Implications of monkeypox declared a public health emergency in the United States

Implications of monkeypox declared a public health emergency in the United States

On August 4, the Biden administration declared monkeypox a public health emergency. The announcement comes after the World Health Organization declared monkeypox a public health emergency of international concern in July. This implies that monkeypox poses a global risk to public health through international spread, which requires a coordinated international response.

In the United States, prior to the Biden administration’s declaration, a growing number of municipalities and even several states – California, Illinois and New York – had declared monkeypox a public health emergency.

A public health statement allows the Secretary of Health and Human Services (HHS) to take certain actions to address the threat of a disease or crisis of some kind to public health. Public health emergencies are not only declared in the event of outbreaks of infectious diseases such as Covid-19 and monkeypox. For example, in October 2017, President Trump declared the “opioid crisis” to be a “public health emergency”.

Importantly, a public health emergency declaration frees up resources earmarked for an actual (or emerging) public health crisis. In the case of monkeypox, the federal government can now significantly scale vaccine production and availability, expand testing capacity, and make testing more affordable. The declaration also facilitates coordination between federal, state and local authorities, particularly in relation to access to testing and treatment in conjunction with a prevention campaign to members of at-risk communities, aimed at curbing the spread of the virus.

In addition, the declaration allows the Secretary of the HHS to conduct and support investigations into the cause, treatment or prevention of the disease or crisis, as well as supporting the advanced research and development and bio-surveillance needed to address the problem in question. Finally, it allows the CDC to access the Infectious Disease Rapid Response Reserve Fund to prevent, prepare for, or respond to an infectious disease emergency.

According to the Centers for Disease Control and Prevention (CDC), more than 26,000 cases of monkeypox have been reported in 87 countries. With over 6,500 confirmed cases, the United States accounts for 25% of confirmed infections worldwide.

No monkeypox deaths have yet been reported in the United States, but in the latest worldwide outbreak, which began in May this year, there were at least 6 deaths outside the United States. Additionally, between 3% and 13% of confirmed cases were hospitalized. Most admissions are for pain management. Patients often suffer from debilitating pain due to the rash caused by the virus. Skin lesions can occur anywhere on the body. Common systemic features that precede the rash include fever (62%), lethargy (41%), myalgia (31%), headache (27%), and enlarged lymph nodes (56%).

In addition to pain management, reasons cited for hospitalizations included pharyngitis that limits oral intake, encephalitis, eye lesions, acute kidney injury, and myocarditis.

Men who have sex with men are currently at higher risk, but anyone can contract monkeypox. And, in fact, an increasing number of women and children have tested positive for the virus.

What is definitively known is that monkeypox is spread through direct contact with bodily fluids or sores on the body of someone who has monkeypox, or by direct contact with materials, such as clothing and underwear, that have touched fluids. body or sores. It can also spread through respiratory droplets when people have close, face-to-face contact.

The United States has increased testing capacity to 80,000 per week. However, the current test demand exceeds the current capacity in the United States in terms of test supplies.

In 2019, the Food and Drug Administration (FDA) approved a vaccine called Jynneos for adults aged 18 and over at high risk of exposure to monkeypox or smallpox. Jynneos is the only monkeypox vaccine in the United States approved by the FDA. It is administered in two doses 28 days apart. On July 15, 2022, the HHS Strategic Preparedness and Response Administration announced that it had ordered an additional 2.5 million doses of Jynneos to strengthen monkeypox preparedness, which will increase the federal government’s available supply to over 6.9 million doses by mid-2023.

So far, HHS has made 786,000 doses of Jynneos available to state and local authorities. But lawmakers and local communities have criticized the pace of the response. And due to supply shortages, the FDA is now considering dividing the doses of Jynneos into fifths.

CDC director Dr. Walensky acknowledged that demand for the vaccine is outstripping supply. Another 11.1 million doses are on deposit in Denmark with the manufacturer Bavarian Nordic. However, these doses must be “filled and finished” before they can be administered, which will require additional funding from Congress.

The United States also has more than 100 million doses of an older generation smallpox vaccine, called ACAM2000, which is likely effective against monkeypox. However, ACAM2000 can have serious side effects and is not recommended for those with compromised immune systems, such as HIV patients, pregnant women, and people with autoimmune diseases.

As for other treatments, the United States has 1.7 million cycles of tecovirimat antiviral treatment in their strategic national inventory. Some doctors are using tecovirimat to treat monkeypox patients. But this drug was only approved by the FDA for smallpox.

It is hoped that the health emergency declaration will soon increase monkeypox testing and treatment, but also public health messages on preventing the spread of the disease, particularly in vulnerable communities.

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