Federal government adjusts monkeypox vaccine strategy

https://mailchi.mp/11f2d4aad100/the-weekly-gist-august-12-2022?e=d1e747d2d8

This week, the Food and Drug Administration (FDA) announced a change intended to stretch out the limited supply of monkeypox vaccine doses, allowing the shots to reach five times the number of patients. Monkeypox, a disease in the smallpox family, is spread primarily through skin-to-skin contact, often causing patients to develop painful lesions.

Although most cases resolve within a few weeks, the rapid growth in cases, now more than 9K domestically and 30K globally, is still a cause for concern, leading federal officials to declare a public health emergency last week. The FDA is also recommending that providers administer the vaccine between layers of skin, rather than below the skin into fatty tissue. This dosing change will allow providers to extend the nearly half a million doses not yet sent to states, in order to reach the more than 1.6M Americans considered highest risk.

The Gist: The country is now dealing with two public health emergencies from highly contagious diseases simultaneously. While monkeypox isn’t nearly as transmissible, deadly, or overwhelming to the healthcare system as COVID, the public health response has nonetheless been lackluster (and this week’s new COVID guidance suggests that the CDC has largely given up on managing the response, devolving responsibility to individuals in nearly all settings). 

For those hoping that the COVID experience would spark faster action by our public health system, the federal response to monkeypox shows we haven’t applied the lessons learned. Public health authorities aren’t conducting rigorous disease surveillance, testing and treatments remain hard to get, and Congress isn’t dedicating funds for the response. The lack of proactive leadership is likely to result in healthcare providers again bearing the brunt of efforts to manage another unsuppressed viral outbreak. 

How does monkeypox spread? An epidemiologist explains why it isn’t an STI and what counts as close contact

Monkeypox is caused by a virus that, despite periodic outbreaks, is not thought to spread easily from person to person and historically has not spurred long chains of transmission within communities. Now, many researchers are left scratching their heads as to why monkeypox seems to be propagating so readily and unconventionally in the current global outbreak.

The monkeypox virus typically spreads through direct contact with respiratory secretions, such as mucus or saliva, or skin lesions. Skin lesions traditionally appear soon after infection as a rash – small pimples or round papules on the face, hands or genitalia. These lesions may also appear inside the mouth, eyes and other parts of the body that produce mucus. They can last for several weeks and be a source of virus before they are fully healed. Other symptoms usually include fever, swollen lymph nodes, fatigue and headache.

I am an epidemiologist who studies emerging infectious diseases that cause outbreaks, epidemics and pandemics. Understanding what’s currently known about how monkeypox is transmitted and ways to protect yourself and others from infection can help reduce the spread of the virus.

How is this outbreak different from prior ones?

The current monkeypox epidemic is a bit unusual in a few ways.

First, the sheer scope of the current epidemic, with over 25,000 cases worldwide as of early August and in countries where the virus has never appeared, sets it apart from previous outbreaks. Monkeypox is endemic to specific areas in central and western Africa, where cases occur sporadically and outbreaks are usually contained and quickly burn out. In the current outbreak, global spread has been rapid. Young men, mostly ages 18 to 44, account for the majority of cases, and over 97% identify as men who have sex with men (MSM). Some superspreading events associated with air travel, international gatherings and multiple-partner sexual encounters contributed to early transmission of the virus.

Second, the way symptoms are appearing may facilitate spread among people who don’t yet know they are infected. Most patients reported mild symptoms without fever or swollen lymph nodes, symptoms that typically appear before a skin rash is visible. While most people do develop skin lesions, many reported having only a single papule that was often obscured inside a mucosal area, such as inside the mouth, throat or rectum, making it easier to miss.

A number of people reported no symptoms at all. Asymptomatic infections are more likely to go undiagnosed and unreported than those with symptoms. But it is not yet known how asymptomatic individuals may be contributing to spread or how many asymptomatic cases may be undetected so far.

Who is at risk of getting monkeypox?

For most people, the risk of getting monkeypox is currently low. Anyone who has prolonged, close contact with an infected person is at risk, including partners, parents, children or siblings, among others. The most common settings for transmission are within households or health care settings.

Because of sustained transmission within the community of men who have sex with men, they are considered an at-risk group, and targeted recommendations can help allocate resources and limit transmission. While monkeypox is spreading primarily among MSM, this does not mean that the virus will remain confined to this group or that it won’t jump to other social networks. The virus itself has no regard for age, gender, ethnicity or sexual orientation.

Anyone who comes into direct contact with the monkeypox virus is at risk of being infected. New cases are recorded daily, with additional countries and regions reporting their first cases and already affected countries observing a continued rise in infections.

As with most infections, other factors, such as the amount of viral exposure, type of contact and individual immune response, play a role in whether an infection takes hold.

Is monkeypox an STI?

While sexual encounters are currently the predominant mode of transmission among reported cases, monkeypox is not a sexually transmitted infection. STIs are spread primarily through sexual contact, while monkeypox can spread through any form of prolonged, close contact.

Close contact that transmits the monkeypox virus involves encounters that are typically more intimate or involved than having a casual conversation or standing next to someone in an elevator. Transmission requires exchange of mucosal fluids or direct contact with the virus in sufficient quantity to seed an infection. This could occur through physical contact during kissing or cuddling.

Because sexual encounters involve direct skin-to-skin physical contact where bodily fluids may be exchanged, these close encounters can transmit viruses more easily. Recently, monkeypox DNA has been detected in feces and various body fluids, including saliva, blood, semen and urine. But the presence of viral DNA does not necessarily mean that the virus can infect someone else. Transmission from these sources is still under investigation.

As the virus moves through populations, public health officials focus on getting the message out to the most at-risk and hardest hit communities about how to stay safe. Currently, breaking the transmission chain among sexual contacts is a priority, including but not limited to MSM communities. Targeted messaging is meant to protect the health of a specific group, not to stigmatize the intended audience.

Other modes of transmission may play a greater role outside the MSM community. Household transmission, where individuals may come into close contact with infected people or contaminated items, is one of the most common types of exposure. Research is ongoing into the potential airborne and respiratory droplet spread of monkeypox in the current situation.

Outbreaks are dynamic situations that evolve over time, which is why public health messages may change as the epidemic progresses. Not every outbreak looks or behaves the same way – even pathogens seen in previous outbreaks can be different the next time around. As researchers learn more about how the disease is transmitted and identify changes in patterns of spread, public health officials will provide updates about specific forms of contact, behaviors or other factors that could increase infection risk. While changing guidelines can be frustrating or confusing, keeping up to date with the latest recommendations can help you protect yourself and stay safe.

What do I do if I’ve been exposed to monkeypox?

Anyone who has been infected can help contain spread by isolating from others, including pets. Covering skin lesions, wearing a mask in shared spaces and decontaminating shared surfaces or items, such as bed linens, dishes, clothes or towels, can also reduce spread.

You can also help interrupt the transmission chain by participating in contact tracing, notifying public health officials of others who may have been exposed through you, which is a basic tenet and common practice of disease control.

The Centers for Disease Control and Prevention has further guidance on how to control monkeypox spread in both household settings and shared living facilities.

Lastly, getting vaccinated as soon as possible can still protect you from severe illness even if you’ve already been infected.

U.S. declares public health emergency over monkeypox

The Biden administration has declared the monkeypox outbreak a public health emergency — a move that gives officials more flexibility to tackle the virus’ spread.

Why it matters: New YorkCalifornia and Illinois all declared public health emergencies related to monkeypox in the last two weeks. The World Health Organization has already declared monkeypox a global emergency.

Details: Department of Health and Human Services secretary Xavier Becerra made the announcement Thursday in a briefing on monkeypox.

  • Federal health officials can now expedite preventative measures to treat monkeypox without going through a full federal review, the Washington Post reports.

What they’re saying: “We’re prepared to take our response to the next level in addressing this virus,” Becerra said Thursday. “We urge every American to take monkeypox seriously and to take responsibility to help us tackle this virus.”

  • Dr. Rochelle Walensky, the director of the Centers for Disease Control and Prevention, said the declaration will help “exploit the outbreak” and potentially increase access to care for those at risk.
  • Dr. Demetre Daskalakis, the White House national monkeypox response deputy coordinator, said “today’s actions will allow us to meet the needs of communities impacted by the virus … and aggressively work to stop this outbreak.”

State of play: Dr. Robert Califf, the commissioner of the Food and Drug Administration, said the U.S. is “at a critical inflection point” in the monkeypox outbreak, requiring “additional solutions to address the rise in infection rates.”

  • There are 6,600 cases of monkeypox in the U.S. as of Thursday, Becerra said.
  • There were less than 5,000 cases of monkeypox last week, he added.

The big picture: Biden’s decision to declare monkeypox a public emergency allows him to raise awareness of the virus and unlock more flexibility for spending on ways to treat and tackle the virus.

  • About 20% of Americans are worried they’ll contract monkeypox, Axios previously reported. But there are still some gaps in Americans’ knowledge of the virus and how it impacts our population.

What’s next: U.S. health officials said that 800,000 monkeypox vaccine doses will be made available for distribution. But in hotspot states for the monkeypox outbreak, there’s a drastic disconnect between the number of doses that local health officials say they need versus what they have been allotted.

  • The U.S. will receive another 150,000 monkeypox vaccine doses in the strategic national stockpile in September, Dawn O’Connell, administrator at HHS’ Administration for Strategic Preparedness & Response, told reporters Thursday. These were previously scheduled to arrive in October.

1 in 5 Americans fear they’ll get monkeypox

https://www.axios.com/2022/07/29/monkeypox-cases-virus-vaccine-us

About 20% of Americans are afraid they’ll soon contract monkeypox, but there are still some significant holes in the public’s understanding of the virus, according to a new survey from the Annenberg Public Policy Center.

The big picture: These early stages of monkeypox outbreaks aren’t nearly as dangerous as early COVID outbreaks were, but some of the challenges for public health officials — like educating people about a virus they’re not familiar with, and mobilizing vaccination efforts — are similar.

By the numbers: One in five Americans are worried about getting monkeypox in the next three months, the Annenberg survey found.

  • Nearly half are unsure whether monkeypox is less contagious than COVID, although 69% correctly identified the way it usually spreads (through close contact with an infected person).
  • Two-thirds said they either don’t think there’s a vaccine for monkeypox, or aren’t sure. (There is a vaccine. The Biden administration said Thursday that it’s allocating another 786,000 doses, on top of the more than 340,000 it distributed this month.)
  • Women were more worried about contracting monkeypox than men, even though the overwhelming majority of cases in the U.S. have been among men.

Between the lines: Memories of false assurances and mixed messaging about the coronavirus in the early days of the pandemic are factoring into public sentiment on monkeypox, said Kathleen Hall Jamieson, director of the Annenberg center.

  • “There is some suspicion scientists don’t know what they know, so that translates to higher worry,” Jamieson told Axios.

Misinformation and conspiracy theories are also a problem.

  • 12% of respondents in the Annenberg survey said they believe the monkeypox virus was probably or definitely created in a lab; 21% said they were not sure whether it was caused by exposure to a 5G signal.
  • The fact that the virus has so far spread primarily among men who have sex with men has also fueled widespread perceptions that it’s a sexually transmitted infection, which it is not.

What we’re watching: Perceptions of risk remain fluid and could shift if monkeypox finds new modes of transmission, or if it continues to affect children.

  • “If kids get it and there’s been no contact with individuals at risk, then you have a completely different situation than you have now,” Jamieson said.

San Francisco, New York state call monkeypox an emergency: 5 updates

New York state declared an imminent threat and San Francisco issued a state of emergency over monkeypox July 28 as the virus continues to spread in the U.S., NBC News reported. 

The news comes after the World Health Organization declared monkeypox a global emergency July 23 and as the CDC reported 4,907 confirmed cases nationwide as of July 28. California and New York account for more than 40 percent of the reported cases in the U.S., according to The Washington Post.

In a statement, New York State Commissioner of Health Mary Bassett, MD, said the declaration allows local health departments “to access additional state reimbursement, after other federal and state funding sources are maximized, to protect all New Yorkers and ultimately limit the spread of monkeypox in our communities.” It covers monkeypox prevention response and activities from June 1 through the end of the year. 

In San Francisco, the monkeypox public health emergency takes effect Aug. 1, city officials said in a news release. The release, from Mayor London Breed and the San Francisco Department of Public Health, said the declaration “will mobilize city resources, accelerate emergency planning, streamline staffing, coordinate agencies across the city, allow for future reimbursement by the state and federal governments and raise awareness throughout San Francisco about [monkeypox].”

Four other updates: 

1. HHS announced July 28 that nearly 800,000 additional monkeypox vaccine doses will be available for distribution to states and jurisdictions. The 786,000 additional doses are on top of the more than 300,000 doses already distributed. This means the U.S. has secured a total of about 1.1 million doses “that will be in the hands of those who need them in the next several weeks,” HHS Secretary Xavier Becerra said during a July 28 news conference. The additional doses will be allocated based on the total population of at-risk people and the number of new cases in each jurisdiction. “This strategy ensures that jurisdictions have the doses needed to complete the second dose of this two-dose vaccine regimen for those who have been vaccinated over the past month,” HHS said in a news release. 

2. As of the morning of July 29, the U.S. has held off on declaring a national monkeypox emergency. Mr. Becerra said July 28 that HHS “continue[s] to monitor the response throughout the country on monkeypox” and will weigh any decision regarding a public health emergency declaration based on the response.

3. The monkeypox response is straining public health workers. Health experts are concerned over how the monkeypox response will further deplete the nation’s public health workforce, still strained and burnt out from the ongoing COVID-19 pandemic. Barriers to testing, treatment and vaccine access largely mirror the missteps in the early coronavirus response, Megan Ranney, MD, emergency physician and academic dean of  Brown University School of Public Health in Providence, R.I, told The Washington Post. “I can’t help but wonder if part of the delay is that our public health workforce is so burned out,” she said. “Everyone who’s available to work on epidemiology or contract tracing is already doing it for COVID-19.” 

4. Monkeypox testing demand is low, commercial laboratories told CNN. In recent weeks, five major commercial laboratories have begun monkeypox testing, giving the nation capacity to conduct 80,000 tests per week. While Mayo Clinic Laboratories can process 1,000 samples a week, it’s received just 45 specimens from physicians since it began monkeypox testing July 11, according to the July 28 CNN report. “Without testing, you’re flying blind,” William Morice, MD, PhD, president of Mayo’s lab and chair of the board of directors at the American Clinical Laboratory Association, told the news outlet. “The biggest concern is that you’re not going to identify cases and [monkeypox] could become an endemic illness in this country. That’s something we really have to worry about.”

WHO declares monkeypox a global health emergency

The World Health Organization (WHO) has declared the monkeypox outbreak a global health emergency after the virus reached more than 70 countries around the world. 

WHO Director General Tedros Adhanom Ghebreyesus said at a press conference on Saturday that he decided the outbreak represents a “public health emergency of international concern.”

WHO’s assessment is that the risk of monkeypox is moderate globally and in all regions, except in the European region where we assess the risk as high,” he said.

Tedros said the WHO’s International Health Regulations Emergency Committee came to a consensus at a meeting a month ago that monkeypox did not represent an international public health emergency, but the situation has changed.

He said the WHO had received reports of just more than 3,000 cases from 47 countries at the time, but more than 16,000 cases have now been reported from 75 countries and territories. He said there have been five deaths.

Tedros said the committee was unable to reach a consensus on whether the outbreak should be considered a public health emergency of international concern, but he considered five factors in declaring it an emergency.

He said the first factor is information countries have shared with the WHO, and that data from countries around the world shows that the virus has spread rapidly to many countries that have not seen it before.

He added that the second factor is the definition of a public health emergency and that the three criteria for declaring such an emergency have been met.

A public health emergency of international concern is considered a situation that is serious, sudden, unusual or unexpected, carries implications for public health beyond a country’s borders and may require immediate international action, according to the WHO.

Tedros said the third factor is the advice of the committee, which was divided, and the fourth factor is scientific principles and evidence, which is currently “insufficient” and leaves “many unknowns.”

He said the fifth factor is the risk to human health, international spread and the potential for interfering with international traffic.

He said there is a “clear risk” for international spread, but the risk of interfering with international traffic is currently low.

“So in short, we have an outbreak that has spread around the world rapidly, through new modes of transmission, about which we understand too little and which meets the criteria in the International Health Regulations,” Tedros said.

The Hill has reached out to the WHO for comment.

Monkeypox has spread quickly in the United States since cases were first detected in the country in May. The virus appears to be spreading primarily among men who have sex with men and spreads through extended physical contact.

The virus can cause symptoms like lesions, a rash and swelling of lymph nodes.

Ghebreyesus said he is making recommendations for four categories of countries in managing monkeypox.

For countries that have not seen any cases or not reported a case in 21 days, they should take measures like activating health mechanisms to prepare to respond to monkeypox and raise awareness about transmission, according to a WHO statement.

Countries with recently imported cases of monkeypox and that are experiencing human-to-human transmission — which includes the United States — should implement a coordinated response, work to engage and protect their communities and implement public health measures like isolating cases and using vaccines.

The Biden administration announced earlier this month that it would distribute an additional 144,000 doses of the Jynneos vaccine to address monkeypox after having distributed about 40,000 doses previously.

The third group of countries are those with the “known or suspected” transmission of the virus from animals to humans. They should establish or activate mechanisms for understanding and monitoring the animal-to-human and human-to-animal transmission risk and study transmission patterns.

The fourth group are countries with the manufacturing capacity to create vaccines and other medical countermeasures. The WHO statement calls on these countries to increase production and availability of these measures and work with WHO to ensure necessary supplies are made available based on public health needs at “reasonable cost” to countries that need support the most.

Ghebreyesus said the outbreak is concentrated among men who have sex with men and especially those with multiple sexual partners.

“That means that this is an outbreak that can be stopped with the right strategies in the right groups,” he said.

He added that countries should work with communities of men with male sexual partners to inform them and offer support and to adopt measures that protect the “health, human rights and dignity of affected communities.”

Ghebreyesus said civil society organizations, especially those with experience working with people who are HIV-positive, should work with WHO to fight stigma and discrimination.

The spread of HIV and AIDS in the 1980s led to increased stigma for those who identify as gay as the virus was initially reported to be spreading among gay men.

Explainer: What to Know About Monkeypox

Explainer: What to Know About Monkeypox

The COVID-19 pandemic is still fresh in the minds of the people around the world, so it comes as no surprise that recent outbreaks of another virus are grabbing headlines.

Monkeypox outbreaks have now been reported in multiple countries, and it has scientists paying close attention. For everyone else, numerous questions come to the surface:

  • How serious is this virus?
  • How contagious is it?
  • Could monkeypox develop into a new pandemic?

Below, we answer these questions and more.

What is Monkeypox?

Monkeypox is a virus in the Orthopoxvirus genus which also includes the variola virus (which causes smallpox) and the cowpox virus. The primary symptoms include fever, swollen lymph nodes, and a distinctive bumpy rash.

There are two major strains of the virus that pose very different risks:

  • Congo Basin strain: 1 in 10 people infected with this strain have died
  • West African strain: Approximately 1 in 100 people infected with this strain died

At the moment, health authorities in the UK have indicated they’re seeing the milder strain in patients there.

Where did Monkeypox Originate From?

The virus was originally discovered in the Democratic Republic of Congo in monkeys kept for research purposes (hence the name). Eventually, the virus made the jump to humans more than a decade after its discovery in 1958.

It is widely assumed that vaccination against another similar virus, smallpox, helped keep monkeypox outbreaks from occurring in human populations. Ironically, the successful eradication of smallpox, and eventual winding down of that vaccine program, has opened the door to a new viral threat. There is now a growing population of people who no longer have immunity against the virus.

Now that travel restrictions are lifting in many parts of the world, viruses are now able to hop between nations again. As of the publishing of this article, a handful of cases have now been reported in the U.S., Canada, the UK, and a number of European countries.

On the upside, contact tracing has helped authorities piece together the transmission of the virus. While cases are rare in Europe and North America, it is considered endemic in parts of West Africa. For example, the World Health Organization reports that Nigeria has experienced over 550 reported monkeypox cases from 2017 to today. The current UK outbreak originated from an individual who returned from a trip to Nigeria.

Could Monkeypox become a new pandemic?

Monkeypox, which primarily spreads through animal-to-human interaction, is not known to spread easily between humans. Most individuals infected with monkeypox pass the virus to between zero and one person, so outbreaks typically fizzle out. For this reason, the fact that outbreaks are occurring in several countries simultaneously is concerning for health authorities and organizations that monitor viral transmission. Experts are entertaining the possibility that the virus’ rate of transmission has increased.

Images of people covered in monkeypox lesions are shocking, and people are understandably concerned by this virus, but the good news is that members of the general public have little to fear at this stage.

I think the risk to the general public at this point, from the information we have, is very, very low.
–TOM INGLESBY, DIRECTOR, JOHNS HOPKINS CENTER FOR HEALTH SECURITY

A deadly virus was just identified in Ghana: What to know about Marburg

Epidemiologist Luke Nyakarahuka sprays disinfectant on scientists Jonathan Towner and Brian Amman in Queen Elizabeth National Park, Uganda, in 2018. The scientists were researching how bats transmit the Marburg virus to humans.

After the coronavirus pandemic and the rise of monkeypox cases, news of another virus can trigger nerves globally. The highly infectious Marburg virus has been reported in the West African country of Ghana this week, according to the World Health Organization.

Two unrelated people died after testing positive for Marburg in the southern Ashanti region of the country, the WHO said Sunday, confirming lab results from Ghana’s health service. The highly infectious disease is similar to Ebola and has no vaccine.

Health officials in the country say they are working to isolate close contacts and mitigate the spread of the virus, and the WHO is marshaling resources and sending specialists to the country.

“Health authorities have responded swiftly, getting a head start preparing for a possible outbreak. This is good because without immediate and decisive action, Marburg can easily get out of hand,” said the WHO’s regional director for Africa, Matshidiso Moeti.

Fatality rates from the disease can reach nearly 90 percent, according to the WHO.

Here’s what we know about the virus:

What is the Marburg virus?

Marburg is a rare but highly infectious viral hemorrhagic fever and is in the same family as Ebola, a better-known virus that has plagued West Africa for years.

The Marburg virus is a “genetically unique zoonotic … RNA virus of the filovirus family,” according to the Centers for Disease Control and Prevention. “The six species of Ebola virus are the only other known members of the filovirus family.”

Fatality rates range from 24 percent to 88 percent, according to the WHO, depending on the virus strain and quality of case management.

Marburg has probably been transmitted to people from African fruit bats as a result of prolonged exposure from people working in mines and caves that have Rousettus bat colonies. It is not an airborne disease.

Once someone is infected, the virus can spread easily between humans through direct contact with the bodily fluids of infected people such as blood, saliva or urine, as well as on surfaces and materials. Relatives and health workers remain most vulnerable alongside patients, and bodies can remain contagious at burial.

The first cases of the virus were identified in Europe in 1967. Two large outbreaks in Marburg and Frankfurt in Germany, and in Belgrade, Serbia, led to the initial recognition of the disease. At least seven deaths were reported in that outbreak, with the first people infected having been exposed to Ugandan imported African green monkeys or their tissue while conducting lab research, the CDC said.

Where has Marburg been detected?

The Ghana cases are only the second time Marburg has been detected in West Africa. The first reported case in the region was in Guinea last year. The virus can spread quickly. More than 90 contacts, including health workers and community members, are being monitored in Ghana. The WHO said it has also reached out to neighboring high-risk countries to put them on alert.

Cases of Marburg have previously been reported elsewhere in Africa, including in Uganda, the Democratic Republic of Congo, Kenya, South Africa and Zimbabwe. The largest outbreak killed more than 200 people in Angola in 2005.

The virus is not known to be native to other continents, such as North America, and the CDC says cases outside Africa are “infrequent.” In 2008, however, a Dutch woman died of Marburg disease after visiting Uganda. An American tourist also contracted the disease after a Uganda trip in 2008 but recovered. Both travelers had visited a well-known cave inhabited by fruit bats in a national park.

What are the symptoms?

The illness begins “abruptly,” according to the WHO, with a high fever, severe headache and malaise. Muscle aches and cramping pains are also common features.

In Ghana, the two unrelated individuals who died experienced symptoms such as diarrhea, fever, nausea and vomiting. One case was a 26-year-old man who checked into a hospital on June 26 and died a day later. The second was a 51-year-old man who went to a hospital on June 28 and died the same day, the WHO said.

In fatal cases, death usually occurs between eight and nine days after onset of the disease and is preceded by severe blood loss and hemorrhaging, and multi-organ dysfunction.

The CDC has also noted that around day five, a non-itchy rash on the chest, back or stomach may occur. Clinical diagnosis of Marburg “can be difficult,” it says, with many of the symptoms similar to other infectious diseases such as malaria or typhoid fever.

Can Marburg be treated?

There are no vaccines or antiviral treatments approved to treat the Marburg virus.

However, supportive care can improve survival rates such as rehydration with oral or intravenous fluids, maintaining oxygen levels, using drug therapies and treating specific symptoms as they arise. Some health experts say drugs similar to those used for Ebola could be effective.

Some “experimental treatments” for Marburg have been tested in animals but have never been tried in humans, the CDC said.

Virus samples collected from patients to study are an “extreme biohazard risk,” the WHO says, and laboratory testing should be conducted under “maximum biological containment conditions.”

Anything else to know?

The WHO said this week it is supporting a “joint national investigative team” in Ghana and deploying its own experts to the country. It is also sending personal protective equipment, bolstering disease surveillance and tracing contacts in response to the handful of cases.

More details are likely to be shared at a WHO Africa online briefing scheduled for Thursday.

“It is a worry that the geographical range of this viral infection appears to have spread. This is a very serious infection with a high mortality rate,” international public health expert and professor Jimmy Whitworth of the London School of Hygiene and Tropical Medicine told The Washington Post on Monday.

“It is important to try to understand how the virus got into the human population to cause this outbreak and to stop any further cases. At present, the risk of spread of the outbreak outside of Ashanti region of Ghana is very low,” he added.

Monkeypox is in the US. Here’s what you need to know.

Amid an international string of cases, a Massachusetts man has been infected with the first case of monkeypox in the United States this year. And while the virus isn’t likely to cause a pandemic like Covid-19, experts say the outbreak is still concerning.

What is monkeypox?

Monkeypox—so called because it was first identified in laboratory monkeys—is a rare viral infection that begins with flu-like symptoms and progresses to a distinctive rash on the face and body. Most infections resolve within weeks, but some cases can be fatal, according to the World Health Organization (WHO).

People can catch monkeypox through contact with infected animals or animal products. Human-to-human transmission, meanwhile, can occur via contact with bodily fluid, sores, or items contaminated by bodily fluid, but most often occurs via large respiratory droplets, which rarely travel more than a few feet.

According to WHO, “There is no evidence, to date, that person-to-person transmission alone can sustain monkeypox infections in the human population.”

Symptoms of monkeypox are typically mild, including headaches, muscle pain, chills, and swollen lymph nodes, The Hill reports. Patients can also develop rashes on their face and body that then turn into skin lesions that eventually fall off.

Although there are no specific treatments for monkeypox, at least one vaccine has been approved in the United States to protect against both monkeypox and smallpox.

Monkeypox cases pop up around the world

On Wednesday, the Massachusetts Department of Public Health (MDPH) reported the first confirmed case this year of monkeypox in the United States in a man who had recently traveled to Canada.

According to MDPH, “The case poses no risk to the public, and the individual is hospitalized and in good condition.”

MDPH said it’s “working closely with the CDC, relevant local boards of health, and the patient’s health care providers to identify individuals who may have been in contact with the patient while he was infectious. This contact tracing approach is the most appropriate given the nature and transmission of the virus.”

Generally, monkeypox cases are very rare in the United States, however two cases were reported in the United States last year—one in Texas and one in Maryland.

Monkeypox cases have also been popping up recently around the world. The United Kingdom has reported nine monkeypox cases, Spain has reported 23 suspected cases, Portugal has reported five and is investigating another 15, and Canadian health officials are investigating at least 15 potential cases in Montreal.

British officials noted that four of the nine cases it identified were among men who have sex with men, suggesting that the virus could be spreading through sexual contract.

What experts are saying

According to Jimmy Whitworth, a professor of international public health at the London School of Hygiene and Tropical Medicine, the monkeypox virus isn’t likely to follow a similar path to Covid-19.

“This isn’t going to cause a nationwide epidemic like COVID did, but it’s a serious outbreak of a serious disease—and we should take it seriously,” he said.

Still, experts said they are concerned by the monkeypox outbreaks. Typically, monkeypox doesn’t spread easily between humans, but the fact that multiple cases are emerging in different countries at the same time is concerning, said Aris Katzourakis, a professor of evolution and genomics at the University of Oxford.

“It’s either a lot of bad luck or something quite unusual happening here,” he said.

“The fact that it’s in the U.K. in multiple unrelated clusters, plus Spain, plus Portugal, is a surprise,” said Tom Inglesby, director of the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health.

According to Mateo Prochazka, an epidemiologist at the U.K. Health Security Agency, the fact that the virus appears to be spreading through sexual contact is especially strange.

“What is even more bizarre is finding cases that appear to have acquired the infection via sexual contact,” he said. “This is a novel route of transmission that will have implications for outbreak response and control.”

While experts aren’t worried about the virus being a global threat as of now, Jay Hooper, a monkeypox expert from the U.S. Army Medical Research Institute of Infectious Diseases, noted that “[e]very time there’s an outbreak—and the more people get infected—the more chances monkeypox has to adapt to people.”

“With viruses that spill over from animals, you just never know what’s going to happen,” he added.