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CDC sends monkeypox vaccines to people at high risk in race to prevent spread

This illustration, taken on May 23, 2022, shows test tubes labeled “Positive and Negative Monkeypox Virus”.

Dado Ruvic | Reuters

The Biden administration has distributed 1,200 doses of monkeypox vaccine to people exposed to the high-risk virus as part of a nationwide public health effort to eradicate the disease before it causes a major outbreak.

US health officials, concerned that the virus is spreading faster than previously thought, said the global monkeypox outbreak is the largest on record. The World Health Organization said on Wednesday that there are now more than 550 cases in 30 countries. In the US, there have been at least 20 confirmed or suspected cases in 11 states, including California, Colorado, Florida, Georgia, Illinois, Massachusetts, New York, Pennsylvania, Virginia, Utah and Washington state. according to the Centers for Disease Control and Prevention.

“A monkeypox outbreak of this magnitude and scope around the world has never been seen before,” Dr. Raj Punjabi, who heads the White House pandemic preparedness office, told reporters last week.

However, CDC officials have been keen to reassure the public that the emergence of monkeypox in the US is very different from the Covid-19 that blinded the country two years ago. Scientists knew little about Covid when it first appeared, and in 2020 there were no vaccines or antivirals in the US to fight the virus.

Monkeypox, on the other hand, has been known to scientists since 1958, when the virus was first identified during outbreaks in monkeys kept for research purposes, and its transmission to humans has been studied since the 1970s. Global health authorities also have a long track record of successfully controlling smallpox, which was declared eradicated by the World Health Organization in 1980 following a successful global vaccination effort. Monkeypox belongs to the same family of viruses as smallpox, although it is much milder.

Vaccine Stockpiling

CDC director Dr. Rochelle Walensky told reporters last week that the US has been preparing for decades for a monkeypox outbreak. The US has millions of doses of vaccine in a strategic national stockpile that protect against monkeypox and smallpox, as well as antiviral pills to treat disease.

Dawn O’Connell, who heads the Health and Human Services Administration responsible for the strategic national stockpile, said on Friday that enough vaccine is available in the US to deal with the current monkeypox outbreak. However, O’Connell did not disclose how many shots the US had at the ready.

There are two vaccines in the US, but the preferred option is in short supply. Jynneos is a two-dose vaccine approved by the FDA in 2019 for the prevention of monkeypox in people 18 years of age and older. The CDC generally recommends Jynneos over another option, ACAM2000, which is an older generation smallpox vaccine that can have serious side effects.

Last week, CDC spokesperson Dr. Jennifer McQuiston said there were 1,000 doses of Jynneos in the US. However, the Danish biotech company that makes the injections Bavarian Nordic said it actually has more than 1 million frozen doses of Jynneos in the US, stored in the US and Denmark on an order placed in April 2020. The expiration date of vaccinations is three years.

The US has ordered about 30 million doses of Jynneos since 2010, but 28 million of them are overdue, the spokesman said. Bavarian Nordic plans to ramp up production this summer and has the capacity to produce 30 million rounds a year, a spokesman said.

The US government also has a stockpile of more than 100 million doses of ACAM2000 manufactured by Emergent BioSolutions, McQuiston told reporters last week. As of Tuesday, the US has released 500 doses of Jynneos and 200 doses of ACAM2000, according to the CDC. The US has also sent 100 courses of the oral antiviral tecovirimat to the states, health officials said Friday.

“We want people at high risk of infection to have quick access to vaccines and, if they get sick, to be able to receive appropriate treatment,” Punjabi said in a telephone conversation with reporters on Friday. Jynneos and ACAM2000 can be administered before or after exposure to the virus. However, patients must receive the vaccine within 4 days of exposure to prevent the onset of the disease.

According to Mike Slifka, an immunologist at the Oregon Health and Science University who has studied monkeypox, ACAM2000 has demonstrated high levels of protection against monkeypox in animal models and is expected to provide 85% protection against the virus, similar to earlier versions of smallpox vaccines. . Less is known about Jynneos because the vaccine is newer, but it produces reasonable levels of antibodies in humans and should protect against severe illness, Slifka said.

Side effects

The CDC generally recommends Jynneos over ACAM2000 as it is considered more secure. ACAM2000 could have serious side effects, and wide distribution of the vaccine would require serious discussion, McQuiston told reporters last week. ACAM2000 uses a weak strain of a virus from the same family as monkeypox and smallpox that can still replicate, meaning that there is a risk that the live virus in the vaccine could spread to humans or to other people.

ACAM2000 is injected with a two-pronged needle that is scratched into the upper arm, after which the virus turns into a local infection in the form of a blister. The patient could potentially transmit the virus to other people or other parts of the body if, for example, they scratched a blister and then rubbed their eyes, which could damage their eyesight. The FDA warns that it is very important for people vaccinated with ACAM2000 to take proper care of the vaccination site so that they do not transmit the virus to other people or other parts of the body.

CDC warning

CDC said women who are pregnant or breastfeeding, people with weak immune systems, people with skin conditions such as eczema or atopic dermatitis, and people with heart disease should not take ACAM2000. In pregnant women, the virus can spread to the fetus and cause stillbirth. People with weak immune systems face the risk that the virus will grow out of control and cause a dangerous infection, Slifka said. People with skin conditions like eczema or atopic dermatitis are also at risk of spreading the virus on their skin, which can turn into a life-threatening infection, he said.

The Jynneos vaccine, on the other hand, does not come with these risks, Slifka said, because it uses a strain of the virus that is no longer capable of reproducing in humans. It is also given with a regular syringe, like other common shots such as the flu vaccine.

Given the potential side effects of ACAM2000, the vaccine is likely to see widespread use only in the context of a major smallpox epidemic because the virus is highly lethal, according to Dr. Peter Hotez, an infectious disease and vaccine expert at Baylor College of Medicine in the US. Texas. Monkeypox, on the other hand, is a much milder virus, and no deaths have been reported in recent cases in Europe and North America.

Mortality

According to the WHO, the mortality rate from smallpox can be as high as 30%. The West African strain of monkeypox that appears to be the cause of the current outbreak likely has a mortality rate of around 1%, although data is scarce as the virus previously spread mainly in remote parts of Africa. Most people recover within two to four weeks without special treatment, according to the CDC. There is another strain of monkeypox, Congo Basin, associated with a higher mortality rate of 3% to 10%, according to the WHO.

“We are very fortunate that the outbreak is directly linked to a low-virulence West African strain,” said Dr. Rachel Roper, a professor of microbiology and immunology at East Carolina University who has studied monkeypox.

While the US has far more tools and knowledge to fight monkeypox than it did against Covid in 2020, there is still much unknown about the current outbreak. It is unclear why the virus is now spreading to countries outside West and Central Africa where the virus is endemic. Historically, the virus has spread in small villages in Africa by moving from rodents that carry the virus to humans, with very little human-to-human transmission, Slifka said. However, now the virus seems to spread better between people, he said.

“Through intimate contact and skin-to-skin transmission, the virus is better transmitted than under other circumstances,” Slifka said.

Most monkeypox patients in the US traveled the world 21 days before symptoms began, McQuiston said, suggesting they caught the virus outside the country. The CDC does not believe that monkeypox is widespread in the US right now, but is monitoring the situation closely. To date, 120 tests have been conducted in the US for orthopoxvirus, a family that includes monkeypox.

Community Transfer

“There may be community transmission and that’s why we want to really step up our surveillance efforts,” McQuiston told reporters during a call on Friday. “We really want to convince the doctors that if they see a rash and are worried that it might be monkeypox, they should go and get it checked out,” she said.

WHO officials said on Wednesday that the outbreak of monkeypox in several countries in North America and Europe indicates that the virus is likely to be spreading undetected outside West and Central Africa for some time, although it is not clear for how long. Dr. Rosamund Lewis, who’s technical lead on monkeypox, said the virus may be spreading more now because immunity in the human population has weakened since smallpox vaccination was stopped after the disease was eradicated.

Lewis said the WHO does not recommend mass vaccination against monkeypox because the current outbreak can still be contained. According to the WHO, the majority of cases so far have been among men who have sex with men who developed symptoms and sought help from sexual health clinics. Lewis said it’s important to give gay and bisexual men the information they need to protect themselves from the virus and prevent it from spreading.

Symptoms

CDC reported people with confirmed or suspected monkeypox infection isolate at home until local or state health departments decide otherwise. People with confirmed infection should remain in isolation until the skin lesions characterizing the disease have completely disappeared, the scabs have fallen off, and a new layer of skin has formed.

Monkeypox usually begins with flu-like symptoms, including fever, headache, muscle aches, chills, exhaustion, and swollen lymph nodes. Lesions then form on the body, and the virus spreads mainly through skin contact with these lesions. Monkeypox can be spread through the air if a person has lesions in the throat or mouth, but it is not easily transmitted this way.

People get monkeypox Follow up for 21 days for symptoms, according to the CDC. They should check their temperature twice a day and watch for chills, swollen lymph nodes, and a new skin rash. If a person develops a fever or rash, they should self-isolate and contact their local health department immediately.


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