Three burning questions about monkeypox: spread, vaccination, treatment

Monkeypox, once a relatively obscure virus endemic to Africa, has grown into a global threat, infecting more than 20,000 people in 75 countries and forcing the World Health Organization to declare a worldwide health emergency.

On Thursday, New York State and San Francisco declared a state of emergency. But even as the nationwide tally approaches 5,000 cases and experts warn that containment is slipping, federal health officials have not followed suit.

One reason: The virus, unlike the coronavirus, is a known enemy, officials say. Doctors understand how it spreads and there are already tests, vaccines and treatments.

But for scientists, the cumulative research presents a more complex and complex picture. The virus remains a mystery in some important respects, not exactly as researchers have observed during sporadic outbreaks in African countries.

Scientists are aiming to answer three questions in particular that will determine how quickly monkeypox can be stopped—if it can be stopped at all.

At the start of the outbreak, public health officials claimed that the virus was spread by airborne droplets from an infected person coughing or sneezing, or through close contact with festering skin lesions or bedding and other contaminated materials.

All of this was true. But that may not be the whole picture.

Over 99 percent Among the infected people are still men who contracted the virus through intimate contact with other men, according to the Centers for Disease Control and Prevention. As of July 25, only 13 women and two small children had been diagnosed with monkeypox.

Researchers found a virus in saliva, urine, feces and sperm. It is not clear whether these fluids can be contagious and, in particular, whether the virus can be transmitted during sexual intercourse by means other than close skin contact. But the distribution model so far, along sexual networks, has left researchers perplexed.

However, it is clear that monkeypox does not spread easily and has not yet spread to the rest of the population. The average person is not at risk, for example, through store-bought clothing or fleeting interaction with an infected person, as some social media posts suggest.

People without symptoms cannot spread monkeypox, according to the CDC. But at least one study virus detected in men who did not have any symptoms. The nature of the symptoms also dispersed compared to previous outbreaks.

In Africa, some people have become ill after touching infected animals, eating meat from wild animals, or using medicines made from animals. They often develop fever and body aches, followed by a characteristic rash, first on the face, hands and feet, and then all over the body. Infants and pregnant women appear to be at the highest risk for severe symptoms.

During an outbreak outside of Africa, many patients no fever or respiratory symptoms in general, and the rash is often limited to a few genital or rectal lesions that are easily make mistakes with various sexually transmitted infections.

The UK has now changed its official description of monkeypox to include lesions in the mouth, as well as anal or rectal pain and bleeding. Some scientists suggest that manifestations of the disease in Western countries may accurately reflect the natural course of the virus.

Jynneos, the safer of the two monkeypox vaccines, is made by a small company called Bavarian Nordic in Denmark. Supplies were severely limited, and the Biden administration moving slowly for additional doses as the virus spreads.

Now federal officials have ordered almost seven million doses, which will arrive in batches over the coming months. The administration has sent about 320,000 doses to the states so far. The Food and Drug Administration said on Wednesday that it has approved 800,000 more doses, but it is unclear when they will be distributed.

Jynneos is supposed to be administered in two doses 28 days apart. But some cities, including Washington as well as New Yorkwithhold second doses until new ones become available, emulating the strategy adopted Britannia and Canada.

Federal health officials have advised against postponing second doses. But in studies A. single shot or Ginneos it seems protective for up to two years. If this conclusion is true in the real world, then delaying additional vaccinations could help authorities contain the outbreak by immunizing more Americans.

The UK suspended second doses of the Covid vaccine early in the pandemic when supplies were low, said Thinglong Dai, a vaccine supply expert at Johns Hopkins University. “The benefits of prioritizing the first doses outweigh the risks,” he said.

There may not be many choices as vaccination rights expand and more at-risk people seek vaccinations. Some jurisdictions have already expanded the groups eligible for immunization to include sex workers, patients in sexual health clinics, and doctors and other employees who may be exposed to the virus at work.

In Rhode Island, Emily Rogers, 29, a medical anthropologist, said she was able to call the local health department and make an appointment “very, very quickly.”

Mrs. Rogers was eligible for the vaccine because she sometimes has sex with men at high risk of contracting monkeypox. No one doubted her suitability. “They weren’t weird about it at all – it was a very smooth process,” she said.

Due to a shortage, the vaccine is only being offered as a preventative measure, although it may alleviate symptoms if given within a few days of infection.

David Baldwin, 45, a music professor in New York City, was only eligible for the vaccine because doctors didn’t believe he was already infected. (His initial symptom was rectal pain.) “As a result, I don’t think I ever had lesions on my body,” he said.

In 2018, the FDA approved a smallpox drug called tecovirimat, or TPOXX, based on evidence from animal studies. There are only limited data on its use in humans.

Supply is not a problem: the national stock contains about 1.7 million doses. However, the drug has been difficult to obtain, meaning that uncertainty about how well the drug works and for whom remains even as cases rise.

Because tecovirimat is not approved specifically for the treatment of monkeypox, it can only be prescribed through the burdensome “drug study protocol” that until recently required physicians to submit detailed reports to the CDC, a journal that patients keep to record their progress and photographs. defeat.

With so many barriers, many clinics didn’t offer tecovirimat at all; even doctors in well-funded institutions only managed to treat two or three patients a day.

On July 8, Nephi Niven Stogner, 39, sought help for symptoms of monkeypox. He was in excruciating pain and tried to get tecovirimat, but he was told that others were in more pain and needed him more.

While he was waiting for a cure in isolation, three new lesions appeared on his back. “Like your term is being extended,” he said.

mr. Stogner finally received his first dose on July 21st. Within 24 hours, his “lesions turned from swollen and red to flat dark spots,” he said.

Such delays have led the CDC to simplify the rules for accessing tecovirimat. The agency now requires fewer patient visits, samples and forms, and allows physicians to virtually assess patients’ conditions.

Wider use should mean that scientists and health officials will have a better idea of ​​the drug’s effectiveness. The new requirements will help the CDC “determine whether and how well this drug works for monkeypox patients,” agency spokeswoman Kristen Nordlund said.

The National Institute of Allergy and Infectious Diseases is planning a clinical trial of tecovirimat in adults with monkeypox infection, including people living with HIV, that could begin this fall. The agency is partnering with Siga Technologies, which makes the drug, in another trial in the Democratic Republic of the Congo, where the virus is a long-term scourge, also expected this fall.