Monkeypox tracker: New cases down 50%, data shows low hospital transmission rate

UPDATED: Monday, Sept. 19, at 4:14 p.m.

New cases of monkeypox are down 50% since early August, the Center for Disease Control and Prevention announced in a press briefing.

The nation's seven-day average for new cases peaked on Aug. 10, with 461 cases, and on Sept. 14 was 170, according to federal health officials. Credit for the decrease was given to education and vaccination efforts.

"We approach this news with cautious optimism," said Rochelle Walensky, M.D., director of the CDC, at a Sept. 15 press briefing. "We continue to closely monitor data on this outbreak, those at risk, and how prevention measures are being used."

Walensky stated that while overall growth was down, geographical pockets of the U.S. still showed an increase in cases. Over 23,000 cases of the virus have been confirmed in the U.S. as of Sept. 16.

Due to the virus's fast mutation rate, the CDC has advised that Siga's antiviral Tpoxx only be used in severe cases due to the drug's "low barrier to viral resistance."

The agency announced that it is accepting applications for its Monkeypox Vaccine Equity Pilot Program. Organizations able to support the center’s efforts to increase immunizations within Black and Latino populations are encouraged to apply.

The center also released a report out of Colorado showing that healthcare workers' chances of contracting the virus are low.

Three hundred and thirteen Colorado medical professionals were exposed to patients with monkeypox with low use of the CDC-recommended PPE and postexposure prophylaxis vaccination. A reported 23% of exposed health care professionals wore all recommended PPE.

All exposed were monitored for 21 days with none showing symptoms to indicate they contracted the virus. The CDC is still suggesting the continued use of PPE and education regarding the virus until more comprehensive studies are performed.

UPDATED: Tuesday, Aug. 30, at 1:43 p.m.

Texas reports first U.S. death tied to the virus

Texas health officials on Tuesday reported the death of a patient diagnosed with monkeypox— what appears to be the nation’s first-known fatality from the virus.

The patient was an adult resident of Harris County who was "severely immunocompromised," the state's Department of State Health Services said in a press release.

The case is under investigation to determine what role monkeypox played in the death, the agency said.

It is the first death of someone diagnosed with the virus in Texas, according to the state's health officials.

“Monkeypox is a serious disease, particularly for those with weakened immune systems,” said Dr. John Hellerstedt, DSHS Commissioner, in the press release. “We continue to urge people to seek treatment if they have been exposed to monkeypox or have symptoms consistent with the disease.”

For most people, infection with monkeypox is painful but not life threatening, the health agency said.

Monkeypox is a preventable disease that spreads through close contact with an infected person. 

Eight countries have reported 15 deaths from monkeypox since the global outbreak began this year, according to the Centers for Disease Control and Prevention, CNBC reported.

More than 18,000 cases have been reported across the country, with infections now confirmed in every state as well as Puerto Rico and Washington, D.C., according to the latest CDC data. The CDC is still reporting zero deaths in the U.S. from monkeypox.

UPDATED: Monday, Aug. 29, at 12:08 p.m.

HHS devotes $11M to domestic moneypox vaccine manufacturing

Health and Human Services is doling out $11 million to support the first U.S.-based manufacturing of the JYNNEOS smallpox and monkeypox vaccine.

HHS announced the agreement Monday to ensure that Grand River Aseptic Manufacturing (GRAM) in Grand Rapids, Mich., has the equipment necessary to make the vaccine as well as train additional staff. 

“This new agreement solidifies a domestic manufacturing capability that will bring us more vaccine sooner to end this outbreak,” said HHS Secretary Xavier Becerra in a statement. 

Thanks to the support, vaccine production can be underway earlier this year instead of the nine-month estimate typical for this type of work, HHS said in a release. 

Last month, the Biden administration placed orders for 5 million vials of JYNNEOS from a bulk storage facility in Denmark.

“These efforts enhance the U.S response to public health emergencies; the COVID-19 pandemic demonstrated the need to expand the U.S. industrial base for vaccine production,” the agency said.

UPDATED: Tuesday, Aug. 23, at 10:15 a.m.

Monkeypox hits all 50 states; fractional dose strategy runs into hiccups

The monkeypox pandemic reached a new milestone Monday with at least one confirmed case reported across all 50 states, according to public health data

Wyoming was the country's holdout until state officials announced a case in an adult male living in Laramie County. 

Since the U.S.' first cast in May, the Centers for Disease Control and Prevention reports more than 15,400 confirmed cases throughout the nation. More than 40,000 cases of the current outbreak have been reported worldwide.

Monkeypox was declared a public health emergency in the U.S. at the beginning of the month.

In recent weeks, the government adopted an alternative strategy that splits each vaccine dose by a fifth in order to make the most of its limited supply of vaccines. However, state officials recently told STAT that they have struggled to extract all five doses from the supplied vials, with issues ranging from fragile caps and foils to difficulties with subcutaneous administration.

UPDATED: Thursday, Aug. 18, at 1:29 p.m.

HHS to dole out antiviral monkeypox treatments as cases surge past 13K

The Biden administration announced it will be rolling out 50,000 antiviral courses to help treat monkeypox, aiming to prioritize high-risk areas. 

Administration officials also told reporters during a briefing Thursday that it is working to expand access to vaccines after approving stretching doses of the JYNNEOS vaccine. 

“The collaborative outbreak of vaccines will continue,” said Bob Fenton, the White House’s monkeypox coordinator. “We will now surge and target vaccines when and where that can be most effective.”

As of Wednesday there have been more than 13,000 cases of monkeypox in the U.S., with 98% of the cases occurring around men. 

The administration approved the use of the dose splitting to get five doses of the JYNNEOS vaccine out of one vial, hoping to stretch out reduced supplies. It will make 360,000 vials — 1.8 million more doses — available in the coming days. 

The White House is accelerating the delivery of 150,000 vials that was initially coming in the fall, added Dawn O’Connor, assistant secretary for preparedness and response, on the call. 

UPDATED: Tuesday, Aug. 16, at 10:30 a.m.

Amidst criticism, HHS accelerates monkeypox vaccine delivery with 442,000 new doses

The U.S. Department for Health and Human Services (HHS) announced that as many as 442,000 doses of the Jynneos for monkeypox is being made available to states and jurisdictions weeks earlier than originally scheduled. 

The administration had initially planned to release vaccine doses in three segments timed for July 29, Aug. 15 and sometime later in August. This week's release doubles the amount of doses that were originally anticipated, leapfrogging the batch scheduled for later in the month and allowing the government to move ahead to the next phase of its vaccination strategy, HHS said.

Additionally, thanks to emergency declarations made last week, states and jurisdictions will be able to stretch out their vaccine supply so that each single vial can provide a full dose to five people. 

“We are pleased to make these additional doses available to states and jurisdictions faster than originally anticipated,” HHS Assistant Secretary for Preparedness and Response Dawn O’Connell said in the announcement. “We continue to pursue all options that allow us to increase the number of vaccine doses available, expedite their delivery to places that need them, and strengthen the vaccine supply chain.”

The update comes as reports swirl on frustrations among states and staff members regarding the federal government's monkeypox response. 

At least 20 states and jurisdictions have complained have complained of issues surrounding the rollout and delivery of the Jynneos vaccine, such as difficulties submitting orders from the National Strategic Stockpile or shipments arriving late or in the incorrect locations, according to the New York Times.  

Some of the blame has landed at the feet of HHS Secretary Xavier Becerra who previously deflected criticism to states. Politico reports that, although he is unlikely to be fired, Becerra may look to step away from his position at the end of the year in favor of a run for the Senate in 2024. 

UPDATED: Thursday, Aug. 11, at 1:10 p.m.

Lawmaker calls for emergency approval of monkeypox antiviral

The federal government needs to quickly approve a new antiviral treatment for patients diagnosed with monkeypox, a key U.S. House member said. 

Rep. Carolyn Maloney, D-N.Y., wrote a letter to Health and Human Services Secretary Xavier Becerra on Wednesday pressing for expanded access to TPOXX, an antiviral medication that can treat monkeypox. 

“In other countries experiencing monkeypox outbreaks, TPOXX has been authorized or approved to treat patients infected with the virus,” wrote Maloney, head of the House Oversight Committee. 

She noted that the drug has already been approved for emergency use by the European Medicines Agency back in January for use across European Union countries. 

The Centers for Disease Control and Prevention (CDC) and the FDA worked to streamline the expanded access protocols for TPOXX, but providers have told Maloney that isn’t enough to ensure widespread use. 

Some physicians are also calling for the medication to be more available, like at local pharmacies. Maloney also asks HHS to evaluate the expanded access protocols.

New York is one of the states hit hardest by the outbreak, which has led to more than 10,000 cases nationwide as of Wednesday, according to CDC data.

UPDATED: Tuesday, Aug. 9, at 10:21 a.m.

Biden administraion paves way for dose stretching

The Biden administration is paving the way for an alternative vaccination strategy that will stretch out the nation's limited supply of monkeypox vaccine, the New York Times and others reported late Monday.

Officials had previously said they were investigating an approach where one-fifth of a standard vaccine dose would be injected into the skin rather than underlying fat as normal.

New reports say that Health and Human Services and the Food and Drug Administration could issue emergency declarations and authorizations to permit such an approach as soon as Tuesday afternoon. 

The federal government has so far distributed about 600,000 doses of the roughly 1.1 million they have on hand—roughly a third of what's needed, according to the reports.

Smaller doses would allow the government to vaccinate more people, although peer-reviewed data supporting the new approach is limited. Federal officials weighed the available research alongside consultations with outside groups including the Infectious Diseases Society of America, the Times reported.

UPDATED: Friday, Aug. 5, at 1:41 p.m.

ANA presses for more help for nurses amid monkeypox outbreak

The American Nurses Association (ANA) applauded Health and Human Services’ emergency declaration for monkeypox, saying the outbreak could become another major stressor on the nursing workforce.

“Heeding the many lessons learned from COVID-19, ANA calls for swift action and effective collaboration among federal, state and local officials to ensure nurses and all healthcare professionals have the highest level of protection and preparation to respond,” the group said in a statement Friday. 

The public health emergency can ensure more funding for providers to get access for tests and vaccines.
ANA said that nurses have faced constant pressure during the COVID-19 pandemic, which has led to a staffing crisis and a negative impact on their well-being. 

“A widespread outbreak of monkeypox will be yet another stressor on many nurses who say they continue to feel the strain of COVID-19 on their mental health and within their work environments,” the group said.

UPDATED: Tuesday, Aug. 2, at 10:57 a.m.

White House names monkeypox response coordinator

The White House has named Robert Fenton to serve as the response coordinator for the monkeypox outbreak, as calls for a larger federal role intensify. 

Fenton previously helped to coordinate COVID-19 vaccine distribution while working at the Federal Emergency Management Agency. He will work alongside Demetre Daskalakis, M.D., who will be the deputy coordinator. 

The coordinators will lead the administration’s efforts on “strategy and operations to combat the current monkeypox outbreak, including equitably increasing the availability of tests, vaccinations and treatments." 

The appointment comes as several groups and lawmakers have called for a more robust federal response to the outbreak of more than 5,000 cases in the U.S. Rep. Carolyn Maloney, D-N.Y., demanded that Health and Human Services announce a public health emergency on the outbreak, as several states such as New York and California have initiated their own emergencies.

UPDATED: Thursday, July 28, at 3:20 p.m.

HHS to distribute 786K in monkeypox vaccines but won't declare public health emergency

The Department of Health and Human Services (HHS) announced it is distributing another 786,000 doses of monkeypox vaccine as cases continue to spread in the U.S.

The agency said July 28 that the additional vaccines to be sent out to states and localities will build on the 338,000 doses already delivered. HHS Secretary Xavier Becerra, though, shied away from declaring a public health emergency on the outbreak. 

“While this has been a tremendous boost of vaccine availability, we know that more needs to be done,” said Dawn O’Connell, assistant secretary for preparedness and response for HHS, during a call with reporters Thursday.

The announcement of the supplemental doses of the Jynneos vaccine comes roughly a day after the Food and Drug Administration cleared the smallpox vaccine to also prevent monkeypox. There was also an expedited FDA inspection of the manufacturer Bavarian Nordic to help clear the way for the available doses. 

However, even as cases continue to climb, Becerra demurred on whether to grant a monkeypox PHE. He told reporters Thursday that the agency is continuing to monitor the response to the outbreak. 

“We have made vaccines, tests and treatments well beyond the numbers that are currently needed,” Becerra said. “We need to stay ahead of this and be able to end this outbreak.”

He added the goal is to distribute vaccines to areas in the country where monkeypox spread is most prevalent. 

Updated: Monday, July 25, 3:15 p.m.

WHO deems monkeypox global emergency; U.S. weighs declaring its own public health declaration

The World Health Organization (WHO) designated the ongoing multi-country monkeypox outbreak a public health emergency of international concern (PHEIC), sparking renewed pledges from U.S. public health leaders to ramp up vaccination and other response measures.

A PHEIC is the highest level alert at WHO’s disposal. The designation does not come with any specific mandates for WHO member countries, but the global organization does issue temporary recommendations and encourage collaborative efforts between member states.

WHO’s committee was divided in both meetings on whether the outbreak warranted the top alert. Dissenters this past week pointed to the disease’s low severity, no signs of exponential case increases in the hardest-hit countries and the potential risk of a PHEIC designation increasing stigma against LGBTI+ communities that would subsequently hamper response efforts.  

Unlike at last month’s divided meeting, WHO Director-General Tedros Ghebreyesus decided the time was right to declare monkeypox a PHEIC.

"For the moment, this monkeypox outbreak is concentrated among men who have sex with men, especially those with multiple sexual partners. That means that this is an outbreak that can be stopped with the right strategies in the right groups,” Ghebreyesus said in a Twitter post announcing the decision and linking to WHO’s recommendations.

Updated: Thursday, July 7, 12:23 p.m.

'Potentially' infectious monkeypox viral loads detected on high-touch hospital room surfaces, study finds

Researchers have found monkeypox virus lingering throughout the surfaces in patients’ hospital rooms, bathrooms and, to a lesser degree, adjoining rooms used by medical staff, underscoring the need for facilities treating these patients to maintain infection control and sanitation protocol.

The findings, published recently in the European infectious disease journal Eurosurveillance, come from two patients receiving care for monkeypox in a German hospital’s isolation rooms during late June.

Researchers who swabbed the rooms for environmental samples found varying degrees of contamination across each surface.

Monkeypox viral loads were highest in the patients’ bathrooms, particularly on high-touch surfaces such as toilet seats or the control levers of their sink or soap dispenser.

Door handles, chair surfaces and fabrics within the patients’ rooms were heavily contaminated as well, with some degree of viral DNA found “on all other investigated surfaces in the patients’ rooms, although it was not known at the time of testing whether and to what extent the patients had also touched these surfaces,” researchers wrote.

The researchers also detected “traces” of monkeypox viral DNA on all hand-contact points in an anteroom used by staff to don and doff personal protective equipment (PPE). They also found a small quantity of viral DNA on the handle of the door leading into the anteroom from the ward corridor.

Human transmission of monkeypox virus has primarily been attributed to direct person-to-person contact, the researchers wrote, although some cases of transmission within a healthcare setting have been reported when healthcare workers did not have adequate PPE.

While the jury is still out on just how much monkeypox virus is required to trigger an infection in humans, nonhuman primate findings suggest the quantity detected on some of these surfaces “could potentially be infectious and it cannot be ruled out that [the contaminated surfaces’] contact with especially damaged skin or mucous membranes could result in transmission.”