EU health agency advises Member States to design monkeypox vaccines

The EU Infectious Diseases Agency will recommend that Member States prepare strategies for possible vaccination programs to address the increasing incidence of smallpox in monkeys, amid growing evidence of transmission from the community.

The European Center for Disease Prevention and Control (ECDC) said in response to questions Sunday that it would make the recommendation in a risk assessment to be published on Monday. Any vaccination move would use the existing smallpox vaccine as there is no approved smallpox vaccine and would mean immunizing close contacts of confirmed patients with monkeypox.

Smallpox immunity has been shown to offer some cross-protection against smallpox. The smallpox was declared extinct in 1980, but vaccine stocks were maintained to protect against a possible relapse.

The Stockholm-based ECDC said it was not an “easy decision” to recommend the smallpox vaccine to monkeypox at this stage and said a risk-benefit analysis should be performed for each infected person. The vaccine available in the EU, the Danish pharmaceutical company Bavarian Nordic’s Imvanex, is not approved for use against smallpox and there are no safety data for its use in immunosuppressed people or young children who are at higher risk of the disease. , the ECDC reported. .

The approach, known as post-exposure prophylaxis, is recommended because the disease spreads to people without known links to another confirmed case or affected area, in what is known as community transmission.

The arm and torso of a patient with monkeypox skin lesions. Incubation can take up to 21 days © Brian Mahy / CDC / Handout / Reuters

The vaccine is also available in the United Kingdom, where health authorities have recommended a similar strategy.

Scientists and health authorities are struggling to better understand the outbreak, the largest to date outside areas where it is endemic. As of Saturday, 92 laboratory-confirmed cases had been reported to the WHO from 12 countries where the virus does not circulate normally.

Israel, Austria and Switzerland said they had confirmed their first cases on Sunday.

Smallpox is a viral disease and most cases, though not all, have been reported in men who have sex with men. According to the ECDC, transmission between humans occurs mainly through large respiratory droplets. Because these droplets do not travel far, prolonged contact is required. The virus can also be transmitted through other body fluids. Health authorities are seeking to rule out aerosol transmission or the development of the virus into a more contagious strain.

The World Health Organization said at the weekend that the information available suggested that the transmission “occurs in people in close physical contact with cases that are accidental.” All laboratory-confirmed specimens to date have been confirmed to belong to the West African subfamily. No deaths have been reported so far.

The symptoms are similar to the flu and also include a rash, which often starts on the face and then spreads to other parts of the body. Incubation can take up to 21 days, complicating contact detection efforts.

“The situation is evolving and the WHO expects more cases of smallpox to be detected as surveillance extends to non-endemic countries,” added the Geneva-based health agency.

Shares of Bavarian Nordic, the maker of the smallpox vaccine, have risen about 55 percent since May 19, when the number of European cases began to rise. A European health official said “thousands” of doses of Imvanex were immediately available.

Bavarian Scandinavia did not immediately respond to a request for comment Sunday.

Meanwhile, US President Joe Biden said on Sunday that the outbreak “is something everyone should be concerned about”. Speaking from South Korea, where he was on an official visit, he said the United States was in the process of identifying a suitable vaccine to fight the virus.

Ashish Jha, the White House Coroner Coordinator, told ABC on Sunday that the United States had detected one case in Massachusetts and one in New York and was monitoring others. But he said it was “a virus we understand” and that there were vaccines and treatments to fight it.

Additional report by James Shotter in Jerusalem

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