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Monkeypox: What We Know About Outbreaks, Vaccinations, and Treatment

Gottlieb: The United States "failed to contain" monkeypox

Thousands Monkeypox cases that have swelled in humans are deploying both vaccines and treatments to combat the disease, which can cause weeks of painful rashes and lesions in those infected. On August 4, the Biden administration declared a public health emergency to step up federal response.

Several cities facing the outbreak have now declared a state of emergency to combat the virus, andNew York State, Illinois and California

The White House on August 2 Officials from the Centers for Disease Control and Prevention and the Federal Emergency Management Agency, who announced they would be tapping two people, will coordinate a "whole-of-government response" to the outbreak.

Monkeypox infectionwas seen in the United States before, but his two travelers from Nigeria last year and his animals were imported in 2003, when 47 cases were associated with monkeypox. The current outbreak is the largest on record in US history and is expected to continue to grow.

Here's what we know about the monkeypox outbreak and response.

US cases this year

Nearly 9,000 cases talliedExcluding two states — Montana and Wyoming— As of 8 August

New York had the highest total number of reported cases, accounting for nearly a quarter of the national tally. increase.

How will it spread?

Officials say the "majority" of cases in the current outbreak are spread among men who have had sex with men and are generally skin-to-skin. It is spread through intimate contact and sharing of contaminated towels and bedding. 

Young children and Pregnant womenhave also reported a small number of cases. Considered to be at high risk of serious outcome from the disease. 

However, demographic data account for only a fraction of reported cases, according to the CDC. Unlike their overseas counterparts, such as in the UK and Europe, authorities need to rely on details collected 'voluntarily' by local health departments and reported to authorities. there is.

Severity of monkeypox infection.

As of August 1, the United States has so far reported no deaths in an outbreak of thousands of monkeypox infections. AfricaSouth AmericaEurope

A small number of deaths have been reported abroad. Officials say it often resolves within weeks without additional treatment. The variant associated with the current outbreak has spread across Nigeria since 2017and has killed about 3% of people who contract monkeypox.  

After the incubation period estimated by the CDC, on average between exposure to an infected person and the first notable signs of infection, patients generally develop a rash.Painful lesions must be endured as well as other symptoms such as fever and swollen lymph nodes until they crust over. Like other poxviruses, monkeypox can leave scars.

But authorities have been careful not to downplay the dangers that monkeypox complications can pose beyond physical suffering.

For example, inUnited Kingdomauthorities reported that some hospitalized patients faced "severe swelling" that could impede circulation to the penis. In Spainseveral patientswere hospitalized with bacterial wound infections. 

According to the CDC , patients at "extreme risk" for severe monkeypox include: 

  • Age 8
  • Pregnant or immunocompromised
  • Have a history of eczema or atopic dermatitis

According to agency Living with HIV People who contract monkeypox during the current outbreak will not develop more serious illness as long as they are receiving treatment to suppress HIV. 

What tests are available for monkeypox? 

Previous monkeypox cases in the United States have been diagnosed using CDC laboratory tests to determine if someone has the orthopox virus. I can do it. 

These tests rely on physicians "vigorously" swabbing suspicious lesions to obtain samples, which are not available to authorities. can be sent to state public health laboratories that have initiated testing for An increasing number of commercial laboratories

There is a race to develop unique tests for suspected monkeypox patients, although the Food and Drug Administration nowsays these methods "could lead to false test results." I am warning you.

"We are actively conducting research to evaluate what other tests are available, such as saliva tests, throat swabs, and blood tests, but at this time there are no tests available. There are no data to recommend its use.

What vaccines are available for monkeypox cases?


Both relied on less lethal relatives of smallpox to protect infected individuals. But unlike ACAM2000, the Bavarian Nordic Jynneos vaccine, approved by the FDA in 2019, poses much less risk, specifically to combat monkeypox. 224} It relies on a modified version of the virus to preventreplication and reduce its severity.

Prior to the current outbreak, the US signed a contract with Bayern Nordic. and manufactured a “mass vaccine” equivalent to about 13 million doses of the company's Gineos injections. The government hasnowordered about 7 million doses of the vaccine to be filled into vials and shipped from Bavaria Nordic by mid-2023.

For now, federal officials admit that demand for Gyneos far exceeds supply for shot. Doses have been assigned to known close contacts ofcasesor other vaccinated persons who are 'presumed' to be at risk of contact with the case.

Some jurisdictions currently rely on offering only one dose of the two-dose vaccine to expand supply, despite FDA discouraging this move. 

More than 736,000 additional doses available in states on 29 JulyThis is due to Bavarian Nordic vial after FDA inspection cleared the use of a tranche of the vaccine that had already been filled in 

Another wave of vaccinations came when the Biden administration ordered that he fill vials in June

The company also said it had supplied "nearly 30 million doses" of the vaccine in the past, which are now expired. A spokeswoman for the Ministry of Health and Human Services said in a statement on August 2 that it was working with Bayern Nordic to test whether these doses could be recovered, but said, "If these doses are feasible, It is highly unlikely that it will continue."

Can children be vaccinated against monkeypox?

CDC officials disclosed to a panel of outside vaccine advisors that at least one of her pediatric patients had been vaccinated earlier this year, Currently, the FDA has not approved her Jynneos vaccine for children. offered a shot. Agency officials and the local health system later confirmed that other children who were in close contact with the monkeypox case were also vaccinated.

FDA and CDC spokespersons declined to confirm the number of requests granted for vaccine use in children. 

A Bayern Nordic spokesman declined to provide details on whether it plans to test the vaccine in children, but will collect data on the shot's use by the CDC. Said he had a plan.

People who are vaccinated against smallpox are protected from monkeypox.

People in the current outbreak are being vaccinated with vaccines originally designed to combat smallpox, such as ACAM200 and Jynneos, but officials have been using it for decades. It warns that Americans who have been previously vaccinated against smallpox are unlikely to be protected from smallpox. Monkeypox infection.

Although the United States discontinued routine mass vaccination against smallpox in 1972, the CDC reported that exposure to orthopoxviruses (including monkeypox) in laboratories resulted in increased exposure.

In the current outbreak,CDC still recommends revaccination every three years for at-risk scientists. He said some patients had been vaccinated against smallpox "decades ago." And in the 2003 epidemic, researchers at the CDC found that previous smallpox vaccination reduced the chances of some infected patients facing severe illness or hospitalization. No evidence of reduction was found.

"People who have been vaccinated, even as children, expect some immunity to remain. How long that protection lasts, and how many decades ago It defines exactly how much benefit vaccinated people can still get," CDC's Brett Petersen said during a webinar with clinicians on June 30.

How are monkeypox cases treated? 

While many monkeypox cases eventually resolve without medication other than painkillers, the Biden administration has advised doctors tostockpile courses Allowed to claim some remedies that have. Developed in the past for smallpox.

The most commonly claimed of these drugs is the antiviral tecovalimat or TPOXX,launched in 2002. Developed from federal government research and bioterrorist attacks. The FDA approved tecovirimat for the treatment of smallpox in 2018. However, much of its approval was actually based on studies of animals infected with monkeypox and rabbitpox, and regulatory It is not considered feasible or ethical to do a "human efficacy trial" against smallpox.

Physicians seeking a course of tecovirimato for monkeypox patients must refer to the CDC under the "Extended Access" protocol304} According to the agency, The drug is being considered for use in people who have severe illness or who have additional risk factors such as a weakened immune system or lesions in parts of the body.

Can you contain special hazards like genitals?

He expects the number of monkeypox cases to continue to rise at least until August, but officials say they hope to bring the current outbreak under control. ing.

"Community outbreaks are occurring. Public health officials are working around the clock to contain the outbreak, but they say they expect these numbers to continue to rise." is important," said CDC's Jennifer McKiston.

said at a webinar hosted by the American Medical Association on July 14, but as of July 18, had more than 13,000 cases worldwide., and some experts are skeptical that public health officials will be able to stem the spread of the virus. 

"At this point, I don't think we have been able to contain this. Former FDA Commissioner Scott Gottlieb said in "Face the Nation" on July 17

. Don't be surprised that there are thousands of cases now," Gottlieb later added.

Alexander Ting

CBS News A reporter covering public health and pandemics.

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