29 Jun 2022

US begins major vaccine roll-out to combat spread of Monkeypox

We're not seeing a consistent global response to the emergence of this viral outbreak.

As cases of monkeypox virus surge in the U.S., the Biden administration will start distributing the monkeypox vaccine across the country, focusing on people most at risk and communities with the highest numbers of cases, White House officials announced Tuesday.
The U.S. Department of Health and Human Services will send 56,000 doses of the Jynneos vaccine immediately to areas with high transmission. An additional 240,000 doses will be distributed over the next few weeks, with even more to come this summer and fall. Officials expect to make at least 1.6 million doses available by the end of the fall.
States with the highest numbers of cases include California, New York, Illinois and Florida, as well as Washington, D.C., according to the latest count from the Centers for Disease Control and Prevention.   
Manhattan clinic overwhelmed by demand for monkeypox vaccines
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"We are recommending that vaccines be provided to both people with known monkeypox exposures who are contacted by public health and also to those people who’ve been recently exposed to monkeypox,” the CDC’s director, Dr. Rochelle Walensky, said at a news briefing Tuesday. 
The CDC is prioritizing initial access to the vaccine for people who have been in close contact, including sexual contact, with someone who has diagnosed with the virus. The agency will also provide vaccines to men who have sex with men who report having had multiple recent sex partners at a venue or party where the virus is known to have spread, or who have had sex with multiple partners in an area of the country with elevated spread. 
The vast majority of confirmed monkeypox cases, both in the U.S. and in the global outbreak as a whole, have been among men who have sex with men.
While case numbers continue to rise in the U.S., the White House Covid-19 coordinator, Dr. Ashish Jha, seemed hopeful the U.S. could contain the outbreak and said it was important to remain vigilant.
“Monkeypox is not novel,” Jha said at the briefing. “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.”
The U.S. monkeypox outbreak was first detected in Massachusetts in May, after a person who had been traveling tested positive. Since then, the virus has been spreading around the country, with more than 306 cases in 28 states, according to the CDC. But because of limitations with testing for the virus, it’s likely the U.S. is significantly undercounting the numbers of infections, experts say. 
“We’ve already lost control of this outbreak,” said David Harvey, the executive director of the National Coalition of STD Directors. “We think there’s many more cases, and we need to act now to get control of this outbreak.”
New York City and Washington, D.C., were among the first cities to begin vaccinating at-risk groups for monkeypox, including men who have sex with men reporting multiple partners or at least one anonymous partner within 14 days. With just 1,000 doses from the CDC to distribute at one clinic, New York, which began administering shots on June 23, quickly ran out.
It was a similar situation in Washington, where health officials announced Monday that they would also start vaccinating at-risk groups. The 300 available appointments were taken in less than an hour after the online booking system went live.
Number of monkeypox patients are gay and bi-sexual men
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The Biden administration's vaccine strategy is welcome, but questions remain about how the doses will make it to "those most at-risk in an equitable way," NCSD's Harvey said in a statement after the briefing.
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The two-dose Jynneos vaccine, which is approved by the Food and Drug Administration, not only prevents infection, but it can also be used to stop an infection after a person is exposed. Walensky said that people should get vaccinated within two weeks of exposure but that the vaccine works better the sooner it’s given. The doses are given 28 days apart.
An older vaccine that is FDA-approved for smallpox but also protects against monkeypox is also available, but it isn’t recommended because it can’t be given to anyone who is immunocompromised, or people with HIV.
The virus is marked by a rash that looks like pimples or blisters, along with symptoms like fever, headache, muscle aches, swollen lymph nodes and chills. Symptoms typically begin seven to 14 days after exposure, but they may start earlier or as late as 21 days after exposure. 
In the current outbreak, the monkeypox virus is being spread primarily through intimate contact, including sex and prolonged face-to-face interactions, Dr. Jennifer McQuiston, the deputy director of the CDC’s High Consequence Pathogens and Pathology Division, said at the briefing.
Can monkeypox outbreak be stopped?
Epidemiologists who have studied monkeypox are concerned that the CDC’s numbers don’t reflect the true scope of the outbreak and that the U.S. may be reacting too slowly to stop case numbers from escalating. 
“I am quite concerned that given how hard it still is for people to get tested and how difficult it may be for clinicians to recognize who is infected that our official tally of monkeypox cases is a significant undercount of the true number of infections,” said Jennifer Nuzzo, the director of the pandemic center and a professor of epidemiology at Brown University in Providence, Rhode Island. “We urgently need to increase access to testing, vaccines and therapeutic drugs.” 
Walensky said Tuesday that public health and commercial labs can process up to 10,000 tests a week and that HHS plans even more. One challenge is that there is no rapid test yet similar to what is used to diagnose Covid. 
WHO warns monkeypox must be contained before it becomes global issue
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Even with delays in testing, epidemiologist Anne W. Rimoin, the director of the UCLA Center for Global and Immigrant Health, said it’s not too late to bring the outbreak under control. 
“We have the ability to bring this under control using the public health tools needed- including case identification, contact tracing and testing,” Rimoin said in an email. "We need rapid scale up of diagnostics that are widely available to be able to have good situational awareness of where we truly are in terms of case numbers.” 
There are at least 4,700 confirmed cases of monkeypox in 49 countries, Walensky said. The World Health Organization said Saturday that monkeypox didn't yet constitute a global health emergency, but Director-General Tedros Adhanom Ghebreyesus said in a statement that there were serious concerns about the "scale and speed of the current outbreak."

We're seeing different responses from different governments in relation to the community transmission of a strain of the Monkeypox virus.

In the US, the government is pursuing a vaccine-led response - targetting the most at-risk communities and those with the highest number of cases.

Following announcements by the Biden administration, the US Department of Health and Human Services will send 56,000 doses of the Jynneos vaccine immediately to areas with high transmission. An additional 240,000 doses will be distributed over the next few weeks, with even more to come in the following months. Officials expect to make at least 1.6 million doses available by the end of the Autumn.

States with the highest numbers of cases include California, New York, Illinois and Florida, as well as Washington, D.C., according to the latest count from the Centers for Disease Control and Prevention.   

"We are recommending that vaccines be provided to both people with known monkeypox exposures who are contacted by public health and also to those people who’ve been recently exposed to monkeypox,” the CDC’s director, Dr. Rochelle Walensky, said at a news briefing Tuesday. 

The CDC is prioritising initial access to the vaccine for people who have been in close contact, including sexual contact, with someone who has diagnosed with the virus. The agency will also provide vaccines to men who have sex with men who report having had multiple recent sex partners at a venue or party where the virus is known to have spread, or who have had sex with multiple partners in an area of the country with elevated spread. 

The vast majority of confirmed monkeypox cases, both in the US and in the global outbreak as a whole, have been among men who have sex with men. There are a number of factors that could be centring detection around gay men - most importantly, gay men are regularly testing for STIs so are more likely to detect the presence of the Monkeypox virus.

While case numbers continue to rise in the US, the White House Covid-19 coordinator, Dr. Ashish Jha, seemed hopeful the U.S. could contain the outbreak and said it was important to remain vigilant.

“Monkeypox is not novel,” Jha said at the briefing. “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.”

Official statistics put the number of confirmed cases of Monkeypox in the US as around 300. However, it's accepted that this likely to be a significant undercount of the actual incidence of the virus.

“We’ve already lost control of this outbreak,” said David Harvey, the executive director of the National Coalition of STD Directors. “We think there’s many more cases, and we need to act now to get control of this outbreak.”

The two-dose Jynneos vaccine, which is approved by the Food and Drug Administration, not only prevents infection, but it can also be used to stop an infection after a person is exposed. Walensky said that people should get vaccinated within two weeks of exposure but that the vaccine works better the sooner it’s given. The doses are given 28 days apart.

An older vaccine that is FDA-approved for smallpox but also protects against monkeypox is also available, but it isn’t recommended because it can’t be given to anyone who is immunocompromised, or people with HIV.

The virus is marked by a rash that looks like pimples or blisters, along with symptoms like fever, headache, muscle aches, swollen lymph nodes and chills. Symptoms typically begin seven to 14 days after exposure, but they may start earlier or as late as 21 days after exposure. 

In the current outbreak, the monkeypox virus is being spread primarily through intimate contact, including sex and prolonged face-to-face interactions, Dr. Jennifer McQuiston, the deputy director of the CDC’s High Consequence Pathogens and Pathology Division, said at the briefing.

Epidemiologists who have studied monkeypox are concerned that the CDC’s numbers don’t reflect the true scope of the outbreak and that the US may be reacting too slowly to stop case numbers from escalating. 

I'm not a doctor. I've got the white coat for role-plays, obviously, but there's a lot of people who are a lot more qualified than I am who you should be listening to when it comes to your health.
Make sure you're getting your updates and insights from experts who are informed and know what they're talking about.
But one of the things that is on our radar is a small outbreak of Monkeypox.
There is currently a small outbreak of Monkeypox - around 40 identified cases. Cases have been detected in the UK, Spain, and Portugal.
What's interesting is that transmission seems to be happening during sexual contact, and the cases identified so far seem to be in men who have sex with men.
What is Monkeypox?
The name "monkeypox" comes from the first documented cases of the illness, in 1958, when two outbreaks occurred in colonies of monkeys kept for research.
But monkeys aren't major carriers. Instead, the virus is generally spread by squirrels, pouched rats, dormice or another rodent.
How do you catch Monkeypox?
Primarily, from an animal bite, scratch or contact with the animal's bodily fluid. Then the virus can spread to other people through coughing and sneezing or contact with pus from the lesions.
The lesions from monkeypox are similar to those from a smallpox infection.
It's previously been thought that transmission of Monkeypox between people was a very low risk.
But, now it is transmitting between people, which is something that health experts are keeping a close eye on.
How dangerous is Monkeypox?
Monkeypox can be a nasty illness - it causes fever, body aches, enlarged lymph nodes and, eventually, painful, fluid-filled blisters on the face, hands and feet. One version of monkeypox is quite deadly and kills up to 10% of people infected. The version currently being detected from this UK cluster is milder. Its fatality rate is less than 1%. A case generally resolves in two to four weeks.
What should I do if I think I might have been exposed to Monkeypox?
If you notice any unusual rashes or lesions, and you think you might have been exposed to the virus through sexual contact, then contact your local sexual health service for advice.

What is Monkeypox?

The name "monkeypox" comes from the first documented cases of the illness, in 1958, when two outbreaks occurred in colonies of monkeys kept for research.

But monkeys aren't major carriers. Instead, the virus is generally spread by squirrels, pouched rats, dormice or another rodent.

How do you catch Monkeypox?

Primarily, from an animal bite, scratch or contact with the animal's bodily fluid. Then the virus can spread to other people through coughing and sneezing or contact with pus from the lesions.

The lesions from monkeypox are similar to those from a smallpox infection.

It's previously been thought that transmission of Monkeypox between people was a very low risk.

But, now it is transmitting between people, which is something that health experts are keeping a close eye on.

How dangerous is Monkeypox?

Monkeypox can be a nasty illness - it causes fever, body aches, enlarged lymph nodes and, eventually, painful, fluid-filled blisters on the face, hands and feet. One version of monkeypox is quite deadly and kills up to 10% of people infected. The version currently spreading around the world is milder. Its fatality rate is less than 1%. A case generally resolves in two to four weeks.

What should I do if I think I might have been exposed to Monkeypox?

If you notice any unusual rashes or lesions, and you think you might have been exposed to the virus through sexual contact, then contact your local sexual health service for advice.