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CDC is sending monkeypox vaccine to people at high risk in a race to stop the spread

In the illustration taken May 23, 2022, test tubes are labeled “negative and positive for monkeypox virus”.

Dado Ruvic | Reuters

The Biden administration has distributed 1,200 doses of monkeypox vaccine to people at risk of exposure to the virus, part of a nationwide public health drive to contain the outbreak before a major outbreak.

US health officials, fears the virus is spreading faster than previously thought, and says the global outbreak of monkeypox is the largest ever. The World Health Organization said on Wednesday that there are now more than 550 cases across 30 countries. In the United States, at least 20 confirmed or suspected cases have been reported 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.

Dr Raj Panjabi, head of the White House’s pandemic preparedness office, told reporters last week.

Still, CDC officials have sought to reassure the public that the emergence of monkeypox in the US is vastly different from Covid-19, the disease that caused blindness in the country two years ago. Scientists knew very little about Covid when it first emerged, and the United States has no vaccine or antiviral treatment to fight the virus by 2020.

On the other hand, monkeypox has been known to scientists since 1958, when the virus was first identified in outbreaks in monkeys kept for research purposes, and the Its transmission in humans has been studied since the 1970s. Global health authorities also have extensive experience fighting smallpox successfully, which the World Health Organization declared to have eliminated in 1980. a successful global vaccination effort. Monkeypox belongs to the same family of viruses as smallpox, although the disease is much milder.

Stock up on vaccines

CDC Director Dr. Rochelle Walensky told reporters last week that the United States has been preparing for an outbreak from a virus like monkeypox for decades. The United States has millions of doses of vaccine in the strategic national stockpile to protect against monkeypox and smallpox, as well as antiviral drugs to treat the disease.

Dawn O’Connell, the head of the Health and Human Services office responsible for the strategic national stockpile, said Friday that the United States has enough vaccine to manage the current monkeypox epidemic. now. However, O’Connell would not disclose how many shots the US had at readiness.

The US has two vaccines, but the preferred option is a shorter supply. Jynneos is a two-dose vaccine approved by the FDA in 2019 to prevent 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 official Dr. Jennifer McQuiston said the United States had 1,000 doses of Jynneos available. However, the Danish biotech company that produced the photographs, Bavarian Nordicsays the US actually has a supply of more than 1 million doses of Jynneos frozen in stock in the US and Denmark on order in April 2020. The injections have a shelf life of three.

A spokesperson for the US has ordered nearly 30 million doses of Jynneos since 2010 but 28 million of them have expired. A spokesman for Bavarian Nordic plans to increase production this summer and has the capacity to produce 30 million photographs a year.

The US government also has a stockpile of more than 100 million doses of ACAM2000 Outstanding biological solution, McQuiston told reporters last week. The US released 500 doses of Jynneos and 200 doses of ACAM2000 on Tuesday, according to the CDC. The United States has also sent 100 courses of the oral antiviral drug tecovirimat to the states, health officials said Friday.

“We want to make sure that people at high risk of exposure have quick access to the vaccine, and if they get sick, they can get appropriate treatment,” Panjabi said on a call with reporters today. Friday. Jynneos and ACAM2000 can be used before or after exposure to the virus. However, patients need to be vaccinated within 4 days of exposure to prevent disease onset.

According to Mike Slifka, an immunologist at Oregon Health and Science University who has studied smallpox in monkeys, ACAM2000 has demonstrated a high degree of protection against smallpox in monkeys and is expected would provide 85% protection against disease from the virus similar to the smallpox vaccine versions. . Less is known about Jynneos because the vaccine is newer, but it produces reasonable amounts of antibodies in humans and may protect against serious illness, Slifka said.

Side Effects

The CDC generally recommends Jynneos instead of ACAM2000 because it is considered safer. McQuiston said in a call with reporters last week, ACAM2000 can have serious side effects and that widespread distribution of the vaccine will require a serious discussion. ACAM2000 uses a mild virus from the same family as monkeypox and smallpox that is still reproducible, meaning there is a risk that the live virus in the vaccine could spread within the body or to other people.

ACAM2000 is injected with a punctured two-pronged needle into the arm and the virus then develops into a localized infection in the form of a blister. Patients can potentially spread the virus to other people or other parts of their body if they scratch the blister and then rub their eyes, which can lead to vision damage. 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 spread the virus to other people or other parts of their body.

CDC Alert

The CDC said Women who are pregnant or breastfeeding, people with weakened immune systems, people with skin conditions such as eczema or atopic dermatitis, and people with heart conditions should not take ACAM2000. In pregnant women, the virus can spread to the fetus and cause stillbirth. People with weakened immune systems run the risk of the virus growing uncontrollably and causing dangerous infections, says Slifka. People with skin conditions like eczema or atopic dermatitis are also at risk for the virus to spread on their skin and possibly turn into a life-threatening infection, he said.

The Jynneos vaccine, on the other hand, is not associated with these risks because it uses a virus strain that is no longer able to replicate in humans, according to Slifka. It is also given with a normal syringe like other common injections such as the flu vaccine.

According to Dr. Peter Hotez, an infectious disease and vaccine specialist at Baylor College of Medicine, 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 rate

According to WHO, smallpox can have a mortality rate of up to 30%. The West African monkeypox strain that appears to be driving the current outbreak may have a mortality rate of around 1%, although data is sparse because the virus has previously spread mainly in regions of the world. far away in Africa. According to the CDC, most people recover within 2-4 weeks without specific medical treatment. According to the WHO, there is another strain of monkeypox, Congo Basin, which is associated with a 3% to 10% higher mortality rate.

Dr Rachel Roper, a professor of microbiology and immunology at East Carolina University who has studied smallpox in monkeys, said: “We were very fortunate that the outbreak was a West African strain. low virulence.

While the United States has more tools and knowledge to combat monkeypox than it does against Covid in 2020, much remains unknown about the current outbreak. It remains unclear why the virus is spreading in countries outside West and Central Africa, where the virus is endemic. Historically, the virus spread in small African villages by jumping from rodents that carried the virus to humans with little human-to-human transmission, Slifka said. However, the virus now appears to be spreading better among people, he said.

“Through intimate contact and skin-to-skin transmission, it transmits better than it would otherwise,” says Slifka.

According to McQuiston, most monkeypox patients in the US had traveled internationally within the 21 days before symptom onset, which suggests they had contracted the virus outside of the country. The CDC does not believe monkeypox is widespread in the United States right now but is closely monitoring the situation. To date, the United States has conducted 120 tests for orthopoxviruses, which include smallpox in monkeys.

Transmission Community

“There could be community-level transmission going on and that’s why we want to really ramp up our surveillance efforts,” McQuiston told reporters on Friday’s call. “We want to really encourage doctors that if they see a rash and are concerned that it could be monkeypox to go ahead and get tested,” she said.

WHO officials on Wednesday said the sudden emergence of monkeypox in many countries in North America and Europe suggests that the virus may have spread outside of West and Central Africa without being infected. detected for some time, although it is not clear how long. Dr Rosamund Lewis, WHO technical team leader on monkeypox, said the virus may be spreading more now because immunity in the population has weakened since the vaccination against smallpox. The season is stopped after the disease is eliminated.

Lewis said the WHO is not recommending mass vaccination against monkeypox because the current outbreak can still be contained. According to the WHO, most cases to date have been reported in men who have sex with men, develop symptoms, and seek sexual health care. 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.

Symptom

CDC told people with confirmed or suspected monkeypox infections to isolate at home until further notice by the state or local health department. People with confirmed infection should be isolated until the skin lesions characteristic of the disease have completely resolved, the scabs have peeled 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 is spread primarily through skin-to-skin contact with these lesions. Monkeypox can be spread through respiratory droplets if a person has lesions in the throat or mouth, but it is not transmitted easily this way.

People exposure to monkeypox should watch for symptoms for 21 days, according to the CDC. They should check their temperature twice daily and watch for chills, swollen lymph nodes, and new skin rashes. If you have a fever or rash, you should self-isolate and contact your local health department immediately.

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