Monday, May 23, 2022

CDC Advises Doctors to Be on Alert for Monkeypox as WHO Confirms Outbreaks in 11 Countries

This is one occasion when we oldies have the last laugh. We will not get this pox. Why? Because when we were young vaccination against smallpox was compulsory if we wanted to travel overseas. And poxes are related. Our vaccination against smallpox will protect us against monkey pox too

The Center for Disease Control and Prevention (CDC) issued an advisory on Friday asking doctors across the United States to be on the watch for monkeypox, as the World Health Organization has confirmed 80 confirmed cases across 11 countries.

Monkeypox is a viral disease typically endemic to central and western Africa, but since the start of May, dozens of confirmed cases have been reported in several countries outside of the continent. Many more suspected cases are being investigated.

The CDC is asking doctors to “be vigilant to the characteristic rash associated with monkeypox” and describes the rash as involving “vesicles or pustules that are deep-seated, firm or hard, and well-circumscribed,” adding that the lesions “may umbilicate or become confluent and progress over time to scabs.”

It adds that doctors should be more suspicious for the disease and consider it as a possible diagnosis if, in addition to having a characteristic rash, their patient has traveled to countries with recently confirmed cases of monkeypox; reports having had contact with anyone who had monkeypox, or suspected monkeypox, or have a rash similar in appearance to monkeypox; or is a man who regularly has close or intimate in-person contact with other men.

“Lesions may be disseminated or located on the genital or perianal area alone,” the CDC also stated in its advisory.

“Some patients may present with proctitis, and their illness could be clinically confused with a sexually transmitted infection (STI) like syphilis or herpes, or with varicella zoster virus infection,” the agency adds. Proctitis is inflammation of the lining of the rectum and can cause rectal pain, diarrhea, bleeding, and discharge.

Prior to May, cases outside of Africa were among people with a recent history of travel to Nigeria or contact with another person confirmed with monkeypox, the CDC noted. But there have been confirmed cases since the start of the month without a history of travel to Africa, the CDC noted, adding that the source of the cases “is unknown.”

Cases outside Africa have been reported in the United Kingdom, the United States, Australia, and Canada, as well as across Europe including Portugal, Spain, Sweden, Italy, Belgium, France, and Germany. The number of confirmed monkeypox cases in the U.K., where the disease was first detected outside of Africa, has reached 20 as of May 20.

The CDC noted that in the case of the United Kingdom, there was a “temporally clustered group of cases involving four people who self-identify as gay, bisexual, or men who have sex with men.”

“Some evidence suggests that cases among [men who have sex with men] may be epidemiologically linked; the patients in this cluster were identified at sexual health clinics,” it stated. “This is an evolving investigation and public health authorities hope to learn more about routes of exposure in the coming days.”

The WHO said on Friday that the recent outbreaks across 11 countries so far are “atypical, as they are occurring in non-endemic countries.” It said there are about 80 confirmed cases and 50 pending investigations, with more cases likely to be reported in the near future.

“People who closely interact with someone who is infectious are at greater risk for infection: this includes health workers, household members and sexual partners,” the WHO stated.

Monkeypox starts off with flu-like symptoms that include fever, muscle aches, and fatigue, as well as swelling of the lymph nodes. Within days after fever, a rash appears on the face and body, which can also include the genital or perianal area, the CDC states. The incubation period—time from infection to symptoms—can range from 5 to 21 days.

The disease usually self-resolves with the symptoms lasting from 2 to 4 weeks, although severe cases can occur and can even result in death, with recent death rates being around 3 to 6 percent, according to the WHO.

The United States has one confirmed case of monkeypox in Massachusetts, the first this year. The CDC said it is working with the state’s health department to investigate the case. The patient involved has the West African strain of monkeypox virus, and is currently isolated, the CDC stated. He had recently traveled to Canada, where the first two monkeypox cases were confirmed late on May 19 in Quebec.

Another suspected monkeypox case is being investigated in New York City.

In 2021, the United States had two confirmed cases of monkeypox, one in Maryland and one in Texas. Both cases involved people who had recently traveled to Nigeria, where the virus is endemic.

The Biden administration on May 18 placed an order for millions of doses of a vaccine intended to protect against smallpox and monkeypox from Bavarian Nordic, a Denmark-based biotech company. The vaccine is approved under the name Jynneos in the United States, available to those at high risk of smallpox and monkeypox.

“Jynneos does not contain the viruses that cause smallpox or monkeypox. It is made from a vaccinia virus, a virus that is closely related to, but less harmful than, variola or monkeypox viruses and can protect against both of these diseases,” the U.S. Food and Drug Administration stated in September 2021, at the time of the vaccine’s approval. “Jynneos contains a modified form of the vaccinia virus called Modified Vaccinia Ankara, which does not cause disease in humans and is non-replicating, meaning it cannot reproduce in human cells.”

According to the CDC, because the monkeypox virus is related to the virus that causes smallpox, the vaccine can protect people from getting monkeypox.

“Past data from Africa suggests that the smallpox vaccine is at least 85 [percent] effective in preventing monkeypox,” the CDC stated. “The effectiveness of [Jynneos] against monkeypox was concluded from a clinical study on the immunogenicity of Jynneos and efficacy data from animal studies.

“Smallpox and monkeypox vaccines are effective at protecting people against monkeypox when given before exposure to monkeypox. Experts also believe that vaccination after a monkeypox exposure may help prevent the disease or make it less severe.”


Australians dying of COVID while life-saving drugs go unused, doctors say

Top doctors have warned that vulnerable patients who test positive to COVID-19 are missing out on potentially life-saving antiviral treatments, with just a fraction of those at risk of serious disease having accessed the new drugs.

Figures from the federal health department show 1379 patients received antiviral medication Paxlovid through their GP in the first weeks in May, after the drug was listed on the pharmaceutical benefits scheme.

“We are still getting quite a number of deaths – and making sure people know antivirals are available is one way of trying to address this,” infectious disease physician Professor Allen Cheng said. “We don’t have many levers left to pull [to protect those at risk of severe illness]. It is easy for people to fall through the cracks”.

With tens of thousands of COVID-19 cases recorded each week, experts say a major awareness campaign is needed to make sure at-risk people know that highly effective treatments can help prevent severe disease if they are taken within five days of symptom onset.

There were more than 680,000 coronavirus cases recorded nationally in the first two weeks in May and 563 deaths.

Fourth ‘winter’ COVID vaccine recommended for people over 65

“Clearly not everyone eligible or those that would benefit are getting access to the treatments,” Cheng said. A major push is needed to make sure older patients with other risk factors, those with co-morbidities, people who are immunosuppressed and unvaccinated are aware treatments are available, he said.

Evidence from trials show that for every 10 to 20 patients treated with Paxlovid one person will be prevented from being hospitalised, Cheng said.

Paxlovid, a combination of the drugs nirmatrelvir and ritonavir, was listed on the PBS last month. Eligible adults who test positive to COVID-19 through a PCR or rapid antigen test can access the treatment from their local pharmacy with a GP prescription.

Paxlovid is available to people aged 65 or older, with two other risk factors for severe disease, or one factor for those aged 75 and over. It is subsidised for Aboriginal or Torres Strait Islander patients aged 50 or over with two other risk factors and patients who are moderately to severely immunocompromised.

Another antiviral drug, Lagevrio – the trade name for molnupiravir – was also listed on the PBS in March and has since been used to treat more than 15,000 patients, including about 7000 in NSW.

“Clearly not everyone eligible or those that would benefit are getting access to the treatments.”

President of the Royal Australian College of General Practitioners Karen Price said doctors need to tell “eligible patients proactively that if they contract COVID-19 they should contact their GP”.

“A lot of people are sitting at home with a positive rapid test. We must make sure they know about the medication they can access which could stop them ending up in hospital.”

Australian Medical Association president Dr Omar Khorshid said an awareness campaign was needed for vulnerable people, especially because treatments were previously only available from hospital.

“If you get a positive test, and you’re at risk, a telehealth appointment is all that is needed to be assessed for treatment”.

“Paxlovid has many drug interactions, so it does take time for GPs to have a good grasp of who should be having antivirals. There are definitely barriers in accessing medication”.

Last month Health Minister Greg Hunt said the antiviral PBS listings would support the national plan to transition Australia’s COVID-19 response, which outlines steps to remove all remaining coronavirus restrictions in the community.

“This medicine will help reduce the need for hospital admission,” Mr Hunt said.




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