries where monkeypox is not endemic have reported outbreaks of the viral disease as confirmed cases exceeded 4,300.
Lateefat Amao, who heads the NCDC national monkeypox emergency operations centre, told the same briefing that the increase in reported cases could be a result of more people being aware of the symptoms and presenting themselves at hospitals when compared to previous years.
She said there was no evidence in Nigeria so far of sexual transmission of monkeypox.
Adefita, the NCDC head, said Nigeria had approached the United States government and World Health Organisation requesting access to vaccines for monkeypox. He would not say when the vaccines were expected.
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CDC activates Emergency Operations Center for monkeypox
By Virginia Langmaid, CNN
Updated 4:17 PM ET, Tue June 28, 2022
The activation of the EOC "allows the agency to further increase operational support for the response to meet the outbreak's evolving challenges," the agency said in a news release.
This facility is currently activated for Covid-19 and is where experts monitor information on other public health emergencies, such as hurricanes, & earthquakes.
According to CDC's webpage, the center works to outline a structure of response from the government and alongside non-government actors in emergency response.
Most recent data from the CDC show at least 244 probable or confirmed cases of monkeypox in the US.
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June 27, 2022
Review and case study illustrates the challenges of monkeypox ... Full article -- peer reviewed article
Abstract
Background
Human monkeypox (MPX) is a neglected zoonotic disease caused by the MPX virus a double-stranded DNA virus which belongs to the Poxviridae family genus Orthopoxvirus. It is endemic in the rural rainforests of Central and Western Africa where it is responsible of human sporadic cases and outbreaks since 1970. Outside Africa MPXV caused an outbreak in 2003 in the United States linked to importation of infected rodents from Ghana and a few travel-related cases in the USA, United Kingdom, Israel and Singapore. Actually, a worldwide outbreak with more than 1200 confirmed cases mainly concentrated among men who have sex with men is ongoing.
Case report
We present the case of an Italian man living in Portugal that was diagnosed with MPX at our clinic in Milan, Italy. Monkeypox virus infection was confirmed by a specific homemade Real-Time PCR. Samples obtained from different sites (pharynx, skin lesions, anal ulcer, seminal fluid) turned all positive with different viral load.
Conclusions
Our report illustrates the challenge of a disease that seems to present in a different way from classic description with possible human-to-human transmission through sexual contact.
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Minnesota reports first case of monkeypox ...
The Minnesota Department of Health (MDH) today reported a presumptive case of monkeypox virus infection in an adult in the Twin Cities area. Initial testing was completed on Saturday at the MDH Public Health Laboratory and confirmatory testing is being done at the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta. The patient likely was exposed while traveling abroad.
The patient is receiving outpatient care. MDH is conducting contact tracing with local health partners to identify anyone who may be at risk due to direct close contact with the patient while infectious. People with direct close contact are asked to watch for symptoms of illness.
The need for vaccine or antivirals is being evaluated on a case-by-case basis, in consultation with CDC officials. The CDC does not recommend broader use of the vaccine at this time; however, their evaluation of vaccine guidance is ongoing.
The virus does not easily spread between people with casual contact, but transmission can occur through contact with infectious sores and body fluids; contaminated items, such as clothing or bedding; or through respiratory droplets associated with prolonged face-to-face contact.
“While the threat of monkeypox generally remains low, it’s important that everyone be aware of this disease, so that those at risk can seek medical care and get tested promptly if they believe they have symptoms,” said Minnesota Health Commissioner Jan Malcolm.
As of June 24, CDC reports 201 cases of monkeypox/orthopoxvirus in 26 other U.S. states. In recent months, more than 4,100 cases have been reported in 47 countries where the disease is not typically reported. Because monkeypox requires close and prolonged contact, close-knit social networks have been particularly impacted. Close contact, sustained skin-to-skin contact, including sexual contact, with a person with monkeypox or contact with contaminated items are important risk factors.
June 26, 2022
Fatality rate 0.11% vs 1.2% Covid [will try to challenge these numbers]
June 25, 2022
Monkeypox outbreak growing across Britain [British officials said the monkeypox outbreak in the U.K. is growing across the country mainly among men who are gay or bisexual or other men who have sex with men]
Monkeypox cases confirmed in 29 non-endemic countries: CDC
Health experts say some countries are beginning to report apparent cases of community transmission.
LONDON -- British officials said the monkeypox outbreak in the U.K. is growing across the country, mainly among men who are gay or bisexual, or other men who have sex with men. They urged those with new or multiple sex partners to be vigilant for the symptoms of monkeypox.
In a technical briefing released on Friday, Britain's Health Security Agency said their data show monkeypox is spreading in “defined sexual networks of gay, bisexual, or men who have sex with men.” Officials said there were no signs suggesting sustained spread beyond those populations.
Of the 810 monkeypox cases in the U.K. to date, five are in women. Among patients who completed a detailed survey, 96% of those infected were men who were gay, bisexual or had sex with other men. Among the nearly 50 countries reporting monkeypox cases globally, Britain has the biggest outbreak beyond Africa.
“If you are concerned that you may have monkeypox, don’t go to events, meet with friends or have sexual contact," said Dr. Meera Chand, director of clinical and emerging infections at Britain's Health Security Agency. Doctors say people who have unexpected skin lesions or rashes that could be monkeypox should seek help at a sexual health clinic and avoid close contact with others until they have consulted a physician.
She said that anyone who was in close, physical contact with someone who had monkeypox was at risk of catching the disease, regardless of their sexual orientation.
“To assist with our contact tracing, we encourage everyone to ensure they exchange contact details with sexual partners, to help us limit further transmission where cases occur," Chand said.
The Health Security Agency said there were “a relatively high number of cases reported travelling to Gran Canaria in early May,” suggesting they were infected there before returning to Britain.
Earlier this week, British officials said they were widening their vaccination policy to offer shots to gay and bisexual, and other men who have sex with men who were at high risk of catching monkeypox, which it defined as those who have multiple partners, participate in group sex or attend venues where sex occurs on the premises.
On Thursday, the World Health Organization convened an expert committee to decide whether the expanding outbreak of monkeypox should be declared an international health emergency.
Globally, about 50 countries have reported more than 3.300 cases. There have been no deaths reported beyond Africa, which has seen roughly 1,400 cases and 60 deaths this year.
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Monkeypox outbreak in U.S. is bigger than the CDC reports. Testing is 'abysmal'
On June 13, a man in New York began to feel ill.
"He starts to experience swollen lymph nodes and rectal discomfort," says epidemiologist Keletso Makofane, who's at Harvard University.
The man suspects he might have monkeypox. He's a scientist, and knowledgeable about the signs and symptoms, Makofane says. So the man goes to his doctor and asks for a monkeypox test. The doctor decides, instead, to test the man for common sexually transmitted diseases. All those come back negative.
"A few days later, the pain worsens," Makofane says. So he goes to the urgent care and again asks for a monkeypox test. This time, the provider prescribes him antibiotics for a bacterial infection.
"The pain becomes so bad, and starts to interfere with his sleep," Makofane says. "So this past Sunday, he goes to the emergency room of a big academic hospital in New York."
At this point the man has a growth inside his rectum, which is a symptom of monkeypox. At the hospital, he sees both an ER doctor and an infectious disease specialist. Again, the man asks for a monkeypox test. But the specialist rebuffs the request and says "a monkeypox test isn't indicated," Makofane says. Instead, the doctor speculates that the man might have colon cancer.
A few days later, he develops skin lesions — another key sign of monkeypox.
A misleading case count [Accurate case count is always an issue]
On the surface, the monkeypox outbreak in the U.S. doesn't look that bad, especially compared with other countries. Since the international epidemic began in May, the U.S. has recorded 201 cases of monkeypox. In contrast, the U.K. has nearly 800 cases. Spain and Germany both have more than 500.
But in the U.S., the official case count is misleading, Makofane and other scientists tell NPR. The outbreak is bigger — perhaps much bigger — than the case count suggests.
For many of the confirmed cases, health officials don't know how the person caught the virus. Those infected haven't traveled or come into contact with another infected person. That means the virus is spreading in some communities and cities, cryptically.
"The fact that we can't reconstruct the transmission chain means that we are likely missing a lot of links in that chain," Jennifer Nuzzo, an epidemiologist at Brown University, says. "And that means that those infected people haven't had the opportunity to receive medicines to help them recover faster and not develop severe symptoms.
"But it also means that they're possibly spreading the virus without knowledge of the fact that they're infected," she adds.
In other words: "We have no concept of the scale of the monkeypox outbreak in the U.S.," says biologist Joseph Osmundson at New York University. "
Why are so few cases getting detected? Testing. In many ways, the U.S. has dropped the ball on monkeypox testing.
Across the nation, public health agencies are running too few tests — way too few, Osmundson says. "State officials are denying people testing because they're using a narrow definition of monkeypox to decide who receives a test. They're testing in only a very restrictive number of cases."
Take for instance the man Makofane knows. Eventually, after seeing more than four doctors, the man finally finds an activist who's trying to expand testing. The activist connects the man with a doctor who orders a test through a private company (that's working to produce a commercial test.) The result: He's positive. He has monkeypox.
Makofane says the testing situation right now is so "abysmal" in the U.S. that he launched his own study, called RESPND-MI, to figure out the prevalence of monkeypox in New York City and to help friends share information about monkepox.
The CDC would not divulge to NPR how many tests have been performed across the country, nor will the agency say where community transmission is likely occurring in the U.S. (NPR emailed the agency multiple times about these questions but the press person declined to comment or provide an interview.)
On Thursday, the CDC told the New York Times, it has performed 1,058 monkeypox tests. However, it's not clear how many of these tests are duplications for the same person. And several sources involved with monkeypox testing doubt the agency has tested that many cases. One source told NPR that, as of last Friday, the CDC had tested about 300 cases. At that time, about 100 of those tests were positive, giving a positivity rate of more than 30%.
When the outbreak first began last month, the CDC quickly helped to set up testing in about 70 state and local labs across the country. Unlike with COVID, the agency already had a test developed and ready to send to labs.
"We should celebrate that prior investment," Nuzzo says. "That's what preparedness means.
An ineffective testing system
But as the need for testing grew — and the disease became more common than officials initially predicted — the testing system set up by the CDC stopped functioning well, because it actually deters doctors from ordering a monkeypox test.
Providers have to go out of their way to order a test. They have to receive permission and instructions from local or state labs, Nuzzo says. The process is cumbersome and often time-consuming. Sometimes a doctor has to sit on the phone for hours.
"That's really the bottleneck that we're worried about," she says. "We need to cast a wider net with testing to find infections that we're missing. And that's really hard to do if we make it cumbersome and difficult for health care providers to request a test in the course of their busy days."
Nuzzo says the CDC and local health departments need to remove the barriers to testing. "I also want to make testing easier and more widespread so that all clinicians feel that they can test a patient. Any patient with a suspicious rash."
And doctors and nurses need to have a better understanding of what monkeypox actually looks like in patients. It's different from what's in medical textbooks. It can present like many other diseases, including herpes, syphilis and colon cancer.
"Infections have been largely found in men who have sex with men, who may typically seek care at a sexual health clinic," Nuzzo explains. "Those providers may be particularly well-educated now about monkeypox and may be more willing to send a specimen out for testing. But we may not be seeing that level of education and willingness to test with other health care providers, who see different kinds of patients. And that means we may be missing infections in different patient groups."
On Thursday afternoon, the CDC announced they were working to ramp up testing at the main labs that health providers normally use. And the agency is aiming to make testing easier sometime in July.
But Nuzzo says changes to testing need to happen right away. It needs to be easier, right now, for doctors to submit samples to the labs already doing this testing.
"Time is not on our side here," she says. "Every day we delay, we are missing links in the transmission chain and are allowing this outbreak to grow possibly beyond control."
And monkeypox, just like COVID, may become a long-term — perhaps even permanent — problem here in the U.S.
June 24, 2022
The U.S. Is Underreacting to Monkeypox [Getting vaccines to gay and bisexual men is an urgent matter.]
Yesterday, a CDC panel discussed whether smallpox vaccines should be offered more widely as a preventive measure against monkeypox. The panel made no decision. But getting those shots into patients’ arms—and particularly gay and bisexual men’s arms—is an urgent matter. Since May 13, more than 3,300 cases of monkeypox have been reported in 58 countries where the disease was not previously thought to be endemic, including the United States. The CDC is reporting at least 172 cases. Before this outbreak, monkeypox had usually been reported from West and Central Africa, or in travelers from those regions. The new cases are occurring on all inhabited continents, mainly among men who have sex with men (MSM).
The U.S. is underreacting to the monkeypox outbreak. Given that a vaccine is available for the infection—and can be targeted toward the people most at risk—public-health authorities and health-care providers need to move more quickly and forcefully to change the outbreak’s trajectory.
Monkeypox is related to smallpox, the only human virus that has been eradicated worldwide. A highly effective smallpox vaccine, called Jynneos, has been licensed in the United States for use against monkeypox as well. Data from Africa suggest that it is at least 85 percent effective in preventing the latter condition.
On June 1, the CDC updated its recommendations to say that Jynneos is the preferred post-exposure prophylaxis for health-care workers and others who have had close contact with monkeypox patients. The U.S. has about 36,000 doses in its stockpile and expects 300,000 additional doses in coming weeks. It needs to purchase many more—and should offer the vaccine to all MSM at risk of exposure in the next month. Canada just signed a $56 million deal with the manufacturer of the Jynneos vaccine, and Quebec has started offering the vaccine to all MSM. The U.K. is expanding its vaccination campaign as of this week to offer shots to the gay and bisexual men at highest risk of exposure. The New York City Health Department announced the opening yesterday of a clinic in Chelsea that will offer the vaccine to MSM who have had multiple partners in the past 14 days.
When the coronavirus spread worldwide in early 2020, we lacked an effective vaccine, so governments required masks, distancing, ventilation, testing, and contact tracing to try to minimize transmission until the COVID-19 shots arrived. The world is not at the same disadvantage with monkeypox; we have a vaccine, and our current attempts to test and contact trace our way out of this epidemic are failing. A swift, targeted vaccination campaign—one that identifies Americans at risk and persuades them to get a shot—is far more likely to stop the monkeypox outbreak.
Different diseases require different responses. The coronavirus is becoming endemic because it spreads quickly and easily, and even high-quality vaccines that protect against severe disease do not prevent initial infection or reinfection. Smallpox, among the most deadly pathogens in history, could be eliminated because of four distinguishing features that most human pathogens do not have: Its symptoms—most notably, the skin rash it causes—are very characteristic, so doctors could easily identify patients who had it; its infectious period was short; new infections were preventable by a highly effective vaccine; and the virus had no animal reservoirs from which it could infect unvaccinated humans. As such, routine smallpox vaccinations for U.S. populations were stopped in 1972. Yet because of the cessation of mass vaccination programs for smallpox, humans have waning protection from monkeypox.
The name monkeypox comes from the first documented cases of the illness in animals in 1958, when two outbreaks occurred in monkeys being used for research. However, the infection until recently was usually spread by rodents such as rats, mice, and squirrels, and transmitted to humans by a bite from an infected animal, or by touching an infected animal’s blood, body fluids, or fur. A 2003 outbreak among humans in the U.S. was traced to pet prairie dogs infected by a shipment of mammals from Ghana.
Many of the current cases are in MSM ages 30 to 55, at first linked to two large raves held in Spain and Belgium. Of note, sexual transmission of monkeypox has never previously been described. Although monkeypox has been reported in semen, the most likely route of spread during the current outbreak is the close skin-to-skin and respiratory contact during sexual activity. Moreover, transmission from prolonged face-to-face contact can put household members and other close contacts of active cases at greater risk.
That monkeypox is spreading among gay men has led to calls to postpone this month’s Pride celebrations, and the CDC has faced some criticism for recent messaging that offers tips on how to avoid the pathogen during sex. Yet the agencies are following the well-grounded concept of harm reduction—which calls for both minimizing the impact of a health threat while also recognizing the other needs of the individuals and society involved. People crave companionship and intimacy, and messages that ignore those needs and recommend complete abstinence are unlikely to succeed. Harm reduction is the basis of most current public-health messaging about reducing HIV risk, and is profoundly important in the field of addiction and substance use.
Health agencies deserve credit for trying to minimize stigma in their communication, even as they recognize that relevant communities need to be alerted to how this particular outbreak is being spread. (The WHO is also considering a change in the very name monkeypox to prevent stigma against the geographic areas originally connected with the disease and to banish associations with animals that appear to play little role in its spread.)
Stopping the monkeypox outbreak in the U.S. isn’t enough. The WHO is scheduled to meet today to decide whether to declare monkeypox a global health emergency—a move that clinicians from Africa argue is long overdue. Although the virus is not a significant threat to the general population, as COVID-19 was, declaring a global health emergency will raise awareness of both this outbreak and endemic infections. As the World Health Organization has previously pointed out, rich countries have ignored endemic monkeypox in West and Central Africa for far too long, despite having effective vaccines, which should be equitably distributed to the populations at risk worldwide. The crucial point is that all these efforts should be happening right now. We have to stop underreacting to the world’s latest infectious-disease threat.
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WHO weighs declaring monkeypox a global emergency as European cases surge
LONDON — The World Health Organization is weighing whether to declare monkeypox an international emergency — a decision that could come as early as Friday. A declaration could escalate the global response as cases rapidly rise in Britain despite efforts to contain it.
Britain, where almost 800 cases of the virus have been recorded in the past month, has the highest reported number of infections outside of Central and West Africa — and case trends here are worrying experts throughout Europe, the epicenter of the outbreak, who are weighing the best approach in the midst of the years-long coronavirus pandemic.
Monkeypox cases rose almost 40 percent in Britain in under five days, according to data shared by the U.K. Health Security Agency. As of June 16, 574 cases had been recorded, and by June 20, the number had risen to 793.
After Britain, Spain, Germany and Portugal have the most recorded cases. And it’s a growing threat outside of Europe: More than 3,200 cases have been confirmed across 48 nations in the past six weeks, according to the WHO, which publishes data on monkeypox in weekly intervals. As of June 15, one death had been reported.
The WHO’s International Health Regulations Emergency Committee met Thursday to discuss whether the monkeypox outbreak should be labeled a “Public Health Emergency of International Concern,” which would mobilize new funding and spur governments into action. The novel coronavirus, which causes covid-19, was labeled a PHEIC following a similar meeting in January 2020.
So far, the response in most European countries has been to focus on outreach to at-risk communities, contact tracing and isolation for known monkeypox cases. That may change if the WHO, which first sounded the alarm about monkeypox infections in countries where the virus is not endemic in May, increases the threat level of the outbreak.
“The emergency committee and then the [WHO] director general’s announcement will raise the political level of this,” David Heymann, a professor of infectious-disease epidemiology at the London School of Hygiene and Tropical Medicine who attended the meeting as an adviser, told The Washington Post.
U.S. to expand monkeypox testing at commercial labs as outbreak grows
Monkeypox is spread through close contact and has so far primarily affected men who have sex with men. It begins with flu-like symptoms before fluid-filled lumps or lesions appear on the skin, which can leave behind permanent scarring. Health officials say that the latest outbreak has frequently brought genital rashes, and while most cases are mild and patients recover in three weeks, the virus can be fatal and is more of a risk to pregnant people or those with weakened immune systems.
To contain the outbreak, a broader understanding of its origins along with vaccination of at-risk groups and contact tracing is imperative, experts say, although they note some patients may not want to divulge information about who they have been intimate with — which can complicate the public health response.
“One of the difficulties people are having with implementing control is actually getting a full list of people’s sexual contacts,” said Paul Hunter, a professor of medicine at the University of East Anglia. “It’s exactly the issue that we faced when we were dealing with HIV/AIDS in the early [1990s].”
And, as in the early days of the coronavirus outbreak, it’s unclear whether cases in some countries are going undetected. Some experts speculate that Britain may have higher numbers because its extensive public health surveillance network allows it to identify more infections.
WHO director general Tedros Adhanom Ghebreyesus acknowledged at the start of Thursday’s meeting that monkeypox is likely more widespread than official numbers indicate. “Person-to-person transmission is ongoing and is likely underestimated,” he told members of the emergency committee.
The United Kingdom has proactively tracked people with known cases of monkeypox and in some cases, distributed smallpox vaccines, which are known to protect against monkeypox infection, to their close contacts and at-risk groups. In theory, this approach — which Hunter described as “ring vaccination” — “should have worked,” he said.
But as infections have surged and authorities have struggled to “track down the contacts of cases early enough to make an impact,” Hunter said he has grown “less confident.”
“Unless we turn a corner very soon on this, I think we will probably need to start thinking about what’s next,” he added.
Biden: U.S. exploring monkeypox vaccines; ‘everybody’ should be concerned
British health officials said Tuesday that some gay and bisexual men, who are considered to be at higher risk of exposure, will be offered vaccines to help curb the monkeypox outbreak. The U.K. Health Security Agency stressed that although the virus is more of a threat “in the sexual networks of gay, bisexual and other men who have sex with men,” anybody can contract the illness through close contact with an infected individual.
Scientists are studying this outbreak and will know more once the virus is sequenced. “We’re beginning to understand how widespread [monkeypox] really is,” Heymann said. “We know it’s widespread in certain populations, and we need to know whether it’s spreading in other populations as well.”
What is monkeypox, the rare virus now confirmed in the U.S. and Europe?
Two years after he treated Germany’s first coronavirus patient, Clemens Wendtner treated Germany’s first monkeypox patient in May. The man, who has not been identified, was a sex worker from Brazil, said Wendtner, chief physician of infectious diseases at Munich’s Schwabing clinic.
A handful more monkeypox patients have been treated on his ward in recent weeks, Wendtner said. Some have reported “very painful” rectal lesions, for which intravenous painkillers are given to help with the discomfort. Wendtner and his colleagues have been closely recording their discoveries amid this outbreak, documenting recently their discovery of monkeypox virus DNA in both semen and blood.
Most patients were discharged after a day or so and advised to isolate for 21 days at home — in line with Germany’s infectious-disease law. The majority of cases have been reported in Berlin, one of Europe’s party hot spots, which is set to host Pride events next month.
“Summer season is party season,” he warned adding that more cases in the coming week are likely and that the current outbreak may not have peaked yet.
While men are significantly more at risk, Wendtner warned that female sex workers could also be in danger. “The risk factor is a pattern of sex without protection,” he explained.
WHO to rename monkeypox after scientists call it ‘discriminatory’
Outside of Europe, other countries are also grappling with new cases.
The first case of monkeypox in the United States was detected on May 17. Over the past five weeks more than 100 cases have been added, according to data from the Centers for Disease Control and Prevention. California, New York and Illinois are listed as the states with the highest level of infection.
Some experts in the United States are calling on the White House to implement thorough testing to avoid the failures of the coronavirus pandemic.
Singapore confirmed a case of monkeypox in a British man on Tuesday, the first in Southeast Asia. South Korea on Wednesday also confirmed its first case of monkeypox. The patient is a South Korean national who entered the country from Germany, health officials said. On Thursday, South Africa also announced its first case of monkeypox, Reuters reported. The 30-year-old has no travel history, health experts said, meaning his illness would not have been contracted outside of South Africa.
It’s important to remember, experts say, that this is not a new disease. Monkeypox has been circulating in Africa for decades — leading some to point out a double-standard in the response to the outbreak in Europe.
“This is a disease which has been neglected,” Heymann said. After smallpox was eradicated in 1980, the world stopped administering smallpox vaccines as a matter of routine. Monkeypox, which is less contagious than smallpox, continued to spread in West and Central Africa, but outbreaks there were not thoroughly investigated due to lack of resources, he added.
As monkeypox panic spreads, doctors in Africa see a double standard
The WHO’s Tedros said Thursday that nearly 1,500 suspected cases of monkeypox, and some 70 deaths, have been reported in central Africa this year. “While the epidemiology and viral clade in these cases may be different, it is a situation that cannot be ignored,” he warned.
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Taiwan confirms first imported case of monkeypox
TAIPEI, June 24 (Reuters) - Taiwan's government on Friday confirmed its first imported case of monkeypox, a man in his 20s who had studied in Germany from January until June this year when he returned to the island.
Taiwan's Centres for Disease Control said the man flew back to Taiwan on June 16 and returned home for mandatory COVID-19 quarantine for all arrivals.
On June 20 he developed symptoms including a fever, sore throat and a rash and sought medical attention, where he was tested and confirmed to have monkeypox, it added in a statement.
He is now being treated in an isolation ward and his close contacts are showing no symptoms, it said.
In the Asia Pacific, Singapore, South Korea and Australia have also all reported cases.
More than 40 countries where monkeypox is not endemic have reported outbreaks of the viral disease as confirmed cases exceed 3,000.
Monkeypox, which spreads through close contact and was first found in monkeys, mostly occurs in west and central Africa and only very occasionally spreads elsewhere.
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Monkeypox Virus Mutating More Than Expected, Say Scientists
The monkeypox virus may be mutating more than expected, according to researchers in Portugal, as cases rise across the UK and the US.
Scientists said the latest strain of monkeypox, once previously confined to parts of Africa, has about 50 genetic variations compared to related viruses that circulated in 2018-2019. They found the virus is continuing to evolve during the current outbreak, including a number of small changes in the genetic code, minor gene variants and a deleted gene, according to a study published in Nature Medicine on Friday.
“It was quite unexpected to find so many mutations in the 2022 monkeypox virus,” said Joao Paulo Gomes from the National Institute of Health in Lisbon and one of the authors of the report. “In fact, considering the genome characteristics of this type of virus, no more than one or two mutations are likely to emerge each year.”
The monkeypox virus is more stable and slower to mutate than the coronavirus that causes Covid-19. In the past, monkeypox hasn’t spread easily from person to person. It’s still unclear how the mutations seen in the current monkeypox virus might change any of those attributes, or the severity of the disease it causes. More research is needed to better understand the changes in the virus, the researchers said.
A cousin of the smallpox virus, monkeypox typically causes flu-like symptoms, followed by a rash that often starts on the face and spreads down the body. The illness can be deadly in some instances. Many of the current cases are primarily among men who have sex with men.
Authorities all over the world are tracking the evolution of the monkeypox outbreak and expanding vaccination to more at-risk groups to try contain the spread of the virus, with more than 3,300 cases reported globally. The emergency committee of the World Health Organization is expected to announce soon whether it will declare the latest outbreak a public health emergency of international concern -- its highest alert level.
The US Centers for Disease Control and Prevention, which is looking to expand the use of the monkeypox vaccine for children, said the virus was behaving as it expected.
“We’re sequencing all specimens that we can get our hands on,” Gregory Armstrong, director of the CDC’s Office of Advanced Molecular Detection within the National Center for Emerging and Zoonotic Diseases, said in an interview Thursday. Thus far, the CDC is getting specimens from public health labs, he said.
“All the evidence so far suggests the virus is behaving as we anticipated,” he said. “It’s much more stable than most viruses, and we don’t anticipate that it’s going to be mutating at the rate of SARS-CoV-2.”
~~
June 23, 2022
First case of monkeypox in North Carolina reported
RALEIGH, N.C. —
The first case of monkeypox in North Carolina has been reported, according to the North Carolina Department of Health and Human Services.
Officials did not release where the case of monkeypox was reported, but said it was not in the Charlotte area.
Monkeypox is a rare but potentially serious, viral illness that typically involves flu-like symptoms, swelling of the lymph nodes and a rash that includes bumps that are initially filled with fluid before scabbing over, according to NCDHHS.
Health officials said the illness could be confused with a sexually transmitted infection like syphilis or herpes, or with varicella-zoster virus (chickenpox). Most infections last two to four weeks.
Monkeypox is typically spread by skin-to-skin contact. The person is currently isolating at home. No further information will be shared about this case to protect the patient’s privacy.
"The number of monkeypox cases has been growing in the U.S. and globally," said Dr. Zack Moore, state epidemiologist and epidemiology section chief. "Though this is the first confirmed case in North Carolina, we know there are likely other cases in the state. We are encouraging doctors to consider this in people who have a rash or skin lesion that looks like monkeypox."
~
NYC Launches Monkeypox Shots — But Walk-in Demand Overwhelms Capacity
New York City will start offering the monkeypox vaccine, as the city accounts for more than 20% of the total cases nationwide.
New York City began offering vaccination against monkeypox to at-risk groups on Thursday, as authorities scramble to contain a global outbreak.
But demand was so high, within hours of launching the program the city had to cut off walk-in appointments, and scheduled visits were already booked through early next week.
As opposed to the early days of COVID, when there was no effective treatment, there are already multiple vaccines that work against the orthopoxvirus that causes the ailment. Supply, however, is the question.
Some 30 people have tested positive for the virus in the city since early May, almost all of them men who have sex with men, and the number of cases has risen 60% in just the last week. In total New York City represents more than 20% of all cases diagnosed nationwide. The move to offer the vaccine follows similar efforts in cities like Montreal and Toronto.
The Health Department on Thursday announced the opening of a temporary clinic to administer the two-dose JYNNEOS vaccine to eligible people who may have had recent exposure to monkeypox, the city announced. NYC Health Commissioner Dr. Ashwin Vasan said anxiety, particularly among sexually actively gay and bisexual men, prompted the city’s decision to make vaccines available.
The vaccines will be administered at the Chelsea Sexual Health Clinic (303 Ninth Avenue in Manhattan). The clinic will be open on Mondays, Tuesdays, Thursdays, Fridays, and Sundays from 11 a.m. to 7 p.m. moving forward.
But as of 2 p.m. Thursday, just three hours after opening its doors, the city said no more walk-ins would be accommodated and that all appointments were filled through Monday. News 4 counted more than 100 people lined up outside the clinic at the time.
One person in line to get vaccinated said that many appointments were gone about 10 minutes they became available online.
The health department advised people to check back on Sunday for more appointments next week.
"We are in talks with the CDC to obtain more doses and are looking into how we can boost our capacity citywide," the health department said.
Mark Levine, the Manhattan borough president, tweeted that the city had only been allocated about 1,000 doses of the vaccine from the national stockpile.
~
Monkeypox jab to be offered to at-risk gay and bisexual men
Some gay and bisexual men at higher risk of catching monkeypox should be offered a vaccine, say UK health officials. This could help to control the recent outbreak of the rare virus in the UK in which 793 people have been infected so far. Monkeypox is not defined as a sexually-transmitted infection. But it can be passed on by close contact during sex, and with bedding, towels and skin. The UK Health Security Agency (UKHSA) says that a vaccine designed to protect against smallpox, called Imvanex, will help protect people who could be exposed to monkeypox. The vaccine is effective against monkeypox because it is from the same family of viruses. Its use has been signed off by the UK's vaccine experts, the Joint Committee on Vaccination and Immunisation (JCVI).
~
Here is the vaccine to be given:
JYNNEOS U.S. Government Contracts
On May 18, 2022, Bavarian Nordic announced today that BARDA exercised the first options (119 million doses) under the contract to supply a freeze-dried version of the JYNNEOS smallpox vaccine.
Stock -- Bavarian Nordic A/S - ADR
OTCMKTS: BVNRY
June 21, 2022
Outbreak cases seem to be concentrated in the MSM [Men who have sex with men]. More?
https://www.science.org/content/article/why-the-monkeypox-outbreak-is-mostly-affecting-men-who-have-sex-with-men
New Jersey documents 1st case; patient isolating at home. https://www.google.com/amp/s/nypost.com/2022/06/21/new-jersey-records-first-monkeypox-case/amp/
June 20, 2022
- WHO Monkeypox Update: 2103 Confirmed Cases, One Death, Across 42 Countries
- What’s moderate risk look like? Well, in only a week, the total number of laboratory confirmed monkeypox cases since the start of 2022 went from 1285 on June 8 to 2103 on June 15. That’s about a 64% jump, right after a similar one-week 65% jump from 780 cases on June 4.
- First probable monkeypox cases reported in Missouri, Indiana
Cases of monkeypox (likely soon to be dubbed MPXV by the World Health Organization) are proliferating worldwide, but many experts say it seems unlikely to develop into a pandemic like COVID-19, AIDS, or SARS.
The Centers for Disease Control & Prevention (CDC) says the risk to the U.S. population is low. Nonetheless, the World Health Organization (WHO) Director-General tweeted on June 14 that he is convening a meeting June 23 to determine whether the expanding outbreak constitutes a global health emergency.
“Does monkeypox have the potential to become a pandemic of significant proportion?” Cesar Arias, MD, PhD, co-director of the Center for Infectious Disease at Houston Methodist, asks. “The answer, as with any transmissible virus, is yes, but whether that will happen is the million-dollar question. Transmission is occurring (outside the regions in which it is endemic) and the magnitude of the transmission is unknown. After what we experienced these past three years, we should be cautious.”
David Dodd, chairman, president, and CEO of GeoVax, is optimistic. “It’s an issue, but it likely won’t become a pandemic like COVID-19. There probably is an element of hysteria to it right now.” His confidence is based on a body of research into monkeypox going back at least two decades, its method of transmission, and the availability of vaccines and therapeutics to counter this virus.
Two vaccines available in United States
The CDC says the vaccines developed against smallpox also offer 85% protection against monkeypox. Currently, there are two vaccines approved for smallpox in the U.S., Jynneos™ and ACAM2000. Of them, only Jynneos is approved for monkeypox.
Bavarian Nordic’s Jynneos is a nonreplicating modified vaccinia Ankara (MVA) vaccine that is FDA-approved for both smallpox and monkeypox. The company received an order from BARDA for 500,000 liquid-frozen doses for delivery this year. Receipt of that order will increase the U.S. stockpile to 1.9 million doses. Most of Bavarian Nordisk’s remaining bulk Jynneos vaccine will be freeze-dried into approximately 13 million doses by 2025. The vaccine, known as Imvanex® in the U.K., was delivered to England in 2018 in response to a monkeypox outbreak there.
ACAM2000 is a second-generation smallpox vaccine developed by Sanofi Pasteur Biologics. This live vaccinia-based vaccine is licensed to immunize people at high risk of contracting smallpox. It is part of the U.S. Strategic National Stockpile for smallpox.
GeoVax considered monkeypox even before the outbreak. “We already have published in peer-reviewed journals that our MVA vaccines, in addition protecting animal models against HIV and other infections, also prevents monkeypox,” Dodd says. “We are validating our COVID-19 vaccine (CM04S1) now, which, is in Phase II trials, [and we] also will address the monkeypox virus.”
Likewise, “Moderna is investigating potential monkeypox vaccines at a preclinical level, using its mRNA platform,” Luke Mircea-Willats, corporate spokesperson, says.
Others are watching the situation carefully. “Inovio Pharmaceuticals produced preclinical data on a monkeypox vaccine, published in the Journal of Infectious Diseases in 2010,” corporate spokesman Jeff Richardson says. “There has been no further work on this particular vaccine since that publication.” Inovio is monitoring the outbreak of this and any other infectious disease threats, with the potential of applying its DNA medicines platform as applicable.
Mass vaccination not needed
As yet, Arias says, “I don’t see real evidence of airborne transmission. It is not associated with sexual behaviors either, but with proximity to active, infective, skin lesions.” The CDC says monkeypox is transmitted through direct contact with infectious sores, scabs, or bodily fluids from those infected. So, unless the virus becomes airborne—which the WHO says is possible but uncommon—wearing masks won’t affect transmission.
That also means wide-spread vaccination is unnecessary. The CDC recommends vaccination only for people likely to contact monkeypox, such as lab workers exposed to certain orthopoxviruses and certain military personnel.
Vaccination also is recommended after exposure. To prevent the onset of monkeypox, the vaccine must be administered within four days of exposure. When given up to 14 days after exposure, however, vaccination may ease the symptoms but not prevent disease onset.
Baby Boomers and GenXers shouldn’t assume they’re protected from monkeypox or smallpox. “It is unlikely that the first-generation vaccine for smallpox, which was administered until 1972 in the United States, will withstand a new challenge,” Arias says. “The newer vaccines seem to work [better]. The question is whether we have enough, if this gets out of hand.”
Antiviral meds ready, too
If it does spread, antiviral therapies are available. Siga Technologies’ antiviral drug, TPOXX® (tecoviromat), is approved to treat monkeypox in Europe. “TPOXX blocks the spread of virus while allowing the induction of a protective immune response,” Dennis Hruby, CSO, tells GEN. “The approved course of therapy is two oral doses per day for 14 days.” It recently received FDA approval for an intravenous version for those who cannot easily swallow pills.
Although TPOXX is not FDA-approved for use in the United States against monkeypox, it may be used under an expanded access protocol to treat monkeypox during an outbreak. It already has been used on at least one patient during the current outbreak, Hruby adds.
Vistide® (cidofovir) by Gilead Sciences, is approved for the treatment of cytomegalovirus retinitis in AIDS patients and also holds expanded access protocol authorization for monkeypox, as does vaccinia immune globulin intravenous (VIGIV).
Additionally, an expanded access—investigational new drug application (EA-IND) is being prepared for a fourth therapy, Tembexa® (brincidofovir) by Chimerix, for monkeypox. (The intention to sell Tembexa to Emergent BioSolutions was announced in early May.)
Scientists watch closely
During the COVID-19 pandemic, scientists frequently pointed out that the science was changing, while trust in public health officials waned. Going forward, Dodd says, earning the public’s trust “is less about getting the information right or wrong and more about being transparent,” and pivoting as needed. “People are much more accepting of that.” So, as long as the experts admit when they are wrong and adjust their strategies to adapt to new information, they can regain—and maintain—the public’s trust, he suggests.
While no can accurately predict what will happen regarding the monkeypox outbreak, it merits close scientific observation.
“Monkeypox is a serious infection and can be fatal,” Anne Rimoin, PhD, professor of epidemiology and director of the UCLA Center for Global and Immigrant Health, said in a Q&A blog post. She has studied monkeypox for some 20 years and says transmission patterns are changing. Specifically, it is expanding beyond the areas of Africa in which it is endemic. In fact, the current outbreak is “the largest-ever outside of Africa.”
Transmissibility and fatality depend on the clade, with the Central Africa/Congo Basin clade associated with 6% to 10% mortality and the West African clade with 1% to 3.5% mortality. Access to vaccines and therapeutics improves those risks, however. “There haven’t been any fatalities in high-income settings,” she points out. “There are vaccines and treatments, and the world is more aware of what it takes to contain outbreaks.
“The risk of monkeypox to the general public is low. It is still a rare infection…and it is unlikely that most people in the U.S. will ever come in contact with it,” Rimoin says.
Global Cases
https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html
6.7.22
USA - 34 cases
U.S. monkeypox cases are very rare. Monkeypox does not occur naturally in the United States, but cases have happened that were associated with international travel or importing animals from areas where the disease is more common.
***
2003 Outbreak from Imported Mammals
In 2003, forty-seven confirmed and probable cases of monkeypox were reported from six states—Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin. All people infected with monkeypox in this outbreak became ill after having contact with pet prairie dogs. The pets were infected after being housed near imported small mammals from Ghana. This was the first time that human monkeypox was reported outside of Africa.
What caused the 2003 U.S. outbreak?
Investigators determined that a shipment of animals from Ghana, imported to Texas in April 2003, introduced monkeypox virus into the United States. The shipment contained approximately 800 small mammals representing nine different species, including six types of rodents. These rodents included rope squirrels, tree squirrels, African giant pouched rats, brush-tailed porcupines, dormice, and striped mice. CDC laboratory testing showed that two African giant pouched rats, nine dormice, and three rope squirrels were infected with monkeypox virus. After importation into the United States, some of the infected animals were housed near prairie dogs at the facilities of an Illinois animal vendor. These prairie dogs were sold as pets before they developed signs of infection.
All people infected with monkeypox became ill after having contact with infected pet prairie dogs. A study conducted after the outbreak suggested that certain activities associated with animals were more likely to lead to monkeypox infection. These activities included touching a sick animal or receiving a bite or scratch that broke the skin. Another important factor was cleaning the cage or touching the bedding of a sick animal. No instances of monkeypox infection were attributed exclusively to person-to-person contact.
How was the outbreak contained?
CDC and the public health departments in the affected states, together with the U.S. Department of Agriculture, the Food and Drug Administration, and other agencies, participated in a variety of activities that prevented further spread of monkeypox. This included extensive laboratory testing; deployment of smallpox vaccine and treatments; development of guidance for patients, healthcare providers, veterinarians, and other animal handlers; tracking potentially infected animals; and investigation into possible human cases. Partners in the response issued an immediate embargo and prohibition on the importation, interstate transportation, sale, and release into the environment of certain species of rodents including prairie dogs. FDA later rescinded the part of the order that restricted the capture, sale, and interstate movement of prairie dogs or domestically-bred African rodents, but CDC’s restriction on the importation of African rodents remains in place.
CDC
Monkeypox is a rare disease that is caused by infection with monkeypox virus. Monkeypox virus belongs to the Orthopoxvirus genus in the family Poxviridae. The Orthopoxvirus genus also includes variola virus (which causes smallpox), vaccinia virus (used in the smallpox vaccine), and cowpox virus.
Monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, hence the name ‘monkeypox.’ The first human case of monkeypox was recorded in 1970 in the Democratic Republic of the Congo (DRC) during a period of intensified effort to eliminate smallpox. Since then, monkeypox has been reported in people in several other central and western African countries: Cameroon, Central African Republic, Cote d’Ivoire, Democratic Republic of the Congo, Gabon, Liberia, Nigeria, Republic of the Congo, and Sierra Leone. The majority of infections are in Democratic Republic of the Congo.
Monkeypox cases in people have occurred outside of Africa linked to international travel or imported animals, including cases in the United States, as well as Israel, Singapore, and the United Kingdom.
The natural reservoir of monkeypox remains unknown. However, African rodents and non-human primates (like monkeys) may harbor the virus and infect people.
~
Signs & Symptoms
In humans, the symptoms of monkeypox are similar to but milder than the symptoms of smallpox. Monkeypox begins with fever, headache, muscle aches, and exhaustion. The main difference between symptoms of smallpox and monkeypox is that monkeypox causes lymph nodes to swell (lymphadenopathy) while smallpox does not. The incubation period (time from infection to symptoms) for monkeypox is usually 7−14 days but can range from 5−21 days.
The illness begins with:
Fever
Headache
Muscle aches
Backache
Swollen lymph nodes
Chills
Exhaustion
Within 1 to 3 days (sometimes longer) after the appearance of fever, the patient develops a rash, often beginning on the face then spreading to other parts of the body.
Lesions progress through the following stages before falling off:
Macules
Papules
Vesicles
Pustules
Scabs
The illness typically lasts for 2−4 weeks. In Africa, monkeypox has been shown to cause death in as many as 1 in 10 persons who contract the disease.
Transmission
Monkeypox virus can spread when a person comes into contact with the virus from an infected animal, infected person, or materials contaminated with the virus. The virus can also cross the placenta from the mother to her fetus. Monkeypox virus may spread from animals to people through the bite or scratch of an infected animal, by handling wild game, or through the use of products made from infected animals. The virus may also spread through direct contact with body fluids or sores on an infected person or with materials that have touched body fluids or sores, such as clothing or linens.
Monkeypox spreads between people primarily through direct contact with infectious sores, scabs, or body fluids. It also can be spread by respiratory secretions during prolonged, face-to-face contact. Monkeypox can spread during intimate contact between people, including during sex, as well as activities like kissing, cuddling, or touching parts of the body with monkeypox sores. At this time, it is not known if monkeypox can spread through semen or vaginal fluids.
It is not yet known what animal maintains the virus in nature, although African rodents are suspected to play a part in monkeypox transmission to people.
**
The Centers for Disease Control and Prevention updated its guidance last week for travelers wishing to protect themselves against monkeypox. This was one of its recommendations: “Wear a mask. Wearing a mask can help protect you from many diseases, including monkeypox.”
Late Monday night, that recommendation was deleted.
“C.D.C. removed the mask recommendation from the monkeypox travel health notice because it caused confusion,” the agency said in a statement on Tuesday.
However, the agency still says that in countries where monkeypox is spreading, “household contacts and health care workers” should consider wearing masks. That guideline also applies to “other people who may be in close contact with a person who has been confirmed with monkeypox.”
The turnabout hints at a little-discussed aspect of the current monkeypox outbreak: The virus can be airborne, at least over short distances. While airborne transmission is only a small factor in the overall spread, experts said in interviews, there are no firm estimates regarding how much it contributes.
Since May 13, when the first case in the outbreak was reported, more than a thousand people in 31 countries have been diagnosed with the virus, and at least another thousand cases are being investigated. As of Tuesday, the United States had recorded 31 cases in 12 states and the District of Columbia.
In previous outbreaks, a majority of cases were reported in those who had close contact with an infected patient or animal. But in some instances, airborne transmission was the only explanation for the infections.
Transmission
Monkeypox virus can spread when a person comes into contact with the virus from an infected animal, infected person, or materials contaminated with the virus. The virus can also cross the placenta from the mother to her fetus. Monkeypox virus may spread from animals to people through the bite or scratch of an infected animal, by handling wild game, or through the use of products made from infected animals. The virus may also spread through direct contact with body fluids or sores on an infected person or with materials that have touched body fluids or sores, such as clothing or linens.
Monkeypox spreads between people primarily through direct contact with infectious sores, scabs, or body fluids. It also can be spread by respiratory secretions during prolonged, face-to-face contact. Monkeypox can spread during intimate contact between people, including during sex, as well as activities like kissing, cuddling, or touching parts of the body with monkeypox sores. At this time, it is not known if monkeypox can spread through semen or vaginal fluids.
It is not yet known what animal maintains the virus in nature, although African rodents are suspected to play a part in monkeypox transmission to people.
Prevention
There are number of measures that can be taken to prevent infection with monkeypox virus:
Avoid contact with animals that could harbor the virus (including animals that are sick or that have been found dead in areas where monkeypox occurs).
Avoid contact with any materials, such as bedding, that has been in contact with a sick animal.
Isolate infected patients from others who could be at risk for infection.
Practice good hand hygiene after contact with infected animals or humans. For example, washing your hands with soap and water or using an alcohol-based hand sanitizer.
Use personal protective equipment (PPE) when caring for patients.
Image so hand washing.
Practice good hand hygiene after contact with infected animals or humans.
Interim Clinical Guidance for the Treatment of Monkeypox
Many individuals infected with monkeypox virus have a mild, self-limiting disease course in the absence of specific therapy. However, the prognosis for monkeypox depends on multiple factors such as previous vaccination status, initial health status, concurrent illnesses, and comorbidities among others. Persons who should be considered for treatment following consultation with CDC might include:
Persons with severe disease (e.g., hemorrhagic disease, confluent lesions, sepsis, encephalitis, or other conditions requiring hospitalization)
Persons who may be at high risk of severe disease:
Persons with immunocompromise (e.g., human immunodeficiency virus/acquired immune deficiency syndrome infection, leukemia, lymphoma, generalized malignancy, solid organ transplantation, therapy with alkylating agents, antimetabolites, radiation, tumor necrosis factor inhibitors, high-dose corticosteroids, being a recipient with hematopoietic stem cell transplant <24 months post-transplant or ≥24 months but with graft-versus-host disease or disease relapse, or having autoimmune disease with immunodeficiency as a clinical component)
Pediatric populations, particularly patients younger than 8 years of age
Pregnant or breastfeeding women
Persons with one or more complications (e.g., secondary bacterial skin infection; gastroenteritis with severe nausea/vomiting, diarrhea, or dehydration; bronchopneumonia; concurrent disease or other comorbidities)
Persons with monkeypox virus aberrant infections that include its accidental implantation in eyes, mouth, or other anatomical areas where monkeypox virus infection might constitute a special hazard (e.g., the genitals or anus)
Medical Countermeasures Available for the Treatment of Monkeypox
Currently there is no specific treatment approved for monkeypox virus infections. However, antivirals developed for use in patients with smallpox may prove beneficial. The following medical countermeasures are currently available from the Strategic National Stockpile (SNS) as options for the treatment of monkeypox:
Tecovirimat (also known as TPOXX) is an antiviral medication that is approved by the United States Food and Drug Administration (FDA) [PDF – 24 pages] for the treatment of smallpox in adults and children weighing at least 6.6 pounds. CDC holds a special permit that allows for the use of tecovirimat to treat monkeypox during an outbreak. Tecovirimat is available as a pill or an injection. For children who weigh less than 28.6 pounds, the capsule can be opened and medicine mixed with semi-solid food.
Cidofovir (also known as Vistide) is an antiviral medication that is approved by the FDA [PDF – 6 pages] for the treatment of cytomegalovirus (CMV) retinitis in patients with Acquired Immunodeficiency Syndrome (AIDS). CDC holds an EA-IND that allows for the use of Cidofovir for the treatment of orthopoxviruses (including monkeypox) in an outbreak.
Vaccinia Immune Globulin Intravenous (VIGIV) is licensed by FDA for the treatment of complications due to vaccinia vaccination including eczema vaccinatum, progressive vaccinia, severe generalized vaccinia, vaccinia infections in individuals who have skin conditions, and aberrant infections induced by vaccinia virus (except in cases of isolated keratitis). CDC holds and EA-IND that allows the use of VIGIV for the treatment of orthopoxviruses (including monkeypox) in an outbreak.
Brincidofovir (also known as Tembexa) is an antiviral medication that was approved by the FDA [PDF – 21 pages] on June 4, 2021 for the treatment of human smallpox disease in adult and pediatric patients, including neonates. CDC is currently developing an EA-IND to help facilitate use of Brincidofovir as a treatment for monkeypox. However, Brincidofovir is not currently available from the SNS.
State and territorial health authorities can direct their requests for medical countermeasures for the treatment of monkeypox to the CDC Emergency Operations Center (770-488-7100).
How can a person lower the chance of getting monkeypox at places like raves, parties, clubs, and festivals?
When thinking about what to do, seek out information from trusted sources like the local health department. Second, consider how much close, personal, skin-to-skin contact is likely to occur at the event you plan to attend. If you feel sick or have any rashes or sores, do not attend any gathering, and see a healthcare provider.
Festivals, events, and concerts where attendees are fully clothed and unlikely to share skin-to-skin contact are safer. However, attendees should be mindful of activities (like kissing) that might spread monkeypox.
A rave, party, or club where there is minimal clothing and where there is direct, personal, often skin-to-skin contact has some risk. Avoid any rashes or sores you see on others and consider minimizing skin-to-skin contact when possible.
Enclosed spaces, such as back rooms, saunas, or sex clubs, where there is minimal or no clothing and where intimate sexual contact occurs have a higher likelihood of spreading monkeypox.
How can a person lower their risk during sex?
Talk to your partner about any recent illness and be aware of new or unexplained sores or rashes on your body or your partner’s body, including the genitals and anus. If you or your partner have recently been sick, currently feel sick, or have a new or an unexplained rash or sores, do not have sex and see a healthcare provider. This is always a good plan, even if monkeypox isn’t in your area.
If you or a partner has monkeypox, the best way to protect yourself and others is to not have sex of any kind (oral, anal, vaginal) and not kiss or touch each other’s bodies while you are sick, especially any rash or sores. Do not share things like towels, fetish gear, sex toys, and toothbrushes.
If you or your partner have (or think you might have) monkeypox and you decide to have sex, consider the following to reduce the chance of spreading the virus:
Have virtual sex with no in-person contact.
Masturbate together at a distance of at least 6 feet, without touching each other and without touching any rash or sores.
Consider having sex with your clothes on or covering areas where rash or sores are present, reducing as much skin-to-skin contact as possible.
Avoid kissing.
Remember to wash your hands, fetish gear, sex toys and any fabrics (bedding, towels, clothing) after having sex
Limit your number of partners to avoid opportunities for monkeypox to spread.
What should a person do if they have a new or unexplained rash, sores, or other symptoms?
Avoid sex or being intimate with anyone until you have been checked out by a healthcare provider. If you don’t have a provider or health insurance, visit a public health clinic near you.
When you see a healthcare provider, remind them that this virus is circulating in the area.
Avoid gatherings, especially if they involve close, personal, skin-to-skin contact.
Think about the people you have had close, personal, or sexual contact within the last 21 days, including people you met through dating apps. You might be asked to share this information if you have received a monkeypox diagnosis, to help stop the spread.
World Health Org.
https://www.who.int/news-room/fact-sheets/detail/monkeypox
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