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Inslee directs DOH to prevent the spread of Monkeypox (MPV)

OLYMPIA, Wash., August 23, 2022 – Gov. Jay Inslee issued Directive 22-18, on Friday August 12, to expand the Department of Health’s (DOH) effort to prevent and control the spread of monkeypox (MPV) and exercise available statutory authority to take appropriate disease control measures.

The directive also orders DOH to take a broad range of actions, including:

  • Conducting comprehensive public outreach and education within appropriate communities;
  • Prioritizing equitable distribution of existing treatments;
  • Supporting provider education to ensure MPV vaccine is maximized;
  • Monitoring case counts and demographic data;
  • Convening a series of roundtables with key stakeholders and legislators;
  • Working with and supporting local health jurisdictions; and
  • Maintaining adequate testing capacity and addressing identified reporting gaps.

“Public health is at stake and we must continue to protect Washingtonians and do what we can to help control the spread of monkeypox. Thank you to our Department of Health for taking these actions,” said Inslee.

Monkeypox is a virus similar to smallpox (same genus) in that it is a large DNA virus with an appetite for skin tissue. However, unlike smallpox, monkeypox is typically carried by an animal viral reservoir. Despite its name, the virus is most often found in squirrels and other rodents coining its name from first being discovered in a captive primate in Denmark in 1958.

The first recorded case of the virus infecting a human was a nine-month-year old child in the Democratic Republic of Congo, in 1970, amid increasing efforts to eradicate smallpox with worldwide mass vaccinations.

MPV: Case Counts and at-Risk Groups

The first confirmed case of monkeypox in the U.S. was reported on May 17, 2022, and as of August 22, there were approximately 15,433 cases of MPV in the U.S. with 373 cases in Washington state of which there are seven recorded cases in Snohomish County. A vast majority of cases in the state, 82.6% (or 308), are coming from King County.

So far there have been no reported deaths in the United States, related to MPV, yet the Biden Administration declared, earlier this month, the outbreak is still an evolving serious public health concern.

Globally, at the time the World Health Organization declared the monkeypox outbreak an international emergency, there was approximately 43,000 cases spread over 95 countries with only 12 deaths. Before MPV made its way to the U.S., it was rarely found outside Africa.

Monkeypox Rash Photos. Source: NHS England High Consequence Infectious Diseases Network

Although rarely fatal, MPV can be extremely painful and scarring. Symptoms include fever, headaches, and swollen lymph nodes, muscle pain, and fatigue initially (after a long incubation lasting anywhere from 6 to 21 days). Next the patient develops a rash, sometimes resulting in inflammation or skin lesions, that last two to four weeks. The main complication due to monkeypox is dehydration due to these lesions as well as secondary bacterial infections. Children and immunocompromised (particularly HIV-positive individuals) are more likely to experience complications.

Monkeypox Rash Photos. Source: UK Health Security Agency

World Health Organization monkeypox expert Rosemund Lewis reported last month 99% of U.S. cases are men, 95% of which have sex with other men. The CDC released a statement May 18 saying “anyone can spread monkeypox regardless of sexual orientation.”

“Biology doesn’t care about anyone’s sexuality. Anyone can get monkeypox,” Dr. Demetre Daskalakis, CDC Director of HIV/AIDS prevention, told the Advocate when asked if gay people were more susceptible to the disease.

The virus is mainly spread through close skin-to-skin contact, Dr. Daskalakis explained, putting athletes especially at risk because of close physical contact and shared facilities.

In an online survey of gay, bisexual, and other men who have sex with men conducted during August 5-15, 2022, respondents reported changing their behavior because of the monkeypox outbreak: 48% reported reducing their number of sex partners, 50% reported reducing one-time sexual encounters, and 49% reported reducing sex with partners met on dating apps or at sex venues.

MPV: Pets and Animals

Infected people should not take care of exposed pets. Monkeypox (MPV) is a zoonotic disease, meaning that it can spread between animals and people. It can infect a wide range of mammal species, including monkeys, anteaters, hedgehogs, prairie dogs, squirrels, shrews and dogs. MPV can spread between humans and animals through close contact including petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food. For the guidance for preventing zoonotic infection with MPV to pets click here.

MPV: Prevention, Vaccination and Treatment

Take the following three steps to prevent getting monkeypox:

  • Avoid close, skin-to-skin contact with people who have a rash that looks like monkeypox.
    • Do not touch the rash or scabs of a person with monkeypox.
    • Do not kiss, hug, cuddle or have sex with someone with monkeypox.
  • Avoid contact with objects and materials that a person with monkeypox has used.
    • Do not share eating utensils or cups with a person with monkeypox.
    • Do not handle or touch the bedding, towels, or clothing of a person with monkeypox.
  • Wash your hands often.
    • Wash your hands often with soap and water or use an alcohol-based hand sanitizer, especially before eating or touching your face and after you use the bathroom.

There are existing vaccines to help prevent infection and reduce the severity of illness. The CDC recommends anyone who may have symptoms of monkeypox, particularly men who report sex with other men, and those who have close contact with them, should be aware of any unusual rashes or lesions and contact their healthcare provider for a risk assessment.

“It is critical that DOH continues to utilize every tool at its disposal to prevent and control the spread of this virus,” Inslee’s office wrote in a press release Friday.

Two vaccines may be used for the prevention of monkeypox disease:

  • JYNNEOS vaccine is approved for the prevention of monkeypox and smallpox disease.
  • ACAM2000 vaccine is approved for immunization against smallpox disease and made available for use against monkeypox under an Expanded Access Investigational New Drug (EA-IND) protocol.

Vaccination against monkeypox is not currently recommended for the general public. A limited supply of the JYNNEOS vaccine has arrived in Washington State, and the supply remains limited nationwide. Vaccination appointments are not available at the Snohomish Health District.

Vaccination is also prioritized for people who meet the following criteria as part of a strategy known as PEP++.

  • Gay, bisexual, or other men or transgender people who have sex with men AND at least one of the following: 
    • More than 10 sex partners in the prior 3 months
    • History of early syphilis or gonorrhea in the prior year
    • Methamphetamine use in the prior month 
    • Attendance at a bathhouse, other public sex venue, or sex including at least 3 people at the same time in the prior 3 months
    • Experiencing homelessness/unstable housing AND currently living in a congregate setting AND had any sexual activity in the prior 3 months.
    • Exchange sex for money, drugs, or other purposes in the last 3 months
    • Black, Hispanic/Latinx, Native Hawaiian and Other Pacific Islanders, Asian, Indigenous, or American Indian/Alaska Native

These criteria may change as vaccine availability changes or as we learn more about populations at risk of infection.

The Health District is working with multiple community partner clinics to increase the accessibility of the TPOXX treatment (Tecovirimat) for Snohomish County residents who need it. TPOXX is FDA-approved for the treatment of human smallpox disease caused by Variola virus in adults and children. It is currently being used to treat monkeypox under an Investigational New Drug protocol by CDC

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