
<h2 class="wp-block-heading" id="h-topline">TOPLINE</h2>



<p>Monkeypox mainly spreads among women and nonbinary people through sexual contact, but some infections could be flying under the radar as they are often misdiagnosed as other diseases known to be sexually transmitted, according to a study published Thursday in the <em>Lancet</em> medical journal, important findings that provide much needed insight into how the disease affects nonbinary people and cisgender and transgender women.</p>



<h2 class="wp-block-heading">KEY FACTS</h2>



<p>The study, the first to focus on monkeypox transmission among cisgender and transgender women and nonbinary people assigned female at birth, found that sexual contact was likely responsible for 73% of monkeypox infections in this group.</p>



<p>There were key differences between cis women and nonbinary people and trans women, the researchers said, with almost all monkeypox infections among trans women thought to have been acquired through sexual contact.</p>



<p>In contrast, around 24% of cis women and nonbinary people were thought to have acquired monkeypox outside of sexual contact, the researchers said, including household exposure and occupational exposure in healthcare workers.</p>



<p>The figures—based on data from 136 women (69 cis, 62 trans) and five nonbinary people with confirmed cases between 11 May and 4 October across 15 countries—compare to rates of almost 100% transmission through sexual contact reported among men.</p>



<p>As with many cases during the global outbreak, researchers said symptoms tended to match likely routes of transmission—anal and genital lesions have been characteristic— and were frequently misdiagnosed as sexually transmitted infections, particularly among cis women.</p>



<p>Some 33% of cis women received a misdiagnosis before a monkeypox diagnosis was confirmed and nearly half experienced delays and needed more than one appointment to get a diagnosis.</p>



<h2 class="wp-block-heading">NEWS PEG</h2>



<p>Monkeypox has caused limited and sporadic outbreaks in parts of Africa for decades, though it was largely ignored by the rest of the world until it started spreading more widely this year. The global outbreak differed in scope, scale, geographic range, speed and demography of previous outbreaks, which were usually relatively confined, unsustainable and stemmed from the virus spilling over from unknown animal reservoirs (likely rodents). Data from the outbreak suggests the virus is<a href="https://www.nbcnews.com/nbc-out/out-health-and-wellness/sex-men-not-skin-contact-fueling-monkeypox-new-research-suggests-rcna43484" target="_blank" rel="noreferrer noopener">&nbsp;almost exclusively spreading</a>&nbsp;through sex among gay, bisexual and other men who have sex with men, and it was accompanied by a&nbsp;<a href="https://www.forbes.com/sites/roberthart/2022/07/29/monkeypox-symptoms-are-different-from-previous-outbreaks-doctors-warn/?sh=7b657c48617c">different</a>&nbsp;set of&nbsp;<a href="https://www.forbes.com/sites/roberthart/2022/07/01/monkeypox-symptoms-look-different-in-recent-cases-than-previous-outbreaks-doctors-warn/?sh=13f577117585">symptoms</a>&nbsp;than what was seen in previous outbreaks. Options for treating and vaccinating against monkeypox are limited—few exist and most were developed for use against smallpox, a related disease that has been eradicated—and supplies are critically short, as countries where monkeypox has historically spread have predictably been last in line while wealthy countries buy up stock. The outbreak&nbsp;<a href="https://abcnews.go.com/Health/monkeypox-outbreak-us-showing-signs-slowing-data-shows/story?id=90573146" target="_blank" rel="noreferrer noopener">appears</a>&nbsp;to be slowing, possibly more due to behavioral changes in at-risk groups than vaccination efforts.</p>



<h2 class="wp-block-heading">WHAT TO WATCH FOR</h2>



<p>Though women account for a very small fraction of monkeypox infections reported during the current global outbreak, the researchers in Thursday’s&nbsp;<em>Lancet&nbsp;</em>study said they “anticipate that this might change as the outbreak evolves.” The study’s findings, particularly the higher rates of misdiagnosis and multiple appointments before confirmation of diagnosis in cis women and nonbinary people compared with trans women, highlight the need to improve training about and awareness of monkeypox among health professionals beyond sexual health clinics.</p>



<p>Tangent</p>



<p>The prospect of monkeypox spreading to and among children was a significant concern during the global outbreak, particularly as this group has a higher risk of severe disease. While many experts believed monkeypox&nbsp;<a href="https://www.nytimes.com/2022/08/17/well/monkeypox-kids-school-day-care.html" target="_blank" rel="noreferrer noopener">posed</a>&nbsp;little&nbsp;<a href="https://edition.cnn.com/2022/08/25/health/monkeypox-children-schools/index.html" target="_blank" rel="noreferrer noopener">risk</a>&nbsp;to children, fears that the virus would establish itself in populations like children loomed large. These fears have not come to pass and though a small number of children have contracted monkeypox, they make up a miniscule fraction of the total number of cases around the world. The researchers said their study also suggests a limited risk to children. Only two children living in the homes of the cis women involved in the study acquired monkeypox, though 26% had children living in their homes, the researchers said, suggesting “very limited chains of transmission” in line with previous research. Pregnant people also face higher risks of severe disease from monkeypox, though the researchers said their study could not shed light on the issue as it included just two pregnant people who had not yet delivered.</p>



<h2 class="wp-block-heading">BIG NUMBER</h2>



<p>80,064. That’s how many cases of monkeypox have been recorded in more than 100 locations around the world this year so far,&nbsp;<a href="https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html" target="_blank" rel="noreferrer noopener">according</a>&nbsp;to CDC data. Fewer than 1,000 of these infections have been recorded in locations that have historically reported monkeypox, though cases are likely to go&nbsp;<a href="https://www.reuters.com/business/healthcare-pharmaceuticals/africas-monkeypox-outbreak-sickness-death-go-undetected-2022-10-31/" target="_blank" rel="noreferrer noopener">undocumented</a>&nbsp;in some of these areas. Some 51 deaths linked to monkeypox have been reported so far, 13 of which were in locations that historically reported outbreaks.</p>



<h2 class="wp-block-heading">SURPRISING FACT</h2>



<p>Before the global outbreak, monkeypox was not thought to be a disease that transmitted sexually. Transmission almost exclusively in networks of men who have sex with men highlighted the possibility, though there is a difference between something being passed on through the close contact that accompanies sex and something that can only be acquired in a sexual setting, for example through semen or vaginal fluid. Increasingly, evidence is emerging that monkeypox may possibly fit both categories. The virus has previously been found in the semen of men with monkeypox. The researchers of this study tested vaginal swabs for the virus as well, finding monkeypox DNA in all 14 swabs taken. This strengthens the idea that monkeypox can transmit through bodily fluids as well as close skin-to-skin contact.</p>



<h2 class="wp-block-heading">CRUCIAL QUOTE</h2>



<p>Lead study author Chloe Orkin, a professor of HIV medicine at Queen Mary University of London, said case definitions “have rightly focused on the most affected groups, sexually active men who have sex with men,” during the global outbreak, adding that public health efforts have been tailored to reach this group. “However, as the outbreak progresses, it’s important to also focus attention on underrepresented groups such as women and nonbinary individuals to better understand their risk,” as well as to understand how the “infection manifests in women” so doctors can recognize it.</p>



<h2 class="wp-block-heading">FURTHER READING</h2>



<p><a href="https://www.forbes.com/sites/roberthart/2022/11/03/scientists-warn-dangerous-monkeypox-variant-circulating-in-central-africa-could-fuel-new-outbreaks/?sh=37626c5360c6">Scientists Warn Dangerous Monkeypox Variant Circulating In Central Africa Could Fuel New Outbreaks</a>&nbsp;(Forbes)</p>



<p><a href="https://www.npr.org/sections/health-shots/2022/10/17/1129234501/monkeypox-cases-in-the-u-s-are-way-down-can-the-virus-be-eliminated" target="_blank" rel="noreferrer noopener">Monkeypox cases in the U.S. are way down — can the virus be eliminated?</a> (NPR)</p>



<p><strong><em>By Robert Hart, Forbes Staff</em></strong></p>


London Ramps Up Monkeypox Vaccine Rollout As Cases Continue To Rise

Monkeypox In Women Frequently Misdiagnosed As Sexually Transmitted Infections, Study Finds


<h2 class="wp-block-heading" id="h-topline">TOPLINE</h2>



<p>People vaccinated against monkeypox were 14 times less likely than those who were not vaccinated to contract the disease, Centers for Disease Control and Prevention Director Rochelle Walensky said <a href="https://www.youtube.com/watch?v=194KdQ5Ns58" target="_blank" rel="noreferrer noopener">Wednesday</a>, offering the first data on the real-world effectiveness of the Jynneos vaccine since the U.S. began rolling out the shot.</p>



<h2 class="wp-block-heading">KEY FACTS</h2>



<p>Walensky said during a press briefing that she has a “level of cautious optimism,” about the preliminary data, which was collected between July to September 2022 from patients who had received one dose of the Jynneos vaccine across 32 states.</p>



<p>The results suggest that even one vaccine dose offers at least some protection against infection as early as two weeks after getting the shot, though Walensky stressed that two shots are still recommended.</p>



<p>The CDC director added that preventative behavior changes—such as avoiding close skin-to-skin contact with someone who has monkeypox—can also help drive down infections, especially as the government continues to collect data on the durability of the vaccine.</p>



<p>The White House will allow people to get vaccinated in other parts of the body besides the forearm, including their shoulder or upper back, after jurisdictions and advocates have reported to the government that some are declining to get the shot to avoid stigma from having a visible mark from the vaccine on their arm, said Demetre Daskalakis, the deputy White House monkeypox coordinator.</p>



<p>The news comes as the number of monkeypox cases around the world and in the U.S. continues to fall.</p>



<h2 class="wp-block-heading">BIG NUMBER</h2>



<p>More than 800,000. That’s how many monkeypox vaccine shots have been administered so far, White House monkeypox coordinator Robert Fenton said Wednesday.</p>



<h2 class="wp-block-heading">SURPRISING FACT</h2>



<p>The U.S. has reported 25,341 cases across all states since the outbreak began in May,&nbsp;<a href="https://www.cdc.gov/poxvirus/monkeypox/response/2022/us-map.html" target="_blank" rel="noreferrer noopener">according</a>&nbsp;to the CDC. New infections began to fall toward the end of August when more more vaccines become available and after the most at-risk population, men who have sex with men, took a host of actions to prevent the spread of the disease, officials have said in the past. According to a recent study shared by the&nbsp;<a href="https://www.cdc.gov/poxvirus/monkeypox/response/2022/amis-select-behaviors.html" target="_blank" rel="noreferrer noopener">CDC</a>, about 50% of gay, bisexual and other men who have sex with men reported taking steps to protect themselves and their partners from monkeypox.</p>



<h2 class="wp-block-heading">KEY BACKGROUND</h2>



<p>The White House declared monkeypox a public health emergency in August to streamline resources and boost vaccine supply after cases began to surge. The U.S. is reliant on a small Danish biotechnology company, Bavarian Nordic, for the Jynneos two-dose regimen vaccine, the only shot approved by the Food and Drug Administration for monkeypox. Data on the effectiveness of monkeypox vaccines in the real world has been extremely limited, as the Jynneos shot was originally designed to prevent smallpox, a related disease. It’s also because previous cases around the world were rare, though the disease is endemic to certain regions of Africa, where it has been largely ignored by the international community. Studies conducted by Bavarian Nordic and data from Africa have shown Jynneos works against monkeypox,&nbsp;<a href="https://www.cdc.gov/poxvirus/monkeypox/clinicians/smallpox-vaccine.html" target="_blank" rel="noreferrer noopener">according</a>&nbsp;to the CDC.</p>



<h2 class="wp-block-heading">TANGENT</h2>



<p>Facing a shortage of vaccines and a backlash over a slow shot rollout, the federal government last month approved a new vaccination strategy known as “dose-sparing” to stretch the number of shots. The new method allows health care workers to extract up to five doses from a one-dose Jynneos vaccine vial to inject intradermally, or into the skin, instead of subcutaneously, or underneath the skin into the fat. The National Institutes of Health&nbsp;<a href="https://www.forbes.com/sites/madelinehalpert/2022/08/22/nih-will-study-new-dose-sparing-monkeypox-vaccination-method/?sh=3a73cda71924">began</a>&nbsp;a clinical trial earlier this month to evaluate the effectiveness of this new method.</p>



<h2 class="wp-block-heading">FURTHER READING</h2>



<p><a href="https://www.forbes.com/sites/madelinehalpert/2022/08/22/nih-will-study-new-dose-sparing-monkeypox-vaccination-method/?sh=3a73cda71924">NIH Will Study New ‘Dose Sparing’ Monkeypox Vaccination Method</a>&nbsp;(Forbes)</p>



<p><a href="https://www.forbes.com/sites/madelinehalpert/2022/08/09/fda-will-reportedly-change-dose-of-monkeypox-vaccine-to-stretch-supplies/?sh=629116173564">Biden Administration Authorizes New Monkeypox Vaccine Dose Strategy To Stretch Supplies</a>&nbsp;(Forbes)</p>



<p><a href="https://www.politico.com/news/2022/09/06/the-biden-administration-is-gambling-that-a-little-studied-vaccine-can-stop-monkeypox-00054742" target="_blank" rel="noreferrer noopener">The Biden administration is gambling that a little-studied vaccine can stop monkeypox</a> (Politico)</p>



<p><strong><em>By Madeline Halpert, Forbes Staff</em></strong></p>


Monkeypox Photo Illustrations

Monkeypox: Unvaccinated 14 Times More Likely To Contract Disease Than Those Without Shot, CDC Says


<h2 class="wp-block-heading" id="h-topline">TOPLINE</h2>



<p>The global outbreak of monkeypox and linked vaccination campaign could lead to a spate of neurological issues like nerve pain, seizures, brain inflammation and mood disorders like anxiety and depression, a group of scientists warned in a&nbsp;<a href="https://jamanetwork.com/journals/jamaneurology/fullarticle/10.1001/jamaneurol.2022.3491?guestAccessKey=c6ffb068-45c9-4d53-b8b5-9c8874feff29&amp;utm_source=For_The_Media&amp;utm_medium=referral&amp;utm_campaign=ftm_links&amp;utm_content=tfl&amp;utm_term=092022" target="_blank" rel="noreferrer noopener">review</a>&nbsp;of research published Tuesday in&nbsp;<em>JAMA Neurology</em>, urging further research into the poorly understood disease as the number of new cases in the U.S. falls.</p>



<h2 class="wp-block-heading">KEY FACTS</h2>



<p>Issues like nerve pain, seizures, encephalitis—brain inflammation—and mood disturbances, including anxiety and depression, are well-documented complications of infections with viruses like smallpox that are closely related to monkeypox, researchers said in the peer reviewed paper.</p>



<p>While few major neurological issues have been reported during the global monkeypox outbreak, the researchers warned that similar “complications are to be expected” in monkeypox patients and urged clinicians to be vigilant.</p>



<p>Those with compromised immune systems, such as some people living with HIV or AIDS, are particularly at risk as the monkeypox virus may be able to persist in the body for longer or more able to invade the nervous system, the researchers said.</p>



<p>Given the large number of people now receiving monkeypox vaccines to curb the outbreak, clinicians should also be on the lookout for neurological complications from the shots, the researchers added.</p>



<p>Older vaccines used against smallpox, which could also be used against monkeypox, utilize another related virus,&nbsp;<a href="https://www.theatlantic.com/science/archive/2022/08/mystery-inside-monkeypox-vaccines/671256/" target="_blank" rel="noreferrer noopener">vaccinia</a>, to provoke immunity and are associated with a suite of well-documented, potentially serious side effects.</p>



<p>Though newer and safer than previous vaccines—as well as using an inactivated, rather than live, virus—the researchers said clinicians should remain vigilant of any adverse reactions to the Jynneos vaccine being used in monkeypox campaigns.</p>



<h2 class="wp-block-heading">KEY BACKGROUND</h2>



<p>Though scientists have known about monkeypox for decades, the disease has largely been ignored by the world and caused limited, sporadic outbreaks in parts of Africa. Past outbreaks suggested the virus&nbsp;<a href="https://www.gov.uk/guidance/monkeypox" target="_blank" rel="noreferrer noopener">does not transmit easily</a>&nbsp;between people but experts have long&nbsp;<a href="https://www.telegraph.co.uk/news/2022/05/22/british-scientists-warned-monkeypox-would-fill-void-left-smallpox/" target="_blank" rel="noreferrer noopener">feared</a>&nbsp;it had the potential to one day&nbsp;<a href="https://www.statnews.com/2022/05/26/warning-signs-ahead-of-monkeypox-outbreak-went-unheeded-experts-say/" target="_blank" rel="noreferrer noopener">spread</a>&nbsp;and fill the void left behind after smallpox was eradicated. It appeared nearly simultaneously in several countries where it does not normally spread earlier this year and cases were not linked to travel in affected regions. The discovery suggested monkeypox had been spreading&nbsp;<a href="https://edition.cnn.com/2022/06/02/health/monkeypox-endemic-silent-spread/index.html" target="_blank" rel="noreferrer noopener">undetected</a>&nbsp;for some time, probably years, and the scope, scale, geographic range, speed and demography of the outbreak set it apart from previous flare ups, which have usually been relatively confined and burned themselves out. Growing data from the outbreak, which has predominantly affected men who have sex with men, indicates the virus is<a href="https://www.nbcnews.com/nbc-out/out-health-and-wellness/sex-men-not-skin-contact-fueling-monkeypox-new-research-suggests-rcna43484" target="_blank" rel="noreferrer noopener">&nbsp;almost exclusively spreading</a>&nbsp;through sex between men and has a&nbsp;<a href="https://www.forbes.com/sites/roberthart/2022/07/29/monkeypox-symptoms-are-different-from-previous-outbreaks-doctors-warn/?sh=7b657c48617c">different</a>&nbsp;set of&nbsp;<a href="https://www.forbes.com/sites/roberthart/2022/07/01/monkeypox-symptoms-look-different-in-recent-cases-than-previous-outbreaks-doctors-warn/?sh=13f577117585">symptoms</a>&nbsp;than in previous outbreaks.</p>



<h2 class="wp-block-heading">BIG NUMBER</h2>



<p>62,406. That’s how many confirmed cases of monkeypox there have been around the world this year as of September 14,&nbsp;<a href="https://www.cdc.gov/poxvirus/monkeypox/response/2022/index.html" target="_blank" rel="noreferrer noopener">according</a>&nbsp;to the CDC. More than a third of these, nearly 24,000, have been recorded in the U.S., which has the most confirmed cases by far. Monkeypox cases in the U.S. and Europe have been&nbsp;<a href="https://www.forbes.com/sites/madelinehalpert/2022/09/08/monkeypox-may-cause-neurological-issues-study-suggests-though-new-us-cases-declining/?sh=27fc561d7d55">trending</a>&nbsp;<a href="https://www.forbes.com/sites/roberthart/2022/08/30/monkeypox-cases-in-europe-may-have-peaked-world-health-organization-says/?sh=22ab23e43bae">down</a>&nbsp;in recent weeks, though it is&nbsp;<a href="https://www.wired.com/story/monkeypox-cases-falling-united-states/" target="_blank" rel="noreferrer noopener">unclear</a>&nbsp;whether the drop is due to vaccination or changing behaviors in response to the outbreak.</p>



<h2 class="wp-block-heading">FURTHER READING</h2>



<p><a href="https://www.forbes.com/sites/madelinehalpert/2022/09/08/monkeypox-may-cause-neurological-issues-study-suggests-though-new-us-cases-declining/?sh=27fc561d7d55">Monkeypox May Cause Neurological Issues, Study Suggests—Though New U.S. Cases Declining</a>&nbsp;(Forbes)</p>



<p><a href="https://www.nature.com/articles/d41586-022-02931-1" target="_blank" rel="noreferrer noopener">How deadly is monkeypox? What scientists know</a>&nbsp;(Nature)</p>



<p><a href="https://www.nytimes.com/2022/09/20/us/politics/covid-data-outbreaks.html" target="_blank" rel="noreferrer noopener">‘Very Harmful’ Lack of Data Blunts U.S. Response to Outbreaks</a>&nbsp;(NYT)</p>



<p><a href="https://www.forbes.com/sites/roberthart/2022/08/25/monkeypox-misinformation-is-spreading-experts-warn-heres-what-you-need-to-know-about-the-disease/?sh=7daad70b196e">Monkeypox Misinformation Is Spreading, Experts Warn—Here’s What You Need To Know About The Disease</a>&nbsp;(Forbes)</p>



<p><strong><em>By Robert Hart, Forbes Staff</em></strong></p>


Monkeypox Could Cause Neurological Issues Like Nerve Pain And Brain Inflammation, Researchers Warn


<h2 class="wp-block-heading" id="h-topline">TOPLINE</h2>



<p>Monkeypox patients may experience neurological complications like confusion and seizures in rare cases, while psychological issues may be more common, a study published in<em>&nbsp;eClinicalMedicine</em>&nbsp;found, amid an apparent slowdown in new U.S. monkeypox infections.</p>



<h2 class="wp-block-heading">KEY FACTS</h2>



<p>Roughly 2.7% of patients diagnosed with monkeypox experienced at least one seizure, while 2% had encephalitis, serious brain inflammation that can cause long-term disability, according to researchers, who reviewed 19 studies with a total of 1,512 participants in the U.S., Nigeria, Democratic Republic of Congo, Republic of Congo and the United Kingdom.&nbsp;</p>



<p>Another 2.4% of patients experienced confusion, though researchers noted most neurological issues occurred among patients who were hospitalized with the illness, with limited data available for more milder cases.</p>



<p>Psychological issues including depression and anxiety were more prevalent among hospitalized patients, which may in part be due to disfiguring lesions that can be caused by monkeypox as well as the stigma attached to the disease, researchers noted.&nbsp;</p>



<p>Researchers were unable to estimate how long these issues lasted, as most studies did not contain enough information on long-term follow-up with patients.&nbsp;</p>



<p>But the study suggests a need for “ coordinated surveillance for such symptoms” and to be “watchful of psychiatric symptoms” to ensure patients have access to good care, said study co-author Dr. James Badenoch, with Barts Health NHS Trust, which runs five hospitals in London.</p>



<h2 class="wp-block-heading">WHAT WE DON’T KNOW&nbsp;</h2>



<p>Exactly how monkeypox infections affect the brain. Researchers noted symptoms of anxiety and depression are common among patients hospitalized and quarantined with any infectious disease, and viral infections can have profound psychological effects such as fear, loss, discrimination and stigma. Researchers said more studies are needed to estimate the prevalence and longevity of neurological complications among monkeypox patients.&nbsp;</p>



<h2 class="wp-block-heading">CONTRA</h2>



<p>The monkeypox outbreak appears to be slowing in the U.S. with more vaccines available and Americans taking more actions to reduce the spread of the disease, officials&nbsp;<a href="https://www.cnbc.com/2022/09/07/us-monkeypox-outbreak-is-slowing-as-vaccines-become-more-accessible-health-officials-say.html" target="_blank" rel="noreferrer noopener">said</a>&nbsp;Wednesday. The U.S. had 1,699 new infections the week ending September 7, down 440 new cases from the week prior,&nbsp;<a href="https://www.cdc.gov/poxvirus/monkeypox/response/2022/us-map.html" target="_blank" rel="noreferrer noopener">according</a>&nbsp;to the Centers for Disease Control and Prevention. Global cases are also on the decline, but the U.S. still has the most monkeypox cases out of any country in the world, with some 21,274 cases reported as of September 7, according to CDC data.&nbsp;</p>



<h2 class="wp-block-heading">KEY BACKGROUND</h2>



<p>Previous&nbsp;<a href="https://www.forbes.com/sites/roberthart/2022/07/29/monkeypox-symptoms-are-different-from-previous-outbreaks-doctors-warn/?sh=78aee82d617c">research</a>&nbsp;has found the ongoing global outbreak of monkeypox may be resulting in different kinds of symptoms than those reported in previous outbreaks, including rectal pain and penile swelling. The ongoing global outbreak has disproportionately affected men who have sex with men, though anyone can become infected through close physical contact contaminated materials or a person who is infected. Fatalities from the disease are rare, with some 17 deaths reported this year among more than 50,000 infections, according to the CDC. Local health officials are also investigating the&nbsp;<a href="https://www.forbes.com/sites/madelinehalpert/2022/08/30/us-reports-first-suspected-monkeypox-death-in-severely-immunocompromised-patient-in-texas/?sh=35106c19215e">death</a>&nbsp;of a severely immunocompromised patient in Texas who was diagnosed with monkeypox, which could mark the first U.S. death in the ongoing outbreak. Monkeypox symptoms typically last two to four weeks, according to the World Health Organization. Both the WHO and the U.S. have declared monkeypox a public health emergency to better streamline responses to the disease and to ramp up vaccination in the U.S. The U.S. has also adopted a new vaccination method to maximize the number of shots available after facing criticism for a slow vaccine rollout.&nbsp;</p>



<h2 class="wp-block-heading">TANGENT</h2>



<p>The National Institute of Allergy and Infectious Diseases&nbsp;<a href="https://www.nih.gov/news-events/news-releases/clinical-trial-evaluating-monkeypox-vaccine-begins" target="_blank" rel="noreferrer noopener">announced</a>Thursday it’s launching a new&nbsp;<a href="https://www.forbes.com/sites/madelinehalpert/2022/08/22/nih-will-study-new-dose-sparing-monkeypox-vaccination-method/">trial</a>&nbsp;to test the effectiveness of administering the Jynneos monkeypox vaccine—the only shot approved by the Food and Drug Administration to protect against monkeypox—intradermally. The new strategy, which White House officials call “dose sparing,” allows health care workers to extract up to five doses from a one-dose Jynneos vaccine vial to administer into the skin instead of a full dose into fat tissue. The federal government plans to enroll 200 people ages 18 to 50 who have not been vaccinated against smallpox or monkeypox.</p>



<h2 class="wp-block-heading">BIG NUMBER</h2>



<p>461,049. That’s how many vaccines have been administered across 35 U.S. jurisdictions sharing data with the&nbsp;<a href="https://www.cdc.gov/poxvirus/monkeypox/response/2022/vaccines_data.html" target="_blank" rel="noreferrer noopener">CDC</a>.&nbsp;</p>



<h2 class="wp-block-heading">FURTHER READING</h2>



<p><a href="https://www.forbes.com/sites/roberthart/2022/07/29/monkeypox-symptoms-are-different-from-previous-outbreaks-doctors-warn/?sh=78aee82d617c">Monkeypox Symptoms Are Different From Previous Outbreaks, Doctors Warn</a>&nbsp;(Forbes)</p>



<p><a href="https://www.cnbc.com/2022/09/07/us-monkeypox-outbreak-is-slowing-as-vaccines-become-more-accessible-health-officials-say.html" target="_blank" rel="noreferrer noopener">U.S. monkeypox outbreak is slowing as vaccines become more accessible, health officials say</a>&nbsp;(CNBC)</p>



<p><strong><em>By Robert Hart, Forbes Staff</em></strong></p>


Monkeypox blood samples

Monkeypox May Cause Neurological Issues, Study Suggests


<h2 class="wp-block-heading" id="h-topline">TOPLINE</h2>



<p>People infected with monkeypox during the ongoing global outbreak are displaying symptoms not typically associated with the viral infection, according to&nbsp;<a href="https://www.bmj.com/content/378/bmj-2022-072410" target="_blank" rel="noreferrer noopener">research</a>&nbsp;published in the&nbsp;<em>British Medical Journal</em>on Thursday, meaning cases could be overlooked by clinicians as officials struggle to contain the escalating outbreak.</p>



<h2 class="wp-block-heading">KEY FACTS</h2>



<p>Rectal pain and penile swelling, symptoms not generally associated with monkeypox infection, are commonly reported among people infected with monkeypox during the current outbreak, researchers at Guy’s and St Thomas’ NHS Foundation Trust in London found.</p>



<p>Of 197 participants with confirmed monkeypox infections between May and July—all were men and all bar one identified as gay, bisexual or other men who have sex with men—71 reported rectal pain and 31 reported penile swelling.</p>



<p>Twenty of these men were hospitalized for symptom management, the researchers said, most often for rectal pain or penile swelling.</p>



<p>Swollen tonsils and solitary lesions, also not typical symptoms of monkeypox, were reported in nine and 22 participants, respectively.</p>



<p>The researchers warned that these symptoms could be mistaken for other conditions like syphilis, ingrown hairs and tonsillitis and could help explain how the monkeypox outbreak had become so widespread by the time it was detected.</p>



<h2 class="wp-block-heading">BIG NUMBER</h2>



<p>14%. That’s the proportion of the cases studied that did not meet current U.K. Health Security Agency (UKHSA) definition for a probable monkeypox case, the researchers said. Almost half (47%) had symptoms and disease progressions that “contradict” the UKHSA definition for probable cases, notably by displaying systemic symptoms like fever, swollen lymph nodes and muscle aches after, rather than before, the onset of lesions.</p>



<h2 class="wp-block-heading">WHAT WE DON’T KNOW</h2>



<p>Experts are uncertain as to why monkeypox is causing new symptoms in some people. It’s possible the disease itself has changed and other infections among patients—32% screened in the study also had a sexually transmitted infection—mean the way in which it is transmitted could be playing a role. While monkeypox can be passed to anyone and spreads primarily by close physical contact, data suggests the current global outbreak is almost entirely fueled by transmission among gay, bisexual and other men who have sex with men. While the disease is not known to be sexually transmitted, the outbreak is being driven by sexual contact and the WHO recently shifted its stance and advised members of this group to consider reducing their number of sexual partners to curb the disease.&nbsp;<a href="https://www.forbes.com/sites/roberthart/2022/07/01/monkeypox-symptoms-look-different-in-recent-cases-than-previous-outbreaks-doctors-warn/?sh=7279bbec7585">Reports</a>&nbsp;from the current outbreak point to much higher rates of skin lesions in genital and anal areas than expected from previous outbreaks, possibly a result of where the virus was transmitted.</p>



<h2 class="wp-block-heading">KEY BACKGROUND&nbsp;</h2>



<p>Monkeypox has been known for decades but has been ignored by most of the world as its spread was largely limited to some areas of Central and Western Africa. The virus is believed to be hosted in an unknown species of rodent. It can spread to and among humans from close contact and does not spread easily.&nbsp;<a href="https://www.forbes.com/sites/roberthart/2022/05/28/here-are-the-companies-that-could-profit-as-governments-scramble-to-secure-monkeypox-treatments-and-vaccines/?sh=6f8441ef3ecb">Vaccines and treatments,</a>&nbsp;mostly for a related virus, smallpox, are available for monkeypox but are in&nbsp;<a href="https://www.forbes.com/sites/roberthart/2022/07/20/a-one-dose-monkeypox-vaccine-strategy-could-help-extend-scarce-supplies-as-us-outbreak-grows/?sh=51450c911d41">critically short supply</a>. The World Health Organization has&nbsp;<a href="https://www.forbes.com/sites/roberthart/2022/07/23/who-calls-monkeypox-a-global-health-emergency/?sh=5509ef2392a4">designated</a>&nbsp;the outbreak a global public health emergency, its highest alert level, on account of the rapid worldwide spread. More than 21,000 confirmed monkeypox cases have been reported around the world this year,&nbsp;<a href="https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html" target="_blank" rel="noreferrer noopener">according</a>&nbsp;to the Centers for Disease Control and Prevention, almost all in countries that have not historically reported monkeypox. Nearly 5,000 of these are in the United States. Testing is generally poor and these figures are likely to be much higher.</p>



<h2 class="wp-block-heading">FURTHER READING</h2>



<p><a href="https://www.forbes.com/sites/roberthart/2022/07/01/monkeypox-symptoms-look-different-in-recent-cases-than-previous-outbreaks-doctors-warn/?sh=7279bbec7585">Monkeypox Symptoms Look Different In Recent Cases Than Previous Outbreaks, Doctors Warn</a>&nbsp;(Forbes)</p>



<p><a href="https://www.forbes.com/sites/roberthart/2022/07/23/who-calls-monkeypox-a-global-health-emergency/?sh=5509ef2392a4">WHO Calls Monkeypox A Global Health Emergency</a>&nbsp;(Forbes)</p>



<p><a href="https://www.nbcnews.com/nbc-out/out-health-and-wellness/lesions-headaches-debilitating-pain-gay-men-monkeypox-share-stories-rcna36789" target="_blank" rel="noreferrer noopener">Lesions, headaches, debilitating pain: Gay men with monkeypox share their stories</a>&nbsp;(NBC News)</p>



<p><strong><em>By Robert Hart, Forbes Staff</em></strong></p>


Monkeypox Symptoms Are Different From Previous Outbreaks, Doctors Warn


<h2 class="wp-block-heading" id="h-topline">TOPLINE</h2>



<p>Brazil and Spain recorded the first two monkeypox-related deaths outside Africa Friday, as governments try to combat the disease as it spreads rapidly through Europe and the Americas.</p>



<h2 class="wp-block-heading">KEY FACTS</h2>



<p>The Spanish Health Ministry did not disclose the age, sex or medical history of the individual, although Brazilian officials said the man who died in South America was a 41-year-old man who also suffered from lymphoma and a weakened immune system,&nbsp;<a href="https://www.reuters.com/world/americas/brazil-confirms-its-first-monkeypox-related-death-2022-07-29/" target="_blank" rel="noreferrer noopener">Reuters</a>&nbsp;reported.</p>



<p>The five previous monkeypox-related deaths this year all occurred in Africa, where the disease has spread for decades, although it was largely ignored.</p>



<p>Spain has 4,298 confirmed monkeypox cases, according to the&nbsp;<a href="https://www.sanidad.gob.es/profesionales/saludPublica/ccayes/alertasActual/alertaMonkeypox/docs/Informe_de_situacion_MPX_20220729.pdf" target="_blank" rel="noreferrer noopener">Spanish Health Ministry</a>, including 120 patients who have been hospitalized.</p>



<p>he&nbsp;<a href="https://shiny.pahobra.org/monkeypox/" target="_blank" rel="noreferrer noopener">Pan American Health Organization</a>&nbsp;reports Brazil has 978 confirmed cases as of Friday.</p>



<p>U.S. cases have spiked over the past month, reaching 4,907 as of Friday, according to the&nbsp;<a href="https://www.cdc.gov/poxvirus/monkeypox/response/2022/us-map.html" target="_blank" rel="noreferrer noopener">Centers for Disease Control and Prevention</a>.</p>



<p>The deaths come less than a week after the World Health Organization declared the disease a global health emergency.</p>



<h2 class="wp-block-heading">KEY BACKGROUND</h2>



<p>The deaths come as countries across Europe and the Americas race to boost vaccinations. Monkeypox, which is similar to smallpox, has spread for decades in parts of Africa, but gained a foothold in Europe and North America over the past several months, where the vast majority of cases have been in men who have sex with men. Monkeypox spreads through close physical contact and usually only causes mild symptoms. It is “contagious, painful and it can be dangerous,” U.S. Health and Human Services Secretary Xavier Becerra said, with symptoms that include rash, fever and swollen lymph nodes. There are no reported monkeypox deaths in the U.S.</p>



<h2 class="wp-block-heading">TANGENT</h2>



<p>HHS secured another 786,000 doses of the Jynneos monkeypox vaccine Thursday, adding to 338,000 doses that have already been distributed, as the federal government contends with vaccine shortages and spiking cases across the country. The 786,000 doses will be distributed over the next several weeks, Becerra said at a press conference Thursday, bringing the total number of available vaccine doses to roughly 1.1 million.</p>



<h2 class="wp-block-heading">FURTHER READING</h2>



<p><a href="https://www.forbes.com/sites/roberthart/2022/07/23/who-calls-monkeypox-a-global-health-emergency/?sh=510157b8392a">WHO Calls Monkeypox A Global Health Emergency</a>&nbsp;(Forbes)</p>



<p><a href="https://www.forbes.com/sites/suzannerowankelleher/2022/07/26/us-monkeypox-jump-33-percent-risk-low-travelers/?sh=12a162c26aad">U.S. Monkeypox Cases Jump 33% In 3 Days—But Risk Is Low For Most Travelers, Say Health Experts</a>&nbsp;(Forbes)</p>



<p><a href="https://www.forbes.com/sites/roberthart/2022/07/18/struggling-to-find-a-monkeypox-shot-severe-shortages-and-technical-mishaps-are-slowing-down-rollouts/?sh=53717fbee018">Struggling To Find A Monkeypox Shot? Severe Shortages And Technical Mishaps Are Slowing Down Rollouts&nbsp;</a>(Forbes)</p>



<p><a href="https://www.forbes.com/sites/roberthart/2022/07/22/monkeypox-vaccine-gets-thumbs-up-from-eu-regulator-amid-race-to-improve-access/?sh=5331898317c6">Monkeypox Vaccine Gets Thumbs Up From EU Regulator Amid Race To Improve Access</a>&nbsp;(Forbes)</p>



<p><strong><em>By Brian Bushard, Forbes Staff</em></strong></p>


Indonesia Take Precautions Against Monkeypox Virus

Brazil And Spain Report First Monkeypox Deaths Outside Africa


<h2 class="wp-block-heading" id="h-topline">Topline</h2>



<p>Just as the world gets over the shackles of Covid-19, a new problem arises. In July, more than 6,000 cases of monkeypox had been reported from 58 countries in the current outbreak, the World Health Organization (WHO) said.</p>



<h2 class="wp-block-heading">Key Facts</h2>



<p>Since May, monkeypox, usually a mild viral infection that causes flu-like symptoms and skin lesions, has reportedly been spreading worldwide.</p>



<p>“I continue to be concerned by the scale and spread of the virus across the world,&#8221; World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus said, adding that a lack of testing meant that there were likely many more cases going unreported.</p>



<p>Reuters reported around 80% of cases are in Europe, he said.</p>



<p>The WHO said in a statement that Africa has, as of June 28, reported 1,821 cases in 13 countries of which 109 are laboratory-confirmed in nine countries. The number of confirmed cases accounts for 2% of the more than 4500 confirmed cases globally. However, there are a large number of suspected cases in the region, 81% of which are in the Democratic Republic of the Congo, underlining the need for increased diagnostic capacity.</p>



<p>Outside the six countries in Africa with a history of human transmission, monkeypox has also been reported in three countries which have not previously had any human cases. These include Ghana, Morocco and South Africa, which has confirmed the disease in two patients with no travel history, suggesting there is a high possibility of local transmission.</p>



<p>“The geographic spread of monkeypox to parts of Africa where cases have never been detected before is a worrying sign,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “It is critical that we support national efforts to boost surveillance and laboratory diagnosis, which are the cornerstones of disease control.”</p>



<p>According to Forbes, health officials in New York City, San Francisco, Canada and the U.K. are stretching out scarce monkeypox vaccine supplies supply by just focusing on delivering as many first doses to high-risk groups as possible. This is a strategy that has been opposed by key federal regulators amid a sluggish vaccine rollout marred by technical mishaps.</p>



<p>Jynneos, the only vaccine specifically approved to prevent monkeypox, is supposed to be given in two doses delivered 28 days apart. However, Forbes reports that experts and health officials have noted that this is a “the urgent situation” and perhaps the better approach would be to focus on getting as many first doses into high-risk people as quickly as possible.</p>



<h2 class="wp-block-heading">Crucial quote</h2>



<p>“What happened in the early days of the COVID-19 vaccine rollout when Africa watched on the sidelines as other countries snapped up limited supplies must not be allowed to recur. There are some signs that this is already happening,” said Dr Moeti. “The current global spotlight on monkeypox should be a catalyst to beat this disease once and for all in Africa. For this, we know vaccines are a critical tool.”</p>


Monkeypox Cases Still On The Rise: Africa To Be Watchful


<h2 class="wp-block-heading" id="h-topline">Topline&nbsp;</h2>



<p>This week, the National Institute for Communicable Diseases (NICD) confirmed that there are currently no monkeypox cases in South Africa. As of May 23, the institute further confirmed that 15 countries have collectively reported more than 140 cases, none of which are African countries.&nbsp;&nbsp;</p>



<h2 class="wp-block-heading">Key Facts&nbsp;</h2>



<ul class="wp-block-list"><li>The monkeypox outbreak was reported by the World Health Organization (WHO) on May 13. According to WHO, epidemiological investigations are ongoing, however, reported cases thus far have no established travel links to endemic areas.&nbsp;</li><li>A double-stranded DNA virus causes the disease in humans and other animals.&nbsp;&nbsp;</li><li>NCID states that the first case in the current outbreak was a traveler who returned in early May to the United Kingdom from Nigeria, “a monkeypox endemic area”.&nbsp;</li><li>“Clinicians confirmed that the patient had monkeypox three days later. Investigations have been unable to link that case to any of the other cases detected to date, suggesting that there have been multiple introductions of the virus into the United Kingdom and other countries, with cases potentially having gone undetected till now,” NCID stated in a statement.&nbsp;&nbsp;</li></ul>



<ul class="wp-block-list"><li>Furthermore, the NCID have said that a preliminary genome sequence from a confirmed Portuguese case indicates that the virus is the “West African strain” and is most closely related to viruses associated with the exportation of monkeypox from Nigeria to the United Kingdom, Israel, and Singapore during 2018-2019.&nbsp;</li><li>“The implications for South Africa are that the risk of importation of monkeypox is a reality as lessons learnt from COVID-19 have illustrated that outbreaks in another part of the world can fast become a global concern,” says NICD Executive Director, Prof Adrian Puren.&nbsp;</li><li>Puren further reiterated that WHO has not recommended any travel restrictions and is working with the affected countries to limit transmission and determine sources of exposure.&nbsp;</li><li>He adds that for any persons entering South Africa, any illness during travel or upon return from an endemic area should be reported to a healthcare professional, including information about all recent travel, immunisation history and contact with any known cases.&nbsp;</li><li>“The situation is evolving and WHO expects there will be more cases of monkeypox identified as surveillance expands in non-endemic countries,” WHO said in a statement. “Immediate actions focus on informing those who may be most at risk for monkeypox infection with accurate information, in order to stop further spread.”&nbsp;</li></ul>



<h2 class="wp-block-heading">Risk of spread?&nbsp;&nbsp;</h2>



<p>According to WHO, reported cases thus far have no established travel links to an endemic area. Based on currently available information, cases have mainly but not exclusively been “identified amongst men who have sex with men (MSM) seeking care in primary care and sexual health clinics”.&nbsp;</p>



<p>“The identification of confirmed and suspected cases of monkeypox with no direct travel links to an endemic area represents a highly unusual event. Surveillance to date in non-endemic areas has been limited, but is now expanding,” WHO said in a statement.&nbsp;&nbsp;</p>



<p>WHO further states that the monkeypox-endemic countries are: Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Ghana (identified in animals only), Ivory Coast, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan.&nbsp;</p>


Tag: Monkeypox

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