Monkeypox cases are on the rise in the US 0:58
(CNN) --
As the outbreak of monkeypox, also known as monkeypox, continues to spread across the globe, many people who have been sickened by the virus have had mild symptoms and have been able to recover without any specific treatment against it. the suffering.
"For the most part, these illnesses are relatively mild. They can be disfiguring and unpleasant, but they heal on their own, although it may take some time," says Dr. William Schaffner, professor of medicine at the University School of Medicine. of Vanderbilt.
The US Food and Drug Administration (FDA) has not approved any specific therapy for the treatment of monkeypox.
But the US Centers for Disease Control and Prevention (CDC) is making the antiviral drug tecovirimat available during the outbreak and says it may be considered for severe monkeypox patients or with a high risk of severe disease.
Data on the number of monkeypox patients who fall into this category remain limited.
But Dr. Mary Foote, medical director of the New York City Department of Health and Hygiene's Office of Preparedness and Response, said last week that the city's proportion of severe monkeypox cases has been higher than the expected.
Foote said the city's providers have started tecovirimat treatment for "close to 70 patients," and that the number of confirmed cases in the city at that time had reached 336.
Vaccination can prevent or reduce the disease
According to the CDC, monkeypox can be spread from person to person in a number of ways, including direct physical contact with the rash caused by the infection, "respiratory secretions" that can be spread during face-to-face contact, or intimate physical contact, such as sexual intercourse, and contact with items such as clothing that have touched an infectious rash or body fluids.
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Dr. Anthony Fauci, the nation's top infectious disease expert, said Monday that the outbreak is "heavily charged" to affect men who have sex with men.
"When you look at this, does that mean it's just a gay men's disease? No, that's not the case," he said.
"But under the circumstances of certain types of behavior, it can spread, which is why, while you don't want to stigmatize under any circumstances people who are affected by a certain infectious disease, you have to inform the community of the danger, and the doctors who treat these people must be made aware of this so that they do not miss the diagnosis".
The Jynneos vaccine is the only one approved specifically in the United States for monkeypox.
A smallpox vaccine called ACAM2000 is also licensed and can be used during this outbreak.
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The CDC states that vaccination may be recommended for people who are in close contact with someone with monkeypox, who may have been exposed to the virus, and who are at high risk of exposure, such as some health care professionals and laboratory.
The US Department of Health and Human Services announced in June that it will provide vaccines to people with confirmed and suspected exposure to monkeypox, including men with more than one recent sexual partner.
The CDC recommends vaccination within four days of exposure to monkeypox and states that if a person is vaccinated between four and 14 days after exposure, benefits such as relief of symptoms may continue.
"The advantages of vaccination are that people who may have been exposed to monkeypox, prior to the appearance of the rash, may benefit from vaccination, either to prevent the full spectrum of the disease or to reduce the severity. of it," said Dr. Jay Varma, professor of Population Health Sciences at Weill Cornell Medical College.
The Jynneos vaccine is given in two doses four weeks apart.
The FDA approved it for monkeypox based on studies measuring antibody levels in vaccinated humans, as well as efficacy studies in animals.
"The degree of efficacy, that is, the proportion of infections that would be prevented, remains to be determined," Schaffner said, "but that they have some benefit, I think, is pretty clear."
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What to do if you are diagnosed with monkeypox?
Signs of monkeypox infection typically begin within three weeks of exposure and include flu-like symptoms such as fever, headache, muscle aches, sore throat, cough, chills and exhaustion, according to the CDC.
The characteristic features of monkeypox are swollen lymph nodes and a rash.
The CDC states that the rash may look like pimples or blisters and can appear on various parts of the face and body, including the genital area.
"In most cases, we're encouraging people who are at risk, if they develop a rash, to see a medical provider to make the diagnosis and rule out other common things like herpes infection or bacterial infection of the skin," said Dr. Roy Gulick, chief of the Division of Infectious Diseases at Weill Cornell Medicine.
People diagnosed with monkeypox should self-isolate at home, the CDC says.
If they have a rash or other symptoms, they should be "in a separate room or area from other family members and pets when possible."
The World Health Organization recommends that people with monkeypox try not to touch the rash, as this could contribute to the spread of the disease.
Most cases of monkeypox go away on their own.
"Most of these people get better on their own, and that's very fortunate," Schaffner said.
"People may want some symptomatic relief, like Tylenol or this or that, but they won't need any direct antiviral treatment."
The WHO guide for health workers says that paracetamol can be used to control fever and minor pain.
"If there is mild pain at the site of injury, a topical pain reliever may be helpful," added Dr. Timothy Wilkin, professor of medicine at Weill Cornell Medical College.
"Sometimes people are itchy, so we can offer an over-the-counter antihistamine, like Benadryl or Claritin," Gulick said.
Treatment of serious illness
The CDC has made certain antiviral drugs available during the outbreak through a pathway called Expanded Access.
The agency says an antiviral drug called tecovirimat may be considered for people with severe monkeypox illness, such as sepsis, brain swelling or other conditions that need hospitalization.
It may also be considered for people who are at high risk of serious illness, including those with weakened immune systems from conditions such as HIV/AIDS, skin conditions such as eczema, children, pregnant women, and people with other complications such as a bacterial skin infection.
People with symptoms in particularly dangerous areas such as the eyes, mouth, genitals, or anus may also be considered for treatment.
Tecovirimat, sold under the brand name TPOXX, was approved by the FDA for the treatment of smallpox in 2018. It can be given as an oral pill or given intravenously.
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The benefits of the drug were evaluated through tests on animals that were infected with viruses related to smallpox, including monkeypox.
The drug was tested in 359 healthy human volunteers to confirm its safety.
According to the CDC, "no data are available on the efficacy of tecovirimat in the treatment of monkeypox infections in people."
"Most importantly, we've found the drug to be well tolerated so far," Foote said of the New York City experience, "with an occasional report of headaches, maybe nausea, but there's been no reports of any serious adverse event.
The CDC also says that three other treatments, cidofovir, brincidofovir, and Vaccinia Immune Globulin (intravenous), may be considered for the treatment of monkeypox during the outbreak.
But experts say these treatments have been less relevant because of uncertainties about whether they have benefits that outweigh the risks.
Gulick said, for example, that cidofovir treatment can have negative effects on the kidneys.
Challenges of treatment with tecovirimat
Given the paucity of data on the efficacy of monkeypox treatment with tecovirimat, Gulick said, "You have to come up with risks and trade-offs, and that's often a conversation you have with patients."
Dr. Lilian Abbo, associate medical chief of Infectious Diseases at Miami's Jackson Health System, said most of the requests she's seen for tecovirimat have been for people who had malignancies or conditions that compromised their immunity in patients who have a more serious illness.
Wilkin, who has treated monkeypox patients in New York, said he has seen its use primarily for "very painful anal injuries" as well as people who have lesions on the face, which "can be potentially disfiguring with unnecessary complications." ".
Wilkin added that he has seen the drug used in a number of people who have weakened immune systems and are at risk of progressing to more severe disease.
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A medical provider can request access to tecovirimat by contacting their state Department of Health or the CDC.
Doctors have outlined a series of steps, such as lab tests and consent forms, that are necessary to gain access to the drug.
The CDC website indicates that photos and samples of the lesions are optional and not required steps to obtain tecovirimat, starting Friday.
"Just to put it in perspective, in my discussions with some of our treatment providers, between all the forms and administrative requirements, a patient's visit to start treatment can take anywhere from an hour and a half to three hours," Foote said.
Fauci said the FDA and CDC are working to reduce the paperwork required.
Another problem facing clinicians is the lack of available data to guide treatment decisions.
Wilkin compared the experience of treating monkeypox patients to the early days of the Covid-19 pandemic, when there were no robust studies to guide treatment decisions.
"We're under pressure to use what we have, but my part as a researcher says we have to show that this material really works and that it's also safe," Gulick said.
"The best way to do it is a randomized placebo-controlled trial."
Gulick added that discussions are ongoing about these kinds of clinical trials.
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