Monkeypox: World already has vaccine, medicines to control the outbreak; details here

Smallpox: The world already has a vaccine, drugs to control the epidemic; details here


Monkeypox disease is usually mild and most infected people recover within a few weeks without the need for treatment. However, there is treatment for those who get quite ill with the virus

Medicines are not commonly needed to treat chickenpox. The disease is usually mild and most infected people recover within a few weeks without the need for treatment. However, there are vaccines that can be used to control the smallpox outbreaks that some countries already use. And there is a cure for those who get quite ill with the virus.

Monkey pox belongs to orthopoxvirus genus of viruses, which includes smallpox. Fortunately, thanks to what is called cross-protection, smallpox vaccines also work on smallpox.

Although the world was declared smallpox in 1980, many countries have stocks of smallpox vaccines in case of emergency. For example, the smallpox vaccine is used to protect laboratory workers who accidentally come into contact with smallpox viruses (such as monkeypox or vaccinia – a smallpox virus that is similar to smallpox but less harmful). They are also kept in case of terrorist attacks that could use smallpox as a biological weapon.

The smallpox vaccine can be up to 85% effective in stopping the chickenpox virus infection if given before people are exposed to the virus.

There are two types of smallpox vaccine. Both types are based on vaccinia virus. An older type of smallpox vaccine contains a “live” vaccinia virus. The leader in this group is ACAM2000, which is approved in the United States to protect people against smallpox.

Although ACAM2000 cannot cause smallpox, the vaccinia virus it contains can replicate after the vaccine is given and is passed from the vaccinated person to the non-vaccinated person who comes into close contact with the injection site or any leaking fluid for up to 21 days thereafter.

This also means that ACAM2000 can cause many side effects and should not be used in at-risk groups such as pregnant or breastfeeding women and people with weakened immune systems. People with weakened immune systems, including those with HIV, can get sick from the vaccine.

Another “live” vaccinia virus is the Aventis Pasteur smallpox vaccine. It is not formally approved, but may be made available when more supplies run out.

A newer type of smallpox vaccine, called Imvanex, contains a live but modified form of the vaccinia virus called Ankara vaccinia. Imvanex, manufactured by the Danish biotechnology company Bavarian Nordic, has been licensed in the European Union to prevent smallpox.

In the United States, the vaccine has the trade name Jynneos and is licensed to prevent both chickenpox and monkeypox in adults at risk for these diseases. Jynneos has been used in the United Kingdom in previous cases of smallpox monkeys.

Because the Bavarian Nordic vaccines are made from a modified form of the vaccinia virus, they are considered safe for people at risk.

For someone who comes in close contact with an infected person, it would usually take five to 21 days for the symptoms of monkey pox (and most likely seven to 14 days) to appear, so it is difficult to say whether the vaccine will be given after someone has been exposed. smallpox fully protects them. However, in the US and the United Kingdom, it is recommended that people exposed to the monkeypox virus be offered a modified dose of Ankara vaccine as soon as possible, ideally within four days but not later than 14 days thereafter.

Antivirals

In addition to vaccines, there are some drugs that can be used to treat chickenpox.

One such drug is tecovirimat, which stops the spread of infection by interfering with a surface protein orthopoxviruses.

Tecovirimat is approved in the United States only for the treatment of smallpox. It has been tested on healthy people and has been shown to stop the smallpox virus in the laboratory. However, it has not been tested in people with smallpox or others orthopoxviruses. Nevertheless, in Europe, tecovitimat is authorized in exceptional circumstances for the treatment of chickenpox, monkeypox and cowpox.

Another antiviral drug that can be used is cidofovir, an injectable drug licensed in the United Kingdom to treat a serious viral eye infection in people with AIDS.

In the body, cidofovir is converted to the antiviral component cidofovir diphosphate. Because cidofovir stops smallpox in the laboratory, it could be approved for emergency use in smallpox or monkeypox outbreaks.

However, cidofovir is a relatively potent drug and can damage the kidneys, so a closely related drug, brincidofovir, has been approved for the treatment of smallpox in the United States.

Brincidofovir (a brand of Tembexa) is given orally and can be prescribed to people of any age. Its special design helps get the right amount of drug into the cells to release the cidofovir component, and also does less damage to the kidneys.

Brincidofovir has been tested in humans for other viral diseases. Its approval for use in smallpox in the United States comes from laboratory studies that show that it works against orthopoxviruses. For this reason, brincidofovir is also listed as a potential drug for the treatment of monkeypox.

However, we still lack data on how effective cidofovir, brincidofovir and tecovitimat will be in treating monkeypox infections in humans. A recent study published in The Lancet Infectious Diseases examined the efficacy of brincidofovir (three patients) and tecovirimat (one patient) in monkeypox cases between 2018 and 2021 in the United Kingdom. The researchers reported poor efficacy of brincidofovir and required further tecovirimate studies in human monkeypox.

Parastou Donyai, Professor of Social and Cognitive Pharmacy, University of Reading

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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