The U.S. Is Underreacting to Monkeypox

Yesterday, a CDC panel discussed whether smallpox vaccines should be offered more widely as a preventive measure against monkeypox. The jury made no decision. But getting these vaccines into the arms of patients — and especially into the arms of gay and bisexual men — is a pressing issue. Since May 13, more than 3,300 cases of monkeypox have been reported in 58 countries, including the United States, where the disease was previously not considered endemic. The CDC reports at least 172 cases. Prior to this outbreak, monkeypox had generally been reported in West and Central Africa, or in travelers from these regions. The new cases are occurring on all inhabited continents, primarily among men who have sex with men (MSM).

The United States is underreacting to the monkeypox outbreak. Since a vaccine is available against the infection and can target those most at risk, public health authorities and healthcare providers need to act faster and stronger to alter the trajectory of the disease. epidemic.

Monkeypox is related to smallpox, the only human virus that has been eradicated worldwide. A highly effective smallpox vaccine, called Jynneos, has also been licensed in the United States for use against monkeypox. Data from Africa suggests that it is at least 85% effective in preventing the latter condition.

On June 1, the CDC updated its recommendations to say that Jynneos is the preferred post-exposure prophylaxis for healthcare workers and others who have been in close contact with patients with monkeypox. The United States has about 36,000 doses in stock and expects another 300,000 doses in the coming weeks. It needs to purchase many more and is expected to offer the vaccine to all MSM at risk of exposure within the next month. Canada just signed a $56 million deal with vaccine maker Jynneos, and Quebec has started offering the vaccine to all MSM. The UK is expanding its vaccination campaign from this week to offer vaccines to gay and bisexual men most at risk of exposure. The New York City Health Department announced yesterday the opening of a clinic in Chelsea that will offer the vaccine to MSM who have had multiple partners in the past 14 days.

When the coronavirus spread around the world in early 2020 we lacked an effective vaccine, so governments required masks, distancing, ventilation, testing and contact tracing to try to minimize transmission until injections of COVID-19 arrive. Not everyone is at the same disadvantage with monkeypox; we have a vaccine, and our current attempts at testing and contact tracing to get out of this outbreak are failing. A quick, targeted vaccination campaign — one that identifies Americans at risk and persuades them to get vaccinated — is much more likely to stop the monkeypox epidemic.

Different illnesses require different responses. The coronavirus becomes endemic because it spreads quickly and easily, and even high-quality vaccines that protect against serious disease do not prevent initial infection or re-infection. Smallpox, one of the deadliest pathogens in history, could be eliminated because of four distinguishing characteristics that most human pathogens do not have: its symptoms, including the rash it causes , are very characteristic, so doctors could easily identify patients who had this; its infectious period was short; new infections could be prevented with a highly effective vaccine; and the virus had no animal reservoirs from which it could infect unvaccinated humans. As such, routine smallpox vaccinations for American populations were stopped in 1972. Yet, due to the discontinuation of mass smallpox vaccination programs, humans have diminishing protection against smallpox from the monkey.

The name monkeypox stems from the first documented cases of the disease in animals in 1958, when two outbreaks occurred in monkeys used for research. However, until recently, the infection was usually spread by rodents such as rats, mice, and squirrels, and transmitted to humans through the bite of an infected animal or by touching blood, body fluids, or skin. fur of an infected animal. A 2003 human outbreak in the United States was traced to pet prairie dogs infected with a mammalian shipment from Ghana.

Most of the current cases involve MSM between the ages of 30 and 55, first linked to two large raves held in Spain and Belgium. It should be noted that the sexual transmission of monkeypox has never been described before. Although monkeypox has been reported in semen, the most likely route of spread during the current outbreak is through close skin-to-skin and respiratory contact during sexual activity. Additionally, transmission through prolonged direct contact may put household members and other close contacts of active cases at increased risk.

The fact that monkeypox is spreading among gay men has led to calls to postpone this month’s Pride celebrations, and the CDC has come under fire for recent posts that offer advice on how to avoid the pathogen during sex. Yet the agencies follow the well-founded concept of harm reduction, which calls for both minimizing the impact of a health threat while recognizing the other needs of the individuals and society affected. People crave companionship and intimacy, and messages that ignore these needs and advocate complete abstinence are unlikely to succeed. Harm reduction is the basis of most current public health messages about HIV risk reduction and is extremely important in the field of substance abuse and substance abuse.

Health agencies deserve credit for trying to minimize stigma in their communication, even as they recognize that affected communities need to be alerted to how this particular outbreak is spreading. (WHO is also considering changing the name itself monkeypox to prevent the stigmatization of geographic areas originally linked to the disease and to ban associations with animals that appear to play little role in its spread.)

Stopping the monkeypox epidemic in the United States is not enough. The WHO is due to meet today to decide whether or not to declare monkeypox a global health emergency – a decision that African clinicians say is long overdue. Although the virus is not a significant threat to the general population, as was COVID-19, declaring a global health emergency will raise awareness of both this epidemic and endemic infections. As the World Health Organization has already pointed out, rich countries have ignored endemic monkeypox in West and Central Africa for too long, despite the presence of effective vaccines, which should be equitably distributed to at-risk populations around the world. The crucial point is that all these efforts should be made now. We must stop under-reacting to the latest global infectious disease threat.

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