The Centers for Disease Control and Prevention has identified 21 monkeys in 11 states and their number is expected to increase, officials said Friday.
Genetic analysis has shown that although most cases are closely linked to the epidemic in Europe, two patients have versions of the virus that were caused by a monkey disease that was diagnosed in Texas last year.
Of the 17 patients for whom the agency had complete information, all but one were men who had sex with men; 14 traveled to other countries within three weeks before the onset of symptoms. Immunity was reduced in three patients.
CDC researchers have not been able to determine how an unnamed patient became infected. This shows that there is an infection in the community, at least in that state and perhaps in others, Dr. Jennifer McQueiston of the CDC told reporters.
“We really want to step up our oversight efforts,” he said.
Health officials identified about 400 of the 13 patients at risk of contracting smallpox in monkeys. Identifying risky connections will help officials determine what resources are needed to stop the epidemic.
So far, health workers have delivered 1,200 doses of vaccine and 100 courses of treatment to eight states, the doctor said. Raj Punjabi, White House Senior Director for Global Health Security and Bioprotection.
The number of cases of smallpox in the world has risen sharply this week, to about 800 cases as of Friday. The virus has spread to at least 31 countries outside Africa, where its endemicity has alarmed scientists and public health workers.
In some lands, health officials are asking for the isolation of all those who test positive for monkeys. The UK, which recorded the highest number of cases, urged patients to abstain from sexual intercourse until their symptoms cleared, and then to use condoms for eight weeks and limit contact with pets and other animals.
As the disease progresses, health care workers around the world are rushing to collect vaccines and treatments to protect infected people and their loved ones. The options are very limited.
The United States is one of the few countries that has stockpiled millions of doses of smallpox vaccines and drugs. Smallpox is closely linked to smallpox and vaccines and medicines are expected to be just as effective.
Theoretically, there are at least two drugs and two types of vaccines against smallpox in monkeys, but most of them have been tested mainly in animals.
In a recent study of two drugs in seven patients, only one showed some benefit, and the other gave toxic side effects.
The oldest of the two vaccine variants has been used to eradicate smallpox and can cause heart disease and death. Most doses have been stored for decades and may have lost their effectiveness.
The second version of the vaccine, developed by the Danish company Bavarian Nordic, was approved in 2019 by the Food and Drug Administration to prevent smallpox and monkeys. Called Jynneos in the United States, it is safer than previous vaccines, but deliveries are even more limited.
Several countries, including Canada, the United Kingdom and France, have begun vaccinating close contacts of infected people, and many other countries have ordered additional deliveries to Bavarian Nordic.
Several experts point out that African countries that have struggled with monkey disease for many years have had little or no access to these vaccines and treatments. So far this year, 44 cases have been reported in Nigeria and six other African countries, but those numbers may be lower.
Some experts fear that the spread of monkey disease in Western countries could limit access to vaccines and treatment in poor countries. “Vaccines and treatments that are stored elsewhere are not necessarily shared,” he said. Ifedayo Adetifa, Director of the Nigerian Center for Disease Control.
In Switzerland, the World Health Organization maintains 2.4 million doses of the smallpox vaccine, and has prepared another 31 million doses in five donor countries that could be given to countries in need.
However, the WHO has so far recommended the vaccine only to people at risk of infection, said Tariq Jasarevic, a spokesman for the organization. Experts called by the World Health Organization were due to review the leadership in October, but “this deadline needs to be accelerated,” he said.
The WHO is also evaluating the new Jynneos vaccine for pre-qualification, a necessary step for its use in many countries.
In November, CDC scientific advisers recommended that Ginneos immunize researchers and health workers at risk of contracting smallpox or monkeys.
The U.S. emergency warehouse contains 100 million doses of an old smallpox vaccine called ACAM2000. However, the vaccine contains a live vaccinia virus, and for every 1,000 people who receive it, it causes six cases of myopericarditis, an inflammation of the heart muscle.
ACAM2000 should not be used in pregnant women, infants or people with weakened immune systems – people who need protection from the monkey virus.
Jynneos, on the other hand, have been proven to be safe for older people, people with HIV or AIDS, and those who have received bone marrow transplants and therefore have weakened immune systems.
According to Paul Chaplin, CEO of Bavarian Nordic, there were once 28 million doses of Jynneos in a U.S. warehouse, but all of those doses have expired. Federal health officials say Jyneos has about 1,000 doses, but the Bavarian Nordic has delivered thousands more doses in recent weeks, Dr. said. Chaplin.
In all, the United States has access to about a million doses, he said.
People with smallpox can be vaccinated a few days after the disease. They can also be treated with one of two drugs approved for smallpox, tecovirimate, and brincidofovir, which slow down the virus and buy time for the immune system to destroy it.
The FDA has approved an oral form of tecovirimate called Tpoxx to treat smallpox in adults and children weighing at least 13 pounds or 28.6 pounds, but the drug has never been tested in children.
What you need to know about the monkey smallpox virus
What is ape monkey? Smallpox is a virus that has spread to parts of Central and West Africa. It looks like a smallpox, but it is less severe. According to the Centers for Disease Control and Prevention, it was discovered in 1958 after an outbreak of the disease in monkeys being kept for research.
The drug, developed by New York-based Siga Technologies, is taken twice a day for 14 days and has not been shown to have significant side effects other than stomach symptoms in safety tests.
The U.S. warehouse has 1.7 million courses of tecovirimate. On May 12, before the monkey disease broke out, the Department of Defense sought another $ 7.5 million for drug courses, about half of which will be delivered this year.
Dennis Hrubi, Siga’s chief scientist, said “many countries” have asked for drug courses since the outbreak began. The company expects to distribute up to 190,000 treatment courses by the end of June, he said.
The FDA worked with Siga to develop an intravenous formula and approved it on May 19. This version can be used in patients who are unable to take oral medication due to blisters in their mouths.
The Canadian Ministry of Health, the country’s national health department, approved tecovirimate in 2020 and purchased doses of $ 13 million, the doctor said. hruby. The European Medicines Agency approved the drug in January to treat all orthopox viruses – a viral family that includes smallpox and monkeys – but was still in talks with the company when the epidemic broke out.
Both tecovirimat and briincidofovir are approved by the FDA’s Animal Regulations, which allows the agency to rely on data from rodents or monkeys if testing the drug in humans is unethical.
The second drug, brincidofovir, is made by Chimerix and appears to have more side effects, including the risk of death, prompting the agency to introduce something called a black box warning – its harshest warning -.
In a recent study of both drugs, brincidofovir “did not show any convincing clinical benefit,” the researchers said. However, the study was too small and the treatment regimens offered to patients were too varied to draw any conclusions about the effectiveness of the drugs, said David Evans, a virologist at the University of Alberta, in consultation with Chimericks.
People who are unable to safely take tecovirimat or brincidofovir, such as those with weakened immune systems, may be given immunotherapy called immunoglobulin vaccine, but the number is limited.
The United States is helping to develop a cocktail of monoclonal antibodies that will block the monkey smallpox virus. Several vaccines are still in the early stages of development, including those based on smallpox.
In the long run, it may be important for the United States to stockpile enough vaccines and drugs to protect the entire population, including those who were vaccinated against childhood smallpox, the doctor said. Seth Lederman, CEO of Tonix, a developer of the smallpox vaccine.
Numerous studies have shown that people who are vaccinated against smallpox can be protected from serious illness if they do not have an infection. However, multiple ulcers are enough to spread the virus to others, says the doctor. Lederman noted.
“If there’s something like monkey smallpox, I don’t think people are affected,” he added.
The tonic vaccine should not be used in the current epidemic. “Our relationship will be slow and steady,” he said. “These problems will not go away.”