Monkeypox outbreak slows as Fed promises action and reach

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September 15, 2022 — The number of Americans newly diagnosed with monkeypox has fallen by about 50% since early August, the White House and other federal health officials said Thursday.

Although the overall picture is improving, there are still rising infection numbers in some areas in the US. For this reason and others, the CDC plans to “stay on the gas” and continue to educate, vaccinate and treat highest-risk communities, said CDC Director Rochelle Walensky, MD.

“In recent weeks, we have been pleased to see a slowdown in the growth of new cases here and abroad,” Walensky said Thursday at a news briefing by the White House Monkeypox Response Team and public health officials.

What’s exciting is that the management strategy works here,” said Walensky.

“It’s really important to say that we’re not the only ones with our foot on the accelerator,” said Demetre Daskalakis, deputy coordinator of the White House monkeypox response. He said communities of gay, bisexual and other men who have sex with men, including men of color, “have their foot on the accelerator too.” This population will help officials understand, for example, how best to use the treatment drug TPOXX and the Jynneos vaccine, and will be crucial for ongoing research.

Monkeypox was also identified in a small number of women, but in each of those cases no further transmission took place, officials noted.

TPOXX and resistance concerns

Some experts have questioned whether tecovirimat or TPOXX, an FDA-approved antiviral drug used to treat the related smallpox virus, might one day be less effective against the virus.

“Whenever you have a viral disease that’s broadly spreading through the community with replication, and you’re using a single drug, there’s always a theoretical possibility of resistance,” said Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases.

“That’s why we’re uncomfortable when you only have a single drug that’s been shown to be effective or you’re proving that it’s effective, which is part of the clinical trial,” Fauci said.

Fauci’s team is sponsoring a clinical trial that started Sept. 8 and plans to enroll 500 adults and children. Researchers plan to evaluate the drug’s safety and see if tecovirimat works better than placebo in terms of healing time, pain scores, preventing the development of severe monkeypox, and more. The risk of resistance will also be addressed in this study, Fauci said.

Future research will examine other antiviral drugs, so there is more than one option, especially if resistance to tecovirimate emerges.

Vaccination: Achievements, Justice Efforts, and Research

More than 540,000 doses of the Jynneos vaccine have been administered in 39 jurisdictions, which have reported data to the CDC, Walensky said.

CDC data shows that 47% of people who receive a first dose are White, 21% Hispanic, and 12% Black.

Officials are also reporting an increase in people getting their second dose of Jynneos in the past few weeks. The recommended interval between the first and second dose is 28 days.

“As a reminder, Jynneos is a two-dose vaccine and it is important to receive the second dose in the series to have the best protection against monkeypox,” Walensky said. She added that current data suggests that maximum protection occurs 14 days after the second dose.

It’s the early adopters, or as Walensky describes them, “the people who roll up their sleeves before they even get to the pharmacy” that account for most vaccinations so far.

Officials recognize that we are entering a more challenging phase in getting more reluctant people vaccinated.

In an effort to “crouch down and dig deeper into vulnerable communities,” the White House plans to build on its past successes by reaching out at major Pride events and expanding the pilot program to smaller community events, said Bob Fenton, White House Monkeypox Response Coordinator.

Effective interventions depend on reaching out to men of color, which is part of the CDC Monkeypox Vaccine Equity Pilot Project.

“We also saw how the racial and ethnic makeup of this outbreak evolved,” Walensky said. Initially, cases of monkeypox were reported primarily in non-Hispanic white males. In recent weeks, however, the demographics have shifted. Now, non-Hispanic white men account for 26% of cases, non-Hispanic black men for 38%, and Hispanic or Hispanic men for 25% of cases.

“As we have said before, justice must remain the cornerstone of our response,” Daskalakis said.

In terms of vaccine research, NIAID is sponsoring a study to evaluate the effectiveness of administering the Jynneos vaccine between layers of skin rather than under the skin to protect against monkeypox. Beginning August 10, the FDA allowed a single dose of Jynneos, which is normally given under the skin or subcutaneously, to be split into five doses, which are given between skin layers or intradermally. Now the researchers are further investigating the safety and effectiveness of the practice in the study.

monkey pox“Don’t travel alone”

Data shows that monkeypox does not travel alone, so leveraging existing services that focus on HIV and sexually transmitted infections in affected communities is another strategy to educate and reduce monkeypox, Daskalakis said.

For example, of 1,969 people diagnosed with monkeypox, 38% had HIV and 41% had a sexually transmitted disease in the previous year, according to a study published Sept. 9 in the CDC’s Morbidity and Mortality Weekly Report.

“We are rapidly using this data to transform how monkeypox services can be supported by public health agencies, clinics and community-based organizations,” Daskalakis said. “The same people that we need to test for and lead to prevention and treatment for HIV and STDs are the same people that need monkeypox-related services like testing, education and vaccines.”

“This important change in guidance … allows our frontline health agencies and community-based organizations to leverage their HIV and STI resources to accelerate all of us to the end of the monkeypox outbreak.”



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