Experts warn of “test narrow neck” control for smallpox, experts warn

AndInfectious disease experts warn that the U.S. monkey disease testing strategy is becoming increasingly worrying, creating a barrier and wasting limited time to control the epidemic in the country.

Under the current system, samples must be sent to one of 74 laboratories across the country before they can be sent to the Centers for Disease Control and Prevention. Experts interviewed by STAT argue that the United States should undergo extensive testing for monkey disease and allow more laboratories to be part of the process.

“Every day we waste time not fixing the barriers to testing, every day we fail to deliver information to the networks that need to know about it. it will close to close the window, ”said Boguma Titanji, an infectious disease assistant at Emory University.

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Titanji, who was involved in a study of monkey disease in his native Cameroon, said the number of cases in the United States was much lower than in other similar countries – an underestimation of how contagious the disease was. The UK announced 302 cases on Monday. Canada reported 77 cases last Friday.

“There are a lot of cases in the U.S. like Canada or the UK,” he said. “We have not been tested enough to be sure that there are only 25 cases. I think we need to try harder than we are doing, ”he said. After talking to STAT Titanji, the CDC updated the number of monkey cases to 25 to 31; Cases were identified in 13 states.

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Jennifer Nuzzo, director of Brown University’s new Pandemic Preparedness and Response Center, said the current system is important for a small epidemic, but does not meet the needs of clinics that need to actively search for monkey smallpox.

“This two-step process will not be large-scale,” he said in an interview. “It’s a tedious process,” he said. If you have something that is spreading in ways we can’t see – in the sense that we’re finding instances where we don’t have specific connections or specific transition links – it really feels like we’re in a different mode of response. ”

STAT asked the CDC if it was changing the testing protocol, but did not seek a response at the time of publication. Agency in late May He said he was weighing What needs to be done to expand testing capabilities to other laboratories.

The unprecedented epidemic drew international attention in mid-May when the United Kingdom announced four cases of smallpox in men who had not traveled to endemic West and Central African countries. Since then, nearly 1,000 monkeys have been diagnosed with smallpox in 40 countries, the vast majority of whom are gay, bisexual, or men who have sex with men.

Reports from national health agencies have shown that some cases do not match the patterns of disease described in the medical literature. Some monkey rashes appear before they experience systemic symptoms, such as fever and weakness. Many of them have localized ulcers in the genital and anal areas. Some have only a few sores.

Disagreements between leading health professionals described in the medical literature raise concerns that some people with smallpox may not feel well enough to seek help or may not be recognized as having smallpox.

Joseph Osmundson, a molecular microbiologist in New York, said: “This level of community prevalence is undefined and we can’t help people make dangerous decisions, we can’t help people protect their loved ones and sexual partners unless they know what’s going on.” University.

Prepared by Osmundson first online Information about the virus for men who have had sex with men, pictures of anal and genital lesions caused by monkeys, and information to help people submit to clinics for analysis. Osmundson said community health groups have found that some people seeking the test have found that their clinics are not ready to provide it.

“Because some providers are unaware of the situation, you may be in favor of testing against monkeys,” the primer warned.

Currently, if a health worker suspects that a patient has a monkey disease, he or she will need to contact someone State Department of Health and refer the patient to a facility called the Laboratory Response Network, which is designed to test for biological or chemical hazards. These laboratories can determine if a sample is positive for a family of orthopoxiruses – monkeys and smallpox. According to the CDC, the unified testing capacity of orthopox for this industry is 7,000 per week and 46 tests in 46 laboratories.

If the sample tests are positive, the CDC will perform a validation test. This was reported by the CDC The two-stage approach has so far been sufficient and stressed that a positive orthopox test is considered a possible monkey infection, Activation of all clinical and restrictive measures required for final diagnosis. This includes seeking contact, vaccinating high-risk contacts, and accessing antiviral medications for the patient if necessary.

Ranu Dillon, a global health instructor at Harvard Medical School, said the testing system should be designed to normalize monkey smallpox testing, so the network needs to be expanded to find more cases. Dillon, who works part-time at a community hospital in Vallejo, California, said he now has to clear a test order with the hospital’s lab manager.

“It would be a process, it would be a discussion,” he said. “I think the sooner we move on to normalization, the better we can reduce professional stress or the inconvenience of having to take a test on something you’ve never seen. [before]…. Since you have learned from Covid and many tests turned out to be negative, you need to take a comprehensive test. That’s how you find positive people. ”

Wide nets are very important, as they are now seen in most men who have sex with men, but it is unlikely that they will continue to spread monkeys.

Paul Sachs, an infectious disease doctor at Brigham and Women’s Hospital in Boston, said: “Because the disease is unfamiliar to many and is highly variable in terms of presentation, there are fewer cases, especially among milder or atypical cases.” STATUS IN EMAIL. “I was also worried that I would miss the case if I didn’t fall into this high-risk group at the moment.”

Luciana Borio, a former director of the National Security Council’s medical and biosecurity training, said the country should learn from the test fiasco at the start of the Covid-19 pandemic and respond to commercial diagnostic testing companies.

“We need to open the test and take it to the place where the test is as usual. We learned that from Covid, didn’t we? said Borio, senior researcher on global health at the Council on Foreign Relations. “It’s a lot more effective.”

This will no doubt take time for companies to conduct tests and verify. But that work must continue, he said.

“It has to start now, if it hasn’t started yet,” Borio said. “How long will it take? But we don’t have to argue about whether it’s necessary or not. ”

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