On June 6, 2022, the U.S. Centers for Disease Control and Prevention (CDC) raised its monkeypox travel alert to Level 2, warning Americans to “Practice Enhanced Precautions.”1
The agency stated that monkeypox cases have been rising in at least 29 countries, with 1,019 infections reported to date. Currently, the United States has confirmed 31 cases of the viral infection in 13 states.2 The CDC has said that although the risk level of contracting monkeypox is low, it has raised the travel alert to Level 2 for Americans traveling to endemic and non-endemic countries.3
CDC’s guidance states that Americans should…
Avoid close contact with sick people, including those with skin lesions or genital lesions. Avoid contact with dead or live wild animals such as small mammals including rodents (rats, squirrels) and non-human primates (monkeys, apes). Avoid eating or preparing meat from wild game (bushmeat) or using products derived from wild animals from Africa (creams, lotions, powders). Avoid contact with contaminated materials used by sick people (such as clothing, bedding, or materials used in healthcare settings) or that came into contact with infected animals.4
Initially, CDC’s guidance included a recommendation addressing the airborne risks of contracting monkeypox, with officials stating, “Wear a mask. Wearing a mask can help protect you from many diseases, including monkeypox.”5 Later that day, the CDC withdrew that recommendation, saying it had done so because it “caused confusion.”6
The CDC’s website cites that transmission of monkeypox occurs between people primarily through direct contact with infectious sores, scabs, or body fluids; however, it can also spread via respiratory secretions during prolonged, face-to-face contact. CDC advises that monkeypox can spread during intimate contact between people, including during sex, as well as kissing, cuddling, or touching parts of the body with monkeypox sores.7
WHO Reports a Significant Number of Monkeypox Cases Have Been Transmitted Through Sexual Contact
The World Health Organization (WHO) has reported that the majority of the cases in the monkeypox outbreak have been identified at health clinics in communities of gay, bisexual and other men who have sex with men.8 The organization notes that the risk of monkeypox is not limited to men who have sex with men but to anyone who has close contact with someone who is infectious.9
The monkeypox outbreak coincides with a time where many cities are having Gay Pride celebrations. According to the Center for Infectious Disease Research and Policy (CIDRAP) at University of Minnesota, evidence from Spain, Portugal and the United Kingdom suggests that venues, where men have had sex with multiple male partners at parties in Ibiza, Lisbon, and Antwerp, have been identified as some of the sources of the current outbreak.10
In response to WHO’s updates on transmission via sexual contact, Demetre Daskalakis, MD, CDC’s director of the Division of HIV/AIDS Prevention, said, “I urge everyone to approach this outbreak without stigma and without discrimination.”11
In response to the monkeypox cases, the Biden administration has distributed 1,200 doses of the new Jynneos monkeypox vaccine manufactured by Bavarian Nordic and licensed by the U.S. Food and Drug Administration (FDA) in 2019. Doses of the ACAM2000 smallpox vaccine manufactured by Emergent Biosolutions, which has been stored in national stockpiles in case of a weaponized smallpox attack, have also been distributed.
Health officials say both vaccines protect against smallpox and monkeypox. Antivirals have also been made available across the country, as well, for those who are at high-risk exposure to the monkeypox virus.12
Adverse Affects of the ACAM2000 Smallpox Vaccine
The CDC recommends the Jynneos vaccine over ACAM2000 because it is considered to have a better safety record.
ACAM2000 is a live attenuated vaccinia virus vaccine similar to the original smallpox vaccine. The vaccinia virus in ACAM2000 can replicate and cause a smallpox-like infection (progressive vaccinia and eczema vaccinatum) that can spread to other people.13 The vaccinia virus is spread to other parts of the body from the skin lesion at the vaccination site and can infect other people when a person comes in contact with the fluids in the skin lesion. The vaccine strain vaccinia virus can spread until the vaccination scab falls off (two to four weeks after vaccination).14
ACAM2000 also can cause heart inflammation. The FDA website states:
ACAM2000 may cause serious heart problems called myocarditis and pericarditis, or swelling of the heart tissues. In studies, about 1 in every 175 persons who got the vaccine for the first time may have experienced myocarditis and/or pericarditis. On rare occasions these conditions can result in an irregular heartbeat and death.15
Jynneos Smallpox/Monkeypox Vaccine
The FDA approved the Jynneos vaccine on Sept. 24, 2019 for adults 18 years old and older who are at risk for smallpox or monkeypox infection. The vaccine is made from a vaccinia virus which is closely related but less harmful than the viruses that cause smallpox or monkeypox. It contains a modified form of the vaccinia virus called Modified Vaccinia Ankara, which does not cause disease in humans and cannot reproduce in human cells.16
The safety of Jynneos was determined in a study involving more than 7,800 people who received at least one dose of the vaccine. The most common side effects reported were pain, redness, swelling, itching, firmness at the injection site, muscle pain, headache and fatigue. The vaccine is given in two doses four weeks apart.17
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Click here to view References:
1 Kelleher SR. CDC Raises Monkeypox Travel Alert To Level 2. Forbes June 7, 2022.
2 Soucheray S. CDC raises travel alert level for monkeypox. Cidrap June. 7, 2022.
3 U.S. Centers for Disease Control and Prevention. Monkeypox in Multiple Countries. June 6, 2022.
5 Mandavilli A. Monkeypox Can Be Airborne, Too. NThe New York Times June 7, 2022.
7 CDC. Transmission. May. 29, 2022.
8 World Health Organization. Monkeypox: public health advice for gay, bisexual and other men who have sex with men. May. 25, 2022.
10 Center for Infectious Disease Research and Policy. Experts highlight sexual aspect of monkeypox spread. June 2, 2022.
12 Kimball S. The CDC is sending monkeypox vaccines to people at high risk in a race to prevent the spread. CNBC June 4, 2022.
14 U.S. Food and Drug Administration. Medication Guide Smallpox (Vaccinia) Vaccine, Live ACAM2000.
16 News Release. FDA approves first live, non-replicating vaccine to prevent smallpox and monkeypox. FDA Sept. 24, 2019.