The Centers for Disease Control and Prevention has identified 21 cases of monkey pox in 11 states, and the number is expected to rise, officials said Friday.
Genetic analysis has revealed that most cases appear to be closely linked to the European outbreak, but both patients have versions of the virus that appeared to have evolved from a case of monkeypox identified in Texas last year.
Of the 17 patients with specific information from the agency, all were men who had sex with men; They traveled to 14 other countries in the three weeks before the onset of symptoms. Three patients were immunocompromised.
CDC researchers were unable to identify how a patient acquired the virus in an unnamed condition. This suggests that there is an ongoing community transmission in this situation and perhaps in others, Dr. Jennifer McQuiston of the CDC told reporters.
“We really want to step up our surveillance efforts,” he said.
Health officials have identified a total of about 400 contacts of 13 patients who are at risk of infection with the monkey. Identifying at-risk contacts will help determine what resources are needed for officials to sustain the occurrence.
To date, health care providers have provided about 1,200 vaccine doses and 100 treatment courses to eight states, Dr. Raj Panjabi, Director General of Global Health Security and Biosafety at the White House.
The number of Monkeypox has risen sharply this week, to nearly 800 cases as of Friday. The spread of the virus to at least 31 countries outside Africa, where it is endemic, has raised alarm among scientists and public health officials.
Health officials in some countries are calling for anyone to test positive for monkey pox at home. The UK, which has the highest number of reported cases, has asked patients not to stop having sex until they have clarified their symptoms, limiting their use of condoms for eight weeks and limiting interactions with potentially contaminated pets and other animals.
As the outbreak spreads, health care providers around the world are rushing to collect vaccines and treatments to protect infected people and their close relationships. The options are very limited.
The United States is one of the few countries in the world that has accumulated millions of doses of smallpox and vaccines as a precaution to return. The monkey is closely related to the smallpox and is expected to be just as effective as vaccines and medicines.
In theory, at least two drugs and two types of vaccine are available to prevent a monkey outbreak, but most of them have been tested primarily on animals.
In a recent study of two drugs in seven patients, only one offered a benefit, while the other caused side effects.
The older of the two vaccine options was used to eliminate the smallpox and can cause serious side effects, including heart problems and death. Most doses have been stored for decades and may have lost their effectiveness.
The second vaccine, developed by the Danish company Nordic Bavarian, was approved by the Food and Drug Administration in 2019 to prevent smallpox and monkeypox. In the United States, called Jynneos, it is safer than previous vaccines, but the supply is even more limited.
Several countries, including Canada, the United Kingdom and France, have already started vaccinating people in close contact with infected people, and many others have applied to the Bavarian Nordic for additional supplies.
Several experts point out that African countries that have been fighting the monkey for years have had little access to such vaccines and treatments. So far this year, 44 cases have been reported in Nigeria and six other African countries where the virus is endemic, but these numbers are likely to be underestimated.
The outbreak of monkeys in Western countries may further restrict access to vaccines and treatments in poor countries, according to some experts. “Vaccines and treatments that are piling up elsewhere are not necessarily shared,” said Drs. Ifedayo Adetifa, Director of the Nigerian Centers for Disease Control.
In Switzerland, the World Health Organization maintains about 2.4 million doses of the vaccine used to eradicate the vaccine, and has accumulated another 31 million doses in five donor countries, which can be delivered to countries in need.
But the WHO only recommended vaccination to people at high risk of exposure, said Tarik Jašarević, a spokesman for the organization. Experts called by the WHO planned to review the guidelines in October, but “that timeline will need to be accelerated,” he said.
The WHO is also evaluating a newer Jynneos vaccine for prequalification, a step required for use in many countries.
The CDC’s scientific advisers voted in November to recommend Jynneos to immunize researchers and health care workers who are at risk of being bitten or stung by a monkey.
The U.S. Emergency Department has 100 million doses of an older vaccine called ACAM2000. But the vaccine contains the live vaccinia virus, which affects about six people in 1,000 people who receive myopericarditis – inflammation of the heart muscle.
ACAM2000 cannot be used in pregnant women, children or those who are immunocompromised, especially those who need the most protection from the monkey virus.
Jynneos, on the other hand, has been shown to be safe in older adults, people living with HIV or AIDS, and those who have had a bone marrow transplant, and therefore those who are immunocompromised.
There were 28 million doses of Jynneos in the U.S. warehouse, but all of those doses have expired, according to Bavarian Nordic CEO Paul Chaplin. Federal health officials have said about 1,000 doses of Jyneos are available, but the Bavarian Nordic has donated thousands more in recent weeks, Drs. Chaplin.
In all, the United States has about a million doses available, he said.
People infected with Monkeypox can be vaccinated just a few days after exposure. Baztanga, tecovirimat and brincidofovir can also be treated with one of the two approved medicines, which slow down the virus and gain time for the immune system.
What to know about the Monkeypox virus
What is monkeypox? Monkeypox is an endemic virus in some parts of Central and West Africa. Baztanga is similar, but not so severe. It was discovered in 1958 after appearances in monkeys kept for research, according to the Centers for Disease Control and Prevention.
The FDA has approved an oral form of tecovirimat, also called Tpoxx, for the treatment of smallpox in adults and children weighing at least 13 kilograms or 28.6 pounds, although the drug has never been tested in children.
The drug, made by New York-based company Siga Technologies, is taken twice a day for 14 days, and has not been shown to have a serious side effect beyond gastric symptoms.
The U.S. warehouse has 1.7 million courses of tecovirimat. On May 12, before the monkey’s appearance appeared, the Department of Defense sought another $ 7.5 million in drug courses, about half of which would be given this year.
“A significant number of countries have been asking for courses in medicine since the outbreak began,” said Dennis Hruby, a senior scientist at Siga. By the end of June, the company expects to distribute 190,000 treatment courses, he said.
The FDA worked with Siga to develop an internal formulation that was pending and approved it on May 19th. This version can be used in patients who cannot take oral medications because they have blisters in their mouth.
Health Canada, the country’s national health department, approved tecovirimat in 2020 and has purchased doses of $ 13 million, Dr. prudent. The European Medicines Agency also approved the drug in January to treat all orthopox viruses – a viral family that includes smallpox and monkey – but it was still in negotiations with the company when it appeared.
Tecovirimat and brincidofovir were both approved under the FDA’s Animal Standards, which allow the agency to rely on rodent or monkey data when it is unethical to test a drug on humans.
The second drug, brincidofovir, is made by Chimerix and seems to have more side effects, including the risk of death, to give the agency a so-called black box warning – its strictest warning – about the use of the drug.
In the latest study of the two drugs, brincidofovir “did not provide a credible clinical benefit,” the researchers reported. But the study was too small and the treatment regimens offered to patients were too diverse to draw conclusions about the effectiveness of the drugs, said David Evans, a University of Alberta virologist who consults Chimerix.
Those who are unable to take Tecovirimat or brincidofovir safely, such as those who are immunocompromised, may be given immunological therapy called immunoglobulin vaccinia, but only in limited quantities.
The United States is helping to develop a cocktail of monoclonal antibodies that can block the monkey virus. Several vaccines are also in the early stages of development, including some based on horsepox.
In the long run, the United States may have enough vaccines and medications to protect the entire population, including those who may be vaccinated in childhood, said Dr. Seth Lederman, CEO of Tonix, is developing a horsepox-based vaccine.
Several studies suggest that people who have been vaccinated against smallpox may be protected from serious illness, if not from infection. But even developing some lesions would be enough to spread the virus to others, Dr. Lederman stated.
“In the case of something similar to the monkey, I think the goal would be to keep people from getting injured,” he added.
The Tonix vaccine will not be available at this time. “Our approach will be to go slow and steady,” he said. “These problems will not go away.”