NIH experts review monkeypox challenges

Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), and H. Clifford Lane, M.D., NIAID deputy director for clinical research and special projects, discuss a published case series (JP Thornhill et al.) detailing the symptoms and outcomes of 528 people with monkeypox from 16 countries in five continents.

The authors note that the epidemiologic pattern of the multi-continent outbreak of monkeypox resembles that of the early cases of AIDS in that most cases are among men who have sex with men. They caution, however, that it should not be assumed that cases of monkeypox will remain confined to this population. Monkeypox virus has been known to spread from direct lesion-to-skin contact — in prior outbreaks, such spread was often from an infected child to a caregiver. Data suggest that sexual transmission likely plays a role in the current outbreak, the authors note. They call for detailed observational studies, serosurveys and ongoing surveillance to learn more about the epidemiology of the current outbreak.

Drs. Fauci and Lane also compare monkeypox, HIV/AIDS and COVID-19 regarding the causes of each disease and the countermeasures available to fight them. Fortunately, diagnostics, vaccines and treatments for monkeypox already exist. A challenge for the public health and research communities is ensuring equitable, efficient distribution of these existing countermeasures while simultaneously conducting rigorous clinical research to gather more data on their safety and optimal use, they conclude.

Journal References:

1. H. Clifford Lane, Anthony S. Fauci. Monkeypox — Past as Prologue. New England Journal of Medicine, 2022; 387 (8): 749 DOI: 10.1056/NEJMe2210535
2. John P. Thornhill, Sapha Barkati, Sharon Walmsley, Juergen Rockstroh, Andrea Antinori, Luke B. Harrison, Romain Palich, Achyuta Nori, Iain Reeves, Maximillian S. Habibi, Vanessa Apea, Christoph Boesecke, Linos Vandekerckhove, Michal Yakubovsky, Elena Sendagorta, Jose L. Blanco, Eric Florence, Davide Moschese, Fernando M. Maltez, Abraham Goorhuis, Valerie Pourcher, Pascal Migaud, Sebastian Noe, Claire Pintado, Fabrizio Maggi, Ann-Brit E. Hansen, Christian Hoffmann, Jezer I. Lezama, Cristina Mussini, AnnaMaria Cattelan, Keletso Makofane, Darrell Tan, Silvia Nozza, Johannes Nemeth, Marina B. Klein, Chloe M. Orkin. Monkeypox Virus Infection in Humans across 16 Countries — April–June 2022. New England Journal of Medicine, 2022; 387 (8): 679 DOI: 10.1056/NEJMoa2207323