How Monkeypox spreads

Monkeypox spread

In this video, Dr. Seheult of MedCram provides the latest update on Monkeypox. At the present time, the number of cases have slowly and steadily been climbing every day. Worldwide, over 30,000 people have confirmed cases of Monkeypox. 

Who is getting Monkeypox?

In a NEJM article, they reviewed 528 Monkeypox infections across 16 countries and found that 98% of the cases were amongst men who have sex with men and 41% of these patients also had HIV with a median CD4 count of 680. The authors concluded that 95% of the transmission was through sexual contact. However, the authors noted that Monkeypox can be contracted by anyone and is not to be considered as disease of only men who have sex with men. There was a case of a physician in Tel Aviv who contracted it despite being in full protective gear and was thought to have gotten it when removing his gloves. 

How is it spread?

In a Lancet article, it discusses how the virus is being spread. It found that the viral load of the Monkeypox virus within the pustules and lesions themselves was higher than what was found in the pharynx (upper airway) which suggested that spread of the virus is less likely through respiratory spread. This observation along with the location of the lesions (more in the genital areas) is suggestive that close contact during sex is the dominant mode of transmission in the Monkeypox outbreak.

Signs and symptoms of Monkeypox

Signs of symptoms in the NEJM article included fever, lymph node enlargement (typically regional), lethargy, myalgia, headache, and rash. 

Treatment of Monkeypox

In the NEJM article, 5% of the individuals received a course of treatment with an antiviral called Tecovirimat.  Tecovirimat is being used off-label for the treatment of Monkeypox. It was originally made for smallpox infections. This medication affects the protein that is responsible for the virus’ ability to bud off the cell. There actually hasn’t been a randomized trial with this as it would not be ethical to infect people with Monkeypox and prior to the outbreak, the incidence of Monkeypox was low.  MedCram is providing a link for those clinicians that need to obtain tecovirimat. 

Monkeypox vaccines?

What about vaccines? There are none available specifically for Monkeypox, but instead vaccines that were created for smallpox are being utilized.  There are two vaccines available ACAM2000 and Jynneos. The first vaccine made, ACAM2000 vaccine, allows the virus to replicate which can lead to possible side effects. The subsequent vaccine Jynneos that was approved later is a replication deficient vaccine meaning the virus can’t replicate and hence has less side effects as compared to ACAM2000.

Are the vaccines available?

At this time, the US only has 400,000 doses.  However, a study in 2015 found that giving the vaccine intradermally required 5x less material but was still effective. Now a vial that would normally be 1 dose can now do 5 doses which can increase the 400,000 doses to approximately 2 million doses. Eligibility for the vaccine is being given for post-exposure prophylaxis and to lab workers with a high likelihood of exposure. There are vaccine campaigns also occurring in the at risk population of men who have sex with men. The company is also working on trying to make more vaccine.

 

LINKS / REFERENCES:

Nov 3, 2021 ACIP Meeting – Orthopoxviruses Vaccines (CDC) | https://youtu.be/4SCUOppgtxE

Monkeypox (Our World in Data) | https://ourworldindata.org/monkeypox

Monkeypox Tracker (Esri Canada) | https://monkeypox-tracker-esricanada….

Monkeypox Virus Infection in Humans across 16 Countries — April–June 2022 (NEJM) | https://www.nejm.org/doi/full/10.1056…

Pathogen Safety Data Sheets: Infectious Substances – Monkeypox virus (Government of Canada) | https://www.canada.ca/en/public-healt…

Medical staff call to be vaccinated against monkeypox after doctor infected (Times of Israel) | https://www.timesofisrael.com/medical…

Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study (Lancet) | https://www.thelancet.com/journals/la…

Information for Healthcare Providers on Obtaining and Using TPOXX (Tecovirimat) for Treatment of Monkeypox (CDC) | https://www.cdc.gov/poxvirus/monkeypo…

Comparison of lyophilized versus liquid modified vaccinia Ankara (MVA) formulations and subcutaneous versus intradermal routes of administration in healthy vaccinia-naïve subjects (Science Direct) | https://www.sciencedirect.com/science…

Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study (Lancet) | https://www.thelancet.com/journals/la…

Monkeypox DNA found in Sacramento wastewater samples (ABC10) | https://www.abc10.com/article/news/he…

Monkeypox Virus (AABB) | https://www.aabb.org/docs/default-sou…

Monkeypox Explained Clearly (MedCram) | https://youtu.be/lWEj4J9cu7Y

Visit MedCram.com for more updates on pox virus infectious disease details including monkeypox uk, monkeypox virus diagnosis, and more. 

 

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