Monkeypox infections double as vaccines and antivirals become scarce

BarcelonaThe spread of monkeypox continues unchecked: in just one month the number of infections has doubled in Catalonia and Spain. International health authorities have already declared the simultaneous outbreaks last May in the United Kingdom as a public health emergency, but the real and future behaviour of the virus remains an unknown for experts, who dare not predict how many people may catch it nor what health consequences may result from the contagions. Spain is the European country which has detected the most cases (4,900) with the Madrid region leading the way (1,817). It has also reported two deaths (two men in their 30s in Andalusia and the Valencian Country). These are, so far, the only deaths in Europe linked to the virus. The trickle of cases coincides with a stagnation in the production of vaccines, which delays the prevention and protection strategy for the most vulnerable groups, and also with a shortage of some antiviral treatments given exceptionally to hospital patients in a serious condition (2.8% of diagnoses).

In Catalonia the incidence of monkeypox has been increasing since May 27 and is already very high. In just one month the number of confirmed infections with a laboratory test has more than doubled: while on July 8 the Department of Health announced 665 cases, by this Friday the figure had risen to 1,558 (with about 700 more suspected cases). In Spain the evolution is similar: the last month the Ministry of Health went from registering 2,034 cases to 4,942. And although most infections are mild and heal spontaneously (those affected do not require any treatment and, in many cases, not even health care), the medical director of BCN Checkpoint and researcher at IrsiCaixa, Pep Coll, recalls that, as with any infectious outbreak, as the number of infected people increases so does the risk of more people being seriously affected by the disease. Now 139 people have required some kind of hospital care, about 3%. "We don't know how the outbreak will evolve, whether it will become endemic or not. There are many more uncertainties than certainties, but suspicions have grown and many asymptomatic cases are slipping through because we are not looking for them," says the physician

The mokeypox outbreak is spreading mainly among men who have sex with men. It is not a sexually transmitted infection (STI) and the routes of infection are not yet fully defined, but, according to the study of the cases, in over 80% of those affected, intimate and sexual contact was identified as the source of infection. For this reason, the vaccination campaign is aimed, for the time being and almost exclusively, at young adult men who have sex with several men (especially if they do it in a group or without any kind of protection) and who take the HIV prevention pill, pre-exposure prophylaxis (PrEP). In the first two weeks of this strategy in Catalonia, 1,045 vaccines have been inoculated, 60% of the assigned doses (1,600). Most of the immunogens awaiting to be administrated are already nominally assigned (appointments have been scheduled in advance) and will be administered in the coming days.

The BCN Checkpoint, one of the three centres authorised to administer the vaccine, has inoculated about 300 and next week it expects to use up its remaining available doses, a total of 700. The Catalan authorities chose to prioritise the vulnerable population, partly because of the difficulties in accessing the doses, which are being produced very slowly.

More doses "in two weeks' time"

Spain has purchased, via the European Commission, 12,000 vaccines, but has so far only been able to access 5,000. The Minister of Health, Carolina Darias, assured that the second batch, foreseeably with the 7,000 missing vials, will arrive "in the next few weeks". According to sources consulted by ARA, they are expected to land in Madrid within two weeks and can be distributed "immediately" among regions.

ISGlobal researcher Laia Vázquez stresses that the virus began to spread three months ago and, since then, the curve has escalated progressively and relentlessly. For this reason, she appreciates the fact that the health authorities have declared a health emergency, although she believes this could have been done earlier. "It is the first time monkeypox has left its transmission niche, the African continent, and that cases are not imported and isolated, but community transmission takes place," she explains

Monkeypox is a viral zoonosis (it is transmitted from animals to humans) and, although it is endemic in Africa, in the West it was until now a notifiable but very anecdotal disease. "Publicly acknowledging the concern about this disease will allow us to involve the authorities in obtaining better tools to respond to this emergency: more vaccines and more antivirals," says Vázquez.

In fact, as ARA has learnt, the most widely used treatment for severe cases of monkeypox has been exhausted. This is Tecovirimat, a drug that limits the progression of the pathogen in the body and slows the spread of the infection, but is used exceptionally. In this case there is also an evident shortage and, in fact, it is not known how many units have arrived in Spain from the centralised European purchase (although initially there was talk of some 200 doses). Darias herself admitted that "few" would arrive because the cases were eminently "mild". These statements, however, were made at the beginning of June, when the incidence of infection was much lower and there were no seriously ill patients.