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Monkeypox

WHO Director-General declares monkeypox Public Health Emergency

“There’s clear risk of further international spread, although the risk of interference with international traffic remains low for the moment”

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Sign being carried during the Berlin Pride parade on July 23, 2022 (Blade photo by Michael K. Lavers)

GENEVA, Switzerland – The World Health Organization’s Director-General Dr. Tedros Adhanom Ghebreyesus declared the escalating global monkeypox outbreak a Public Health Emergency of International Concern (PHEIC) on Saturday. This is an upgraded alert status but below the requirements needed for a declaration of a pandemic, in part over its low death rates.

Around 65 countries in which monkeypox is not endemic have reported outbreaks of the viral disease as confirmed cases are approximately 15,600.

Currently, the vast majority of reported cases are in the WHO European Region. “WHO/Europe remains committed to partnering with countries and communities to address the outbreak with the required urgency,” Dr. Tedros said during a media briefing.

In laying out reasons for the declaration the WHO head noted; “We have an outbreak that has spread around the world rapidly through new modes of transmission, about which we understand too little,” Tedros said. “I know this has not been an easy or straightforward process and that there are divergent views.”

There had been reservations by the health agency’s expert committee who said the monkeypox outbreak did not yet amount to an international emergency in a meeting in June. Tedros had reconvened that committee in a special session this past Thursday.

“A month ago, I convened the Emergency Committee under the International Health Regulations to assess whether the multi-country monkeypox outbreak represented a public health emergency of international concern,” Tedros told reporters. “At that meeting, while differing views were expressed, the committee resolved by consensus that the outbreak did not represent a public health emergency of international concern.”

“At the time, 3040 cases of monkeypox had been reported to WHO, from 47 countries. Since then, the outbreak has continued to grow, and there are now more than 16 thousand reported cases from 75 countries and territories, and five deaths,” he added.

“In light of the evolving outbreak, I reconvened the committee on Thursday of this week to review the latest data and advise me accordingly. I thank the committee for its careful consideration of the evidence, and issues,” Tedros continued.

“On this occasion, the committee was unable to reach a consensus on whether the outbreak represents a public health emergency of international concern. The reasons the committee members gave for & against are laid out in the report we are publishing today.”

“Under the International Health Regulations, I am required to consider five elements in deciding whether an outbreak constitutes a public health emergency of international concern.”

“First, the information provided by countries – which in this case shows that this virus has spread rapidly to many countries that have not seen it before. Second, the three criteria for declaring a public health emergency of international concern under the International Health Regulations, which have been met.

“Third, the advice of the Emergency Committee, which has not reached consensus. Fourth, scientific principles, evidence and other relevant information – which are currently insufficient and leave us with many unknowns. Fifth, the risk to human health, international spread and the potential for interference with international traffic,” Tedros told the press laying out the foundation to his decision.

“WHO’s assessment is that the risk of monkeypox is moderate globally and in all regions, except in the European region where we assess the risk as high,” he said adding “There is also a clear risk of further international spread, although the risk of interference with international traffic remains low for the moment.”

“So in short, we have an outbreak that has spread around the world rapidly, through new modes of transmission, about which we understand too little and which meets the criteria in the International Health Regulations.” The WHO chief then noted “For all of these reasons, I have decided that the global monkeypox outbreak represents a public health emergency of international concern.”

WHO Director-General Dr. Tedros Adhanom Ghebreyesu
(Photo credit: WHO)

Tedros then pivoted to WHO recommendations for the international public health community in addressing the outbreak.

“Accordingly, I have made a set of recommendations for four groups of countries: First [group], those that have not yet reported a case of monkeypox, or have not reported a case for more than 21 days.

Second [group], those with recently imported cases of monkeypox and that are experiencing human-to-human transmission. This includes recommendations to implement a coordinated response to stop transmission and protect vulnerable groups; to engage & protect affected communities; To intensify surveillance & public health measures; To strengthen clinical management & infection prevention & control in hospitals & clinics to accelerate research into the use of vaccines, therapeutics & other tools; And recommendations on international travel.

The third group of countries is those with transmission of monkeypox from animals to humans and the fourth is countries with manufacturing capacity for vaccines and therapeutics.”

Tedros acknowledged the work of the committee saying: “I thank the Emergency Committee for its deliberations and advice. I know this has not been an easy or straightforward process, and that there are divergent views among the members. “The International Health Regulations remains a vital tool for responding to the international spread of disease. But this process demonstrates once again that this vital tool needs to be sharpened to make it more effective.”

“Although I am declaring a public health emergency of international concern, for the moment this is an outbreak that is concentrated among men who have sex with men, especially those with multiple sexual partners,” he said. “That means that this is an outbreak that can be stopped with the right strategies in the right groups.”

“It’s therefore essential that all countries work closely with communities of men who have sex with men, to design & deliver effective information & services, and to adopt measures that protect both the health, human rights & dignity of affected communities,” Tedros said and then warned, “Stigma and discrimination can be as dangerous as any virus.”

The WHO Director-General’s full statement is linked here: (WHO)

The Centers for Disease Control and Prevention released a statement saying that the agency was “supportive” of WHO’s emergency declaration and hoped it would galvanize international action to stamp out the outbreaks. The U.S. has reported more than 2,800 monkeypox cases and sent more than 370,000 vaccine doses to U.S. states reporting cases.

Raj Panjabi, the Coordinator of the White House Pandemic Office released a statement commenting on the WHO action Saturday:

Today’s decision by the World Health Organization (WHO) to declare the current monkeypox outbreak as a Public Health Emergency of International Concern is a call to action for the world community to stop the spread of this virus. A coordinated, international response is essential to stop the spread of monkeypox, protect communities at greatest risk of contracting the disease, and combat the current outbreak.”

Since the earliest days of the outbreak, the Biden Administration has deployed a robust and comprehensive strategy to combat monkeypox here in the US, including dramatically scaling the procurement, distribution, and production of vaccines, expanding access to testing and treatments, and communicating with communities most at risk of contracting the virus.  But that is not enough.  As the Department of Health and Human Services has said, we must step up our work to aggressively combat this virus and protect communities in the United States that have been affected by monkeypox.”

Speaking with reporters Friday, Jennifer McQuiston the Deputy Director for High Consequence Pathogens and Pathology at the Centers for Disease Control and Prevention said that two cases of the monkeypox virus have been diagnosed in children.

“We became aware of these cases just this week, and we’ve been working with the jurisdictions to understand more about these cases,” McQuiston said.

In a Washington Post Live session Friday, CDC Director Walensky, while discussing the highly contagious Omicron BA.5 coronavirus variant and the ongoing monkeypox outbreak, noted that the CDC was made aware of the cases adding that both children “are doing well.” 

McQuiston said that the agency determined that both cases were “likely the result of household transmission” and “had no contact with each other.”

The agency is now aware of at least eight cases in people who identify as cisgender women, McQuiston said. Most cases so far have been among men who have sex with men. The number of cases as of July 22 is a total of 2,891 in the U.S. in 44 states and territories including the District of Columbia.

“There is no evidence to date that we’re seeing this virus spread outside of those populations to any degree, and I think that the primary drivers for this infection in the U.S. remain in the gay, bisexual, and men who have sex with men communities right now,” McQuiston added.

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Monkeypox

LA County Public Health expands Monkeypox vaccination eligibility

Eligible residents can go to a Public vaccinating site or visit Myturn.ca.gov to find other vaccinating sites near you

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Photo Credit: County of Los Angeles

LOS ANGELES – The Los Angeles County Department of Public Health has expanded eligibility to the monkeypox vaccine to closely align with the Centers for Disease Control and Prevention’s recent expansion, which includes persons in select occupational groups whose jobs may expose them to orthopoxviruses (such as monkeypox).

Monkeypox vaccine will be available to residents who self-attest to being in the following groups:

  • Gay, bisexual or other men who have sex with men or transgender people who have sex with men or other transgender people
  • Persons of any gender or sexual orientation who engage in commercial and/or transactional sex
  • Persons living with HIV, especially persons with uncontrolled or advanced HIV disease
  • Persons who had skin-to-skin or intimate contact with someone with suspected or confirmed monkeypox, including those who have not yet been confirmed by Public Health
  • (NEW) Sexual partners of people in any of the above groups
  • (NEW) People who anticipate being in any of the above groups

Monkeypox vaccine is also available for persons in select occupational groups whose may be exposed to orthopoxviruses including:

  • Research laboratory personnel working with orthopoxviruses
  • Clinical laboratory personnel performing diagnostic testing for orthopoxviruses
  • Designated public health response team members
  • Health care personnel who administer ACAM2000 (Smallpox [Vaccinia] Vaccine)
  • Designated health care workers who care for persons with suspected or confirmed orthopoxvirus infections, including clinicians and environmental services personnel

Note that the risk of monkeypox transmission remains very low for health care workers if appropriate personal protective equipment is worn and other infection control practices are followed.

Eligible residents can go to a Public vaccinating site or visit Myturn.ca.gov to find other vaccinating sites near you.

Residents do not need to show ID in order to get a vaccine at sites run by Public Health. However, because residents may need to show vaccination record and ID if you travel or visit certain venues, it is recommended that when getting a vaccine that residents provide the name that is on their ID.

Residents who met prior eligibility criteria can still get vaccinated (see below for prior criteria).

Gay or bisexual men or transgender people who:

  • Had multiple or anonymous sex partners in the past 14 days
  • Had skin-to-skin or intimate contact with persons at venues or events in the past 14 days
  • Had a history of early syphilis or gonorrhea in the past 12 months
  • Are on HIV pre-exposure prophylaxis (PrEP)
  • Had anonymous sex or sex with multiple partners in the past 21 days in a commercial sex venue or other venue.

Residents who have monkeypox symptoms or are currently under isolation for monkeypox, should not come to the vaccination clinics or walk-up sites. If residents think they have monkeypox, they should speak with a provider and get tested. If residents do not have a provider, residents can call the Public Health Call Center for more information on monkeypox, including general information, testing, treatment, and vaccines at (833) 540-0473 (open 7 days a week 8am – 8:30pm).

For more information, please visit: http://publichealth.lacounty.gov/monkeypox/.   

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Monkeypox

Los Angeles County Supervisors approve sick leave for monkeypox

Both coronavirus and the monkeypox outbreak has disproportionately affected essential workers, who are predominantly Black and Latino

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The Los Angeles County Board of Supervisors meeting room (Photo Credit: County of Los Angeles)

LOS ANGELES – The Los Angeles County Board of Supervisors unanimously passed a motion Tuesday, sponsored by Supervisors Hilda Solis and Sheila Kuehl, which directs County attorneys to report back to the board in three weeks on how the County could implement a paid sick leave policy for people who contract monkeypox, or other new and emerging infectious diseases.

The Board also is urging California Governor Gavin Newsom to extend the state’s coronavirus supplemental paid sick leave by signing the AB-152 COVID-19 relief leave bill.

Supervisor Solis prior to the vote pointed out that both coronavirus pandemic and the monkeypox outbreak has disproportionately affected essential workers, who are predominantly Black and Latino.

Solis further noted that without a form of paid sick leave, are in most cases, unable to take the recommended five to 10 days to isolate for COVID-19 — much less the two to four weeks needed to isolate for the duration of a monkeypox diagnosis as recommended by the Centers for Disease Control and Prevention as well as the County Dept. of Public Health .

During a monkeypox townhall hosted by the Blade in East Los Angeles last week, which was also attended by Supervisor Solis, Sherrill Brown, M.D, AltaMed’s Medical Director of Infection Prevention, in her presentation noted the need for economic relief.

In her practice treating primarily Latino monkeypox cases at AltaMed clinics in Los Angeles and Orange Counties, she told the townhall attendees she was hearing some of her patients were having difficulty with the required isolation protocols because of their economic needs.

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Monkeypox

Unvaccinated 14 times more likely to contract monkeypox

Racial disparities persist in new cases of monkeypox as Black & Latino people are overrepresented in the numbers

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White House Monkeypox Response Team and Public Health Officials (Screenshot/YouTube)

WASHINGTON – U.S. health officials are celebrating preliminary data on the vaccine used in the monkeypox outbreak, which has led them to conclude eligible persons who didn’t get a shot were 14 times more likely to become infected than those who are vaccinated.

The new data, as described by health officials on the White House monkeypox task force during a call with reporters on Wednesday, comes as the overall number of new cases of monkeypox is in sharp decline, although considerable racial disparities persist in the remaining cases as Black and Latino people are overrepresented in the numbers.

Rochelle Walensky, director of the Centers for Disease Control & Prevention, said during the conference call the preliminary data — collected from 32 states between July 2022 and September 2022 — provides an early shapshot of the effectiveness of the vaccine and cause for optimism on the path forward.

“These new data provide us with a level of cautious optimism that the vaccine is working as intended,” Walkensky said. “These early findings and similar results from studies and other countries suggest even one dose of the monkeypox vaccine offers at least some initial protection against infection.”

Walensky during the conference call admitted the data is incomplete in numerous ways. For example, the data is based on information on individuals who have obtained only the first shot as opposed to both shots in the two-shot vaccination process. (The data showing positive results from individuals who have only one shot contradicts previous warnings from the same U.S. health officials that one shot of the monkeypox vaccine was insufficient.)

The data also makes no distinction between individuals who have obtained a shot through subcutaneous injection, a more traditional approach to vaccine administration, as opposed to intradermal injection, which is a newer approach adopted in the U.S. guidance amid the early vaccine shortage. Skeptics of the new approach have said data is limited to support the idea the intradermal injection is effective, particularly among immunocompromised people with HIV who have been at higher risk of contracting monkeypox.

Not enumerated as part of the data were underlying numbers leading health officials to conclude the unvaccinated were 14 times more likely to contract monkeypox as opposed to those with a shot, as well as any limiting principle on the definition of eligible persons. Also unclear from the data is whether individual practices in sexual behavior had any role in the results.

Despite the positive data on the monkeypox vaccine based on one shot, U.S. health officials warned during the conference call the two-shot approach to vaccine administration is consistent with their guidance and more effective.

Demetre Daskalakis, the Biden administration’s face of LGBTQ outreach for monkeypox and deputy coordinator for the White House monkeypox task force, made the case that for individuals at risk obtaining a second dose is “really important.”

“So we see some response after the first [shot] in the laboratory, but the really high responses that we want to really get — that you know, level 10 forcefield as opposed to the level five forcefield — doesn’t happen until the second dose,” Daskalakis said. “So the important message is this just tells us to keep on trucking forward because we need that second dose at arms that people haven’t gotten the first should start their series of two vaccines.”

Also during the call, health officials said they would be expanding opportunities for vaccines as pre exposure prophylaxis, as opposed to practices in certain regions granting vaccines in their limited supply to individuals who meet certain criteria or have had risk of exposure.

The Centers of Disease Control & Prevention, officials said, is also updating its guidance to allow injection of the vaccines in places other than a patient’s arm.

Daskalakis said fear of stigma about getting a noticeable shot in the forearm after obtaining a monkeypox vaccine was a key part of the decision to issue the new guidance on implementation.

“Many jurisdictions and advocates have told us that some people declined vaccine to monkeypox because of the stigma associated with the visible but temporary mark often left on their forearm,” Daskalakis said. “New guidance from CDC allows people who don’t want to risk a visible mark on their forearm to offer a vaccine on their skin by their shoulder or their upper back. Those are areas more frequently covered by clothes.”

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