Monkeypox Virus - Credit CDC PHIL
#16,802
The plot, as they say, thickens.
The CDC has just finished a 40-minute conference call with representatives from the CDC, HHS, and the White House in advance of the release of an (embargoed until 1 pm EST) MMWR report (see below) on Monkeypox cases in the United States.
The audio file will probably be posted in the next hour or two, and a transcript will be posted when available.
Helen Branswell of STAT news, however, published a scoop a couple of hours ago, with a report indicating at least 2 genetically distinct variants of the Monkeypox virus have been identified in the United States. This suggests that more than one spillover event has happened - probably in Nigeria - and that at least two outbreaks are spreading concurrently.
Both are of the milder West African clade, with one genetically similar to the imported case reported in Maryland last November, and the other genetically similar to the case imported into Texas last summer.
All of which suggests these viruses have been circulating unnoticed in humans for months.
These two distinct variants aren't discussed in today's MMWR, although they do state: Genome sequencing results from virus recovered from the patient in Massachusetts display similarities to other published genomes in this outbreak from Europe (Nextstrain/monkeypox)¶¶ and are related to the 2017–2018 monkeypox outbreak in Nigeria.
Two weeks ago public health officials were still fairly confident that Monkeypox could be quickly contained, but now - with over 800 cases identified across 3 dozen countries (and growing) - prospects for a quick or satisfactory resolution are dimming.
A link to, and excerpts from, today's MMWR follow.
Monkeypox Outbreak — Nine States, May 2022
Early Release / June 3, 2022 / 71
Faisal S. Minhaj, PharmD1,2; Yasmin P. Ogale, PhD1,3; Florence Whitehill, DVM1,2; Jordan Schultz, MPH4; Mary Foote, MD5; Whitni Davidson, MPH2; Christine M. Hughes, MPH2; Kimberly Wilkins2; Laura Bachmann, MD3; Ryan Chatelain, MPH6; Marisa A.P. Donnelly, PhD1; Rafael Mendoza, MPH7; Barbara L. Downes, MS8; Mellisa Roskosky, PhD1,9; Meghan Barnes, MSPH10; Glen R. Gallagher, PhD4; Nesli Basgoz, MD11; Victoria Ruiz, PhD5; Nang Thu Thu Kyaw, PhD1,5; Amanda Feldpausch, DVM12; Amy Valderrama, PhD13; Francisco Alvarado-Ramy, MD14; Chad H. Dowell, MS15; Catherine C. Chow, MD16; Yu Li, PhD2; Laura Quilter, MD3; John Brooks, MD17; Demetre C. Daskalakis, MD17; R. Paul McClung, MD3; Brett W. Petersen, MD2; Inger Damon, MD, PhD2; Christina Hutson, PhD2; Jennifer McQuiston, DVM2; Agam K. Rao, MD2; Ermias Belay, MD2; Andrea M. McCollum, PhD2; Monkeypox Response Team 2022 (View author affiliations)View suggested citation
Summary
What is already known about this topic?
Monkeypox, a rare disease caused by infection with Monkeypox virus, is endemic in several Central and West African countries. Cases in persons outside Africa are often linked to international travel or imported animals.
What is added by this report?
CDC is tracking multiple reported U.S. monkeypox cases, and monitoring cases in persons in countries without endemic monkeypox and with no known travel links to an endemic area; current epidemiology suggests person-to-person community spread.
What are the implications for public health practice?
CDC urges health departments, clinicians, and the public to remain vigilant, institute appropriate infection prevention and control measures, and notify public health authorities of suspected cases to reduce disease spread.
(SNIP)
Discussion
The current identification of monkeypox clusters in several countries that do not have endemic disease and involving patients with no direct travel history to an area with endemic monkeypox suggests person-to-person community spread. Close contact with infected persons or fomites (e.g., shared linens) is the most significant risk factor for Monkeypox virus infection in human monkeypox outbreaks (10).
Monkeypox virus is spread through close, often sustained skin-to-skin contact, but the initial appearance or occurrence of lesions in the anogenital area observed in the current outbreak differs from the typical appearance or occurance beginning on the face, oral mucosa, and hands and feet, then spreading to other parts of the body in a centrifugal distribution. The high proportion of initial cases diagnosed in this outbreak in persons who identify as gay, bisexual, or other MSM, might simply reflect an early introduction of monkeypox into interconnected social networks; this finding might also reflect ascertainment bias because of strong, established relationships between some MSM and clinical providers with robust STI services and broad knowledge of infectious diseases, including uncommon conditions. However, infections are often not confined to certain geographies or population groups; because close physical contact with infected persons can spread monkeypox, any person, irrespective of gender or sexual orientation, can acquire and spread monkeypox.
The following measures can be taken by the public to prevent infection with monkeypox: 1) isolate ill persons from uninfected persons; 2) practice good hand hygiene and use appropriate personal protective equipment to protect household members if ill or caring for ill persons at home (e.g., a surgical mask, long sleeves and pants, and disposable gloves); 3) use an Environmental Protection Agency–registered disinfectant with an emerging viral pathogens claim that is found on EPA’s List Q for disinfection of surfaces.††† Patients should also avoid contact with pets and other animals while infectious, because some mammals might be susceptible to monkeypox. Persons with symptoms of monkeypox, including unexplained lesions, should contact their health care provider for an evaluation and should avoid close contact with others, including intimate or sexual contact, until they are evaluated or receive testing.
CDC urges health care providers in the United States to be alert for patients who have rash illnesses consistent with monkeypox, regardless of a patient’s gender or sexual orientation or a history of international travel or specific risk factors for monkeypox. Clinicians should contact their local or state health department if they suspect a case of monkeypox. There are 110 LRN laboratories available and equipped for rapid diagnostic testing of emerging pathogens across the United States; currently 68 test for orthopoxviruses. The prolonged interval from rash onset to positive test result was reflective of delays in clinical suspicion of an unfamiliar illness; all patients had results within 0–2 days after specimens were collected. During this outbreak, a positive test result for an Orthopoxvirus at an LRN laboratory is presumed to be monkeypox and is actionable for antiorthopoxviral treatment, and by public health authorities to initiate isolation, contact tracing, monitoring, investigation, and PEP of exposed contacts. PEP with smallpox vaccines remains available from the strategic national stockpile for eligible exposed persons.
As the source and spread of this outbreak are being investigated, it is crucial to assess all possible modes of transmission and identify risk groups, as well as institute appropriate public health preventive measures. CDC is providing guidance on case definitions, identification of contacts, clinical management, and infection control and prevention within health care facilities and the home, creating resources for disseminating information on monkeypox, and supporting laboratory testing infrastructure domestically and globally.§§§
Remarkably, the world seems surprised that Monkeypox could spread as it has, despite years of warnings (see below).
WHO Update & Risk Assessment On Monkeypox In The DRC
WHO: Modelling Human-to-Human Transmission of Monkeypox
Just as I assume they will be when avian influenza, swine flu, another novel coronavirus, or Nipah begins their world tour. Details and dates to be announced at a later date.
