Health

Three Pressing Questions About Monkeypox: Spread, Vaccination, Treatment

Once a relatively ambiguous virus endemic to Africa, monkeypox has blossomed into a global threat, infecting more than 20,000 people in 75 countries and declaring a global health emergency to the World Health Organization. Is forcing.

On Thursday, New York and San Francisco declared their own emergencies. However, federal health officials have not followed suit, despite a national count approaching 5,000 and experts warning that containment has been delayed.

One of the reasons: Officials say the virus, unlike the coronavirus, is a known enemy. Doctors understand how it spreads and already have tests, vaccines and treatments.

But for scientists, the accumulated research presents a more complex and challenging situation. The virus remains a mystery in several important ways and does not work exactly as researchers have seen during sporadic outbreaks in African countries.

Scientists are competing to answer three questions that determine how quickly monkeypox can be stopped — can it be stopped?

At the beginning of the outbreak, health officials said the virus spreads through respiratory droplets released when an infected person coughs or sneezes, and close contact with pus-filled skin lesions, bedding, and other contaminants. Insisted.

That was all true. But that may not be the big picture.

99% or more According to the Centers for Disease Control and Prevention, some men who have been infected so far have acquired the virus through close contact with other men. As of July 25, only 13 women and 2 infants were diagnosed with monkeypox.

Researchers Virus found Saliva, urine, feces, semenIt is unclear whether these fluids are infectious, especially if the virus can be transmitted during sexual activity by means other than close skin-to-skin contact. But so far, the pattern of spread along sexual networks has cast doubt on researchers.

However, it is clear that monkeypox has not spread easily and has not yet spilled into other populations. As some social media posts suggest, the average person is not at risk of fleeting interactions with, for example, clothes purchased in stores or infected people.

According to the CDC, asymptomatic people cannot spread monkeypox.But at least one study Virus detected In a man who did not experience any symptoms.Symptom pattern Branched From what was observed in previous outbreaks.

In Africa, some people get sick by touching infected animals, eating wild animal meat, and using medicines made from animals. They often developed fever and body aches, followed by a characteristic rash on the face, palms, feet, and then on the whole body. Infants and pregnant women seemed to be at greatest risk of severe symptoms.

Outbreaks outside Africa have many patients No fever Or have respiratory symptoms and the rash is often confined to some lesions in the genital or rectal area, which is easy to happen Be mistaken For various sexually transmitted diseases.

The UK is now modifying the official description of monkeypox to include mouth lesions, anal or rectal pain and bleeding. Some scientists speculate that the symptoms of the disease in Western countries may accurately reflect the natural history of the virus.

The safer of the two vaccines against monkeypox, Jynneos, is manufactured by Bavarian Nordic, a small Danish company. Supply was severely restricted and the Biden administration moved slowly to obtain additional doses as the virus spread.

Currently, federal officials have ordered about 7 million doses, which will arrive in batches over the next few months. So far, the government has shipped about 320,000 batches to the state. The Food and Drug Administration said it approved an additional 800,000 doses on Wednesday, but it was unclear when they would be distributed.

Jynneos is to be given twice every 28 days.But some cities, including Washington When New York CityEmulates the strategy adopted by, and refrains from a second dose until more are available United Kingdom And Canada.

Federal health officials advise not to postpone the second dose. But in the study, Single shot Jynneos protection Up to 2 years. If that finding applies to the real world, postponing additional shots may help authorities contain the outbreak by immunizing more Americans.

Tinglong Dai, a vaccine supply expert at Johns Hopkins University, said the UK had refrained from receiving a second Covid vaccine during the early days of the pandemic, when supply was in short supply. “The benefits of prioritizing the first dose outweigh the risks,” he said.

There may not be many options as the qualifications are widespread and more endangered people seek shots. Some jurisdictions have already expanded the groups targeted for immunization to include sex workers, patients in sexual health clinics, clinicians and other employees who may be exposed to the virus at work. increase.

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

Rogers qualified for a shot because he may have sex with a man who is at high risk of monkeypox infection. No one doubted her eligibility. “They weren’t strange about it at all-it was a very smooth process,” she said.

Due to the lack of vaccines, administration within a few days of exposure can relieve symptoms, but it is only provided as a precautionary measure.

David Baldwin, a 45-year-old music professor in New York, was eligible for vaccination just because his doctor didn’t believe he was already infected. (His first symptom was rectal pain.) “As a result, I don’t think I’ve ever had a lesion in my body,” he said.

In 2018, the FDA approved a drug to treat smallpox called Tecobilimat (TPOXX), based on data from animal studies. Data on people’s use is limited.

Supply is not an issue: the national stockpile holds about 1.7 million doses. Still, it is difficult to get medicines, which means that as the number of cases increases, there remains ambiguity about how well the medicines work and for whom.

Since tecovirimat is not specifically approved for the treatment of monkeypox, until recently it was a hassle for doctors to submit detailed reports of the CDC, patient-managed journals to record progress, and photographs. It can only be prescribed through the Protocol. Of the lesion.

Due to the large number of hurdles, many clinics did not offer tecovirimat at all. Even doctors in well-funded institutions could only treat a few patients a day.

Nephi Niven Stogner, 39, sought help with monkeypox symptoms on July 8. He felt intolerable pain and tried to get a Tecobilimat, but others were told he was ill and needed more.

Three new lesions appeared on his back while he was waiting for the drug alone. “It seems that your sentence has been extended,” he said.

Stoner finally received his first dose on July 21st. Within 24 hours, he said, “the lesions were swollen and turned from red to flat, dark spots.”

Due to these delays, the CDC has relaxed access rules to tecovirimat. Distributors now need to reduce patient consultations, samples, and forms, allowing doctors to effectively evaluate patients.

Wider use should mean that scientists and health authorities have a better understanding of the effectiveness of medicines. The new requirements will help the CDC “determine if this drug works for monkeypox patients and how well it works,” said Kristen Nordland, a spokeswoman for the agency. I am.

The National Institute for Allergic Infections is planning a clinical trial of Tekobilimat in adults with monkeypox infection, including people living with HIV, which may begin this fall. The agency is working with Siga Technologies, which manufactures the drug, in another trial in the Democratic Republic of the Congo, where the virus has been a long-standing tragedy, and is expected to begin this fall as well.

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