Although the trajectory of the spread of monkeypox in the United States remains uncertain, we know that the virus is unlikely to behave like other more contagious germs, such as the coronavirus.
“Monkeypox will never have the explosive spread that the coronavirus has had,” Dr. David Freedman, president-elect of the American Society of Tropical Medicine and Hygiene, told BuzzFeed News. It is a zoonotic disease, so it is more common for people to get sick from coming into contact with infected animals. (People can also transmit the virus to animals.)
Although person-to-person transmission can occur through prolonged face-to-face contact with large respiratory droplets, spread primarily involves direct contact with broken skin, bodily fluids, or contaminated materials such as bedding.
“You could see clusters of cases in some areas, especially if people don’t take precautions and regularly touch each other in health care settings,” Freedman said.
All of this means that the vaccination strategy to contain monkeypox infections will require a “different approach”, Freedman said.
An effective method of suppressing outbreaks of monkeypox is “ring vaccination“, Freedman said. The strategy was used to eradicate smallpox in the 20th century by sending out a kind of SWAT team to quickly vaccinate all primary and secondary close contacts of confirmed smallpox patients.
“It’s like putting a ring around the infected person,” Freedman said, adding that this approach would work well for controlling monkeypox infections because of the telltale symptoms of the virus.
CDC officials said the United States was not using the ring vaccination strategy at a Monday news conference, but was taking similar steps by vaccinating contacts of confirmed cases if they come into a high-risk category.
“The good thing about this is that unlike COVID, which can look like many different diseases and be transmitted asymptomatically… the only people who transmit monkeypox are those who have lesions,” Freedman said. (WHO says “the extent to which asymptomatic infection may occur is unknown.”)
“You can isolate them and do a ring vaccination and be fairly certain that only people they have been in contact with are suspect because they wouldn’t have been contagious before they developed skin lesions,” he said. he declares.
The CDC suggests that eligible people receive the monkeypox vaccine within four days of exposure to prevent disease development, but the sooner the better. If a person who has been exposed gets vaccinated between four and 14 days after exposure, they will likely still develop the disease but will be protected against severe symptoms.
Monkeypox infections usually go away on their own without treatment, although you can treat the symptoms. There are no drugs developed specifically to combat the monkeypox virus, but there are three treatments – cidofovir, ST-246 and anti-vaccine immunoglobulin – which can be used to treat it in emergency scenarios.
There is an antiviral drug called TPOXX (tecovirimat), which has been approved for the smallpox treatment in 2018, but it is not approved for use in patients with monkeypox in the United States. (It’s in Europe.)
Is the United States ready to vaccinate people against monkeypox if needed?
The United States already has doses of Jynneos in its strategic national stockpile, a supply of life-saving medical supplies and drugs for use in public health emergencies, according to the FDA.
The CDC said the national stockpile contains more than 1,000 available doses of the Jynneos vaccine, which the United States says will increase over time, and more than 100 million doses of the ACAM2000 vaccine.
Health officials said they plan to maximize distribution of the vaccine to those they know will benefit, including healthcare workers, people with known contacts of the virus and people with high risk of serious illness. The agency said a request to release doses of the Jynneos vaccine from the national stockpile “is actively underway.”
Bavarian Nordic, the biotech company that developed Jynneos, said last week that the The United States purchased $119 million worth of its monkeypox vaccine in freeze-dried form. The first doses of this version of the vaccine, which have a longer shelf life, will be manufactured and delivered from next year.
The announcement was “completely coincidental,” a company spokesperson told BuzzFeed News via email, adding that the purchase was based on a contract 2017 “several years of preparation” and unrelated to the current spread of monkeypox.
But how easily the monkeypox vaccine could be given if new cases emerge in the United States remains unclear because the CDC has yet to officially release its recommendations on who should receive it and when, Freedman and Weber said. .
In November, the CDC’s Advisory Committee on Immunization Practices voted to recommend Jynneos vaccine for people at “occupational risk of orthopoxvirus”, including laboratory workers, those who administer the smallpox vaccine, and people caring for patients infected with orthopoxviruses. The recommendations also state that these individuals should receive a booster every two years.
Freedman said the CDC generally doesn’t like to greenlight the release of vaccines from the national stockpile unless there are published recommendations from the ACIP.
During Monday’s briefing, the CDC said it was working to develop recommendations to ensure vaccines are available to those who need them.
“It’s a technicality, but that’s the way it is,” Freedman said. The last time the CDC published recommendations for orthopoxviruses That was six years ago, when a vaccine was not yet licensed for monkeypox, he said, “so they couldn’t consider an indication of monkeypox.”
Weber said the ACIP could theoretically formalize its recommendations at any time. But as a doctor, he said, he would still need FDA approval before writing a prescription for the Jynneos vaccine to treat a patient with monkeypox right now.
Officials in the UK have already said vaccination is offered to high-risk contacts of infected people, the WHO said last week.
“I expect that shortly we will start getting advice on these issues,” Weber said.