US, other countries report new cases of monkeypox
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The CDC on Wednesday confirmed that a Massachusetts resident who traveled from Canada via private transportation was infected with monkeypox virus, the first U.S. case of monkeypox this year.
Cases of the disease have popped up in other countries, too, sparking concern among experts. A widening outbreak in Europe that was first reported in the United Kingdom has grown to include several other countries.
The U.S. reported two cases of monkeypox last year in travelers who had returned from Nigeria, where there has been an ongoing outbreak since 2017 — the first in 4 decades.
Faisal Minhaj, PharmD, a CDC epidemic intelligence officer in the National Center for Emerging and Zoonotic Infectious Diseases, said the CDC is coordinating with state and local health officials to identify people who may have been in contact with the Massachusetts man while he was infectious.
“While the overall risk to the general public appears low, it is possible there are some other cases of monkeypox occurring in the US that have not yet been detected or diagnosed,” Minhaj told Healio. “CDC is working with state health partners to provide guidance for increased surveillance and testing for monkeypox.”
Monkeypox virus is closely related to the virus that causes smallpox, but presents with milder symptoms. The virus is usually transmitted to humans via contact with an infected animal, including through a bite or scratch or while preparing bush meat for consumption, but it also can be transmitted from person to person, probably via respiratory droplets, according to the CDC.
The Nigerian outbreak has shown evidence of both primary zoonotic transmission and secondary human-to-human transmission.
There are two primary strains of the virus, which is found in Central and West Africa. The U.S. infections reported last year matched the outbreak strain in Nigeria — called the West African strain — which is less virulent and less lethal than the other strain, the Congo Basin strain
[Editor’s note: A CDC disease detective answered questions about monkeypox for Healio last year. You can read his answers here.]
Prior to these new clusters of cases, monkeypox outbreaks outside of Africa were rare, but a 2003 outbreak in the U.S. involved dozens of people and was related to exposure to imported prairie dogs.
The CDC said it is unclear how the patients in these new clusters were exposed to the virus but noted that cases include people who identify as men who have sex with men (MSM).
“CDC is urging health care providers in the U.S. to be alert for patients who have rash illnesses consistent with monkeypox, regardless of whether they have travel or specific risk factors for monkeypox,” the agency said.
WHO said it was notified on May 13 of two confirmed cases and one probable case from the same household in the U.K. By May 15, four additional cases were reported among MSM. Cases have since been reported in Spain, Portugal, Italy and Sweden.
The CDC, which is tracking the clusters, noted that monkeypox is not common in these countries.
“The recent clusters in other countries are a new phenomenon that we are working to understand better,” Minhaj said.
There is a licensed vaccine that protects against monkeypox and smallpox ⎼⎼ Bavarian Nordic’s Jynneos, which was approved by the FDA in 2019 for adults aged 18 years or older in the U.S. The company said in 2020 that the U.S. had ordered millions of doses of the vaccine for the national stockpile.
On Thursday, Bavarian Nordic announced that the U.S. Biomedical Advanced Research and Development Authority had exercised an option for freeze-dried versions of the vaccine, with those doses to be delivered in 2023 and 2024.
Another company, SIGA Technologies, announced that the FDA had approved an IV formulation of TPOXX, a smallpox treatment approved in the U.S., Canada and Europe for the treatment of smallpox in 2018.
SIGA noted that the European approval also included the use of TPOXX to treat monkeypox. According to the company, the IV formulation of TPOXX was cited in a budget request by President Joe Biden as being used to treat a U.S. patient with monkeypox.
References:
Bavarian Nordic. Secures vaccine order from European Country after confirmed monkeypox cases. https://www.bavarian-nordic.com/investor/news/news.aspx?news=6574. Published May 19, 2022. Accessed May 19, 2022.
Bavarian Nordic to manufacture first freeze-dried doses of smallpox vaccine upon exercise of contract option by the U.S. government. https://www.bavarian-nordic.com/investor/news/news.aspx?news=6569. Published May 18, 2022. Accessed May 18, 2022.
CDC. Monkeypox transmission. https://www.cdc.gov/poxvirus/monkeypox/transmission.html. Accessed May 19, 2022.
SIGA. SIGA receives approval from the FDA for intravenous (IV) formulation of TPOXX (tecovirimat). https://investor.siga.com/news-releases/news-release-details/siga-receives-approval-fda-intravenous-iv-formulation-tpoxxr. Accessed on May 19, 2022.
WHO. Monkeypox – United Kingdom of Great Britain and Northern Ireland. https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON383. Published May 18, 2022. Accessed May 19, 2022.
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