Monkeypox: Steps Businesses Can Take to Keep Risk Low

Key Points:

• In today’s Recommendation for Industry, we discuss the low risk of monkeypox in the US, and what businesses can do to keep it low. Read more below.
• Omicron is as much as 50% less likely to lead to long COVID, study finds. The numbers of individuals that were infected with Omicron were more significant than other variants, such as Delta. Omicron is an easily transmissible variant of COVID. Long COVID was defined as having new or ongoing symptoms 4 weeks or more after COVID-19 onset. Symptoms include fatigue, shortness of breath, loss of concentration, and joint pain. These symptoms can limit daily activities and in some cases be severely limiting. The odds of long COVID for Omicron patients were 24% to 50% less than for Delta patients.
• CDC Recommends COVID-19 Vaccines for Young Children. On June 18, the CDC began recommending that all children 6 months through 5 years of age receive a COVID-19 vaccine. This age group can receive both Pfizer and Moderna vaccines to help protect themselves from COVID-19. Parents can reach out to their doctor, nurse, local pharmacy, or health department, or visit vaccines.gov to see where vaccines for children are available.    
• US & Global Status
  • For two years, a few weeks after infections climbed so did deaths, but that pattern appears to have changed. At nearly three months since new Omicron variants launched a springtime resurgence of cases, fewer people are dying from COVID – closest to the lowest rate of the pandemic and at only one-tenth of the deaths of January 2021. (NYT)
  • However, WHO’s epidemiological update for COVID shows while there has been a global decline of cases for the past 5 weeks, the weekly deaths have risen. There are over 8,700 fatalities reported, with an increase of 4% compared to the previous week. As of 12 June 2022, over 533 million confirmed cases and over 6.3 million deaths have been reported globally.
• Canada drops COVID-19 vaccine travel restrictions Monday. Starting on June 20, vaccinations will no longer be required to board a plane or train in Canada. Masks will remain mandatory except for when individuals are eating or drinking for everyone over 2. Unvaccinated foreign visitors remain banned from entering Canada. They must be fully vaccinated against COVID or submit to a mandatory 14 day quarantine and multiple PCR tests.

Influenza:

• Reported through data collected by the CDC there has been a 3.4% positive clinical test positive for influenza last week. Influenza cases are decreasing as this week there are 3 jurisdictions that experienced high activity and 0 jurisdictions experienced very high activity. There is a current report of 29 influenza- related pediatric deaths. This flu season there is estimated to be at least 8 million flu illnesses, 82,000 hospitalizations, and 5,000 deaths.
• WHO reports in the temperate zones of the southern hemisphere, overall influenza activity increased slightly in recent weeks.

Public Health & Food Safety:

• Reported by HealthMap.org: In yet another possible health impact of the pandemic, TB cases in the US showed a substantial decline in 2020, likely due to a shifting of surveillance resources to COVID-19.  Health officials encourage continued vigilance, so TB cases are not missed.
• Hepatitis source infection is still under debate – There is insufficient evidence to support the view that the recent unexplained acute hepatitis in children is contagious, and the disease’s link to COVID-19 or adenovirus remains unclear, the National Health Commission in the UK suggests.  However, a small study in Israel suggests that there may be a link between the recent unexplained cases of hepatitis in children and prior coronavirus infections, but the sample size is very small. Although recent cases of hepatitis of unknown origin are concerning, a US CDC study showed no increase in pediatric hepatitis or adenovirus types 40/41 above pre–COVID-19 pandemic baseline levels.
• As more states report monkeypox, officials urge caution. In new research, yet to be peer reviewed, there is found to be a 4–17 day incubation period for monkeypox. Nineteen states and Washington DC have all reported cases. The overall count of cases in the U.S. is at 84.
• After 40 million dead birds, hot weather may be killing off the bird flu virus. 40 million birds have been reported dead from the avian flu since February. Avian flu was confirmed in 372 commercial and backyard flocks in 36 states. The avian flu does not survive hot weather so an end might be in sight.
• APHIS turns attention to swine fever after months of battling avian flu. USDA’s Animal and Plant Health Inspection Service is putting forth efforts to help prevent the spread of African swine fever which is found in pork. Although this disease does not affect humans, we can spread it from pig to pig through clothing, farming equipment, and uncooked pork. The U.S. has never had a confirmed case but nearby countries have, such as Haiti and the Dominican Republic. There isn’t a current treatment for this disease and there isn’t an effective vaccine. If this hits the U.S., it is estimated to cost about $50 billion dollars over the next 10 years. Protect our Pigs campaign information can be found here.
• Floodwaters force infant formula plant to close again ‘for a few weeks’. Abbott Nutrition has closed now due to floodwaters that have swept through Sturgis, MI. They are currently assessing damage that was caused and cleaning and re-sanitizing the plant. This situation will push back production and distribution for a few weeks.

Recommendations for Industry

Monkeypox: Steps Businesses Can Take to Keep Risk Low

All indications are showing that the U.S. has reached a peak and is possibly on a downward trend in COVID cases, even while Europe has shown an uptick of BA.5. However, the U.S. is seeing an increase in the number of states that are reporting cases of monkeypox, including 19 states and Washington DC, however only 84 cases have been reported. As CDC has stated, “Monkeypox is rare and does not spread easily between people without close contact. The threat of monkeypox to the general U.S. population remains low.”

Thus, the reality is that businesses are at very low risk from monkeypox, so general awareness and infection prevention are primarily recommended. However, there are some things that businesses and individuals can do to help prevent transmission.

1. Be aware of symptoms and seek medical attention when necessary. Generally, the risk is very low among the general public, but healthcare workers or household members of infected individuals are at higher risk.
2. Since transmission in humans can occur from rashes, scabs, body fluids or respiratory secretions, ill people should isolate from others as much as possible to avoid spreading the virus. 
3. Isolation precautions should be continued until all lesions have resolved, the scabs have fallen off, and a fresh layer of intact skin has formed.
4. Practice effective hand hygiene using an alcohol-based hand rub or hand washing with soap and water.
5. Since the virus is known to be hardy and can survive in linens, clothing and on environmental surfaces, particularly when in dark, cool, and low humidity environments, cleaning and disinfecting hard surfaces that may be contaminated with respiratory droplets from an infected person is essential. The CDC has provided guidance for household precautions. Many of these are fairly standard recommendations against infectious diseases.
6. Use an EPA registered disinfectant and following labeled directions is important.
7. Caregivers or those doing cleaning and disinfecting should wear PPE including disposable gloves and a mask.
8. Avoid contact with infected animals (e.g., infected rodents or monkeys), from being scratched or bitten by the animal or by preparing or eating meat or using products from an infected animal.

In case you missed it:

• In last Thursday’s Recommendation for Industry, we discussed the current data on COVID case rates and hospitalizations. Read more here.
• FDA committee approves Moderna COVID vaccine for kids 6 to 17. Previously only Pfizer was approved for ages 5-17 and the CDC had recommended that age range receive a single-dose booster. The CDC reports that 67% of the US population is currently living in areas of medium or high community transmissions, this was up from 55% last week. In its weekly update on variant and subvariant activity, the CDC said BA.5 now makes up 13.3% of new sequenced samples, up from 7.7% last week. Also, BA.4 now makes up 8.3% of new cases, up from 5.4% the week before.
• Data in Clinical Infectious Disease show low level of COVID rebound with Paxlovid. This study was done prior to Omicron variants BA.4 and BA.5. Paxlovid, made by Pfizer, is a two-drug regimen (nirmatrelivir and ritonavir) taken together twice a day for 5 days. Paxlovid, once taken for 2 to 8 days and testing negative, some people are testing positive again while their symptoms also reappear. Within the study, out of 483 participants only 4 reported rebound- which were fully vaccinated.
• Study spotlights Omicron’s impact on unvaccinated, rural Americans. Though it causes less severe disease than the Delta variant, the highly transmissible Omicron SARS-CoV-2 variant has been twice as deadly in unvaccinated people and has therefore hit rural Americans harder than those living in cities. This study can be read here. During the study period, the incidence rate increased from 538.9 new cases per 100,000 population to 2,827.9. And the death rate rose from 6.1 per 100,000 to 11.2. Currently, scientists are predicting a higher probability of chronic illness from long COVID in rural areas due to unvaccinated populations.
• FDA advisers OK COVID-19 vaccines for kids aged 6 months to 5 years old. Moderna and Pfizer were approved. Moderna will be given in two 25 microgram doses (this is a fourth of an adult dose). Pfizer will be given to kids 6 months through 4 years old a three-shot series consisting of 3 microgram doses (one tenth of an adult dose). The FDA still needs to sign the approval and the CDC has to formally recommend this decision of vaccinating this age group.

Public Health & Food Safety:

• WHO discourages mass vaccination for monkeypox outbreak. More than 3,100 confirmed and suspected cases of monkeypox in 32 non-endemic and 7 endemic countries. WHO emphasized contact tracing and isolation to limit further spread of the poxvirus. Researchers in Italy have detected monkeypox DNA in semen samples from patients, offering more evidence that sexual transmission may be at play in the current outbreak.
• FDA Infant Formula Update: Mead Johnson Nutrition/Reckitt in Singapore is sending 4.5 million pounds of base powder that will be used to produce about 5.7 million cans (more than 66 million full-size, 8- ounce bottles). The shipments will begin in June. Additionally, the FDA announced Nestle in Germany will be providing 28,200 cans (745,000 full-size, 8-ounce bottles) in June to the U.S. as well.
• Senate bill dictates infant formula fix. The name of this bill is the FDA Safety and Landmark Advancements (FDASLA) Act. Senator Patty Murray said, “[this Act] requires [the] FDA to investigate and resolve the mailroom issues that hindered its response, requires manufacturers to notify the FDA of issues that could disrupt supply, requires FDA to put forward a concrete plan to get formula on shelves as soon as possible, and more. “ There are many more elements this bill brings to the table and those can be found here.
• Raspberries recalled in Canada over norovirus contamination. New Alasko Limited Partnership is recalling Alasko brand IQF Whole Raspberries because of possible norovirus contamination. The recalled product has been sold in Canada in Quebec, Ontario and Nova Scotia. #Lot: SY 21278P.O: 116381-01BB: 2023-OC-04 Inner Bag:6 95058 00205 4 Outer Carton: 1 069505 800205 1
• Protein bars recalled after testing finds E. coli contamination. Built Brands, LLC. of American Fork, UT, is recalling 4,196 individual bars of its “Banana Cream Pie Puffs” protein bar because of potential pathogenic E. coli contamination. The product comes in a 40-gram package marked with lot # D22151011 on the outside of the wrapper.