Public health officials are shipping monkeypox vaccines to states with ongoing transmission and to protect high-risk populations, such as men who have sex with men and those with human immunodeficiency virus.
Testing capacity also is being greatly expanded to identify cases quickly as the case count continues to climb. As of July 13, 2022, there were 1,053 cases in 40 states, Washington, DC, and Puerto Rico.1 Internationally, there were 10,015 cases, the vast majority of them in Europe and other non-endemic nations.
There appears to be growing concern that the virus could establish an endemic presence in the United States, in part because traditional contact tracing is less effective in identifying chains of transmission in a community that fears stigma and some sexual contacts are anonymous.
“High [percentages] of contacts cannot be identified,” said Brett Peterson, MD, of the National Center for Emerging and Zoonotic Infectious Diseases at the Centers for Disease Control and Prevention (CDC).
The CDC is implementing an expanded vaccination plan similar to those used in Montreal and the United Kingdom. This approach includes broadly immunizing not only cases for post-exposure prophylaxis but those with risk factors that are circulating in the same communities, he said.
“This aims to vaccinate people with certain risk factors who are more likely to be exposed to monkeypox even if they have not had an exposure,” Peterson said at a CDC clinical briefing.
The Biden Administration announced it will ensure vaccine supplies and continue to engage directly with leaders and stakeholders in the LGBTQI+ community to combat stigma and promote testing and vaccine access. But monkeypox is not limited to this community and it is not a traditional sexually transmitted disease. It is spread by close contact with the skin of those infected, and family members and other non-sexual contacts of cases are at risk. However, this monkeypox outbreak is unusual in that it appeared suddenly and almost simultaneously in many non-endemic countries that rarely see cases. Given this unusual epidemiology, the CDC is investigating whether traditional routes of transmission have changed or if viral infectiousness has increased.
“We are keeping an open mind in this outbreak to make sure that we consider whether or not it can spread more easily,” said Agum Rao, MD, in the CDC Division of High-Consequence Pathogens and Pathology.
Monkeypox is endemic in parts of Africa and that is likely where this outbreak originated. Given the harsh pandemic lessons regarding global health, one view is to get vaccine to these impoverished countries and try to eliminate the disease at the source. Although monkeypox usually is a self-limiting infection, it can be serious in children and pregnant women.
- Centers for Disease Control and Prevention. Monkeypox. 2022 U.S. Map & Case Count. Data from July 13, 2022. https://www.cdc.gov/poxvirus/monkeypox/response/2022/us-map.html
