Monkeypox: What It Is and How It Spreads

Key Points:

• In today’s Recommendation for Industry, we discuss the recent monkeypox outbreak. Read more below.
• In-utero COVID exposure tied to language, motor delays by 1 year. Infants born to mothers infected with SARS-CoV-2 during pregnancy were more likely to receive a neurodevelopmental diagnosis by 1 year of age, regardless of whether they were born pre-term. JAMA Network conducted this study.
• Report profiles aerosol spread in hospital COVID-19 outbreak. Airborne particles in three size ranges: larger than 10.0 micrometer (μm,) 2.5 to 10.0 μm, and smaller than 2.5 μm were collected within multiple hospitals in the Boston area. All three particle sizes tested positive within an outbreak facility. The study concluded that “improvements in air filtration, ventilation, and masking in shared hospital spaces may further decrease transmission of SARS-CoV-2 and other airborne respiratory viruses.”
• CDC Rescinds Order Requiring Negative Pre-Departure COVID-19 Test Prior to Flight to the US. This was effective June 12, 2022, at 12:01 AM ET. Passengers flying to the U.S. will no longer need to be tested or show test results or documentation of recovery from COVID. CDC continues to recommend that those travelers boarding a flight to the U.S. get tested for current infection with a viral test as close to the time of departure as possible (no more than 3 days) and not travel if they are sick.
• Federal government to end COVID-19 vaccine mandates for domestic, outbound international travellers. Sources confirm the Canadian government is putting an end to COVID-19 vaccine mandates for domestic and outbound international travellers and federally regulated workers.

Influenza:

• The high rates of influenza are continuing in Australia reported by HealthMap.org
• CDC weekly influenza update, the following has been reported: this week, 2 jurisdictions experienced high activity and 2 jurisdictions experienced very high activity.

Public Health & Food Safety:

• Hepatitis: In the past week, there was just one report related to the continuing concerns with hepatitis of unknown origin. This is down from a high of a couple dozen each week over the previous timeframes. Unclear whether incidence is dropping, or press has just moved on to other topics.
• An ongoing meningitis outbreak in Nigeria has killed 65. About 250 total cases have been reported.
• Monkeypox: Transmission (CDC). Monkeypox is spread through direct contact with bodily fluids or sores on the body of someone that is infected. Monkeypox is rare and does not spread easily between people without close contact, so CDC states that the threat of monkeypox to the general U.S. population remains LOW. Currently, 49 cases have been confirmed, with the the blue states in the graph below depicting these cases. Additional data and statistics for this graph can be found here, and we also provide more information in the Recommendations for Industry article.

• WHO Considers Renaming Monkeypox Virus to Minimize Stigma, Racism. The current name doesn’t fit with WHO guidelines that recommend avoiding geographic regions and animal names. The WHO is consulting experts in orthopoxviruses — the family to which monkeypox belongs — on more appropriate names.
• Pandemic policy changes in Canada appear to have eased Rx drug shortages. Implementation of policy measures in March 2020 in Canada stemmed prescription drug shortages—especially generic drugs—exacerbated by the COVID-19 pandemic. To help ensure a steady drug supply, the Canadian minister of health allowed the importation of key drugs at high risk of shortage from countries with similarly rigorous regulatory systems. The government also revised the country’s Patent Act on Mar 25, 2020, to allow the manufacture and sale of versions of patented drugs without needing to negotiate with patent holders. Average 30-day moving shortages per 10,000 drug identification numbers peaked in April 2020, at 2,345, up from 901 shortages 5 years earlier. The numbers now show that there is a positive trend for patients with chronic diseases because of the news Act.
• FSIS Stopping Salmonella Sampling of Raw Siluriformes in all raw fish. This will apply to all domestic and imported products. After July 13, 2022, IPP will no longer receive sampling tasks for the project codes: If any sampling tasks remain after July 13, 2022, IPP should cancel the remaining sampling tasks and select “Not collected for miscellaneous reasons” as the reason for the cancellation.

Recommendations for Industry

Monkeypox: What It Is and How It Spreads

With news continuing to circulate about monkeypox transmission, TAG has been receiving client questions about the disease.

To provide background: Monkeypox is a rare disease that is caused by infection with monkeypox virus. The virus belongs to the Orthopoxvirus genus and also includes variola virus (which causes smallpox), vaccinia virus (used in the smallpox vaccine), and cowpox virus. Monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, thus the name “monkeypox.” The first human case of monkeypox was recorded in 1970 in the Democratic Republic of the Congo (DRC) during a period of intensified effort to eliminate smallpox. Since then, it has been reported in people in several other central and western African countries, but also has occurred outside of Africa linked to international travel or imported animals.

As noted in the key points above, monkeypox (which the WHO is seeking to rename to reduce the stigma) is transmitted through direct contact with the bodily fluids or sores of an infected person or materials which have been soiled with the same. Because there also is the potential for spread through face-to-face respiratory secretions, CDC recommends that infected persons wear a mask if close, face-to-face contact is likely, even in their homes. However, in most cases, close intimate contact is required for transmission, with casual contact posing lesser risk.

There is thought that, with public health surveillance so focused on COVID, the emerging signs and symptoms may have been missed, which also has led to its increased spread beyond endemic countries.

With COVID appearing to have disrupted other infectious disease infection patterns (flu, monkeypox, etc.), the disruptions could​ increase the probability of more widespread transmission of previously known or unknown pathogens.

TAG is keeping an eye on the progression of the virus and will continue to provide information and recommendations for businesses.

In case you missed it:

• In last Thursday’s Recommendation for Industry, we discussed the westward movement of COVID and increase of BA.4 and BA. 5 in the U.S. Read more here.
• Reporting Home COVID Test Results Can Be Confusing. Here’s How to Do It. The Centers for Disease Control and Prevention “strongly encourages” everyone who self-tests to report their positive results to a health care provider, who may order a P.C.R. test or otherwise report the data to state authorities. But only a few state health departments, including those in Colorado and Washington, collect data from home tests. Others, like in Massachusetts and New York, allow individual county health departments to decide whether they want to collect home test results. The result is that official case counts are becoming an increasingly unreliable measure of the virus’s true toll.
• Moderna’s Omicron-targeted booster shot shows promise. Moderna announced on Wednesday that data from its study on Omicron-containing bivalent booster, revealed that it offers superior antibody response against Omicron – one month after injection – compared to the company’s current vaccine. Moderna plans to propose this new booster to the FDA soon. The geometric mean titer (GMT), a measure of antibody response, was 2,372 for the bivalent vaccine against Omicron, compared with 1,473 for the original Moderna vaccine.
• FDA advisers recommend authorizing Novavax coronavirus vaccine. A panel of independent vaccine experts recommended Tuesday that the Food and Drug Administration authorize a coronavirus vaccine developed by the Maryland biotechnology company Novavax, paving the way for the fourth shot in the United States. There is not yet a date that this vaccine will become available because the FDA must review data in regard to manufacturing. The Novavax shot is a protein-based vaccine from traditional technology used against influenza and shingles. Many scientists believe that the creation of this vaccine will potentially help convince individuals to take this vaccine because it is closely related to traditional vaccines.

Public Health & Food Safety:

• CDC raises travel alert level for monkeypox. The CDC raised the monkeypox travel alert to level 2 which warns Americans to practice enhanced precautions when traveling to both endemic and non-endemic countries that are experiencing outbreaks. The agency said 29 countries have reported 1,019 infections of the poxvirus as of yesterday. The United States has 31 cases of the virus so far in 13 states, according to CDC data. New York has 7 monkeypox cases, and California has 6.
• FDA Launches Campaign Aimed at Preventing E-Cigarette Use Among American Indian/Alaska Native Youth. “Next Legends” Youth E-cigarette Prevention Campaign as part of the agency’s ongoing efforts to protect youth from the dangers of tobacco use. The campaign will educate American Indian/Alaska Native (AI/AN) youth, ages 12-17, about the harms of vaping. 47.3% of AI/AN high school students reported past 30-day use of “electronic vapor products” including e-cigarettes compared to 32.7% of high school students overall.
• No, you’re not imagining it — package sizes are shrinking. From toilet paper to yogurt and coffee to corn chips, manufacturers are quietly shrinking package sizes without lowering prices. It’s dubbed “shrinkflation,” and it’s accelerating worldwide. In the U.S., a small box of Kleenex now has 60 tissues; a few months ago, it had 65. Chobani Flips yogurts have shrunk from 5.3 ounces to 4.5 ounces. Global consumer price inflation was up an estimated 7% in May, a pace that will likely continue through September, according to S&P Global.
• Researchers hope to develop rapid pathogen testing for poultry. Researchers at Michigan State University are working on a rapid testing cell phone method to detect bacteria on poultry that causes human illnesses such as infections from Salmonella and Campylobacter. Currently it can take days for culture testing to identify bacteria on poultry, according to researchers, and some modern rapid tests are extremely expensive and require training. The goal is to create rapid tests that are inexpensive and accessible, and easy enough to use that people from many different industries can implement them.
• Nine baby deaths reported to FDA during Abbott Nutrition investigation. Between December 1, 2021, and March 3, 2022, the US Food and Drug Administration (FDA) received nine (9) reports of infant deaths among babies who were fed powdered infant formula manufactured by Abbott Nutrition in Sturgis, Michigan. The infections some of the babies had were: Cronobacter sakazakii and Proteus mirabilis, COVID-19, CDIFF (Clostridioides difficile), Salmonella, Shigella, astrovirus, and “shigelloides.”