The Centers for Disease Control and Prevention has identified 21 monkeypox cases in 11 states and the number is expected to rise, officials reported Friday.
Genetic analysis shows that in most cases closely related to the outbreak in Europe, two patients – one in Florida and one in Virginia – have versions of the virus that appear to have infected one patient in Texas last year. .
This suggests that at least two separate cases have occurred where the virus has spread from animal to human, the agency said.
Of the 17 U.S. patients for whom the agency has detailed information, all but one had sex with men; 14 They traveled to another country three weeks before their symptoms started. Three patients were immunocompromised.
CDC researchers have not been able to identify how a patient in an unnamed state acquired the virus. This suggests that there is ongoing community transmission, at least in that state and possibly among others, CDC’s Dr. Jennifer McQueston told reporters.
“We really want to increase our surveillance efforts,” he said.
Health officials have identified about 400 acquaintances out of 13 patients who are also at risk of contracting monkeypox. Risk identification will help officers determine which resources are needed for the outbreak.
So far, health officials have provided approximately 1,200 doses of vaccines and 100 treatment courses in eight states, according to Dr. Raj Punjabi, senior director of global health protection and biodiversity at the White House.
The number of monkeypox worldwide has risen sharply this week, with about 800 cases as of Friday. The virus has spread to at least 31 countries outside Africa, where it has raised fears among locals, scientists and public health officials.
Health officials in some countries are asking anyone with a positive test for monkeypox to isolate them at home. The UK, which has recorded the highest number of cases, has asked patients to abstain from sex until their symptoms are clear, then use condoms for eight weeks and limit contact with pets and other animals that may be infected.
As the outbreak spreads, health officials around the world are rushing to collect vaccines and treatments to protect infected people and their close acquaintances. Options are severely limited.
The United States is one of the few countries that has stockpiled millions of doses of vaccine and medicine for smallpox as a precaution against its return. Monkeypox is closely related to smallpox, and vaccines and drugs are expected to be almost as effective.
Theoretically, at least two drugs and two types of vaccines are available to combat the monkeypox outbreak, but most of these have been primarily tested in animals.
In a recent study of two drugs in seven patients, only one had some benefit, the other produced toxic side effects.
The older of the two vaccine alternatives was used to eradicate smallpox and can cause severe side effects, including heart problems and death. Most doses have been in storage for decades and have lost their effectiveness.
The second vaccine alternative, developed by the Danish company Bavarian Nordic, was approved by the Food and Drug Administration in 2019 to prevent smallpox and monkeypox. Known in the United States as Genius, it is safer than previous vaccines, but the supply is more limited.
Several countries, including Canada, Britain and France, have already begun vaccinating infected people for close contact, and many more have ordered the Bavarian Nordic for additional supplies.
Several experts point out that African countries that have been battling monkeypox for years have had little access to the vaccine and treatment. So far this year, 44 cases have been recorded in Nigeria and six other African countries where the virus is endemic, but those numbers may be underestimated.
Outbreaks appear to be exacerbated in the West, with some experts fearing that the spread of the monkeypox could further limit access to vaccines and treatments in poorer countries. “Vaccines and treatments stored elsewhere are not necessarily shared,” said Dr. Efidayo Adetifa, director of the Nigeria Center for Disease Control.
In Switzerland, the World Health Organization maintains about 2.4 million doses of the vaccine used to eradicate smallpox, and it has stockpiled another 31 million doses in five donor countries that could be released to countries in need.
However, the WHO had previously recommended the vaccine only for those at high risk, said Tariq Jasarevich, a spokesman for the agency. Experts called by the WHO were scheduled to review the guidelines in October, but “that timeline needs to be accelerated,” he said.
The WHO is also evaluating the new Jynneos vaccine for predisposition, a step necessary for use in many countries.
The U.S. emergency stockpile contains 100 million doses of an old smallpox vaccine called ACAM2000. But the vaccine contains the live vaccine virus and causes about six cases of myopicarditis – inflammation of the heart muscle – for every 1,000 people who receive it.
ACAM2000 cannot be used by pregnant women, children or those who are immunocompromised – just those who need protection from the monkeypox virus the most.
In contrast, genotypes have been shown to be safe for older adults, people with HIV or AIDS, and those who have had bone marrow transplants and are therefore immunocompromised.
According to Paul Chaplin, chief executive of Bavarian Nordic, US stocks once contained 28 million doses of Genius, but those doses have run out. Federal health officials say about 1,000 doses of Genius are available, but according to Dr. Chaplin, the Bavarian Nordic delivered thousands more last week.
In all, the United States has access to about one million doses, he said.
People infected with monkeypox can be vaccinated a few days after exposure. They can also be treated with one of the two drugs approved for the treatment of smallpox, tecovirimet and brinsidofovir, which slow down the virus and take time to root out immunity.
What to know about monkeypox virus
What is a monkeypox? Monkeypox is a virus endemic to parts of Central and West Africa. It is like smallpox, but less severe. It was discovered in 1958 after an outbreak of monkeys kept for research, according to the Center for Disease Control and Prevention.
The FDA has approved an oral form of tacovirimet, also called Tpoxx, for the treatment of smallpox in adults and children, although the drug has never been tested in children.
The drug, developed by New York-based company Siga Technologies, is taken twice daily for 14 days, and safety tests do not indicate that it has serious side effects other than gastric symptoms.
There are 1.7 million courses of Tecovirimet in US stockpile. Prior to the May 12 monkeypox outbreak, the Department of Defense raised another $ 7.5 million in drug courses, about half of which will be distributed this year.
“A significant number of countries have applied for a course of medicine since the outbreak began,” said Dennis Harubi, chief cigar scientist. By the end of June, the company expects to distribute up to 190,000 treatment courses, he said.
The FDA worked with Cigar to create an intravenous formulation and approved it on May 19 This version can be used in patients who are unable to take oral medication due to blisters on their face.
Health Canada, the country’s national health department, approved Tecovirimet in 2020 and bought doses worth $ 13 million, according to Dr. Hruby. The European Medicines Agency approved the drug in January for the treatment of all orthopedic viruses – a viral family that includes both smallpox and monkeypox – but was still negotiating with the company when an outbreak occurred.
Both tecovirimat and brincidofovir were approved under the FDA’s animal regulations, which allow the agency to rely on rat or monkey data when it is unethical to test drugs in humans.
The second drug, Brinsidofovir, manufactured by Chimerix and appears to have more side effects, including the risk of death, prompting the agency to issue a so-called black box warning – its most stern warning – on drug use.
In a recent study of both drugs, Brinsidofovir was found to provide “no credible clinical benefits,” the researchers said. But the study was too small and the treatment methods given to patients were too varied to draw any conclusions about the effectiveness of the drug, says David Evans, a virologist at the University of Alberta who advises on chimerax.
Those who cannot safely take Tecovirimet or Brinsidofovir – such as immunocompromised people – may be given an immunotherapy called Vaccinia immunoglobulin, but only in limited quantities.
The United States is helping to create a cocktail of monoclonal antibodies that can block the monkeypox virus. Several vaccines are also in the early stages of development, some of which rely on horsepox.
In the long run, it may make sense for the United States to stockpile enough vaccines and drugs to protect the entire population – including those who were vaccinated against smallpox as a child, said Dr. Seth Lederman, chief executive of Tonics. Making horsepox-based vaccines.
Multiple studies have shown that people who have been vaccinated against smallpox can be protected from serious illness if they do not become infected. But creating some wounds will be enough to spread the virus to others, Dr. Lederman noted.
“In the case of something like MonkeyPix, I think the goal would be to keep people from getting hurt,” he added.
The Tonics vaccine will not be available for current use. “Our approach will be to slow down and settle down,” he said. “These problems are not going away.”