Three pressing questions about monkeypox: Spread, Vaccination, Treatment

Monkeypox, once a relatively unknown virus in Africa, has become 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 their own states of emergency. But even as the national tally approaches 5,000 cases and experts warn that containment is dwindling, federal health officials have not followed through.

One reason: This virus — unlike the coronavirus — is a known enemy, officials said. Doctors understand how it spreads and have tests, vaccines and treatments in place.

But for scientists, the cumulative research presents a more complex and challenging picture. In some important ways, the virus remains a mystery, not working exactly in the ways that researchers have seen in sporadic outbreaks in African countries.

Scientists are racing to answer three specific questions that will determine how quickly monkeypox can be stopped – if it can be stopped.

How exactly is the virus spread?

At the beginning of the outbreak, health officials asserted that the virus was spread through respiratory droplets emitted when an infected person coughs or sneezes, and through close contact with purulent skin lesions or blankets. bedding and other contaminated materials.

All of that is true. But it may not be the whole picture.

More than 99 percent Among those infected so far are men who contracted the virus through intimate contact with other men, according to the Centers for Disease Control and Prevention. Only 13 women and two young children had been diagnosed with monkeypox as of July 25.

Researchers have virus found in saliva, urine, feces and sperm. It is not yet clear whether those fluids are contagious, and in particular whether the virus can be transmitted during sex by means other than skin-to-skin contact. But the pattern of contagion so far, along sexual networks, has puzzled researchers.

However, it is clear that monkeypox is not contagious and has not yet spread to the rest of the population. For example, the average person is not at risk from store-bought clothing or from a fleeting interaction with an infected person, as some social media posts have suggested.

According to the CDC, people without symptoms cannot spread smallpox in monkeys. But at least one study has detect virus in men who did not experience any symptoms. Pattern of symptoms was also different since then observed in previous outbreaks.

In Africa, some people get sick after touching infected animals, eating wild boar, or using medicinal products made from animals. They often develop fever and body aches, followed by a characteristic rash first on the face, palms, and feet, and then all over the body. Infants and pregnant women appear to be most at risk for severe symptoms.

During the outbreak outside Africa, many patients don’t have a fever or respiratory symptoms, and the rash is usually limited to a few lesions in the genital or rectal area, which can easily made a mistake for various sexually transmitted infections.

He has now revised his official description of monkeypox to include oral lesions, pain, and anal or rectal bleeding. Some scientists have speculated that the manifestation of the disease in Western countries may accurately reflect the natural course of the virus.

Is one dose of vaccine enough?

Jynneos, the safer of the two monkeypox vaccines, is manufactured by Bavarian Nordic, a small Danish company. Supplies have been severely limited, and the Biden administration move slowly to get additional doses as the virus spreads.

Currently, federal officials have ordered nearly seven million doses of the drug, which will arrive in batches over the coming months. To date, the administration has shipped about 320,000 doses to the states. The Food and Drug Administration said Wednesday that it has approved another 800,000 doses, but it is unclear when they will be distributed.

Jynneos was supposed to be given two doses 28 days apart. But some cities, including Washington and New York Cityis withholding a second dose until more are available, simulating a strategy adopted by England and Canada.

Federal health officials have advised against delaying the second dose. But in studies, a one shot Jynneos’s seems to be guard for up to two years. If that finding holds true in the real world, postponing additional shots could help officials contain the outbreak by immunizing more Americans.

Tinglong Dai, a vaccine supply expert at Johns Hopkins University, said Britain prevented a second dose of the Covid vaccine during the early stages of the pandemic, when supplies were low. “The benefits of prioritizing the first dose outweigh the risks,” he said.

There may not be much choice as eligibility expands and more at-risk people seek out the shots. Some jurisdictions have expanded eligible groups for vaccination to include sex workers, patients of sexual health clinics, clinicians, and other employees who may be exposed to the virus. at the workplace.

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

Ms. Rogers is eligible for the shot because she sometimes has sex with men who are at high risk for monkeypox. No one questioned her status. “They’re no stranger to it – it’s been a very smooth process,” she said.

Due to shortages, the vaccine is offered only as a precaution, although it can relieve symptoms if given within a few days of exposure.

David Baldwin, 45, a music professor in New York, was eligible for the shot only because doctors didn’t believe he had been infected. (His initial symptom was rectal pain.) “As a result, I think, I never developed lesions on my body,” he says.

How effective is drug treatment?

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

Supply is not an issue: The National Reserve has about 1.7 million doses. However, the drug is difficult to buy, and that means that ambiguity about how effective and effective the drug will be persists even as the number of cases increases.

Because tecovirimat is not specifically approved to treat monkeypox, it can only be prescribed through a cumbersome “drug investigation process” that, until recently, required doctors to submit detailed CDC reports, a journal maintained by patients to document their progress and images of lesions.

With so many barriers, many clinics did not offer tecovirimat; even doctors in well-funded facilities only treat two or three patients a day.

Nephi Niven Stogner, 39, sought help with monkeypox symptoms on July 8. He was in great pain and tried to take tecovirimat, but was told that others had sicker and need it more.

While he waited for the isolation medicine, three new wounds appeared on his back. “It’s like your sentence is being extended,” he said.

Mr. Stogner finally received his first dose on July 21. Within 24 hours, “his wounds ranged from swollen and red to flat, dark spots,” he said.

Such delays prompted the CDC to relax the rules for accessing tecovirimat. The agency now requires fewer patient visits, collects samples and forms, and allows doctors to assess patients virtually.

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

The National Institute of Allergy and Infectious Diseases is planning clinical trials of tecovirimat in adults infected with monkeypox, including those with HIV, possibly starting this fall. The agency is working with Siga Technologies, the company that makes the drug, on another trial in the Democratic Republic of the Congo, where the virus is a perennial scourge, which is also expected to begin in the summer. fall this year.