Monkeypox, once a relatively stealthy virus endemic to Africa, has grown into a global threat, infecting more than 20,000 people in 75 countries and forcing the World Health Organization declare a global health emergency.
New York and San Francisco declared their own states of emergency on Thursday. But even as the national total of cases nears 5,000 and experts warn that containment measures are fading, federal health officials have not followed suit.
One reason: The virus — unlike the coronavirus — is a known enemy, officials say. Doctors understand how it spreads, and tests, vaccines and treatments are already available.
But for scientists, the accumulation of research presents a more complex and challenging picture. The virus remains a mystery in some important ways, not quite the way researchers have seen during sporadic outbreaks in African countries.
Scientists are racing to answer three questions that will determine how quickly monkeypox can stop — if at all.
How exactly does the virus spread?
At the beginning of the outbreak, health officials asserted that the virus was spread through respiratory droplets released when an infected person coughed or sneezed, and through close contact with pus-filled skin lesions or bedding and other contaminated materials.
All this is true. But that might not be the full picture.
more than 99% So far, men have contracted the virus through close contact with other men, according to the Centers for Disease Control and Prevention. As of July 25, only 13 women and 2 young children had been diagnosed with monkeypox.
researchers have virus found in saliva, urine, feces and semenIt is not known whether these fluids are contagious, especially whether the virus can be transmitted by means other than skin-to-skin contact during sexual intercourse. But so far, the pattern of propagation along the sexual network has puzzled researchers.
However, it is clear that monkeypox does not spread easily and does not spread to other populations. For example, as some social media posts suggest, ordinary people are not at risk from clothing purchased from stores or brief interactions with an infected person.
What to know about monkeypox virus
What is monkeypox? Monkeypox is a virus similar to smallpox, but with milder symptoms. It was discovered in 1958 during an outbreak of monkeys for research. The virus is mainly found in parts of Central and West Africa, but in recent weeks it has spread to dozens of countries and infected tens of thousands of people, the vast majority of whom have sex with men. July 23, WHO declares monkeypox a global health emergency.
According to the CDC, monkeypox cannot be spread by people without symptoms.But at least one study shows Virus detected in men who do not experience any symptoms.symptom pattern also parted ways observed from previous outbreaks.
In Africa, some people have gotten sick after touching infected animals, eating game or using medicines 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. Babies and pregnant women appear to be at the highest risk for severe symptoms.
In outbreaks outside Africa, many patients no fever or respiratory symptoms, the rash is usually limited to a few lesions in the genital or rectal area, and it is easy to Misunderstand For various sexually transmitted infections.
The UK has now revised the official description of monkeypox to include oral lesions, pain and bleeding in the anus or rectum. Some scientists speculate that the disease’s manifestations in Western countries may accurately reflect the virus’ natural history.
Is one dose of vaccine enough?
Jynneos, the safer of the two monkeypox vaccines, is made by Bavarian Nordic, a small company in Denmark.Supply severely constrained, Biden administration move slowly Get additional doses as the virus spreads.
Federal officials have now ordered nearly 7 million doses of the vaccine, which will arrive in batches over the next few months. So far, the government has shipped about 320,000 doses of the vaccine to states. The U.S. Food and Drug Administration said Wednesday that it had approved another 800,000 doses, but it was unclear when they would be distributed.
Jynneos should be administered in two divided doses, 28 days apart.But some cities, including Washington and New York Cityis delaying the second dose until more is available, to follow suit U.K. and Canada.
Federal health officials advise against delaying the second dose.But in the study, a Single shot Jynneos seems to be protected up to two years. If the finding holds true in the real world, delaying additional shots could help officials control the outbreak by vaccinating more Americans.
Dai Tinglong, an expert on vaccine supply at Johns Hopkins University, pointed out that in the early days of the pandemic, when supplies were low, the UK delayed the second dose of the new coronavirus vaccine. “The benefits of prioritizing the first dose outweigh the risks,” he said.
As eligibility expands and more high-risk groups seek injections, there may not be many options. Some jurisdictions have expanded immunization-eligible groups to include sex workers, patients in sexual health clinics, and clinicians and other employees who may have been exposed to the virus on the job.
In Rhode Island, Emily Rogers, a 29-year-old medical anthropologist, said she was able to call the local health department and make an appointment “very, very quickly.”
Ms Rogers is eligible for the injection because she sometimes has sex with men at high risk of contracting monkeypox. No one questioned her qualifications. “They weren’t surprised at all about it – it was a very smooth process,” she said.
Because of the shortage, the vaccine is only offered as a preventive measure, even though it can reduce symptoms if given within days of exposure.
New York music professor David Baldwin, 45, is eligible for the vaccine only because doctors don’t believe he has been infected. (His initial symptoms were rectal pain.) “So, I don’t think my body ever had a lesion,” he said.
How effective is the drug treatment?
In 2018, the FDA approved a drug called tecovirimat, or TPOXX, to treat smallpox based on data from animal studies. There is limited data on its use in humans.
Supply is not an issue: there are about 1.7 million doses in the national stockpile. However, the drug has been difficult to obtain, meaning that even as the number of cases increases, ambiguity remains about how well the drug works and for whom.
Because tecovirimat is not approved specifically to treat monkeypox, it can only be prescribed through a cumbersome “investigational drug regimen” that, until recently, required doctors to send detailed reports to the CDC, a patient-maintained journal with to document their progression and photograph lesions.
Due to numerous barriers, many clinics do not offer tecovirimat at all. Even doctors at well-funded institutions treat only two or three patients a day.
Nephi Niven Stogner, 39, sought help with monkeypox symptoms on July 8. He was in excruciating pain and tried to take tecovirimat, but was told others were sicker and needed it more.
Three new lesions suddenly appeared on his back while he was in isolation awaiting medication. “It’s like your sentence is getting longer,” he said.
Mr. Storgner finally got his first dose on July 21. Within 24 hours, his “lesions went from swelling and redness to flat black spots,” he said.
This delay led the CDC to relax the rules for obtaining tecovirimat. The agency now requires fewer patient visits, samples and forms, and allows doctors to conduct virtual assessments of patients.
Wider use should mean scientists and health officials will have a better understanding of the drug’s efficacy. Kristen Nordlund, a spokeswoman for the agency, noted that the new requirements will help the CDC “determine whether and how well the drug is effective in monkeypox patients.”
The National Institute of Allergy and Infectious Diseases is planning a clinical trial of tecovirimat in adults infected with monkeypox, including those with HIV, that could begin this fall. The agency is working with Siga Technologies, which makes the drug, on another trial in the Democratic Republic of Congo, a long-standing scourge of the virus that is also expected to begin this fall.