Who Is Protected Against Monkeypox?

For a world tired of fighting the coronavirus, the outbreak of monkeypox raises an important issue: Am I at risk?

The answer is encouraging. Experts said in an interview that most children and adults with a healthy immune system are more likely to fend off severe illness. However, there are two high-risk groups.

One consists of babies under 6 months old. However, they are not yet affected by the current outbreak. And studies suggest that many older people, the group most likely to be infected with the monkeypox virus, are at least to some extent protected by smallpox vaccination decades ago.

Vaccinated older people can get infected However, it can escape with mild symptoms.

“The bottom line is that even those vaccinated decades ago maintain very high levels of the ability to neutralize antibodies and viruses,” said the National Institute on Aging Science Director. Dr. Luigi Ferucci said.

“Even if they were vaccinated 50 years ago, their protection should still be there,” he said.

In the United States, regular immunity to smallpox ended in 1972. The military continued its vaccination program until 1991 as a precautionary measure against bioterrorist attacks.

After the 2001 anthrax attack, questions about the durability of the smallpox vaccine have risen, said Dr. Anthony S. Forch, Biden’s top infectious disease adviser. It was reasonable to assume that most vaccinated people were still protected, he said, “but the sustainability of protection varies from person to person.”

“We cannot guarantee that people vaccinated against smallpox will be protected from monkeypox,” said Dr. Fauci.

Outbreaks of monkeypox have grown to include approximately 260 confirmed cases and scores under investigation in 21 countries.

In the United States, the Centers for Disease Control and Prevention is tracking nine cases in seven states, but not all have travel history to countries where monkeypox is endemic. It suggests that there may already be some community communication, agency director Dr. Rochelle Walensky told reporters Thursday.

Dr. Wallensky said 74 laboratories in 46 states have access to tests that can detect monkeypox, and can screen up to 7,000 samples per week. The agency is working to expand her capabilities, she added. “We have been preparing for this kind of outbreak for decades.”

Monkeypox infections begin with respiratory symptoms, first in the mouth, then on the palms and soles of the feet, and gradually on the rest of the body, with a clear rash. The rash eventually rises and grows into pus-filled blisters.

Each pustule contains a live virus, and a ruptured blister can contaminate bed linen and other items, endangering close contact. Infected people should also be careful about rubbing their eyes. Viruses can destroy eyesight..

“Before Jenner developed the smallpox vaccine, smallpox was the number one cause of blindness in the world,” said Mark Slifka, an immunological scientist at Oregon Health & Science University. He said the infected people were contagious until the pustules became scabs and shed.

Dr. Slifka and other experts emphasized that monkeypox can be severe and even fatal, but the current outbreak is unlikely to spread to an epidemic.

Anne Rimoin, an epidemiologist at the University of California, Los Angeles, who studies monkeypox in Africa, said: “We have the ability to stop this virus.”

Monkeypox can take up to 12 days to cause symptoms and give doctors at least 5 days to prevent vaccinations and illness. (This approach, called post-exposure prophylaxis, is not an option for Covid patients because the coronavirus can begin to destroy the body just days after exposure.)

The monkeypox virus does not spread in the absence of symptoms. According to Dr. Limoin, careful surveillance, quarantine of infected individuals, contact tracking, and contact quarantine must include outbreaks.

The majority of people currently infected are men under the age of 50, and many have been identified as gay or bisexual. This may reflect the potential for a gay pride event in the Canary Islands. (According to experts, the outbreak could easily have started among heterosexuals at a large event.)

“The risk of exposure is not limited to any particular group,” Dr. Warensky said Thursday. “Our priority is to enable everyone to make informed decisions to protect their health and the health of their communities, because it raises science-guided awareness, not stigma. to start.”

No deaths have been reported. However, experts are particularly concerned about their close relationship with children, the elderly, or those with weak immunity for other reasons.

There are conflicting opinions about how long the immunity from smallpox vaccination lasts.

CDC Booster is recommended The smallpox vaccine is given every three years, but “only for those at risk of occupational exposure,” said agency spokesman David Dygle in a statement.

“Until we know more, vaccine stocks are available for people who are in close contact with known cases and for those who are at the highest risk of exposure through work, such as healthcare professionals treating monkeypox patients. I will use it, “he said.

The United States and several European countries have begun immunization against close contact with infected patients. This is an approach called ring vaccination.

Many of the most vulnerable groups may already be protected.In one study, Dr. Slifka and his colleagues took blood from 306 vaccination volunteersSome people were immunized decades ago, including those who were immunized 75 years ago. Most of them maintained high levels of antibodies against smallpox.

In another study, Dr. Slifka and his colleagues showed that: Antibodies generated Even a single dose of the smallpox vaccine declines very slowly in the body and halves after about 92 years.

NIH’s Dr. Ferrucci and his colleagues, as well as other teams, also have antibody levels. Lasts for decades After vaccination. Some studies have found The other branches of the immune system also slowly declined, but the antibodies Smallpox vaccination may be sufficient Do it yourself to protect yourself from monkeypox.

If smallpox begins to spread, it makes sense to immunize those exposed due to high mortality, regardless of previous vaccinations, according to a biosecurity expert at the John’s Hopkins Health Security Center. One Gigi Grombal said.

“I don’t want to miss the chance that someone has been unprotected,” she said.

But it’s not needed now, she added: “This is monkeypox.”

Laboratory evidence of antibodies does not prove that smallpox vaccination can protect against monkeypox. However, to answer that question, study participants must be deliberately infected with smallpox or a related virus. This is clearly an unethical experiment.

For the same reason, new smallpox vaccines and medicines have been tested only in animals.

Still, one way to study the effectiveness of vaccines in people is to collect evidence at the time of outbreak. Dr. Slifka’s team did just that in 2003, when dozens of Americans became infected with monkeypox after being exposed to infected prairie dogs.

Researchers jumped into Milwaukee and collected blood from 28 people exposed to infected prairie dogs. Of the eight previously vaccinated, five developed an average of three pus-filled blisters, while an average of 33 were unvaccinated.

Three other vaccinated individuals There were no symptoms Jeez. “They didn’t even know they were infected,” Dr. Slifka said.

another Study of its occurrence In a family of three, it was found that a previously vaccinated father developed only two monkeypox lesions compared to the 200 lesions of an unvaccinated mother. The unvaccinated 6-year-old daughter had about 90 lesions and was in a coma for 12 days.

Questions about the sustainability of vaccine protection against monkeypox are of particular importance as the number of cases increases worldwide. Monkeypox reappeared among Nigerian people in 2017, and since then there have been about 200 confirmed cases and 500 suspicious cases.

Democratic Republic of the Congo Record 58 deaths Since the beginning of this year, there have been about 1,300 suspicious cases.

People in African villages were infected with monkeypox from animals during hunting, but rarely infected others. “We only started seeing this very recently, as in just a few years,” said Dr. Limoin about the larger outbreak.

While eradicating smallpox is one of the greatest public health achievements, it leaves a population vulnerable to the virus and its cousins.

Decreased immunity, coupled with increased populations and increased access to wildlife, can lead to more frequent monkeypox outbreaks, Dr. Limoin and her colleagues said. Warning in 2010..

Unsuppressed outbreaks, especially among people with weakened immunity, will give the virus a chance to acquire more resilient mutations — in people and animals.

“If monkeypox settles in non-African wildlife reservoirs, the public health recession will be enormous,” Dr. Limoin said. “I think it’s a legitimate concern.”