Should the U.S. Give Out More Monkeypox Vaccine for Party Season?

As monkeypox cases increase around the world, the Biden administration is ramping up its ability to deploy thousands – or possibly millions of doses of vaccine to combat what has quickly become an outbreak. The biggest virus outbreak in history. But early indicators that make it difficult for high-risk groups could mean guidelines governing who is eligible for those vaccines may need to change.

On Monday, the Department of Health and Human Services directed the maker of the latest vaccine for the virus to distribute 36,000 doses from a US stockpile in Europe. Once delivered, the Centers for Disease Control and Prevention will be able to distribute them to dozens of states where rare disease cases has been confirmed since mid-May.

The swift request for tens of thousands of doses of the vaccine came as the number of known domestic cases reached 31 on Monday, According to CDC, part of a pair of outbreaks that have seen more than a thousand cases in nearly three dozen countries. The request, as well as the prompt release of guidance on who should receive doses of the vaccine, suggests some lessons have been learned from early mistakes in the response, public health experts said. The COVID-19 pandemic has been put into practice.

But with some super-popularity related to LGBT venues and events in Europe, some public health experts are hoping for a more positive view of who should be able to receive the vaccine — although no public health expert has called for a strategic COVID-esque mass vaccination.

“I applaud the Biden administration for securing additional doses of vaccine, but it needs a more rigorous strategy to identify cases and close contacts, as well as to identify individuals or Which populations should be vaccinated,” said Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at the Georgetown Law Center. “I am very worried that we will see an increase in cases, especially in high-risk groups like men who have sex with men. I also worry that we are repeating the mistakes of the AIDS epidemic by stigmatizing these communities and promoting them underground.”

The monkeypox virus – despite its name, mainly affects rodents – has previously been largely confined to Central and West African communities, although an outbreak in the US in 2003 has spread infected more than 40 people after the virus found reservoir in prairie dogs in the southwestern United States. . But this most recent outbreak is the widest in the known history of the virus, with more than a thousand confirmed cases as of Tuesday, largely in Western Europe and the United States.

Monkeypox is no different from chickenpox and smallpox, with symptoms including fever, headache, and soreness, as well as swollen lymph nodes, which eventually lead to fluid-filled lesions that can leave behind. permanent scars. All of those who became ill during the most recent outbreak have recovered, but the long-term side effects of the disease are still poorly understood.

Dr Raj Panjabi, White House Senior Director of Global Health Security and Biosecurity, told reporters on a call on Friday. “An outbreak of monkeypox of this size and scope worldwide, it has never been seen before.”

Although President Joe Biden called the outbreak “something everyone should be worried about” on May 22, he has since sought to allay concerns about the virus, especially for those America is suffering from pandemic anxiety about another virus.

“I just don’t think it rises to the level of the kind of concern that exists with COVID-19,” Biden told reporters last month. “But I think people should be careful.”

A spokesperson for HHS declined to comment on the filing, but noted that the request to increase vaccination doses from the US stockpile is intended to give public health agencies the ability to respond to any demand. in the future, instead of responding to any expected increase in .

“We will continue to work with jurisdictions to support their response,” said Dawn O’Conell, HHS assistant secretary for preparedness and response, wrote in a blog post announced vaccine guidelines on Monday. “However, at this time, we do not anticipate the need for widespread, mass deployment of vaccines and treatments.

If there is such a need, the US has a huge stockpile of vaccines, currently stored in Europe.

“Actually, about 1.5 million doses have been produced,” says Freedman. “They come in unique, FDA-approved, ready-to-use vials.”

The 36,000 doses requested by HHS on Monday will come from that stock, and will be distributed by the CDC to state health agencies.

Previous outbreaks outside Central and West Africa have mainly been limited to zoonotic transmission of the disease — that is, direct animal-to-human transmission. But the current outbreaks seem to have spread from person to personRapid implementation of a vaccination strategy is of critical importance to prevent this disease from becoming endemic in new human populations.

“Based on what we have seen so far, it is unlikely that there is a need for a strategy for mass vaccination of the general population — thoughts now are to continue with the so-called ‘vaccination’ strategy round’,” said Dr. David Freedman, professor emeritus of infectious diseases at the University of Alabama and expert in tropical diseases. they’re exposed for seven days or 14 days before they actually get sick, and then vaccinate those people.”

Effectively, Freedman said, “you’re vaccinating a circle around those people to stop the virus from spreading.”

However, the ring can be quite extensive, including not only close physical contacts such as family members, roommates and sexual partners, but also medical personnel tasked with treating these conditions. confirmed case.

But while infectious disease experts note that monkeypox is less contagious than smallpox, the virus involved was once a global scourge but was effectively extinct in the late 1970s. by a worldwide vaccination campaigna number of apparently super-spreading events in Europe – most of which are popular with transgender people and men who have sex with men – have raised concerns that this outbreak is more effective at transmission from person to person.

The Biden administration told The Daily Beast that the dose increase requested from the national stockpile — about 1,200 of which has already been administered — has nothing to do with the expected increase in the outbreak. , or the possibility that guidance on who is eligible for these vaccines will change to include members of high-risk groups.

But as Pride Month begins rolling out in the United States, Freedman said, the CDC’s current guidance on who’s eligible to receive doses of the vaccine could be expanded, especially after “amplifying events,” said Freedman. era” evident in Europe – a sauna in Madrid, a rally in Antwerp, a Pride festival in the Canary Islands – is associated with a large number of cases of monkeypoxmany of them seem to be transmitted through sexual contact.

“If more such events come to light, it makes sense to say that if you attended this event, you would be eligible,” Freedman said.

The CDC hasn’t gone as far as some other national health organizations in highlighting the risk of monkeypox posed to men who have sex with men, but a new guideline has been published on “Transportation.” social distancing, safer sex, and monkeypox” includes recommendations for safer hives, parties, clubs, and festivals — as well as Clip art of waving rainbow flags at a parade. (Sample guidance: “A party, party or club where clothing is minimal and where direct, personal, frequent skin-to-skin contact presents some risks.”)

Tarik Jašarević, WHO spokesman, said the World Health Organization was still “finalizing adequate guidance to national authorities on the best approach to vaccination in the management of smallpox”. season in monkeys”.

However, the US guidelines were in effect. Currently, CDC guidelines for monkeypox vaccination call for dispensing doses for confirmed cases, as well as “circling” people who have had unprotected contact with skin or mucous membranes. or bodily fluids of a known case, as well as close enough physical proximity to the risk of infection by aerosolized saliva. That strategy is called post-exposure prophylaxis, or PEP. probably the best known as a course of treatment after possible exposure to human immunodeficiency virus.

That’s the level of eligibility for monkeypox vaccination so far, said Dave Daigle, deputy communications director for the CDC’s Office of Public Health Preparedness and Response.

“We’re not currently recommending a ‘second round’ – it’s a recommendation to vaccinate contact people,” Daigle said. “Until we know more, we will use the vaccine that is available to people who have been in close contact with known cases and who are most at risk of exposure through their work, like healthcare workers treating monkeypox patients.”

Dr. Timothy Brewer, professor of epidemiology at UCLA’s Fielding School of Public Health, notes that the “vaccination ring” strategy has been a successful tool in the fight against smallpox, reinforcing his argument. administration that targeted vaccination has been an effective tactic in fighting the outbreak to date.

“Case identification and vaccination of contacts are the methods WHO has used to eradicate smallpox, a virus more easily transmitted to humans than monkeypox,” Brewer said. “With success with smallpox, limiting vaccination to people who have direct contact with cases and individuals potentially infected with monkeypox because of their work is a sound initial strategy.” physical.”

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