Coming off the heels of COVID and the failed vaccines and treatments like Paxlovid, it seems we are facing another health concern. Enter, monkeypox. While monkeypox has been endemic through various regions in Africa, we are seeing more cases throughout other continents, namely Europe, Australia, and North America. With the successful use of fear through media, it seems the strategy is once again alive and well, as monkeypox and smallpox are commonly reported as from the same virus family.
With memories and fear of smallpox just a few generations back, many people have heard stories; either through history textbooks or from parents and grandparents. Since that time, we’ve learned a lot. And monkeypox is not smallpox. Neither is it COVID. Monkeypox spreads through respiratory droplets, bodily fluids, and direct contact with skin lesions.
So, What is Monkeypox?
According to the CDC’s website, the main difference between monkeypox and smallpox is the effect on the lymph nodes. Monkeypox will cause the lymph nodes to swell while smallpox does not. Monkeypox was first observed when monkeys used in research presented two outbreaks in 1958. In 1970, during the attempt to eradicate smallpox through vaccination, the first human case of monkeypox was observed in the Democratic Republic of Congo. In a Science Direct publication, the authors stated:
After the eradication of smallpox, there was concern that the monkeypox virus might fill the epidemiological niche left by smallpox. Smallpox had no known zoonotic host and was transmitted only on a human-to-human basis, whereas monkeypox may be transmitted to man by animal hosts.
Monkeypox has been considered endemic in regions of Africa, and cases outside of the continent were typically attributed to travel from those areas. There are two clades (think variants) of monkeypox. The West African clade is the less serious of the two, the other being Central African. The West African clade is the one that has been reported in outbreaks around the world.
Early symptoms of monkeypox are similar to various illnesses until the lesions appear, or pox, on the skin. The images we have seen splashed across the news and media sources, are typically from the most serious cases.
The CDC, WHO, and Others Already Prepared
On May 13th, the World Health Organization (WHO) was informed of cases of monkeypox outside of Africa where the infection is typically considered endemic (around, but not pandemic). Five days later, the FDA approved a commonly used drug to be used intravenously for those who are unable to swallow the pill form. to treat smallpox. Smallpox has been considered eradicated since 1980. Last June, an additional drug was also approved for use.
Why are they using a drug that’s been approved for smallpox? Doctors and scientists have suggested that monkeypox and smallpox come from the same viral family, so treatments and vaccines should offer cross-protection between the two infections. An additional interestingly timed recommendation by the CDC’s ACIP committee is the use of a new vaccine on May 27, 2022. The vaccine, JYNNEOS, received a unanimous vote by the CDC’s ACIP committee to be the vaccine of choice over the ACAM 2000 vaccine recommended in 2015.
Currently, the U.S. has 100 million doses of ACAM2000 in its reserves. On May 18th, just after the first cases of the outbreak were noted, and 11 days before the ACIP recommendation, the manufacturer of JYNNEOS released a press statement. The U.S. Biomedical Advanced Research and Development Authority’s (BARDA) $299 million contracts with Bavarian Nordic is for freeze-dried doses of JYNNEOS. The statement also shared that Phase 3 and additional manufacturing data will be reviewed for an anticipated approval for this version of the vaccine in 2024. Manufacturing will begin in 2023.
While monkeypox is most concentrated in African nations, the continent doesn’t have resources to prevent or treat patients with monkeypox.
CDC Issues Travel Alert Over Monkeypox Concerns
Last week, the CDC issued a Level 2 Alert for travelers to practice enhanced precautions in regard to monkeypox. The 3-Level system was used widely during the COVID pandemic.
Some are concerned that with COVID so fresh in our minds, we’ll soon reach the levels of precautions and procedures we did during 2020 and 2021. In LA County, Dr. Edward Jones-Lopez of USC indicated the same strategies used to mitigate COVID, such as masks and distancing, “will keep you safe.” Yet, monkeypox is much less transmissible in general congregate settings than COVID.