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Biden administration declares monkeypox outbreak a public health emergency

Health workers sit at a check-in table at a pop-up monkeypox vaccination clinic, which was opened by the Los Angeles County Department of Public Health at the West Hollywood Library on August 3, 2022, in West Hollywood, California.
Enlarge / Health workers sit at a check-in table at a pop-up monkeypox vaccination clinic, which was opened by the Los Angeles County Department of Public Health at the West Hollywood Library on August 3, 2022, in West Hollywood, California.

The Biden administration on Thursday declared the explosive monkeypox outbreak a public health emergency, clearing the way for more resources to slow the rise in US cases, which now total 6,617 across 48 states. No deaths have been reported in the US.

The country’s cases are part of an international outbreak that the World Health Organization declared a public health emergency of international concern (PHEIC) on July 23. The global case count is now over 26,000 across 87 countries. At least 10 deaths have been reported from six countries. The US has the largest tally of cases of any other country, behind Spain, which has documented over 4,500 cases.

In a press briefing Thursday, US officials said the emergency declaration would allow federal, state, and local officials to better coordinate and respond to the outbreak. “We are prepared to take our response to the next level,” Department of Health and Human Services Secretary Xavier Becerra said after announcing the emergency declaration. “We urge every American to take monkeypox seriously.”

Rochelle Walensky, director of the Centers for Disease Control and Prevention, said that the declaration would allow the CDC to mobilize more personnel, increase testing and access to treatments, spur states to share more case data, and help improve awareness of the virus and outbreak.

Federal officials continue to work to get vaccine supplies out to states and jurisdictions. They have made more than 1 million doses available so far. The rollout of a vaccine has been slow, and supplies have not met demand. In the briefing, FDA Commissioner Robert Califf noted that the agency is considering allowing fractional doses of the Jynneos vaccine, enabling health providers to stretch out the current supply to provide more people with some protection.

With all the efforts planned, “there should be no reason why we can’t stay ahead of this [outbreak],” Secretary Becerra said optimistically.

Outbreak so far

The virus, which can cause flu-like symptoms and painful lesions, is not easily transmitted from person to person relative to other pathogens, such as SARS-CoV-2. In this outbreak, monkeypox is generally spreading through very close, often intimate, prolonged face-to-face interactions and skin-on-skin contact—such as sexual encounters or among people who live together.

The lesions contain high levels of virus, and direct contact with them is a main route of transmission. If lesions occur in the mouth and/or throat, then prolonged, close face-to-face interaction with an infected person can lead to respiratory transmission. But the monkeypox virus is not thought to linger in the air or spread easily via respiratory droplets. Brief encounters or being in the same room with someone is not thought to pose a risk. The virus may also spread to others via highly-contaminated surfaces or materials, such as bedding. But again, this is not thought to be a common transmission route in the outbreak.

The outbreak continues to be mainly spreading through sexual networks of gay, bisexual, and other men who have sex with men (MSM). Though historical monkeypox cases included an outbreak of lesions all over the body, in this outbreak, lesions are often appearing first and concentrating in the genital and anal areas.

Health experts have called for more intense health responses to raise awareness of the risk within those communities and help members best protect themselves. That includes the CDC offering explicit recommendations on how men who have sex with men can have safer sex.

Last week, WHO Director-General Tedros Adhanom Ghebreyesus advised men who have sex with men to lower their risk by “reducing your number of sexual partners, reconsidering sex with new partners, and exchanging contact details with any new partners to enable follow-up if needed.”

Though members of the MSM community are at the highest risk presently—and many health experts emphasize that they should be the main focus of prevention measures—they are not uniquely susceptible to the infection. The monkeypox virus can transmit to anyone, and health experts fear that as more cases arise, the virus will begin spreading more in different communities and groups, including the most vulnerable: children and pregnant people. Already, the US has reported several cases in women and children.

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