Double Trouble: Vaccines Lag, Virulent Mpox Clade 1 Spreads
Vaccine apathy, emerging virus brewing
The Centers for Disease Control and Prevention (CDC) has released two health advisory alerts only a week apart, one dealing with the “urgent need” to vaccinate people for seasonal respiratory viruses; the second warning that a virulent type of mpox (monkeypox) virus (MPXV) is spreading in Africa.1,2
On Dec. 14, 2023, the CDC sounded the alarm on low vaccination rates for COVID-19, influenza, and respiratory syncytial virus (RSV), all of which are increasing in activity.
“In addition, a recent increase in cases of multisystem inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection in the United States has been reported,” the alert stated. “Healthcare providers should administer influenza, COVID-19, and RSV immunizations now to patients, if recommended. Healthcare providers should recommend antiviral medications for influenza and COVID-19 for all eligible patients, especially patients at high-risk of progression to severe disease, such as older adults and people with certain underlying medical conditions.”
Currently, the highest respiratory disease activity in the United States is occurring across the southern half of the country, with increasing activity in northern states. “In the past four weeks, hospitalizations among all age groups increased by 200% for influenza, 51% for COVID-19, and 60% for RSV,” the CDC warned. “To date, 12 pediatric influenza deaths have been reported during the 2023-2024 season.”
From Sept. 1 through Dec. 10, 2023, the CDC received 30 reports of MIS-C, a rare complication that typically occurs one month after SARS-CoV-2 infection.
Vaccination for influenza, COVID-19, and RSV reduces the risk of severe disease, including pneumonia, hospitalization, and death,” the CDC emphasized. “Vaccination for COVID-19 can also reduce the risk of MIS-C and post-COVID conditions.”
A More Severe Clade of Mpox
On Dec. 7, 2023, the CDC warned about sexually associated human-to-human transmission of Clade I MPXV in the Democratic Republic of the Congo (DRC).
MPXV has two distinct genetic clades, with Clade II spreading globally though networks of men who have sex with men in 2022.
“Cases of Clade I MPXV have not been reported in the United States at this time,” the CDC stated. “However, clinicians should be aware of the possibility of Clade I MPXV in travelers who have been in DRC. Clinicians should notify their state health department if they have a patient with mpox-like symptoms, which may include a diffuse rash and lymphadenopathy, and recent travel to DRC. Clinicians should also submit lesion specimens for clade-specific testing for these patients.”
Vaccines and other medical countermeasures are available and expected to be effective for Clade II, just as they were for Clade 1. MPXV vaccination generally is not available in the DRC.
“Clade I MPXV is capable of human-to-human spread but has previously been associated with non-sexual routes of transmission,” the CDC states.” Clade I has previously been observed to be more transmissible and to cause more severe infections than Clade II.” The CDC report did not clarify the nature of the sexual transmission.
Since Jan. 1, 2023, the DRC has reported 12,569 suspected MPXV cases (i.e., clinically diagnosed but not laboratory-confirmed) and 581 deaths.
“This is a substantial increase from the median 3,767 suspected MPXV cases reported annually in DRC during the years 2016-2021,” the CDC notes.
Clade II became endemic in the United States after the global outbreak, which saw the virus spread to countries that had rarely had a single case of MPXV. If Clade II begins spreading sexually — a mode of transmission rarely seen in the virus — more global spread could be in the offing.
“There are no direct commercial passenger flights from DRC to the United States, and the current threat for Clade I MPXV in travelers remains low,” the CDC said.
REFERENCES
- Centers for Disease Control and Prevention. Urgent need to increase immunization coverage for influenza, COVID-19, and RSV and use of authorized/approved therapeutics in the setting of increased respiratory disease activity during the 2023-2024 winter season. Published Dec. 14, 2023. https://emergency.cdc.gov/han/2023/han00503.asp
- Centers for Disease Control and Prevention. Mpox caused by human-to-human transmission of monkeypox virus with geographic spread in the Democratic Republic of the Congo. Published Dec. 7, 2023. https://emergency.cdc.gov/han/2023/han00501.asp
The Centers for Disease Control and Prevention has released two health advisory alerts only a week apart, one dealing with the “urgent need” to vaccinate people for seasonal respiratory viruses; the second warning that a virulent type of mpox (monkeypox) virus is spreading in Africa.
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