The Biden administration will declare monkeypox a public health emergency

The Biden administration is declaring monkeypox a public health emergency as the U.S. outbreak has become the world’s largest, the nation’s top health official said Thursday.

The emergency declaration by Health and Human Services Secretary Xavier Becerra will help mobilize more resources to fight the outbreak, which has spread rapidly since Boston health officials confirmed the first US case in May. The last time the US declared a public health emergency was in response to Covid-19 in January 2020.

The U.S. has confirmed more than 6,600 cases of monkeypox in 48 states, Washington, D.C., and Puerto Rico as of Thursday, according to the Centers for Disease Control and Prevention. The actual number of infections is likely higher than official figures because patients can only be tested after they develop a rash, which can take a week or more after initial exposure to the virus.

“In light of all these developments and the changing circumstances on the ground, I want to make an announcement today that I will declare a public health emergency,” Becerra told reporters on a call Thursday.

Monkeypox is rarely fatal and no deaths have been reported in the U.S. so far, but patients often suffer debilitating pain from the skin rash caused by the virus. Eight people have died from the disease worldwide during the current outbreak, mostly in Africa, where health systems are not as robust as the United States. Spain and Brazil reported the first confirmed deaths from the virus outside Africa at the weekend.

Currently, monkeypox is primarily spread through skin-to-skin contact during sex. Gay and bisexual men are at the highest risk of infection right now, public health officials say. About 98 percent of patients who provided demographic information to the clinics identified as men who have sex with men, according to the CDC. But anyone can catch the virus through close physical contact with someone who is infected or contaminated materials.

Scientists and public health officials worry that monkeypox could continue to circulate in the United States if more immediate action is not taken to contain the outbreak.

Last month, the WHO declared monkeypox a global emergency. More than 26,000 cases of monkeypox have been reported in 87 countries, according to the CDC. The US accounts for 25% of the world’s confirmed infections. Health authorities in the United Kingdom first alerted the world to the outbreak in May after confirming several cases there.

The global outbreak is highly unusual because monkeypox first spread widely in North America and Europe, where the virus is not normally found. Historically, monkeypox has spread at low levels in remote parts of West and Central Africa, where rodents and other animals carry the virus. Human-to-human transmission has been relatively rare in the past, with the virus usually passing from animals to humans.

State and local emergencies

Lawmakers in Congress and local communities have criticized the speed of the federal government’s response, but Becerra said last week that HHS has done everything it can to increase resources to fight the outbreak. The health secretary said states must do more to prevent transmission, and Congress must pass funding to support the outbreak response.

The largest outbreaks in the US are in New York, California, Illinois, Florida, Georgia, Texas and the District of Columbia New York, Illinois and California declared states of emergency before the federal declaration.

Public health officials are concerned that the virus may begin to spread more in households among the wider population as infections rise. Although physical contact during sex is currently the main mode of transmission, people can contract monkeypox through hugging, kissing, and contaminated towels and sheets.

Last month, the CDC confirmed the first U.S. cases of monkeypox in children, a toddler in California and an infant whose family had traveled to D.C. The baby’s family is not a US resident. The children have symptoms but are in good health and receiving the antiviral treatment tecoxiramit, according to the CDC. Young children likely caught the virus through family transmission, according to the CDC.

Monkeypox can also be spread through respiratory droplets when people have lesions in their mouths, but that requires prolonged face-to-face contact, according to the CDC. Health officials do not believe that monkeypox is spread by small aerosol particles like Covid. Respiratory droplets are heavier so they don’t stay in the air as long, whereas Covid is an airborne virus, which is one of the reasons it’s so contagious.

Monkeypox usually starts with flu-like symptoms and then progresses to a painful rash that can spread over the body. But the symptoms in the current outbreak are unusual. Some people develop a rash first, while others develop a rash without any flu-like symptoms. Many people have localized lesions on the genitals or anus, according to public health officials.

Patients usually recover in two to four weeks without additional medical treatment, according to the CDC. But some people are admitted to hospital because the rash is very painful.

In 2003, there was a small outbreak of monkeypox in the US with dozens of confirmed and probable cases in six states. People have become ill after contact with domestic prairie dogs. The pets were infected after being housed near small mammals imported from Ghana. The 2003 U.S. outbreak was the first time monkeypox was reported outside of Africa, according to the CDC.

Public health officials are also concerned that as monkeypox spreads across the U.S., the virus could become established in animal populations, making the virus even more difficult to eliminate from the country.

Delivery of vaccines, tests and antivirals

The federal government has delivered more than 600,000 doses of the monkeypox vaccine, called Jynneos, to state and city health departments since May. CDC Director Dr. Rochelle Walensky acknowledged last month that demand for the vaccine is outstripping supply, leading to long lines at clinics and protests in some cities.

HHS made 786,000 doses available for local governments to begin ordering last Friday, which could help ease supply problems. Dawn O’Connell, who heads the Office of Strategic National Stockpiles, said HHS ships doses within 30 hours of states ordering them.

The U.S. has ordered more than 5 million additional doses, with deliveries scheduled through mid-2023. Another 11.1 million doses are in storage in Denmark at manufacturer Bavarian Nordic, according to HHS. But those doses must be filled and completed before they can be administered, which would require additional funding from Congress, according to HHS.

The Food and Drug Administration approved Jynneos in 2019 for adults 18 years of age and older who are at high risk of exposure to monkeypox or smallpox. Jynneos is the only FDA-approved monkeypox vaccine in the US. It is administered in two doses with an interval of 28 days.

The US also has more than 100 million doses of an older-generation smallpox vaccine called ACAM2000, which is believed to be effective against monkeypox. But ACAM2000 can have serious side effects and is not recommended for people with weak immune systems, such as HIV patients, pregnant women, and people with eczema and similar skin conditions.

The U.S. currently has no real-world data on how effective vaccines are at preventing disease in the current outbreak, according to the CDC. The vaccination campaign targets people with confirmed or suspected exposures and men who have sex with, as they face the highest risk of infection.

The US increased testing capacity to 80,000 a week after bringing on board several commercial laboratories last month. Becerra said last month that the current demand for tests is a small fraction of the total capacity the U.S. now has.

The US also has 1.7 million courses of the antiviral treatment tecovirimat in the strategic national stockpile. Health care providers use tecociramit to treat patients with monkeypox, but prescribing the drug has an extra layer of red tape because the FDA only approved it for smallpox. The CDC cut red tape last month to make it easier for doctors to prescribe tecovirimat.

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