Gothamist on October 18 wrote that New York City has almost eliminated monkeypox, and in San Francisco, the local government announced that the public health emergency due to monkeypox will end on October 31 as cases there have dropped to under one per day. On October 20, however, health officials in New York and Nevada said they had recorded their first monkeypox-related deaths, according to CBS News. The CDC reported that the total of confirmed deaths worldwide from the current outbreak stands at 32 with 4 total deaths in the United States.

Americas Remain Hot Spot as Cases Decline

Figures from the CDC as of October 20 reveal that the total number of monkeypox cases in the United States is at least 27,835. The country has by far the most infections in the world, followed by Brazil (8,778), Spain (7,277), France (4,084), the United Kingdom (3,686), and Germany (3,656). Worldwide infections have topped 73,000. In a media briefing on October 20, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus, PhD, said that cases have now dropped globally for eight weeks in a row, but risks and uncertainties remain, and some countries are still seeing increasing transmission and a few are entering the peak phase of the outbreak. Dr. Ghebreyesus expressed concern that Ghana is now experiencing a surge in cases. “Once again, we caution that a declining outbreak can be the most dangerous outbreak because it can tempt us to think that the crisis is over, and to let down our guard,” warned Ghebreyesus.

More Dangerous Monkeypox Variant Could Spread Worldwide

New Scientist reported this month that a more deadly variant of monkeypox now circulating in the Democratic Republic of the Congo could spread globally. Sudan is also seeing an outbreak of this more virulent variant, called clade 1, according to the WHO. It is estimated to have a fatality rate of 10.6 percent compared with a 3.6 percent fatality rate for clade 2, which is driving the current spread of infections in most of the world.

Early Real-World Data on Monkeypox Vaccine Shows Promise

Early real-world findings suggest that a single Jynneos monkeypox vaccine dose provides “some protection” against monkeypox infection, according to the CDC. Analysis of data published by the CDC this month, from 32 U.S. jurisdictions of males ages 18 to 49 who were eligible for the vaccine, showed that monkeypox incidence was 14 times as high among unvaccinated males compared with those who had received a first vaccine dose at least 14 days earlier. The degree and durability of such protection is unknown, and it is recommended that persons who are eligible for monkeypox vaccination receive the complete two-dose series. Girisha Fernando, the founder and CEO of Lyfegen, a Switzerland-based company focused on software analytics for value-based contracting in healthcare, wrote in Stat News that the only way to truly determine efficacy of the Jynneos monkeypox vaccine will be to collect and analyze real-world data, and much more is needed.

Sexual Contact Is Primary Means of Transmission, Study Confirms

A study published this month in The Lancet Infectious Diseases contributes to mounting evidence that the outbreak is mostly driven by by sexual contact. An examination of 226 monkeypox cases from 15 countries indicated that, of 219 patients for whom data were available, 216 (99 percent) reported sexual or close intimate contact in the 21 days before symptom onset. A total of 208 reported being gay, bisexual, or men who have sex with men (MSM). Those who identified as MSM said they had a median of three partners. Of 195 patients for whom data were available, 78 (40 percent) reported close contact with someone who had confirmed monkeypox. Overall, 30 (13 percent) of 226 patients were admitted to hospital — 16 of whom had severe illness.

A paper published October 17 by the CDC details the first occupationally acquired monkeypox infection in a U.S. healthcare worker during the 2022 monkeypox outbreak. In July, a nurse in Florida accidentally stuck herself while recapping a needle used to obtain a fluid sample from a monkeypox patient’s lesion. The prick caused a break in the skin on the index finger through the nurse’s gloved hand, accompanied by a small amount of bleeding. Ten days after the incident, a lesion formed at the site of the needlestick. It was swabbed and subsequently tested positive for the virus. Apart from this single lesion at the puncture site, no additional lesions or other symptoms were reported. The report highlights the need to take extra precautions with monkeypox testing.

Monkeypox Survives on Hospital Surfaces and in Air

New research from the United Kingdom published in The Lancet Microbe shows widespread monkeypox DNA surface contamination in healthcare settings, with 93 percent of surfaces in occupied patient rooms contaminated, and significant contamination on healthcare worker personal protective equipment (PPE). The data revealed contamination in isolation facilities and potential for suspension of monkeypox virus into the air during specific activities. Analysis was based on testing in four respiratory isolation rooms in the Royal Free Hospital in London. The authors noted that this detection does not mean that transmission leading to infection would necessarily occur. They added, however, “The environmental contamination findings could be relevant to public health measures for other spaces and settings where individuals with monkeypox spend prolonged periods, such as residential bedrooms and bathrooms.”

First Commercial Test Kit Authorized

The U.S. Food and Drug Administration (FDA) granted emergency use authorization for the first commercial test kit to detect monkeypox. The Alinity m MPXV from Abbott Molecular is designed to detect monkeypox DNA using lesion swab specimens from individuals suspected of monkeypox virus infection. The test, which provides real-time results, is intended for use by qualified and trained clinical laboratory personnel specifically instructed and trained in the techniques of polymerase chain reaction (PCR) and in vitro diagnostic procedures. The testing is also limited to certified laboratories. Study from Abbott showed that, overall, the test correctly detected the virus in all 36 positive samples and correctly reported the absence of the virus in 35 negative samples.

Friday, October 6, 3:22 P.M. EDT

CDC Says Monkeypox Outbreak Is Slowing

Based on analysis of data through September 19, the Centers for Disease Control and Prevention (CDC) has said that it has “high confidence” that the growth rate of the monkeypox outbreak in the United States is slowing. In its report of September 29, the CDC added that it is moderately confident that daily cases in the United States will most likely continue to decline or plateau over the next two to four weeks. The health agency noted, however, that there is a possibility that infections could grow slowly or rapidly. The CDC’s seven-day daily average as of October 5 was 68 — a significant drop from more than 440 two months ago. The health agency has attributed the decline to an increased vaccination rate and changes in behavior among men who have sex with men (MSM). An online survey of gay, bisexual, and other MSM conducted in early August found half of respondents reported that they had changed their behavior and reduced sexual partners and encounters due to the monkeypox outbreak. (Among U.S. cases, 96.9 percent have occurred in men and 78.9 percent in men who reported male-to-male sexual or intimate contact.)

In Europe, Some Countries See Decline While Others See Numbers Rise

The European Centre for Disease Prevention and Control (ECDC) reported on October 4 that monkeypox infections are falling in 17 Europeans countries but increasing in seven. The seven nations seeing numbers rise are Croatia, Estonia, Germany, Iceland, Latvia, Norway, and Portugal. Meanwhile, Bulgaria, Denmark, and Luxembourg have experienced the biggest declines. In terms of overall cases. Spain has the most in Europe (7,209), followed by France (3,998), Germany (3,631), the Netherlands (1,215), and Portugal (855). The United States, however, leads the world in monkeypox, with more than 26,000 infections, according to the CDC.

Some May Be Avoiding Vaccination Due to Scarring

An investigation by the Washington Post published October 6 revealed that some men may be avoiding getting the intradermal injection of the Jynneos monkeypox vaccine because it can leave a painful, itchy red mark for weeks and possibly cause long-term discoloration or scarring. Some interviewed said that the mark left behind on the forearm can make people feel stigmatized. Health authorities found that delivering the vaccine intradermally into the immune cells between the layers of the skin would require less vaccine than administering it subcutaneously into the fat layer under the skin or into the muscle.

Scientists Note That Monkeypox Is Mutating

As published in the journal Nature on October 5, researchers are keeping a close eye on changes occurring in the monkeypox virus. Scientists at the Minnesota Department of Health in St. Paul observed that a large piece of the virus’s genome (set of genes) was missing in a sample collected from an infected person. In another sample, a sequence of genes had moved to an entirely different spot. Researchers interviewed said they weren’t alarmed but closely monitoring these mutations to understand why they may be occurring and what they could mean to the monkeypox outbreak.

Monkeypox in Children Is Rare but Not an Impossibility

In an article published October 3, ContagionLive, a news source covering infectious diseases, presented data showing how monkeypox is uncommon among children but not impossible. As of September 23, 27 confirmed monkeypox cases have occurred in children aged 15 and younger in the United States, according to federal data. Even if infected, children can recover with proper treatment. The CDC detailed the case of a 2-month-old baby who was brought to the hospital with a severe rash. The baby was not immediately diagnosed with monkeypox until pustules covered the baby’s back, face, bottoms of the feet, and eyelid. After receiving the proper antiviral medication —tecovirimat (TPOXX), per the CDC — the baby fully recovered.

Biden Administration Expands Who Can Administer Monkeypox Vaccine

The U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra declared on October 3 that more providers can administer the vaccines that protect against monkeypox virus. “As our supply of Jynneos vaccine steadily increases, we are exceeding demand in all 50 states,” said Dawn O’Connell, HHS assistant secretary for preparedness and response. “By expanding the pool of providers who can administer monkeypox vaccines, we can increase equitable access for people at high risk for monkeypox infections who have not yet had an opportunity to get vaccinated.” The list of authorized providers now includes:

Advanced or intermediate emergency medical techniciansDentistsLicensed or certified professional midwivesNurses, advanced practice registered nurses, registered nurses, licensed practical nursesOptometristsParamedicsPharmacistsPharmacy interns, pharmacy techniciansPhysiciansPhysician assistantsPodiatristsRespiratory therapistsVeterinariansRecently retired healthcare professionals and students of the listed professions

Breakthrough Infection Is Possible After Vaccination

A recent study published in JAMA found that of 7,339 individual who received a first dose of the monkeypox vaccine, 90 tested positive for the virus at least one day after vaccination. A total of 37 infections were detected one to seven days after vaccination, and 32 occurred 8 to 14 days after inoculation. Eight cases were identified more than 28 days after the first dose. The researchers noted that two people were infected with the virus three weeks or more after receiving both doses of the vaccine. “Because the incubation period for monkeypox is 3 to 17 days, some of the cases occurring between 1 and 14 days after vaccination may not represent true vaccine failure because patients may have sought vaccination after realizing they were exposed,” the authors concluded. “Of concern is that at least two breakthrough infections were observed in individuals at least three weeks after a second dose.”