Nigeria has received 10,000 doses of a vaccine to combat mpox, making it the first African country to receive a batch amid the current outbreak of disease that used to be called monkeypox.
The country began the process to secure the vaccines well before it was declared a global health emergency by the World Health Organization (WHO) earlier this month.
Africa has been hit hardest by the recent rapid spread of mpox - and there has been calls for a speedier response by international agencies to such emergencies.
Nigeria - which has confirmed 40 mpox cases this year but says the true number could be more than 700 - received its vaccine doses as a donation from the US.
The West African nation has not recorded any deaths from the virus. It has also not recorded any cases of Clade 1b, a new variant in the east of the Democratic Republic Congo that has also spread to neighbouring countries.
DR Congo, located in central Africa, has recorded more than 18,000 suspected cases of mpox and 615 deaths this year.
There are still no mpox-specific vaccines but smallpox ones work against the disease - and are being manufactured by two pharmaceutical companies.
Nigeria says it will prioritise health workers and at-risk communities in the 13 affected states during the vaccination campaign.
The Africa Centres for Disease Control and Prevention (CDC) estimates that 10 million doses are needed across the continent, with DR Congo being the most in need.
Clade 1b has caused concern among governments, scientists and international health bodies, but it is currently unclear just how deadly and contagious the variant is.
Mpox can be fatal if left untreated and causes symptoms such as fever, muscle aches and lesions across the body.
The process of getting the first jabs to Africa has been slow, with critics saying the WHO's regulatory process poses a major challenge.
Many low- and middle-income countries rely on the WHO, rather than their own drug regulators, to judge which medications are safe and effective.
But the WHO is "painfully risk-averse" and "concerned with a need to protect its trustworthiness", the New York Times recently reported.
Although two years have passed since the onset of the last outbreak driven by the Clade 2 variant prevalent in Nigeria, the WHO has not officially approved the two available vaccines, saying it does not have the data it requires to do a full review.
Professor Helen Rees, an adviser to the WHO and the Africa CDC, told the BBC the WHO's regulation process was "not fit for purpose in an emergency".
She said international health bodies needed to "really look" at how they were conducting approvals when medical products were needed urgently.
Only this month did the WHO ask vaccine manufacturers to register their interest in receiving an emergency licence for mpox jabs. This would allow WHO to fast track its approvals.
That could have begun years ago, numerous public health officials and scientists told news agency Reuters.
WHO is expected to grant its mpox emergency licences in September.
Africa's first 10,000 vaccines went to Nigeria and not DR Congo as a result of an early campaign from Nigerian health officials following the onset of the 2022 outbreak.
At a press conference held in the capital, Abuja, to mark Wednesday's arrival of the vaccines produced by Danish pharmaceutical company Bavarian Nordic, US Ambassador Richard Mills praised Nigeria for leading a co-ordinated effort to respond to the outbreak before it escalates.
The US Agency for International Development (USAid) said it had also donated 50,000 doses to DR Congo but a delivery date had not been released.
Although Africa has finally received its first delivery, the delay could have been shorter if a larger number of wealthy countries had donated jabs like the US had done, Ms Rees told the BBC's Newsday programme.
"After 2022 many of the countries that were affected by the [mpox] outbreak many of them have stockpiles with millions of vaccines collectively stored," she said.
"Those stockpiles are obviously from a country perspective to protect their own citizens. But when you have a global emergency like this, every country should look at its stockpile and say 'can we actually help globally?'"
Monkeypox virus particles (shown in this coloured electron micrograph) can spread through close contact with people and animals.Credit: NIAID/Science Photo Library
When the World Health Organization (WHO) declared a public-health emergency over mpox earlier this month, it was because a concerning form of the virus that causes the disease had spread to multiple African countries where it had never been seen before. Since then, two people travelling to Africa one from Sweden and one from Thailand have become infected with that type of virus, called clade 1b, and brought it back to their countries.
Monkeypox virus: dangerous strain gains ability to spread through sex, new data suggest
Although researchers have known about the current outbreak since late last year, the need for answers about it is now more pressing than ever. The Democratic Republic of the Congo (DRC) in Central Africa has spent decades grappling with clade I virus a lineage to which Ib belongs. But in the past, clade I infections usually arose when a person came into contact with wild animals, and outbreaks would fizzle.
Clade Ib seems different, and is spreading largely through human contact, including through sex. Nearly 18,000 cases of mpox, many of them among children, and at least 600 deaths have been reported this year in the DRC alone.
How does this emergency compare with one declared in 2022, when mpox cases spread across the globe? How is this virus behaving compared with the version that triggered that outbreak, a type called clade II? And will Africa be able to rein this one in? Nature talks with researchers about information they are rushing to gather.
Its hard to determine, says Jason Kindrachuk, a virologist at the University of Manitoba in Winnipeg, Canada. He says that the DRC is experiencing two outbreaks simultaneously. The clade I virus, which has been endemic in forested regions of the DRC for decades, circulates in rural regions where people get it from animals. That clade was renamed Ia after the discovery of clade Ib. Animal studies suggest that clade I is deadlier than clade II1 but Kindrachuk says its hard to speculate what that means for humans at this point.
Even when not fatal, mpox can trigger fevers, aches and painful fluid-filled skin lesions.
Growing mpox outbreak prompts WHO to declare global health emergency
Although many reports claim that 10% of clade I infections in humans are fatal, infectious disease specialist Laurens Liesenborghs at the Institute of Tropical Medicine in Antwerp, Belgium, doubts that this figure is accurate. Even the WHOs latest estimate of a 3.5% fatality rate for people with mpox in the DRC might be high.
There are many reasons fatality estimates might be unreliable, Liesenborghs says. For one, surveillance data captures only the most severe cases; many people who are less ill might not seek care at hospitals or through physicians, so their infections go unreported.
Another factor that can confound fatality rates is a secondary health condition. For example, people living with HIV who represent a significant proportion of the population in many African countries die from mpox at twice the rate of people who do not have compromised immune systems, especially if their HIV is untreated2. And the high death rate among children under age 5 could be partly due to malnutrition, which is common among kids in rural parts of the DRC, Liesenborghs says.
The clade 1b virus has garnered particular attention because epidemiological data suggest that it transmits more readily between people than previous strains, including through sexual activity, while clade Ia mostly comes from animals. An analysis published ahead of peer review last week to the preprint server medRxiv3 shows that clade Ibs genome contains genetic mutations that seem to have been induced by the human immune system, suggesting that it has been in humans for some time. Clade Ia genomes have fewer of these mutations.
But Liesenborghs says that the mutations and clades might not be the most important factor in understanding how the monkeypox virus spreads. Although distinguishing Ia from Ib is useful in tracking the disease, he says, severity and transmissibility of disease could be more affected by the region where the virus is circulating and the people there. Clade Ia, for instance, seems to be more common in sparsely populated rural regions where it is less likely to spread far. Clade Ib is cropping up in densely populated areas and spreading more readily.
Jean Nachega, an infectious disease physician at the University of Pittsburgh in Pennsylvania, says that scientists dont understand many aspects of mpox transmission they havent even determined which animal serves as a reservoir for the virus in the wild, although rodents are able to carry it. We have to be very humble, Nachega says.
Just as was the case during the COVID-19 pandemic, health experts are looking to vaccines to help curb this mpox outbreak. Although there are no vaccines designed specifically against the monkeypox virus, there are vaccines proven to ward off a related virus the one that causes smallpox. Two currently exist. Jynneos, made by Bavarian Nordic in Hellerup, Denmark, contains a type of poxvirus that cant replicate but can trigger an immune response. LC16m8, made by KM Biologics in Kumamoto, Japan, contains a live but weakened version of a different poxvirus strain.
Hopes dashed for drug aimed at monkeypox virus spreading in Africa
Still, its unclear how effective these smallpox vaccines are against mpox generally. Dimie Ogoina, an infectious disease specialist at Niger Delta University in Wilberforce Island, Nigeria, points out that vaccines have been tested only against clade II virus in European and American populations because these shots were distributed by wealthy nations during the global outbreak that started in 2022. And those recipients were primarily young, healthy men who have sex with men, the population that drove that outbreak. One study in the United States found that one dose of Jynneos was 80% effective at preventing the disease in people at risk while two doses was 82% effective4; the WHO recommends getting both jabs.
People in Africa infected with either the clade Ia or 1b virus especially children and those with compromised immune systems might respond differently, although one study in the DRC found that the Jynneos vaccine could generally raise antibodies against mpox in about 1,000 healthcare workers who received it5.
But researchers are trying to fill in some data gaps. A team in the DRC is about to launch a clinical trial of Jynneos in people who have come into close contact with the monkeypox virus but have not shown symptoms to see whether it can prevent future infection, or improve outcomes if an infection arises.
Mpox vaccines have so far been largely unavailable in Africa, but several wealthy countries have pledged to donate doses to the DRC and other affected African nations. The United States has offered 50,000 Jynneos doses from its national stockpile, and the European Union has ordered 175,000, with individual member countries pledging additional doses and Bavarian Nordic adding another 40,000. Japan has offered 3.5 million doses of LC16m8 (which requires only one jab instead of two).
Monkeypox in Africa: the science the world ignored
None of them has arrived yet, though, says Espoir Bwenge Malembaka, an epidemiologist at the Catholic University of Bukavu in the DRC. Low- and middle-income nations that rely on vaccine donations cannot receive them until the WHO has determined that the jabs are safe and effective. And so far, the WHO has not given its thumbs up. It is evaluating additional data that it received from vaccine manufacturers, delaying donors ability to send the vaccines.
Even when the vaccines arrive, Bwenge Malembaka says, its really a drop in the bucket. The African Centres for Disease Control and Prevention in Addis Ababa, Ethiopia, estimates that 10 million doses are needed to rein in the outbreak.
Bwenge Malembaka says that the uncertainty over vaccine arrival has made it difficult for the government to form a distribution plan. I don't know how one can go about this kind of challenge, he says. Bwenge Malembaka suspects children are likely to receive doses first, because they are highly vulnerable to clade I, but officials havent decided which regions to target. Its also unclear how the government would prioritize other vulnerable populations such as sex workers, who have been affected by clade Ib. Their profession is criminalized in the DRC, so they might not be able to come forwards for treatment.
Researchers lament that public-health organizations didnt provide vaccines and other resources as soon as the clade I outbreak was identified, especially given lessons learned from the 2022 global mpox outbreak. The opportunity was there a couple months ago to cut this transmission chain, but resources werent available, Liesenborghs says. Now it will be more challenging to tackle this outbreak, and the population at risk is much broader.
Monkeypox, a viral zoonotic disease endemic to Central and West Africa, has emerged as a significant health concern globally and poses a notable challenge for India. With its recent spread beyond traditional boundaries, the disease's symptoms and transmission mechanisms underscore the urgency for robust preparedness and response strategies. Monkeypox: While symptoms are stealthy, the transmission rate gets wider Monkeypox presents with symptoms that begin with fever, headache, muscle aches, and fatigue, followed by a characteristic rash. This rash progresses from flat spots to raised bumps, then to fluid-filled blisters and eventually to scabs. Infected individuals often experience swollen lymph nodes, which help distinguish monkeypox from similar diseases like smallpox. The virus primarily spreads through direct contact with the rash, bodily fluids, or contaminated materials of infected individuals. It can also be transmitted via respiratory droplets during prolonged close contact, and zoonotic transmission can occur through contact with infected animals. Global health challenge and the role of WHO Globally, monkeypox has been identified as a rising health threat, with increasing cases reported outside its endemic regions. The World Health Organization (WHO) has been actively involved in coordinating international efforts to address the outbreak. On August 14, it had declared monkeypox to be a disease of global emergency. The WHOs approach includes providing technical support to affected countries, offering guidelines for case management, and facilitating research into effective treatments and vaccines. The WHO has emphasized the importance of international collaboration and information sharing to control the spread of monkeypox. By working with global health partners, the WHO aims to improve the understanding of the diseases transmission dynamics, support vaccination efforts, and ensure that affected countries receive the necessary resources and expertise to manage outbreaks effectively. How is India preparing to tackle monkeypox virus? In response to the monkeypox threat, the Indian government has taken several measures to enhance preparedness and mitigate potential outbreaks. The Ministry of Health and Family Welfare has issued guidelines for surveillance, case management, and public health interventions. These guidelines emphasize early detection, reporting, and isolation of suspected cases to prevent further spread. The Indian government has also initiated training programs for healthcare professionals to recognize and manage monkeypox cases effectively. Indian states are actively working to tackle the challenge through tailored strategies. States like Maharashtra and Kerala, which have experienced higher numbers of infectious cases, are particularly focused on enhancing surveillance systems, setting up dedicated treatment facilities, and increasing public awareness. State health departments are collaborating with local health agencies to ensure prompt reporting and response to suspected cases, and they are working on improving diagnostic capabilities to confirm monkeypox infections accurately. Now, India has developed its own home-grown indigenous RT-PCR testing kit to fight against Mpox, which has been approved by Central Protection Drugs Standard Control Organisation (CDSCO). IMDX Monkeypox Detection RT-PCR Assay by Siemens Healthineers has received manufacturing approval from the Central Drugs Standard Control Organisation (CDSCO). This is a significant achievement for our "Make in India" initiative and a critical advancement in the fight against the Monkeypox public health emergency. "IMDX Monkeypox Detection RT-PCR Assay will be manufactured at our molecular diagnostics manufacturing unit in Vadodara, which has a manufacturing capacity of 1 million reactions per year. The factory is all set to make the kits available," said Siemens Healthcare Private Ltd. Do we have enough vaccines against monkeypox? Vaccination plays a crucial role in controlling the spread of monkeypox. Currently, there are two primary vaccines recommended for monkeypox: JYNNEOS and ACAM2000. JYNNEOS, a newer vaccine, is a modified smallpox vaccine with proven efficacy in preventing monkeypox. ACAM2000, an older smallpox vaccine, also offers protection against monkeypox but is less commonly used due to its higher risk of side effects. The Indian government is closely monitoring the global vaccine situation and working with international partners to assess the feasibility of introducing these vaccines into the countrys immunization programs if necessary. In the meantime, efforts are focused on enhancing surveillance, public education, and preventive measures to manage the risk of monkeypox.
African nations, with their limited healthcare resources, face challenges in accessing these vaccines. Efforts are underway to enhance vaccine availability and distribution through international aid and partnerships. By improving vaccination coverage and strengthening healthcare infrastructure, African countries aim to better control monkeypox outbreaks and reduce the impact on affected communities. Global collaboration remains vital in addressing this ongoing health challenge.
Covina, Aug. 28, 2024 (GLOBE NEWSWIRE) -- According to Prophecy Market Insights, the global monkeypox vaccine and treatment market size and share value is projected to grow from USD 85.4 Billion in 2024 and is forecasted to reach USD 215.7 Billion by 2034, exhibiting a compound annual growth rate (CAGR) of 10.7% during the forecast period (2024 - 2034).
Monkeypox Vaccine and Treatment Market Report Overview
Monkeypox is a rare but potentially serious viral illness caused by the monkeypox virus, which is related to the variola virus that causes smallpox. Historically found in Central and West Africa, monkeypox has garnered global attention due to recent outbreaks in various countries.
In order to manage and contain outbreaks, the creation and application of vaccines and therapies for monkeypox have become indispensable. Due of their efficiency in cross-protection, many vaccinations, including modified smallpox vaccines, have been developed and authorized for use against monkeypox.
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The Monkeypox Vaccine and Treatment Market is characterized by rapid growth, technological innovation, and fierce competition. Companies are expanding their global presence, focusing on sustainability, and diversifying their service offerings to stay competitive.
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In addition to investigating innovative vaccine platforms and delivery techniques, researchers are concentrating on enhancing the safety and efficacy characteristics of currently available vaccinations. One aspect of this is the creation of vaccines that offer a more comprehensive defense against different orthopoxviruses such as smallpox and monkeypox.
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SHENZHEN, China, Aug. 28, 2024 /PRNewswire/ -- UTime Limited (NASDAQ: WTO) ("UTime" or the "Company") has officially announced the signing of a non-disclosure agreement (the "NDA") with Bowen Therapeutics Inc ("Bowen Therapeutics") for the acquisition of the Bowen Therapeutics laboratory at UMASS Medical School. This strategic move not only marks UTime's in-depth expansion in the global vaccine market, but also provides strong support for the registration of the relevant vaccine through the U.S. Food and Drug Administration (the "FDA").
One of the key drivers behind this acquisition is a growing global need for an effective monkeypox vaccine. Monkeypox, as an infectious disease caused by the monkeypox virus, has broken out in many places around the world in recent years, causing a high degree of alertness in the international community. Especially in the context of global epidemics, the speed and scope of its spread have led to significant public health challenges. According to the World Health Organization, cases of monkeypox have been reported in a number of countries and regions around the world, making the need for effective prevention and control measures and vaccines increasingly urgent.
Mpox is now a public health emergency of international concern, according to a declaration by the World Health Organization (WHO) on August 14.
Cases have risen in Africa, where there have been more than 15,000 cases and 537 deaths this year, and this particular strain of mpoxknown as clade Ibhas also been detected in Sweden and Thailand.
However, its not the first time the organization has named the diseaseformerly known in the United States as monkeypoxa global health emergency. That also happened in 2022, during a global outbreak of the virus that sickened almost 100,000 people, including more than 33,000 in the U.S.
So, what are the differences between the 2022 outbreak and whats happening now? Infectious disease doctors explain.
BSIP/Contributor / Getty Images
Mpox is a disease caused by the monkeypox virus. According to the WHO, it causes symptoms similar to smallpox, although they tend to be less severe.
The monkeypox virus can spread through close contact, including sexual contact, per the Centers for Disease Control and Prevention. However, it can also be contracted after touching contaminated objects, such as sheets, towels, and clothing.
Most people infected with mpox wont show signs of the virus for three to 17 days. After that, they may experience flu-like symptoms, followed by a characteristic rash that may show up on the hands, feet, chest, face, mouth, or near the genitals. The majority of infected people will recover on their own, but the virus can be deadly.
The WHO declared mpox a public health emergency of international concern a couple of weeks ago after cases of the virus rapidly increased in the Democratic Republic of the Congo (DRC) and other African nations.
Mpox is more common in central and west Africa, and two clades have emergedclade I and clade II. Clade I is the form of mpox fueling the current outbreak, and its known for causing more severe disease than clade II.
The emergence of a new clade of mpox, its rapid spread in eastern DRC, and the reporting of cases in several neighboring countries are very worrying, WHO Director-General Tedros Adhanom Ghebreyesus, PhD, said in a statement. On top of outbreaks of other mpox clades in DRC and other countries in Africa, its clear that a coordinated international response is needed to stop these outbreaks and save lives.
While this outbreak has some things in common with the 2022 outbreak, there are some key differences.
A major one is that the previous clade that sparked the global outbreak was clade IIthis is clade I, John Hu, MD, PhD, infectious disease physician and clinical assistant professor of medicine at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences, told Health.
The 2024 strain likely represents a recent mutation, he said. Studies show that it diverges from previously circulating strains in the Democratic Republic of Congo, where this new variant was first identified.
Clade I has traditionally been more severe than clade II, Cameron Wolfe, MBBS, infectious disease physician and professor of medicine at the Duke University School of Medicine, told Health. But its too early to know for sure whether it will cause more severe illness, he added.
There have been fatalities already this year, typical of Clade I, but whether its more infectious than the parent strain or original versions of Clade I, we need more time to figure out, he said.
Anne Rimoin, PhD, MPH, a professor of epidemiology at the UCLA Fielding School of Public Health, agreed.
This is the big question, she told Health. Clade I is thought to be more severe than clade II, but we dont have enough data to truly make that statement today, she said. Factors like immunity in the population and access to care can also play a role in how severe this strain of mpox can be for someone, Rimoin said.
The other difference between the two outbreaks is the route of transmission. The 2022 mpox outbreak primarily affected men who have sex with men, but thats not the case this time around.
Close sexual contact is still a risk factor, Wolfe said, but this particular outbreak appears to be affecting a larger demographic that includes heterosexual people and children. Whether thats a viral difference, or more likely an effect of different behaviors that lead to spread isnt fully determined yet, he said.
Public health officials do not seem concerned about a COVID-19-style lockdown in the future. WHOs European director Hans Kluge told reporters in a media briefing on August 20 that mpox is not the new COVID. He added, We know how to control mpox, andin the European Regionthe steps needed to eliminate its transmission altogether.
Wolfe also thinks the mpox outbreak is unlikely to cause a future lockdown. This is not spread through respiratory transmission like COVID or an avian flu pandemic, he said, so mass public health restrictions just dont work for an infection like this.
While research showed the antiviral drug tecovirimat (or TPOXX), which is used to treat mpox, did not reduce how long people with the clade I virus had lesions and doesnt seem to be as effective against this strain as it as on clade II infections, there is a vaccine for mpox.
The vaccine is readily available in the U.S., where its primarily given to men who have sex with men in the U.S.the clade II strain has been circulating at low levels in the U.S. since the 2022 outbreak, with around six to seven cases of mpox detected each day. However, its not as readily available in the countries currently dealing with the outbreak.
Access to vaccines remains a significant challenge in many regions affected by the current mpox outbreak, Hu said. However, the Africa CDC has received pledges of vaccine donations from the European Union, the U.S., and Japan.
We have plenty of vaccine [in the U.S.], and we do not currently expect this to make as significant an impact as it did in 2022, Wolfe added.
But Rimoin anticipates that mpox will continue its spread before the outbreak is contained. People travel, and viruses do not respect borders, she said. An infection anywhere is potentially an infection everywhere. This is certainly true when it comes to mpox.
Rimoin recommends that Americans keep the mpox outbreak in perspectivebut also stay informed. We have been seeing cases of mpox increase over time for two decades, some of which has been expected, she said. But this huge increase is certainly beyond what we expected.
Nearly one million doses of vaccine against Mpox, the infection previously known as monkeypox (monkeypox), are expected in Africa. This was announced today by the director of the Africa CDC, which brings together the African Centers for Disease Control and Prevention. We are moving toward securing close to a million doses of smallpox vaccine, he said Jean Kaseya at a meeting of the World Health Organization (WHO) regional committee for Africa, organized in Congo-Brazzaville. Kaseya, a doctor by profession, indicated that 215 thousand doses of vaccines - a quota recently promised by the European Commission - have already been "secured" by the Danish manufacturer Bavarian Nordic. It is estimated that the vials needed to contain the current emergency on the African continent are two million, equivalent to 10 million doses.
The African continent is now the epicenter of the infection. With over 15.600 reported cases and 537 deaths since the beginning of the year, the Democratic Republic of Congo (DRC) is the country most affected by MPOX in Africa, where the majority of deaths are children under 15 years of age, but cases albeit to a lesser extent have also been recorded in 11 other African countries (South Africa, Kenya, Rwanda, Uganda, Burundi, Central African Republic, Republic of Congo, Cameroon, Nigeria, Ivory Coast and Liberia). A case of the new Clade 1b variant has been reported in Sweden, the first outside the continent. A balance that last August 14th pushed the World Health Organization (WHO) to declare Mpox an "international public health emergency".
Faced with the rapid spread of the Mpox virus (formerly known as monkeypox) in East Africa, the Horn of Africa and Southern Africa, the International Organization for Migration (IOM) has launched an appeal to collect 18,5 $.1 million to support infection prevention, control and response efforts, particularly for migrant and displaced populations. These, underlines in an IOM note, are more exposed to contagion due to precarious living conditions and the numerous obstacles to accessing treatment. The spread of the Mpox virus in East Africa, the Horn of Africa and Southern Africa is of serious concern, particularly for vulnerable migrants, highly mobile populations and displaced communities, who are often overlooked in such crises. We must act quickly to protect those most at risk and mitigate the impact of this epidemic on the region, said Amy Pope, Director General of the IOM. According to Unicef, cases among children and vulnerable people are increasing especially in five countries in eastern and southern Africa: Kenya, Uganda, Burundi, Rwanda and South Africa. The new Clade 20b variant has been identified in all affected countries except South Africa and is of concern about its potential for transmission to wider age groups, particularly young children. Burundi is recording the highest number of infections across the region: as of August 2024, 170, 26 confirmed cases of Mpox have been detected in 49 of the country's 45,3 districts, of which 20 percent are women. Children and adolescents under the age of 60 make up nearly 5 percent of detected cases, while children under 21 account for XNUMX percent of cases.
Among the European Union countries that have announced the shipment of vaccines are Germany and Spain. The promise of 100 thousand doses came from Berlin. For Steffen Hebestreit, spokesperson for the chancellor Olaf Scholz, the aim of the initiative is to support in solidarity the international efforts to contain MPOX on the African continent. The doses will be available "in the short term", Hebestreit said, also announcing the creation of a mobile laboratory in Congo. For his part, Spain will donate 500 thousand doses of vaccine against mpox, as announced by the Ministry of Health in Madrid. The Spanish government has informed the European Commission that it will donate 20 percent of its vaccine stock, i.e. 100 thousand vials equivalent to 500 thousand doses, and has asked the institution to extend the proposal to donate 20 percent to other member countries of their vaccine stock.
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Study: International healthcare workers experiences and perceptions of the 2022 multi-country mpox outbreak. Image Credit:Corona Borealis Studio/ Shutterstock
*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
A survey was recently conducted to understand the experiences and perceptions of multi-national healthcare workers during the recent mpox outbreaks worldwide.
The study is currently available on the medRxiv preprint* server.
Healthcare workers play a significant role in health system preparedness and resilience during public health emergencies. The coronavirus disease 2019 (COVID-19) has taught the world how severely a pandemic can impact the health and wellbeing of healthcare workers.
During a pandemic like COVID-19, frontline healthcare workers face major challenges in providing necessary service to people affected by a disease with a largely unknown clinical course and prognostic factors. They also have to cope with uncertainty, anxiety, stress, fear of disease contraction, a lack of personal protective equipment, and extended working hours.
Real-world studies have reported wide-ranging experiences of adversity, moral distress, and resilience among healthcare workers during the COVID-19 pandemic. International knowledge exchange and transfer programs have been found to partially ameliorate the difficulties experienced by healthcare workers during the pandemic.
The 2022-2023 global monkeypox (mpox) disease outbreaks have significantly impacted healthcare workers, especially those residing in non-endemic countries like Europe and the USA. The emergence of mpox outside historically affected regions posed new challenges, particularly in the context of ongoing global health crises like COVID-19. Most of the challenges healthcare workers face are associated with a lack of knowledge and experience about the disease.
In this study, an international team of scientists has examined multi-national healthcare workers' personal and clinical experiences during mpox outbreaks.
This survey was conducted between August and October 2022 on healthcare workers involved in the clinical management of mpox outbreaks. A total of 725 multi-national healthcare workers from 41 non-endemic countries were enrolled for the survey.
Self-reported data on clinical workload, safety, preparedness, workplace training and support, mental wellbeing, and vaccination was collected through online questionnaires. The emergence of mpox outside historically affected regions posed new challenges, particularly in the context of ongoing global health crises like COVID-19.
Healthcare workers in the United Kingdom, the European Union, the Caribbean, Central America, South America, the United States, and Canada participated in this survey.
About 91% of participants were physicians specialized in sexual health or infectious diseases, and 34% were involved in mpox policy.
About 41% of participants reported longer working hours during the mpox outbreak, and 87% reported dealing with this extra load along with their regular clinical responsibilities. This additional workload, without the removal of existing responsibilities, exacerbated the pressure on healthcare systems already strained by the ongoing pandemic.
About 30% of participants reported not having any knowledge about mpox before the outbreak, with only 1% reporting having experience treating a mpox case before the outbreak. This highlights the significant knowledge gap among healthcare workers about re-emerging diseases, a critical concern given the increasing frequency of such outbreaks.
More than 25% of participants reported misdiagnosing someone with a mpox-related rash with another condition initially. The most commonly reported misdiagnoses were chickenpox, syphilis, and herpes.
Over half of the study population agreed that their institutions provided clear, timely, and authoritative information about the disease and that they had received the required education, training, or instruction. However, there were notable regional disparities, with healthcare workers in the Caribbean, Central America, and South America reporting significantly less institutional support compared to their counterparts in Europe and North America.
About 60% and 72% of participants reported following local service guidelines and national guidelines, respectively. About 40% of participants expressed their dissatisfaction with the support received from national public health agencies. This dissatisfaction was particularly pronounced in regions with historically limited access to public health resources, underscoring the need for more equitable support structures.
More than half of the study population reported feeling moral distress due to their work experiences in managing suspected or confirmed clinical cases of mpox. About 37% of participants reported impaired psychological wellbeing due to moral distress.
The studys findings emphasize the significant psychological toll on healthcare workers, which could have long-term consequences for the sustainability of the workforce.
Less than 50% of participants reported receiving smallpox vaccination before the mpox outbreak. In the USA, Europe, and Canada, around one in three participants received the vaccine, whereas the vaccination rate was one in ten in the Caribbean, Central America, and South America.
Overall, the vaccine uptake was high across all studied regions. More than 90% of participants in each region reported that vaccination should be offered to people at high risk of mpox infection prior to exposure.
Despite this high acceptance, the survey revealed significant inequities in vaccine access, particularly in low-resourced regions, which mirrored the challenges faced during the COVID-19 pandemic.
This multi-national survey finds a profound gap in knowledge about mpox among healthcare workers, even though this neglected disease has been circulating among humans since 1970.
Such a deficit in knowledge highlights the urgent need for increasing global pandemic preparedness initiatives for frontline healthcare workers.
The findings suggest that health systems must prioritize educating and training healthcare workers on emerging infectious diseases to ensure rapid and effective responses in future outbreaks.
The survey finds a high vaccine acceptance and uptake level among healthcare workers involved in managing suspected or confirmed mpox cases. However, vaccine inequity and access have been significant in the Caribbean, Central America, and South America. This inequity hampers the effectiveness of outbreak responses in these regions and raises concerns about global health interventions' overall fairness and efficiency.
Such inequity highlights the need to prioritize healthcare workers for mpox vaccination, particularly in regions with scarce infection prevention resources. The study calls for a coordinated global effort to address these disparities and ensure that healthcare workers, especially in low-resourced settings, are adequately protected. The scientists mentioned that similar surveys should be conducted on African clinicians to understand how unavailability or inaccessibility to essential resources like vaccines impacts their psychological well-being and perception of support.
Overall, the survey findings highlight a critical need for strengthening the resilience of global health systems and multidisciplinary approaches against future outbreaks. This resilience-building must include addressing the systemic issues leading to healthcare worker burnout and moral distress, ensuring that the global healthcare workforce is prepared and supported in future public health emergencies.
*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
Jennifer Oosthuizen / CDC
A Clostridioides difficile vaccine candidate was safe, well tolerated, and reduced C difficileinfection (CDI) severity but did not reduce incidence of CDI in at-risk adults, according to the results of a phase 3 randomized clinical trial published late last week in Clinical Infectious Diseases.
The global, phase 3 CLOVER trial, conducted in 23 countries from March 2017 through December 2021, assessed the efficacy of PF-06425090, a genetically detoxified toxin C difficile vaccine candidate from Pfizer, in adults 50 and older who were considered at increased CDI risk. Overall, 17,535 participants (mean age, 68; 51.5% female; 79.2% White) were randomized to receive three doses of PF-06425090 or placebo. The primary end points were the first CDI episode 14 or more days postdose three (PD3) and postdose two (PD2). CDI duration, need for CDI-related medical attention, and antibiotic use PD3 were also evaluated.
Among the participants who received all three doses, 17 PF-06425090 and 25 placebo recipients had a primary CDI episode 14 or more days PD3, resulting in vaccine efficacy (VE) of 31%, but the 96.4% confidence interval ranged well below 0. Among those who received two doses, 24 PF-06425090 and 34 placebo recipients had a first CDI episode 14 or more days PD2, for a VE of 28.6%, with a similarly wide confidence interval. Median CDI duration was lower with PF-06425090 (1 day) versus placebo (4 days). Of participants with a first CDI episode, 0 PF-06425090 and 11 placebo recipients sought CDI-related medical attention (post-hoc analysis estimated VE, 100%) and 0 PF-06425090 and 10 placebo recipients required antibiotic treatment (VE, 100%).
Local reactions were more frequent in PF-06425090 recipients, while systemic events, most of which were mild-to-moderate, were generally similar between groups. Adverse event rates were similar between groups.
The trial investigators say that while the primary end point wasn't met, the results suggest PF-06425090 could provide a public health benefit.
"Together, these findings suggest PF-06425090 may reduce overall disease burden by potentially reducing CDI severity in vaccine recipients and consequent need for medical interventions," trial investigators wrote. "Limiting need for medical attention not only alleviates healthcare resource strains but reduces potential for antibiotic exposure, which may help mitigate increasing global threats of antimicrobial resistance."
Over 20,000 birds are set to be culled in Odisha 's Puri district after a case of H5N1 avian influenza was detected in several poultry farms in Pipli town. This decision is part of the containment measures aimed at controlling the virus, as reported by ANI. Authorities are taking actions to mitigate the potential risk by culling a significant number of birds. The culling process initiated by the Animal Husbandry Department is likely to continue for several days. Besides culling, extensive disinfection measures are being implemented in the affected areas to control the virus' spread. Residents in Pipili have been advised to avoid contact with birds and to report any sick or dead poultry to authorities immediately. To prevent the spread of a virus, authorities have imposed a temporary ban on the sale and transport of poultry products from the region. Officials have requested the public's cooperation in these measures to control the situation effectively. The situation is being closely monitored by health and veterinary authorities, with efforts focused on containing the outbreak and ensuring public safety. Animal influenza viruses normally circulate in animals but can also infect humans. Infections in humans have primarily been acquired through direct contact with infected animals or through indirect contact with contaminated environments. Dr Jaganath Nanda, Additional Director of Disease Control at the Directorate of Animal Husbandry, Odisha told ANI, "On August 17, we received a report from the Pipili area indicating that 1,800 birds had died under unusual circumstances. A team was immediately dispatched to the site to collect samples, which were then sent to Bhopal for testing. The results, received on August 23, confirmed the presence of bird flu. Consequently, culling operations commenced on August 24 in both the Pipili and Satyabadi blocks. The culling process is going on and we will pay Rs 20 and Rs 70 for as per their size." The state's Health and Family Welfare Department, posted on X and informed that Dr Nilakantha Mishra, Director, Public Health Dept., has directed CDMO Puri to remain prepared for the protection of human health due to the ongoing outbreak of bird flu in the district. "As two blocks of Puri district, Pipili & Satyabadi, are affected by the outbreak of BirdFlu, Dr Satya Panigrahi, State RRT & Sunita Jena, Epidemiologist, SSU, are directed to proceed to Puri to investigate and ensure the culling operation as per the guidelines," it posted.
