Monkeypox Virus: There was a monkeypox outbreak of 71 cases in the US in 2003. (File)
The World Health Organization has revealed that there are now 131 confirmed cases of monkeypox, and a further 106 suspected cases, in 19 countries. Experts describe the event as “random” but “containable” and was likely sparked initially by sexual activity at recent raves in Spain and Belgium.
Nevertheless, with the world still reeling from the effects of the covid pandemic, the rise of a different disease is putting many people on edge.
Bloomberg Opinion’s Bobby Ghosh hosted a live Twitter Space discussion with Bloomberg Intelligence senior pharmaceutical analyst Sam Fazeli to get the lowdown on the disease and find out whether we should be worried.
Bobby Ghosh: Let me start by asking the most basic question possible: What is monkeypox?
Sam Fazeli: There are, seemingly, an endless number of viruses that circulate in nature. This happens to be one of them. It’s an orthopoxvirus, like other well-known diseases like chickenpox and smallpox. Monkeypox is less problematic than smallpox was in terms of the mortality rate. The virus which is currently circulating seems to be the strain that is endemic in West Africa.
We’ve known about two strains for a few decades. Both are endemic in different parts of Africa – Central Africa and West Africa, respectively – and there have been occasional cases reported outside of the African continent, usually from someone traveling from an affected area. This outbreak seems quite unusual in that cases are being reported in so many different parts of the world all at the same time. What’s happening?
There was actually an outbreak of 71 cases in the US in 2003, not because of a person traveling but because of imported rodents from Ghana. Those rodents then infected pet prairie dogs, who then infected people. There was a possibility of some local transmission back then, but it certainly was passed on from animals to humans. That’s a problem we’re dealing with in many of these viral outbreaks, from bird flu to covid.
In terms of today’s unusual outbreak, we have to be aware that it’s too early to be able to be sure whether the virus has genuinely been separately seeded in different countries or whether at least most of the cases came from a super spreader event. The best way to know how related the cases are is to sequence them. The first genome was published by Portuguese scientists and they found that the virus seems to be quite close to the virus which was found in several countries in 2018 and 2019. That already tells you that it hasn’t necessarily changed a lot. Although all of this is up for revision, it suggests that hopefully we’ll find that the majority of these cases are actually related.
In passing, it’s worth just unpacking that, although it is called monkeypox, it doesn’t really come from monkeys. We only began to pay attention to it when monkeys began to get it. Does it originate with simians now? What do we know about how the disease is transmitted?
Orthopox viruses, especially monkeypox, are viewed as generalists. That means this virus can and does infect a variety of species. Rodents are the most common vehicles for infection, then it jumped to monkeys and now humans. The transmission can happen relatively easily, not necessarily through a specific route. In this case, the view is that it’s spread through contact with contaminated fluids from an infected person and it needs to be relatively close contact.
The likelihood is that the majority of transmission will be when you’re either in very close proximity to somebody who’s got the virus, so you’re picking up their exhaled droplets, or you’re in physical contact with them. It could also be passed on via fomites – touching a surface that someone infected has touched.
There have been some reports suggesting that it happens mostly through intimate contact, including really close proximity or having sex with a person.
I think we have to be very careful not to misinterpret the conversation and the information that’s coming out. Just because the majority of cases have been found in men who have sex with men doesn’t mean anything with regards to sexual transmission. We are only looking at the way this particular spread happened. It could have easily been any other kind of intimate contact, heterosexual or whatever.
What are the symptoms of monkeypox?
It starts with a headache and fever, the usual things that you deal with when you get a viral infection. These symptoms are basically your defense system kicking in. A lot of viruses don’t like higher temperatures, which is why the body raises its temperature. We get a headache and muscle aches because of all the chemicals – such as cytokines – which get released to fight the infection. Then, within a week or two, some people get a rash which develops into pustules.
If you’re covered in these pustules, then you’d have the risk of bacterial infection and, in some cases, sepsis. That’s where the lethality can come from.
There have been zero deaths so far in this particular cluster. The 1-3 percent mortality rate or the 10-13 percent mortality rate for the Central African strain has been mentioned a lot, but you have to remember that, just like covid, it depends on how patients are looked after. If a patient is at home with no oxygen available, no ICU, no medical professionals looking after them, their risk of death is higher. That may be the situation in rural Africa where these numbers have been calculated, but in countries with good healthcare and drugs, I’m sure the fatality rate will remain below 1 percent – 0 percent, hopefully!
The symptoms remind me of my childhood when I got chickenpox. I was bedridden for several days and I remember it being very uncomfortable. Then it went away.
Do we have a sense of whether monkeypox is more painful, or more threatening than chickenpox?
It’s a much more uncomfortable infection if you get the full-blown pustules on your skin, but it varies. I’ve heard of a case where somebody was infected who had previously been vaccinated against smallpox. They had just one or two lesions, which is nothing. That’s what you assume and hope is going to be the case with most people who have been vaccinated already. The question is around folks who aren’t vaccinated. How bad do they get it?
I grew up in India in the 1970s and 80s and I was vaccinated for smallpox as a child. Then smallpox was eradicated and in many countries, vaccines were no longer given.
Does that make us more vulnerable to monkeypox?
Yes, I think it does, which is what’s likely going on here. There was the suggestion that maybe the covid lockdowns increased our susceptibility to disease. You might say that for flu and the coronavirus, both of which are respiratory viruses. Really in this case, I think it’s just a coincidence. We have an endemic virus in Central and West Africa which has then been given an opportunity to spread among a population of people who have never seen an infection or a vaccine that gives them protection against the virus.
It’s good news that the vaccine already exists, unlike with covid. We have vaccines that work both prophylactically as well as after one has got the disease.
So they can be preventative as well as a cure?
Correct, a few days after a diagnosis of infection, the vaccine seems to still do the job. The interesting thing is that both vaccines are manufacturable today. Stocks may not be as high as one would like in situations like this, but many countries had already been stockpiling it, not in fear of monkeypox, but in fear of a bio-terrorism attack by smallpox.
The disease is less transmissible than covid, you don’t need everybody to get vaccinated. You can use it to treat people who get diagnosed and vaccinate the people around them. This method is called ring vaccination, and it’s proven successful in controlling smallpox before.
There was a great deal of discussion about whether poor countries would be able to afford covid vaccines. Is that an issue for monkeypox vaccines?
The covid vaccine from Pfizer was between $15 and $20 a shot. For most of us who live in England, Sweden or the United States, that’s not expensive given the protection it gives you. I expect that for controlling and better managing the global spread of this virus, the equivalence of COVAX will buy vaccines for countries who can’t afford it. At the same time, the cost is determined clearly by the volume. If we only need one million doses, as opposed to a 400 million doses, then companies will probably have to charge a little bit higher because margins will be lower at those sorts of volumes. I’m not expecting this to be a very expensive vaccine.
That’s reassuring. How have leaders responded to monkeypox? President Biden felt compelled to answer a question about it during his trip abroad in South Korea. Have we learned things from our fight with covid at a policy level that are particularly useful in dealing with monkeypox?
The good thing is, as we’ve said already, that this is not a disease which we’ve never dealt with before, even if it may not be necessarily the living memory of many people. It’s only 50 years ago or so that we stopped the smallpox vaccination programs. Bavarian Nordic, one of the manufacturers of a smallpox vaccine, apparently already had meetings with health authorities from several countries just in the past few days, which were arranged six months ago. That shows countries were already thinking about this — whether it was more smallpox than monkeypox that they were thinking of doesn’t really matter.
Is there any reason to think monkeypox is seasonal?
At the time of year when people are more outdoors than indoors, you’d expect most infections, especially respiratory ones, to decline. This is transmitted by contact. So I don’t think we can classify it as seasonal.
What about variants – which have been a real issue with covid? Has the monkeypox virus shown any sign of developing new variants that are resistant to the existing treatments?
It’s way too early to know. Nigeria gathers great epidemiology data, but with the number of monkeypox cases, it’s not anywhere near the scale of SARS-CoV-2. With SARS-CoV-2 also being an RNA virus, it probably has a higher opportunity to mutate.
The early data that we do have from the Portuguese scientists suggests the virus’s genome is similar to what it was in 2018 and 2019, and that’s quite reassuring. When viruses multiply at high levels, you can’t escape the fact that mutations will occur. So we’ll have to monitor it.
What do we do to protect ourselves from monkeypox?
We’ve had this with covid. There are choices that we can all make in our lives relative to our own circumstances, such as opting to wear a mask. If you’re worried or feel threatened, you can take precautions. I think the expectation by most scientists is that this will self-limit eventually, especially when the awareness is so heightened, because it doesn’t transmit that easily.
Now that it’s been a couple of weeks since the story broke and there have been cases reported in various countries, are we already seeing more research being devoted to this outbreak?
I know that the genomics folks are working 24-7 on sequencing the genomes of the virus to better understand the epidemiology. That’s the best way when you only have 200 cases of knowing how these incidents are potentially related to each other. We already have at least two drugs that could treat the virus and two vaccines, at least. So I don’t think we need to do enormous amounts of research. What we do need to do here is to have the right healthcare public health policy in place to manage it and decide where do we go next. Do we go back and vaccinate everybody that wasn’t vaccinated, or do we just manage it using ring vaccination?
(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)
Women living in states with abortion bans obtained the procedure in the second half of 2023 at about the same rate as before the U.S. Supreme Court overturned Roe v. Wade, according to a report released Tuesday.
Women did so by traveling out of state or by having prescription abortion pills mailed to them, according to the #WeCount report from the Society of Family Planning, which advocates for abortion access. They increasingly used telehealth, the report found, as medical providers in states with laws intended to protection them from prosecution in other states used online appointments to prescribe abortion pills.
“The abortion bans are not eliminating the need for abortion,” said Ushma Upadhyay, a University of California, San Francisco public health social scientist and a co-chair of the #WeCount survey. “People are jumping over these hurdles because they have to.”
Abortion patterns have shifted
The #WeCount report began surveying abortion providers across the country monthly just before Roe was overturned, creating a snapshot of abortion trends. In some states, a portion of the data is estimated. The effort makes data public with less than a six-month lag, giving a picture of trends far faster than the U.S. Centers for Disease Control and Prevention, whose most recent annual report covers abortion in 2021.
The report has chronicled quick shifts since the Supreme Court’s Dobbs v. Jackson Women’s Health Organization ruling that ended the national right to abortion and opened the door to enforcement of state bans.
The number of abortions in states with bans at all stages of pregnancy fell to near zero. It also plummeted in states where bans kick in around six weeks of pregnancy, which is before many women know they’re pregnant.
But the nationwide total has been about the same or above the level from before the ruling. The study estimates 99,000 abortions occurred each month in the first half of 2024, up from the 81,000 monthly from April through December 2022 and 88,000 in 2023.
One reason is telehealth, which got a boost when some Democratic-controlled states last year began implementing laws to protect prescribers. In April 2022, about 1 in 25 abortions were from pills prescribed via telehealth, the report found. In June 2024, it was 1 in 5.
The newest report is the first time #WeCount has broken down state-by-state numbers for abortion pill prescriptions. About half the telehealth abortion pill prescriptions now go to patients in states with abortion bans or restrictions on telehealth abortion prescriptions.
In the second half of last year, the pills were sent to about 2,800 women each month in Texas, more than 1,500 in Mississippi and nearly 800 in Missouri, for instance.
Travel is still the main means of access for women in states with bans
Data from another group, the Guttmacher Institute, shows that women in states with bans still rely mostly on travel to get abortions.
By combining results of the two surveys and comparing them with Guttmacher’s counts of in-person abortions from 2020, #WeCount found women in states with bans throughout pregnancy were getting abortions in similar numbers as they were in 2020. The numbers do not account for pills obtained from outside the medical system in the earlier period, when those prescriptions most often came from abroad. They also do not tally people who received pills but did not use them.
West Virginia women, for example, obtained nearly 220 abortions monthly in the second half of 2023, mostly by traveling — more than in 2020, when they received about 140 a month. For Louisiana residents, the monthly abortion numbers were about the same, with just under 700 from July through December 2023, mostly through shield laws, and 635 in 2020. However, Oklahoma residents obtained fewer abortions in 2023, with the monthly number falling to under 470 from about 690 in 2020.
Telehealth providers emerged quickly
One of the major providers of the telehealth pills is the Massachusetts Abortion Access Project. Cofounder Angel Foster said the group prescribed to about 500 patients a month, mostly in states with bans, from its September 2023 launch through last month.
The group charged $250 per person while allowing people to pay less if they couldn’t afford that. Starting this month, with the help of grant funding that pays operating costs, it’s trying a different approach: Setting the price at $5 but letting patients know they’d appreciate more for those who can pay it. Foster said the group is on track to provide 1,500 to 2,000 abortions monthly with the new model.
Foster called the Supreme Court’s 2020 decision “a human rights and social justice catastrophe” while also saying that “there’s an irony in what’s happened in the post-Dobbs landscape.”
“In some places abortion care is more accessible and affordable than it was,” she said.
There have no major legal challenges of shield laws so far, but abortion opponents have tried to get one of the main pills removed from the market. Earlier this year, the U.S. Supreme Court unanimously preserved access to the drug, mifepristone, while finding that a group of anti-abortion doctors and organizations did not have the legal right to challenge the 2000 federal approval of the drug.
This month, three states asked a judge for permission to file a lawsuit aimed at rolling back federal decisions that allowed easier access to the pill — including through telehealth.
Climate change may be contributing to thousands more wildfire smoke-related deaths every year than in previous decades, a new study suggests — results a Canadian co-author says underline the urgency of reducing planet-warming emissions.
The international study published Monday is one of the most rigorous yet in determining just how much climate change can be linked to wildfire smoke deaths around the world, said Sian Kou-Giesbrecht, an assistant professor at Dalhousie University.
“What stands out to me is that this proportion is increasing just so much. I think that it really kind of attests to just how much we need to take targeted action to reducing greenhouse-gas emissions,” she said in an interview.
The study estimates, using mathematical modeling, that about 12,566 annual wildfire smoke-related deaths in the 2010s were linked to climate change, up from about 669 in the 1960s, when far less carbon dioxide was concentrated in the atmosphere.
Translated to a proportion of wildfire smoke mortality overall, the study estimates about 13 per cent of estimated excessdeaths in the 2010s were linked to climate change, compared to about 1.2 per cent in the 1960s.
“Adapting to the critical health impacts of fires is required,” read the study, published in the peer-reviewed journal Nature Climate Change.
While wildfires are a natural part of the boreal forest ecosystem, a growing number of studies have documented how climate change, driven by the burning of fossil fuels, is making them larger and more intense — and contributing more to air pollution.
The same research group is behind another study published in the same journal Monday that suggests climate change increased the global area burned by wildfire by about 16 per cent from 2003 to 2019.
Those climate-fuelled fires then churn out more fine particle pollution, known as PM2.5, that’s tiny enough to get deep into the lungs — and in the long run can have serious health effects.
The study that estimated the scale of those effects is based on modeling, not historical data about reported deaths from air pollution.
Researchers used established public-health metrics for when pollution is thought to contribute to mortality, then figured out the extent to which wildfire smoke may have played a role in that overall exposure to arrive at the estimates.
Meanwhile, Health Canada estimates that between 2013 and 2018, up to 240 Canadians died every year due to short-term exposure to wildfire air pollution.
Kou-Giesbrecht said Monday’s study did not find that climate change had a major influence on the number of smoke-related deaths from Canada’s boreal wildfires.
She suggested that’s likely due to the country’s relatively small population size, and how tricky it is to model forest fires in the region, given its unique mix of shrubs and peat.
But she also noted that a stretch of devastating Canadian wildfire seasons over the past several years was not captured in the study, and she expects future research could find a bigger increase in deaths and public-health problems linked to climate change.
The most affected regions in the study were South America, Australia and Europe.
Kou-Giesbrecht said the more studies that uncover the link between climate change and disasters as “tangible” as wildfires, the more the case for “drastic climate action” will be bolstered.
“I think that the more and more evidence that we have to support the role of climate change in shaping the past 100 years, and knowing that it will continue to shape the next 100 years, is really important,” she said.
“And I find that personally interesting, albeit scary.”
The study used three highly complex models to estimate the relationship between climate change, land use and fire.
The models, which each contain thousands upon thousands of equations, compare what wildfires look like in the current climate to what they may have looked like in pre-industrial times, before humans started to burn vast amounts of fossil fuels.
The researchers used the models to calculate gas and aerosol emissions from wildfires between 1960 and 2019, and then make estimates about annual smoke-related deaths.
The type of methodology used by Monday’s studies, known as attribution science, is considered one of the fastest-growing fields of climate science. It is bolstered in part by major strides in computing power.
This report by The Canadian Press was first published Oct. 21, 2024.
Some Ontario doctors have started offering a free shot that can protect babies from respiratory syncytial virus while Quebec will begin its immunization program next month.
The new shot called Nirsevimab gives babies antibodies that provide passive immunity to RSV, a major cause of serious lower respiratory tract infections for infants and seniors, which can cause bronchiolitis or pneumonia.
Ontario’s ministry of health says the shot is already available at some doctor’s offices in Ontario with the province’s remaining supply set to arrive by the end of the month.
Quebec will begin administering the shots on Nov. 4 to babies born in hospitals and delivery centers.
Parents in Quebec with babies under six months or those who are older but more vulnerable to infection can also book immunization appointments online.
The injection will be available in Nunavut and Yukon this fall and winter, though administration start dates have not yet been announced.
This report by The Canadian Press was first published Oct. 21, 2024.
-With files from Nicole Ireland
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
