Jul 14, 2022 - Science

"Unprecedented" spread of monkeypox spurs call for faster response

Total confirmed monkeypox cases, by state
Data: CDC; Chart: Erin Davis/Axios Visuals

The federal and state response to the escalating monkeypox outbreak is lacking access to enough vaccines, testing and treatments to keep up with the virus' spread, infectious disease experts are warning.

Why it matters: Public health officials are racing to halt the spread before the disease becomes endemic in more countries. Cases are rising quickly — New York City, for example, has seen a tripling in patients over the past week.

  • Globally, there are now more than 11,000 patients — with 336 in New York City alone — and "a lot of cases that are not being diagnosed," NYC Department of Health's Mary Foote said at a Thursday news briefing held by the Infectious Diseases Society of America.

The big picture: Some experts say this outbreak echoes the start of the HIV epidemic that also first appeared in communities of men who have sex with men (MSM), but NIAID director Anthony Fauci says there are "fundamental differences" from that traumatic time when there was an unknown agent killing patients rapidly.

  • While this outbreak of monkeypox outside endemic countries is "unprecedented" in its rate of human-to-human spread, the virus for monkeypox has been identified, isn't nearly as deadly, and there are potential vaccines and treatments already in existence, Fauci tells Axios.
  • "The challenge, now, is to obviously get a handle on the extent of this and the spread of this, and you do that by testing," Fauci says.
  • "The other challenge is to implement the countermeasures we already have. Like getting the vaccines to the people at risk and to make sure that we mobilize the vaccines we contracted to be made years ago," he adds.

The latest: The CDC has now partnered with five commercial firms to make testing more widely available, but there's concern it hasn't reacted quickly enough.

  • The FDA approved in 2019 the Jynneos vaccine for adults at high risk of monkeypox to Bavarian Nordic A/S, but there are not enough doses to distribute, Foote says. CDC press officer Scott Pauley says the CDC and HHS have delivered more than 41,000 doses of the vaccines as of July 7.
  • While there's an effective antiviral treatment called TPOXX, which is FDA-approved for smallpox, it's only available for use in certain monkeypox patients via an onerous 120-page protocol for expanded access to investigational new drugs, which is a big barrier to access, Foote says. (FDA declined to "confirm, deny or comment" to Axios on "potential/pending applications.")

"We're worried that this could become a treatment only accessible by patients with privilege or who are very savvy at navigating a very complicated system," Foote says.

  • "This is a call to action" that is hampered by the lack of a federal health care system, Lilian Abbo, professor of clinical infectious diseases at the University of Miami Miller School of Medicine, tells the IDSA briefing.

Between the lines: This strain has been affecting patients in unusual ways that include higher person-to-person transmission that sometimes leaves permanent damage, but a lower death rate than in endemic countries, Foote says.

  • "A lot of people with this infection are really suffering, and some actually may be at risk for permanent damage and scarring. We've seen many people with symptoms that are so severe, that they are unable to go to the bathroom, urinate or eat without excruciating pain."
  • Julie Swann, a public health researcher and professor at NC State University, tells Axios that researchers are looking into whether higher rates of syphilis in the MSM communities may play a role in the greater spread of monkeypox.

The CDC updated its guidance this week to warn everyone to take steps against infection, as "anyone who has been in close contact with someone who has monkeypox can get the illness," Pauley tells Axios.

  • They are urging everyone to "use appropriate infection prevention and control measures."
  • The virus is "not known to linger in the air and is not transmitted during short periods of shared airspace" although it can spread through respiratory secretions when people have close face-to-face contact.
  • Monkeypox mainly spreads through direct contact with an infected person's body fluids or sores, or with direct contact with materials that have touched body fluids or sores, such as clothing or linens.
  • "We continue to study other possible modes of transmission, such as through semen," Pauley added.

What's next: The WHO is expected to hold a meeting next week to determine if monkeypox should be declared a Public Health Emergency of International Concern (PHEIC), its highest alert.

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