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Monkeypox

Washington Post- Monkeypox dilemma: How to warn gay men about risk

As the nation confronts its largest-ever monkeypox outbreak, public health authorities navigate a delicate but familiar balancing act

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CDC Headquarters in Atlanta, Georgia (Blade file/US Government photo)

By Fenit Nirappil | SALT LAKE CITY – Monkeypox had arrived in Salt Lake County, with two men testing positive after returning from Europe, the epicenter of a global outbreak concentrated in gay and bisexual men.

Officials there faced a dilemma. They wanted to warn men who have sex with men that they were at higher risk for exposure to the virus. But they feared unintended consequences: heterosexual people assuming they’re not susceptible, closeted men in a heavily Mormon community avoiding care so they’re not seen as gay, and critics exploiting the infections to sow bigotry.

It’s not just Utah officials who are struggling to find the right message. As the United States confronts its largest-ever monkeypox outbreak, with nearly 50 probable cases, public health authorities navigate a delicate but familiar balancing act. In the 17 U.S. cases in which the sexual behavior of the patient is known, all but one involve men who have sex with men, mirroring trends in Europe. It’s something never recognized before in outbreaks of the virus.

Key facts:

In Salt Lake County, health officials consulted with advocacy groups and decided to get the message out to gay and bisexual men without making the message about them. At a booth during the Utah Pride Festival in Salt Lake City this month, Health Department staff distributed business-card-sized monkeypox warnings urging people to avoid close or sexual contact with anyone experiencing a rash or flu-like symptoms. The warning didn’t say anything about the gay community.

Officials nationally want gay and bisexual men to be alert for symptoms, particularly rashes and lesions on or near the genitals, as they travel, party and congregate in June for LGBT Pride month, which commemorates the 1969 Stonewall uprising in New York that marked a seminal moment in the fight for LGBT rights. But they also want to avoid creating a false impression that monkeypox is a gay disease.

The strain of monkeypox driving the current outbreak is rarely deadly and causes an illness lasting several weeks, unlike AIDS, which is incurable and was often lethal before effective treatments emerged in the 1990s. But even if monkeypox does not pose a mortal threat akin to HIV, health officials don’t want to ignore any emerging disease threat disproportionately affecting gay men.

Monkeypox had never been associated with men who have sex with men until the latest outbreak, when Canada, Spain, the United Kingdom and disease trackers in other nations noted that infections were heavily but not exclusively concentrated in that group.

Read the entire article here: https://wapo.st/3xrIg6w.

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Fenit Nirappil is an Out reporter covering healthcare issues for the Washington Post with emphasis on the U.S. Centers for Disease Control and Prevention.

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Monkeypox

En español: Lo que debes saber sobre la viruela del simio

Los estadounidenses tienen bajo riesgo de contraer la viruela del mono: se está propagando entre los hombres que tienen sexo con hombres

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Crédito de la foto: Centros para el Control y la Prevención de Enfermedades de EE. UU.

By Céline R. Gounder, MD | NUEVA YORK – La Organización Mundial de la Salud dijo el 25 de junio que la viruela del simio aún no es una emergencia de salud pública que preocupe a nivel internacional. Se han informado más de 4,500 casos en todo el mundo, y ya superan los 300 en los Estados Unidos. Aunque es probable que haya un subregistro porque no se hace rastreo de contactos.

Todos deberían saber sobre los símtomas, cómo se disemina y los riesgos.

¿Debería preocuparme por la viruela del simio?

Actualmente, los estadounidenses tienen un bajo riesgo de contraer la viruela del simio. Se está extendiendo entre hombres que tienen sexo con hombres, pero es solo cuestión de tiempo antes de que pase a otros. Al 27 de junio, el Centro Europeo para la Prevención y el Control de Enfermedades había informado 10 casos en mujeres.

Generalmente es una enfermedad leve, pero puede ser grave o incluso mortal para las personas inmunodeprimidasembarazadasfetos o recién nacidosmujeres lactantesniños pequeños y personas con enfermedades de la piel, como eccema.

Podría volverse endémica en los Estados Unidos, y en todo el mundo, si continúa propagándose sin control.

¿Cómo se propaga?

La viruela del simio es una infección viral, prima cercana de la viruela. Pero causa una enfermedad mucho más leve.

Se transmite a través del contacto cercano, incluido el sexo, besos y masajes: cualquier tipo de contacto del pene, la vagina, el ano, la boca, la garganta o incluso la piel. En este brote, se ha transmitido principalmente por vía sexual.

Los condones y los protectores dentales reducirán, pero no evitarán, toda la transmisión porque solo protegen contra el contagio por piel, y por las mucosas cubiertas por estos dispositivos. Es importante saber que el virus puede entrar por una abertura en la piel, y penetrar las membranas mucosas de la nariz, la boca, los genitales y el ano.

Los científicos no saben si la viruela del simio se puede transmitir a través del semen o del fluido vaginal.

La viruela del simio se puede transmitir a través de gotitas respiratorias a unos pocos pies, pero no es un modo de transmisión particularmente eficiente. Todavía no se ha documentado transmission aérea, como covid-19.

No se sabe si la infección se puede transmitir cuando la persona no presenta síntomas.

¿Cuáles son los síntomas comunes?

Los síntomas pueden desarrollarse hasta 21 días después de la exposición y pueden incluir fiebre y escalofríos, ganglios linfáticos inflamados, sarpullido y dolores de cabeza.

No se sabe si siempre muestra alguno o todos esos síntomas.

Actualmente, los expertos creen que la viruela del simio, como la viruela, siempre causará al menos algunos de estos síntomas, pero esa creencia se basa en la ciencia anterior a 1980, antes de que existieran pruebas de diagnóstico más sofisticadas.

¿Cómo se ve la erupción de la viruela del simio?

La erupción generalmente comienza con manchas rojas. Luego se convierten en protuberancias llenas de líquido y después pus que pueden parecer ampollas o granos. Estas protuberancias luego se abren en llagas y forman costras. Las personas con viruela del simio se deben considerar infecciosas hasta que aparecen las costras y se caen.

Estas llagas son dolorosas. Antes, la erupción se observaba más en las palmas de las manos y las plantas de los pies, pero muchas personas en este brote presentan lesiones externas e internas en la boca, los genitales y el ano.

También dolor rectal o la sensación de necesitar defecar cuando sus intestinos están vacíos.

¿Cómo hacerse la prueba?

Si la persona tiene síntomas de viruela del simio, hay que hacerse una prueba en una clínica de salud sexual. Un profesional médico debe tomar una muestra de cualquier lesión sospechosa para su análisis. También hay evidencia emergente de que los frotis de garganta pueden detectar la viruela del simio, pero hasta ahora los funcionarios de salud no los recomiendan.

¿Hay una vacuna para la viruela del simio?

Sí. Dos vacunas son eficaces para prevenir la viruela del simio: la vacuna Jynneos y la vacuna ACAM2000. La FDA aprobó la vacuna Jynneos para prevenir la viruela del simio y la viruela en personas mayores de 18 años. ACAM2000 está aprobada por la FDA para prevenir la viruela. Actualmente, en el país se usa solo la vacuna Jynneos porque es más segura y tiene menos efectos secundarios.

La vacuna Jynneos es segura. Se ha probado en miles de personas, incluidas aquéllas inmunocomprometidas o con enfermedades de la piel. Los efectos secundarios comunes de la vacuna Jynneos son similares a los de otras vacunas: fiebre, fatiga, glándulas inflamadas e irritación en el lugar de la inyección.

La vacuna Jynneos es eficaz para prevenir la viruela del simio hasta cuatro días después de la exposición y puede reducir la gravedad de los síntomas si se administra hasta 14 días después de la exposición.

¿Puedo vacunarme contra la viruela del simio?

Actualmente, los Centros para el Control y la Prevención de Enfermedades (CDC) recomiendan la vacunación contra la viruela del simio solo para aquellos en mayor riesgo: personas que han tenido contacto cercano con alguien infectado; hombres que tienen relaciones sexuales con hombres y mujeres trans que recientemente han tenido múltiples parejas sexuales en un lugar donde la infección se está propagando; y algunos trabajadores de la salud, socorristas y militares que podrían entrar en contacto con los afectados.

Actualmente, los suministros de la vacuna Jynneos son limitados. El Departamento de Salud y Servicios Humanos liberará 56,000 dosis de la reserva nacional estratégica de inmediato. En las próximas semanas estarán disponibles 240,000 dosis adicionales, 750,000 a finales del Verano, y 500,000 este otoño. Un total de 1.5 millones de dosis.

¿Cuáles son otras formas de reducir el riesgo de transmisión de la viruela del simio?

La mejor manera es informarse. Si la persona está preocupada, el enlace de los CDC es el mejor recurso para encontrar una clínica de salud sexual: https://gettested.cdc.gov/. Muchas salas de emergencia o centros de urgencia, y otros centros de salud, todavía pueden no estar actualizados con lo ultimo sobre la viruela del simio.

Hay que abstenerse de tener relaciones sexuales si un miembro de la pareja está infectado. Los CDC también advierten sobre el riesgo de ir a raves u otras fiestas o lugares en donde la gente usa poca ropa. Y ofrece otros consejos de prevención, como el lavado de sábanas o juguetes sexuales.

¿Existe un tratamiento para la viruela del simio?

No existe un tratamiento seguro y probado específicamente para la viruela del simio. La mayoría de los casos son leves y mejoran sin tratamiento en un par de semanas. Medicamentos como el paracetamol y el ibuprofeno se pueden usar para reducir la fiebre y los dolores musculares. En casos raros, algunos pacientes desarrollarán una enfermedad más grave y pueden requerir un tratamiento más específico. Los médicos están probando terapias experimentales como cidofovirbrincidofovirtecovirimat e inmunoglobulina vaccinia. Si se administran temprano en el curso de la infección, las vacunas Jynneos y ACAM2000 también pueden ayudar a reducir la gravedad de la enfermedad.

¿Qué información errónea circula sobre la viruela del simio?

Abundan las teorías conspirativas. Pero no es un engaño. Es real. Esta infección no fue inventada por Bill Gates ni por las farmacéuticas. El virus no salió de un laboratorio de China o Ucrania. Los migrantes que cruzan la frontera con México no traen la viruela del simio a los Estados Unidos. No hay mandato de vacunación ni cuarentenas establecidas para la viruela del simio.

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Celine Gounder, MD, ScM, FIDSA, es miembro sénior y editora general de Public Health, y creadora y presentadora de American Diagnosis, un podcast sobre salud y justicia social.

Es profesora asistente clínica de medicina y enfermedades infecciosas en la Escuela de Medicina Grossman de la NYU. Ella atiende a pacientes en las salas de NYC Health + Hospitals/Bellevue y en Indian Health Service y centros de salud tribales en todo el país.

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El artículo anterior fue publicado previamente por Kaiser Health News y se vuelve a publicar con autorización.

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Monkeypox

WeHo victim of monkeypox: “This … sucks and you don’t want it”

“I also currently have monkeypox. Here’s what my experience has been like so far and why you should take it seriously”

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Matt Ford (Screenshot via TikTok)

WEST HOLLYWOOD – A 30-year-old actor who divides his time between Los Angeles and New York was infected in the virulent monkeypox outbreak and took to social media and wrote a post on Buzzfeed about his experience with the illness.

Matt Ford, who is openly gay, wrote in a Buzzfeed commentary titled; “I Have Monkeypox — Here’s What It’s Like And What You Should Know,” detailing that he learned that he had been exposed to the illness on June 17. He went to a doctor three days later to be tested, and a few days afterwards, his positive test was confirmed by the Los Angeles County Department of Public Health.

“I also currently have monkeypox. Here’s what my experience has been like so far and why you should take it seriously. Trust me, you don’t want to have it,” Ford wrote.

Ford explained that after the confirmation by the LA County Public Health officials, his lesions grew in number and intensity, so much so that he “couldn’t sleep some nights,” and he also experienced “intense flu-like symptoms: a fever, full-body chills, night sweats, a cough, a sore throat, and swollen lymph nodes” for about a week.

Public Health also issued Ford a stay-at-home order by email.

“It basically said that I’m legally mandated to stay at home and isolate, except for medical visits or emergencies, until fully recovered (more on what that means in a moment),” he noted.

“The pain was a dull, sore constant, with fun little spikes of sharp pain if I moved the wrong way … All that seemed to help were frequent baths and ointments — until I went back to the doctor and was prescribed narcotic painkillers. Even those were only so-so at managing the pain,” he added.

Courtesy of Matt Ford

Currently in Los Angeles County, Public Health has recorded the number of probable and confirmed cases as of July 1, 2022 at 9:00 a.m. to be 35.

In an interview Ford told KTLA: “From the data, this does seem to primarily affect queer men at present. It is by no means a gay disease, it can spread to anyone,” he said. “But at the moment, we’re being primarily affected, so I do worry that will lend itself to some stigma, as we’ve seen in other epidemics. HIV comes to mind, having affected queer men. That’s why I’m being vocal, to try to fight that stigma and reinforce to everyone that there’s no shame in getting this.”

He also thinks public health officials should do more to expedite testing and encourage vaccines.

“If you can get vaccinated, do go get vaccinated, especially if you think you’re in a demographic where you can be more easily exposed to it,” Ford said. “There’s no reason to go through this. It’s unnecessary and miserable.”

Ford advised in his piece; “So, what to do if you think you have monkeypox? First, don’t panic. Do, however, limit your exposure to others, see a health provider as soon as possible, and inform your local department of public health.”

Joshua Schare, a spokesperson for the City of West Hollywood in an email to the Blade noted:

“What we know from LA County Public Health is that, at this time, the Centers for Disease Control and Prevention (CDC) is not recommending vaccinations for the general public. Vaccines are being allocated to jurisdictions to use for known contacts who are identified by Public Health via case investigation, contact tracing, and risk exposure assessments; as well as presumed contacts who meet the following criteria: had a sex partner in the past 14 days diagnosed with monkeypox or had multiple sex partners in the past 14 days in a jurisdiction with known monkeypox transmission.”

Schare added:

“LA County Public Health held a monkeypox briefing with stakeholders on Tuesday, June 28, 2022 and shared that they are developing a vaccine strategy. It is administering the remaining supply of vaccine for post-exposure prophylaxis (PEP) for those who had an exposure with a confirmed case. LA County Public Health is waiting for a replenishment of doses because the current supply is for the two required doses of PEP. They are planning for the Federal government to deliver 150,000 doses within the next few weeks. 

The City of West Hollywood is working with its contracted providers – such as the LA LGBT Center, Saban Community Clinic, and Men’s Health Foundation – to see when an allocation of vaccines will be more broadly available and the City will share news about this, accordingly, when there is more information.”

From the Los Angeles County Department of Health:

What is monkeypox and how does it spread?

Monkeypox, a disease caused by infection with monkeypox virus, is a rare disease and does not naturally occur naturally in the US. Monkeypox infections in the US are usually associated with travel to West or Central Africa or contact with imported infected animals. However, as mentioned above, cases of monkeypox have recently been identified in some countries where the virus is not typically found, including in the US, and appear to have spread through human-to-human contact.

Monkeypox can spread when a person has close contact with a person infected with monkeypox virus or when a person comes in contact with materials (e.g., bedding, towels) that are contaminated with the virus. The monkeypox virus can also spread from animals to people.

The monkeypox virus can spread by:

  • Touching monkeypox lesions on a person’s skin
  • Touching contaminated objects, fabrics (clothing, bedding, towels), and surfaces that have been in contact with someone with monkeypox
  • Coming into contact with respiratory droplets or secretions from the eyes, nose and mouth from a person with monkeypox

To prevent the spread of the monkeypox virus, persons should avoid:

  • Oral, anal, and vaginal sex, or touching the genitals or anus of someone with monkeypox
  • Hugging, massaging, kissing, or talking closely with someone with monkeypox
  • Touching shared fabrics, shared surfaces, and objects (e.g. sex toys) used by someone with monkeypox

Symptom onset ranges from 5-21 days.

What does monkeypox look like and what are the symptoms?

All of the above images are from GOV.UK, https://www.gov.uk/guidance/monkeypox

Early signs may include fever, muscle aches, headache, swollen lymph nodes, exhaustion, and sometimes cough or sore throat. A rash may develop often beginning on the face and spreads to other parts of the body, including the hands, feet, eyes, mouth and/or genitals. Rashes may vary in severity between people and change in appearance through infection. Infections can last two to four weeks.

Skin lesions typically begin to develop simultaneously, may appear anywhere on the body, and change from being flat to bumps to blisters before scabbing over and resolving.

Many individuals infected with monkeypox virus have a mild, self-limiting disease with the symptoms lasting from 2 to 4 weeks in the absence of therapy. Monkeypox is usually a self-limited disease. Severe cases can occur.

RASH, BUMPS, OR BLISTERS

FEVER & HEADACHES

MUSCLE ACHES

SWOLLEN LYMPH NODES

How is monkeypox treated?

At this time, there are no specific treatments approved for monkeypox virus infections. Most treatment is supportive, easing the symptoms of illness. However, antivirals developed for use in patient with other viral diseases may prove beneficial in certain cases. Additionally, some measures including vaccination may be given to prevent the monkeypox infection after a high-risk exposure to the virus.

How can I prevent monkeypox? 

The risk to the US population remains low. Those who experience symptoms consistent with monkeypox, such as characteristic rashes or lesions, should contact their health care provider for a risk assessment or call DPH at 2-1-1 for assistance if you do not have a regular provider. This includes anyone who traveled to countries where monkeypox cases have been reported or has had close contact, including sexual contact, with someone who has a similar rash or received a diagnosis of suspected or confirmed monkeypox.

Steps to help prevent monkeypox include:

  • Avoid contact with materials, like bedding, that has been in contact with a sick animal or person infected with this virus
  • Keep infected patients away from others
  • Wash hands with soap and water or use an alcohol-based hand sanitizer after contact with infected animals or humans.
  • Avoid contact with animals that could have the virus (such as animals that are sick or that have been found dead)

There is a vaccine that can prevent monkeypox and can be used, under certain circumstances, for the protection of people who are at high risk of exposure to this disease.

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Monkeypox

2.5 Million more doses of JYNNEOS Monkeypox vaccine ordered by U.S.

The order announced today is in addition to 500,000 doses of vaccine being produced for use in the current response to monkeypox in the U.S

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Photo Credit: County of Los Angeles

WASHINGTON – The U.S. Department of Health and Human Services (HHS) announced Friday that it has ordered an additional 2.5 million doses of Bavarian Nordic’s JYNNEOS, an FDA-licensed vaccine indicated for prevention of smallpox and monkeypox, for use in responding to current or future monkeypox outbreaks and as part of U.S. smallpox preparedness.

The FDA first approved Bavarian Nordic‘s Jynneos vaccine in 2019 as the first vaccine meant to prevent a rare viral infection that affected dozens of people in the Midwest nearly twenty years ago.

The vaccine is meant for adults who are considered to be at high risk of either infection. In addition to being the first FDA-approved monkeypox vaccine, it is also the first non-replicating smallpox vaccine to win the agency’s approval, MedCity News had reported at the time.

A 2003 outbreak in the Midwest marked the first time monkeypox was found outside of its native Africa. Smallpox has been eradicated, but bioterrorism concerns remain.

Deliveries from this latest order of the Bavarian Nordic‘s Jynneos vaccine will begin arriving at the Strategic National Stockpile (SNS) later this year and will continue through early 2023 HHS said in a statement.

“We are working around-the-clock with public health officials in states and large metro areas to provide them with vaccines and treatments to respond to the current monkeypox outbreak,” said HHS Secretary Xavier Becerra. “This order of additional JYNNEOS vaccine will help us push out more vaccine quickly, knowing that we have more doses on the way in the coming months – and is only possible because of our longstanding investment in smallpox and monkeypox preparedness.”

The order announced today is in addition to the 500,000 doses of government-owned vaccine the company is producing in 2022 for use in the current response to monkeypox in the U.S and brings the total vaccine doses to be delivered in 2022 and 2023 to more than 4 million.

The company will produce these doses in liquid frozen form using vaccine already manufactured in bulk under an existing 10-year contract with the Biomedical Advanced Research and Development Authority (BARDA), within the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR); that contract was part of ongoing national preparedness efforts against smallpox.

“The medical countermeasures available to help respond to the current outbreak are the result of years of investment and planning made possible through the ongoing work between HHS and private industry,” said Gary Disbrow, director of the Biomedical Advanced Research and Development Authority. “We are pleased that we have been able to work with our partners at Bavarian Nordic to accelerate delivery of vaccines that can help keep people safe and stem the spread of the virus.”

BARDA supported the development of JYNNEOS, which is approved by the FDA to prevent smallpox and monkeypox. The U.S. government owns enough smallpox vaccine – JYNNEOS and ACAM2000 – to vaccinate millions of Americans, if needed.

As of June 24, ASPR’s SNS held approximately 65,000 doses of JYNNEOS in immediate inventory with delivery of an additional 300,000 doses in the coming days. On June 28, HHS announced that it would immediately make available 56,000 doses and soon after would make available 240,000 additional doses. The SNS also has more than 100 million doses of ACAM2000 which was developed with SNS support and is approved by FDA for use in preventing smallpox. The Centers for Disease Control and Prevention (CDC) currently has an expanded access Investigational New Drug protocol which allows use of ACAM2000 for monkeypox.

In addition, the SNS has over 1.7 million treatment courses of the smallpox antiviral drug TPOXX, which was developed with BARDA support and can be used to treat individuals with monkeypox under an appropriate regulatory mechanism. CDC currently has an expanded access Investigational New Drug protocol which allows its use for monkeypox.

As of June 29, the CDC has received reports of approximately 350 cases of monkeypox in the U.S., primarily among men who have sex with men.

To learn more about monkeypox, visit cdc.gov/monkeypox.

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