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Monday, November 11, 2024

Opinion

The U.S. could soon face a threat ‘more powerful’ than nuclear weapons

Researchers around the globe are tinkering with viruses far deadlier than covid-19.



Monkeypox mutation, a variant of smallpox. (Getty Images/iStock)

By Ashish K. Jha, Matt Pottinger and Matthew McKnight
THE CONVERSATION
November 11, 2024

President Richard M. Nixon’s bold 1969 decision to renounce biological weapons and spearhead a treaty to ban them helped contain the threat of a man-made pandemic for half a century.

But our inheritance from Nixon is now fading. And in this age of synthetic biology, unless we act quickly to deter our adversaries from making and using bioweapons, we could face disaster in the near future.



The nightmare of a biological holocaust is far from fanciful. A recent Post investigation showcased Russia’s reopening and expansion of a military and laboratory complex outside Moscow that was used during the Cold War to weaponize viruses that cause smallpox, Ebola and other diseases. In China, senior military officers have been writing for years about the potential benefits of offensive biological warfare. One prominent colonel termed it a “more powerful and more civilized” method of mass killing than nuclear weapons. An authoritative People’s Liberation Army textbook discusses the potential for “specific ethnic genetic attacks.”





At the same time, breakthroughs in gene-editing technology and artificial intelligence have made the manipulation and production of deadly viruses and bacteria easier than ever, for state and non-state actors alike. The 2019 outbreak of covid-19 in Wuhan, China, which might have involved an accidental leak of an artificially enhanced coronavirus, offers a sense of the stakes: Some 27 million people have died as a direct or indirect result of that virus. And researchers around the globe — civilian and military — are tinkering with viruses far deadlier than that one.
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The question is: How do we achieve bioweapons deterrence?



Treaties and conventions alone cannot solve this problem. Nor are nuclear deterrence models quite up to the task. The prospect of mutually assured destruction is unlikely to inhibit death-obsessed terrorists who have a better shot at acquiring bioweapons than nuclear weapons. Dictatorships might be tempted to unleash a bioweapon if they are confident the nations they target would struggle to pinpoint the source of the attack — and if the attackers believe they can do more damage to their enemies than to their own population. They might, for example, covertly vaccinate their people before launching an attack. Or they might succeed in developing pathogens capable of disproportionately affecting specific ethnic groups, as envisioned by Chinese generals.





The Cold War nonetheless offers useful lessons for democracies that have chosen to forgo bioweapons. Foremost is the importance of superior intelligence gathering and analysis. For deterrence to work, Washington and its allies must have a robust, pervasive system for tracking and, where possible, eliminating highly dangerous research around the world. This surveillance system must also harness cutting-edge technologies to quickly detect newly emergent pathogens, gauge their threat level and reliably pinpoint their source — whether natural or engineered.

Our current antiquated warning system depends heavily on foreign governments alerting U.S. health officials after cases of an unusual illness have begun to appear in clinics and hospitals. By then, it is sometimes too late to head off an epidemic, even where governments are competent, conscientious and transparent. Where governments are malign, callous and opaque, the results can be far worse. China, for example, deliberately concealed from other governments and the World Health Organization that covid-19 was highly transmissible, even by asymptomatic patients. Beijing also blocked all serious efforts to investigate the origin of the novel coronavirus.

This is why biological surveillance, detection and attribution must become a core national security function, and not merely a public health activity, of the United States and friendly nations. Congress, working in consultation with the Defense Department and the Office of the Director of National Intelligence, should immediately establish and fund a new intelligence discipline: biological intelligence, or BIOINT, to mobilize allied governments and private companies to detect and assess high-risk scientific research and incipient biological threats.

The history of the U.S. nuclear forensics program provides a rough template. Fearing Nazi Germany’s potential to develop an atomic weapon, scientists affiliated with the Manhattan Project arranged in 1943 for the United States to scoop up German air and water samples to test whether that country was operating a nuclear reactor. A Cold War successor program equipped U.S. aircraft to sniff out radioactive particles over the Pacific Ocean, providing Washington with hard evidence that the Soviets had tested their first atomic bomb in 1949.

Nuclear intelligence, or NUCINT (a term that eventually gave way to a broader discipline called “measurement and signature intelligence,” or MASINT), was further refined to forensically discern the origin of nuclear materials used in bombs. The United States and its allies compiled databases of radiochemical and environmental signatures unique to individual uranium mines and processing facilities. The idea was to deter the covert sale of nuclear weapons by demonstrating that Washington could credibly trace the origin of a weapon even after detonation.

Similar experimental projects are underway today in the realm of biology. The United States has funded pilot programs to conduct environmental sampling and genetic testing of air and wastewater from laboratories, ships, military bases, embassies and key transportation hubs such as airports in several countries. (Full disclosure: Matthew McKnight, a writer on this op-ed, works at Ginkgo Bioworks, which has U.S. government contracts to conduct some of this work.) When combined with anonymized data from hospitals and pharmacies, a biological mosaic begins to emerge, providing analysts with a baseline of “normalcy” against which new biothreats can be quickly detected.

Techniques of molecular forensics mean a newly detected pathogen can also be sequenced and analyzed to determine whether it occurred naturally or through the machinations of scientists. As data libraries grow and AI models improve, analysts will become far less likely to be stumped by the origins of a new disease such as covid-19.

The main impediment to expanding and improving nascent U.S. BIOINT efforts isn’t technology but resolve. Congress recently watered down the Biden administration’s latest budget request for pandemic prevention. The “biosurveillance” network prescribed by the Pentagon’s 2023 Biodefense Posture Review also remains underfunded.

To be sure, effective BIOINT won’t by itself deter our adversaries. The United States must also show that it has the will to impose steep costs on those that pursue, much less employ, bioweapons. We must also learn how to respond to pandemics with vastly greater speed and dexterity than during the coronavirus pandemic. We must improve on the success of Operation Warp Speed, the public-private partnership that delivered coronavirus vaccines in record time, and replicate that model to mass-produce rapid tests, protective equipment and therapeutics quickly enough to mitigate the death and disruption that could be caused by a biological attack.

Yet these elements of deterrence won’t work unless they are underpinned first by world-class BIOINT. By proactively investing in robust biosurveillance, attribution capabilities and rapid countermeasure development, Washington and its allies can safeguard the promise of the life sciences revolution and ensure that biotechnology remains a force for good, not a new frontier of global catastrophe.



Ashish K. Jha, dean of the Brown University School of Public Health, was a White House covid-19 response coordinator in the Biden administration. Matt Pottinger, deputy national security adviser in the Trump administration, is chief executive of the geopolitical research firm Garnaut Global. Matthew McKnight is the head of biosecurity at Ginkgo Bioworks and a Belfer Center fellow at Harvard Kennedy School.

Sunday, October 06, 2024

WHO approves emergency use of first mpox test


Oct. 4, 2024 / UPI

The World Health Organization said Thursday it approved the first mpox invitro diagnostic test for emergency use. The Affinity m MPXV assay, made by Abbott Molecular, will expand global diagnostic capacity.
 FIle Photo by Chris Milosi/EPA-EFE

Oct. 4 (UPI) -- The World Health Organization said Thursday it approved the first mpox invitro diagnostic test for emergency use.

The Alinity m MPXV assay, made by Abbott Molecular, will expand diagnostic capacity for nations dealing with mpox outbreaks, the WHO said.

In Africa, WHO said, limited testing capacity and delays in confirming cases contribute to the continuing mpox spread. Approval of this test is an important step in expanding global access to mpox testing.

"This first mpox diagnostic test listed under the Emergency Use Listing procedure represents a significant milestone in expanding testing availability in affected countries," said the WHO's Dr. Yukiko Nakatani in a statement. "Increasing access to quality-assured medical products is central to our efforts in assisting countries to contain the spread of the virus and protect their people, especially in underserved regions."

According to WHO, in 2024 more than 30,000 suspected mpox cases have been reported across Africa. The highest numbers were in the Democratic Republic of the Congo, Burundi, and Nigeria.

The Alinity m MPXV assay is a real-time PCR test using swabs of skin lesions. It is approved under WHO's Emergency Use Listing procedure.
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EUL is used for vaccines, tests, and medical treatments.

"The EUL process assesses the quality, safety, and performance of essential health products, such as diagnostic tests, to guide procurement agencies and WHO Member States in making informed decisions for time-limited emergency procurement," the WHO said in a statement.

Congo finally beginsmpox vaccinations in a drive to slow outbreaks


 A health worker attends to a mpox patient, at a treatment centre in Munigi, eastern Congo, Monday, Aug. 19, 2024. (AP Photo/Moses Sawasawa, File)

 A health worker attends to an mpox patient, at a treatment center in Munigi, eastern Congo, Aug. 19, 2024. (AP Photo/Moses Sawasawa, File)

A man receives a vaccination against mpox, at the General hospital, in Goma, Democratic Republic of Congo Saturday, Oct. 5, 2024. (AP Photo/Moses Sawasawa)

A man receives a vaccination against mpox, at the General hospital, in Goma, Democratic Republic of Congo Saturday, Oct. 5, 2024. (AP Photo/Moses Sawasawa)


BY RUTH ALONGA
October 5, 2024

GOMA, Congo (AP) — Congolese authorities Saturday began vaccinations against mpox, nearly two months after the disease outbreak that spread from Congo to several African countries and beyond was declared a global emergency by the World Health Organization.

The 265,000 doses donated to Congo by the European Union and the U.S. were rolled out in the eastern city of Goma in North Kivu province, where hospitals and health workers have been overstretched, struggling to contain the new and possibly more infectious strain of mpox.

Congo, with about 30,000 suspected mpox cases and 859 deaths, accounts for more than 80% of all the cases and 99% of all the deaths reported in Africa this year. All of the Central African nation’s 26 provinces have recorded mpox cases.

Although most mpox infections and deaths recorded in Congo are in children under age 15, the doses being administered are only meant for adults and will be given to at-risk populations and front-line workers, Health Minister Roger Kamba said this week.

“Strategies have been put in place by the services in order to vaccinate all targeted personnel,” Muboyayi ChikayaI, the minister’s chief of staff, said as he kicked off the vaccination.


Rwanda begins vaccinations against mpox amid a call for more doses for Africa

WHO and Africa CDC launch a response plan to the mpox outbreak

At least 3 million doses of the vaccine approved for use in children are expected from Japan in the coming days, Kamba said.

Mpox, also known as monkeypox, had been spreading mostly undetected for years in Africabefore the disease prompted the 2022 global outbreak that saw wealthy countries quickly respond with vaccines from their stockpiles while Africa received only a few doses despite pleas from its governments.

However, unlike the global outbreak in 2022 that was overwhelmingly focused in gay and bisexual men, mpox in Africa is now being spread via sexual transmission as well as through close contact among children, pregnant women and other vulnerable groups, Dr. Dimie Ogoina, the chair of WHO’s mpox emergency committee, recently told reporters.

More than 34,000 suspected cases and 866 deaths from the virus have been recorded across 16 countries in Africa this year. That is a 200% increase compared to the same period last year, the Africa Centers for Disease Control and Prevention said.

But access to vaccines remains a challenge.

The continent of 1.4 billion people has only secured commitment for 5.9 million doses of mpox vaccines, expected to be available from October through December, Dr. Jean Kaseya, head of the Africa CDC, told reporters last week. Congo remains a priority, he said.

At the vaccination drive in Goma, Dr. Jean Bruno Ngenze, the WHO representative in the province, warned that North Kivu is at a risk of a major outbreak due to the “promiscuity observed in the camps” for displaced people, as one of the world’s biggest humanitarian crisis caused by armed violence unfolds there.

The news of the vaccination program brought relief among many in Congo, especially in hospitals that had been struggling to manage the outbreak.

“If everyone could be vaccinated, it would be even better to stop the spread of the disease,” said Dr. Musole Mulambamunva Robert, the medical director of Kavumu Hospital, one of the mpox treatment centers in eastern Congo.

Eastern Congo has been beset by conflict for years, with more than 100 armed groups vying for a foothold in the mineral-rich area near the border with Rwanda. Some have been accused of carrying out mass killings.
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Associated Press writers Jean-Yves Kamale in Kinshasa, Congo and Chinedu Asadu in Abuja, Nigeria contributed to this report.
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The Associated Press receives financial support for global health and development coverage in Africa from the Gates Foundation. The AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org


by TaboolaSuggested For You

Saturday, October 05, 2024

EXPLAINER

What is the deadly Marburg virus and where has it spread?

World Health Organization warns outbreak risk is ‘very high at the national level’ in Rwanda, but low at the global level.

A scientist checks for Marburg virus antibodies in a bat near a lead and gold mine in Kitaka inside the Kitomi forest reserve, about 300km from Uganda's capital Kampala [Christopher Black/WHO/AFP]
AL JAZEERA
Published On 5 Oct 2024

Rwanda is fighting its first outbreak of the “highly virulent” Marburg virus which was first reported in late September.

As of Thursday, 11 people were reported to have died of the virus in Rwanda. The health minister announced the country will begin clinical trials of experimental vaccines and treatments.

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What is the Marburg virus?

Marburg is from the same family as Ebola, namely the Filoviridae family (filovirus) of viruses. It has been described as more severe than Ebola.

It causes a haemorrhagic fever, which is a type of fever that can damage the walls of blood vessels, according to information from the Mayo Clinic. Other diseases which produce this type of fever include dengue and yellow fever.

According to the Mayo Clinic, a haemorrhagic fever causes internal bleeding, which can be fatal.

The virus was first identified in 1967 in a town in Germany called Marburg, from which it gained its name. Simultaneously, it was identified in Belgrade, Serbia.

The World Health Organization (WHO) estimates the case fatality rate to be between 24 and 88 percent. On average, about half of all those who contract the virus die from it.

After a person is exposed to the virus, it can take between two and 21 days for symptoms to show, according to the WHO.

“Fatal cases usually have some form of bleeding, often from multiple areas,” the website says, adding that the onset of bleeding can occur within five to seven days.

Bleeding in vomit or faeces is often accompanied by bleeding from the nose, gums and vagina, WHO’s website says.

In severe cases, death can occur eight or nine days after symptoms start to show.

“Those with weakened immune systems are more susceptible to severe illness and death from this virus,” infectious disease expert Amira Roess told Al Jazeera. Roess is a global health and epidemiology professor at George Mason University’s College of Public Health.

The Marburg virus has a ‘filamentous’ structure and is transmitted by fruit bats [Shutterstock]


What are the symptoms?

According to the Centers for Disease Control and Prevention (CDC), Marburg virus symptoms include fever, headache, muscle and joint pain, fatigue, appetite loss, bleeding and gastrointestinal symptoms.
How does the Marburg virus spread?

Some people have contracted the Marburg virus after coming in contact with Rousettus bats, a type of fruit bat found in mines and caves, that carry the virus.

The source of the Rwanda outbreak remains unclear, however

Once an individual contracts the virus, they can transmit it to others through direct contact with bodily fluids via broken skin or mucous membranes. The WHO website says even surfaces contaminated with bodily fluids, such as bedsheets or clothing, can spread the virus.

According to information from the CDC, the virus is not airborne.
What is the situation in Rwanda?

There are currently 36 confirmed cases of Marburg in Rwanda, with 25 people being cared for in isolation, according to the government’s latest update.

According to the WHO, on September 30 when there were 26 confirmed cases, 70 percent of the cases were in healthcare workers in two of the country’s healthcare facilities, which were not named.

“It’s not uncommon to see outbreaks in healthcare facilities, especially in low-resourced healthcare facilities that may not have sufficient infection control,” Roess said.

Additionally, Rwanda is monitoring 300 people who have come into contact with known cases
.
A fruit bat hangs upside-down in its cage, on July 29, 2023 when the World Health Organization said Equatorial Guinea had confirmed its first outbreak of Marburg disease [Bob Child/AP]

Where has the Marburg virus spread?

On September 27, Rwanda’s Ministry of Health confirmed the latest outbreak of the Marburg virus.

The current outbreak has only been reported in Rwanda so far.

There were fears that the virus had reached Germany when two passengers on a train from Frankfurt to Hamburg contacted doctors, fearing they had the virus.

However, local authorities announced on Thursday that both had tested negative in a polymerase chain reaction (PCR) test, where a sample from the inner cheek, called a buccal swab, or blood is tested. It tests genetic material from a specific organism, which in this case is the virus.

Small outbreaks of the virus have occurred in recent years including West Africa’s first outbreak in Guinea in 2021, Ghana’s first outbreak in 2022 and the first outbreaks in Tanzania and Equatorial Guinea in 2023.

These were quickly contained. In Equatorial Guinea, 17 confirmed and 23 probable cases were reported. “12 of the 17 confirmed cases died and all of the probable cases were reported deaths,” according to WHO. In Tanzania, there were one probable and eight confirmed cases, of which five resulted in death.

According to the CDC, in Guinea, only one case was diagnosed after the death of the patient; in Ghana, three cases emerged leading to two deaths.

“We know that an infectious disease that emerges in one area has the potential to become a problem across the globe,” Roess said.

How dangerous is the latest Marburg outbreak?

WHO has assessed the risk of this outbreak to be “very high at the national level, high at the regional level, and low at the global level”.


Is there a vaccine or treatment?

There are no approved vaccines or treatments for the virus.

Rwanda’s Minister of Health Sabin Nsanzimana, announced on Thursday that the country is racing to develop a vaccine.

The WHO said some candidate vaccines are being manufactured. These include vaccines developed by the International AIDS Vaccine Initiative (IAVI) and by the Sabin Vaccine Institute which said it is collaborating with the Rwandan government.

The team at Oxford University which formulated the AstraZeneca vaccine for COVID-19 started a trial of its Marburg vaccine candidate this summer in the United Kingdom, employing similar technology to the COVID vaccine.

The WHO told Reuters that it has released funding for vaccine trials in collaboration with the Canadian government and the European Union’s Health Emergency Preparedness and Response Authority (HERA).

Diagnosed patients should promptly seek treatment of symptoms with painkiller medication and stay well hydrated.

How can you avoid catching Marburg?

Roess said: “The best thing to do is to practise good hygiene and to limit your exposure to individuals who are sick.”

She advised wearing masks when in contact with people who have symptoms of the virus, and not sharing food with people who may be infected.

“If you think that you’ve been exposed to the virus, then limit your contact with other individuals, monitor your symptoms and report to your local healthcare worker or health ministry official,” she said.

She added that the situation is difficult with most disease outbreaks because many healthcare facilities globally do not have the resources to properly monitor how many people are infected.

“It is very important for the global community to work together to fund preventative active surveillance and other programmes. If we don’t take the seriously, more human lives will be lost.”

Why are Marburg outbreaks becoming more frequent?

In the 50 years between 1967 and 2017, 13 outbreaks were recorded.

Since 2021, five outbreaks have been recorded, indicating that the outbreaks are becoming more frequent.

Roess said we will likely continue to see outbreaks and cases rise for multiple reasons.

“First, people are coming into closer contact with wildlife everywhere in the world,” she said, adding that wildlife are adapting to contact with humans and both wildlife and humans are becoming less scared of each other.

She added that cases are rising also because of the rise of chronic conditions and immunocompromising conditions such as diabetes and heart disease. These make people more susceptible to contracting the virus.

Due to technological advancements, people with such conditions are living longer “which is great but that also means that there are more people who are now susceptible to getting sick when they are exposed to pathogens”, Roess said.

She added that the spread of the virus is more likely in places with limited healthcare infrastructure. “People will show up to seek care when they are very sick. [At which point] they may be shedding a lot of virus.” This also increases the chance of transmission.

Source: Al Jazeera

Tuesday, October 01, 2024

Deadly Marburg virus spreads in Rwanda, with no vaccine or treatment

Most of the affected are healthcare workers across six out of 30 districts in the country.

By Ignatius Ssuuna The Associated Press
Posted October 1, 2024 
A medical worker from the Infection Prevention and Control unit wearing full protective equipment prepares to enter an isolation tent housing a man being quarantined after coming into contact in Uganda with a carrier of the Marburg Virus, a hemorrhagic fever from the same family as Ebola, at the Kenyatta National Hospital in Nairobi, Kenya. 
AP Photo/Ben Curtis

Rwanda says eight people have died so far from the Ebola-like and highly contagious Marburg virus, just days after the country declared an outbreak of the deadly hemorrhagic fever that has no authorized vaccine or treatment.


Like Ebola, the Marburg virus originates in fruit bats and spreads between people through close contact with the bodily fluids of infected individuals or with surfaces, such as contaminated bed sheets. Without treatment, Marburg can be fatal in up to 88 per cent of people who fall ill with the disease.

Rwanda, a landlocked country in central Africa, declared an outbreak on Friday and a day later the first six deaths were reported.

So far 26 cases have been confirmed, and eight of the sickened people have died, Health Minister Sabin Nsanzimana said on Sunday night.

The public has been urged to avoid physical contact to help curb the spread. Some 300 people who came into contact with those confirmed to have the virus have also been identified, and an unspecified number of them have been put in isolation facilities.

Most of the affected are healthcare workers across six out of 30 districts in the country.



“Marburg is a rare disease,” Nsanzimana told journalists. “We are intensifying contact tracing and testing to help stop the spread.”

The minister said the source of the disease has not been determined yet. A person infected with the virus can take between three days and three weeks to show symptoms, he added.

Symptoms include fever, muscle pains, diarrhea, vomiting and, in some cases, death through extreme blood loss.

The World Health Organization was scaling up its support and will work with Rwandan authorities to help stop the spread, WHO’s Director-General Tedros Adhanom Ghebreyesus said on Saturday on the social media platform X.

The U.S Embassy in Rwanda’s capital of Kigali has urged its staff to work remotely and avoid visiting offices.

Marburg outbreaks and individual cases have in the past been recorded in Tanzania, Equatorial Guinea, Angola, Congo, Kenya, South Africa, Uganda and Ghana, according to the WHO.

The rare virus was first identified in 1967 after it caused simultaneous outbreaks of disease in laboratories in Marburg, Germany, and Belgrade, Serbia. Seven people died who were exposed to the virus while conducting research on monkeys.

Separately, Rwanda has so far reported six cases of mpox, a disease caused by a virus related to smallpox but that typically causes milder symptoms. Mpox, previously known as monkeypox because it was first seen in research monkeys, has also affected several other African countries in what the WHO has called a global health emergency.

Rwanda launched an mpox vaccination campaign earlier this month, and more vaccines are expected to arrive in the country. Neighboring Congo has so far reported most of the cases of mpox, the epicenter of the emergency.

Saturday, September 28, 2024

Mpox in Africa: Vaccine efforts ramp up
DW
September 27, 2024

An alarming surge in mpox cases has hit Africa, with more than 32,000 suspected infections recorded. The continent faces a critical challenge in mobilizing enough vaccine doses to curb the spread.

Mpox can spread through close contact. Usually mild, it is fatal in rare cases. It causes flu-like symptoms and pus-filled lesions on the body.Image: WHO/Aton Chile/IMAGO

Global efforts are continuing to fight the current mpox outbreak in Africa, where suspected cases have reached over 32,000 — with more than 28,000 of these in the Central Africa region, according to the Africa Centers for Disease Control and Prevention (Africa CDC).

Officials from the organization told a news briefing on Thursday that the Central Africa region accounts for over 28,000 suspected mpox cases.

The Democratic Republic of Congo (DRC) has been at the mpox epicenter where the death toll from the outbreak has now reached at least 840 since the beginning of the year, Africa CDC officials said.

"We are clearly saying that there is an increase of cases across all affected regions in Africa," Africa CDC head Dr. Jean Kaseya said.
Mpox cases in Congo are particularly deadly due to being caused by the clade 1b variantImage: Moses Sawasawa/AP Photo/picture alliance


Vaccination challenges

Kaseya said many countries are recording suspected cases, but the lack of testing means makes it difficult to include those figures in the latest updates on cases.

More than $800 million (€718 million) has been pledged for mpox response, Africa CDC said.

But vaccination programs against the infectious disease in countries badly hit have been restricted due to a lack of access to doses of vaccines.

The Africa CDC said it has so far secured some 4.3 million doses of vaccines but added that it needs over 10 million to contain the outbreak.

Danish biotech firm Bavarian Nordic on Thursday announced it has signed an agreement with the United Nations Children's Fund (UNICEF) for 1 million doses of its mpox vaccine, Jynneos, for affected countries in Africa.

It said the doses would be made available for supply before the end of this year.


Germany will donate 100,000 doses of mpox vaccine to Congo and other African nations to help contain the outbreak.

Berlin will also lend financial support to this effort, providing funding to the World Health Organization (WHO) as well as supporting partners in Africa through the Gavi Vaccine Alliance.

Government spokesman Steffen Hebestreit said Berlin's aim is "to support in solidarity the international efforts to contain mpox on the African continent."

US President Joe Biden announced that 1 million mpox vaccine doses were being donated to Africa to support the fight.

The United States is also making at least $500 million of funding available to African countries to support their response efforts.

"We must now move quickly to face mpox," Biden said.

Japan has also pledged 3 million vaccine shots, the largest number pledged so far.
Vaccine distribution to affected countries

"This week we are sending vaccines to some countries [including] Rwanda, South Africa, Burundi, CAR and Cameroon," Kaseya said.

Rwanda has already started the vaccination campaign targeted at people in high-risk areas. It was the first country in Africa to do so.

"We congratulate Rwanda for starting the campaign," Kaseya told reporters.

Congo is expected to start its vaccination campaign next month, health officials in the country said.


Meanwhile, infections are soaring among children, according to Congolese officials.

Dr. Thierry Turano, chief physician of the Nyiragongo health zone in Goma, one of the worst affected areas in eastern Congo, told DW that containing the spread of the disease has become even more difficult due to the impact of the ongoing conflict in the region.

"The area now has more than 400,000 displaced people, and from there, there is also a disengagement of some partners, unfortunately during this period of the epidemic," Turano said, adding that governmental intervention is needed to counter the spread of the mpox outbreak.

South Kivu begins vaccination drive

Meanwhile in Congo's South Kivu province, officials said the first phase of a 10-day vaccination campaign will begin on October 2.

Justin Bengehya, head of operations in the response to Monkey Pox in South Kivu told DW, vaccines are still inadequate.

"Out of the 34 health zones in the province, 32 are affected. But the vaccine order was made while there were only three health zones that were 'hotspots'."

Meanwhile several local organizations are raising awareness among the population about accepting the vaccines.

Daniel Birindwa, a member of Les Amis de la Nature (Friends of Nature) in France told DW that the mobilization of volunteers to educate people about mpox is vital for the success of the vaccination campaign.

"There is never a lack of resistance. But we are trying hard and persevering in raising awareness," said Birindwa, who added that cases of mpox have been detected among hairdressers.



The city of Bukavu is the epicenter of the mpox outbreak in South Kivu. Health officials there say they are set to help make the vaccination a success.

"Why did it drag on? I can't tell you. But I know that we were preparing everything so that these vaccines could be deployed," Dr Joseph Matundanya, coordinating doctor of the Expanded Vaccination Program (EPI) in South Kivu, told DW.

Mpox is an infectious disease caused by the monkeypox virus. It can enter the body through broken skin and through the respiratory system.

People can become infected by coming into close contact with people who have the virus — through skin-to-skin contact during kissing, hugging, sex and massages.

The infection causes a pus-filled skin rash lasting up to four weeks, which can be very painful.

Edited by: Keith Walker

Friday, September 20, 2024

 

Unnecessary isolation for mpox may be reduced by adopting testing-based protocols



Nagoya University
Unnecessary isolation for mpox may be reduced 

image: 

Unnecessary isolation for mpox may be reduced by adopting testing-based protocols

 

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Credit: Kyoko Kojima




mpox, a disease caused by the monkeypox virus, saw a significant increase in cases from mid-2022. The variant in the 2022 outbreak, named clade IIb, spread globally, primarily affecting men who have sex with men. In response, there has been a growing need for effective isolation strategies that balance public health and personal freedom.

Using individual patient data of clade IIb mpox cases, the dominant clade during the 2022 outbreak in Europe and America, a study led by researchers at Nagoya University in Japan has proposed a sophisticated modeling framework to enhance isolation protocols for mpox patients.

Their results show that the current standard practice to end isolation is effective, but implementing testing-based protocols can further reduce unnecessary isolation after the infectious period. Their findings, published in Nature Communications, may improve our response strategies and reduce patient isolation times.

“Our approach emphasizes the critical role of understanding individual variations in viral shedding dynamics to minimize both the risk of prematurely ending isolation and unnecessary prolonged isolation,” said Shingo Iwami. “Based on our results, the use of PCR testing may reduce the burden of isolation on mpox patients while preventing further transmission, especially when the number of mpox patients is increasing.”

The primary method to control the spread of mpox has been to isolate infected individuals. Current recommendations for the isolation of patients with mpox are symptom-based. The average duration of symptoms is about 3 weeks.

However, the infection period of mpox differs among patients. Some health officials are concerned that strategies based on symptoms or fixed time periods may not address this variability. Consequently, individuals being released into the community may still be infectious.  

Iwami and his colleagues aimed to refine isolation strategies by developing a modeling framework to characterize when infected individuals cease to be infectious, thus optimizing isolation protocols. They built the models using viral load in lesion samples from previous studies of mpox.

They found that the duration of viral shedding among individuals ranged from 23 to 50 days. The researchers also found greater variation in the duration of viral shedding among mpox cases that spread in Europe and the United States in 2022.

Using these data, the group compared three isolation strategies: a symptom-based rule where isolation ends when symptoms disappear; a fixed-duration rule where isolation ends after a fixed period, typically three weeks; and a testing-based rule where isolation is based on a negative test result with varying numbers and intervals of tests.

Their results showed that the fixed-duration rule provided a balance between the risk and unnecessary isolation but was less flexible. However, the testing-based rule shortened this period, depending on the number of tests and intervals. They concluded that, while the fixed-duration rule was effective, the testing-based approach offered a more tailored solution that could better match the infectious period of individuals.

“The testing-based rule proved effective in minimizing the risk of ending isolation prematurely and reducing unnecessary isolation time,” Iwami said. “According to our analysis, 63% of individuals in the analyzed population could benefit from reduced isolation periods using the testing-based rule compared to symptom-based or fixed-duration rules.”

“To maintain the risk of ending isolation early at below 5%, PCR testing optimized by our simulations could reduce isolation periods by more than a week on average compared to the general isolation rule that is based on the disappearance of symptoms,” he said. "Our simulations showed that if patients are tested at intervals of 2 to 5 days and have three to four consecutive negative results, we can safely end their isolation," he continued. “This underscores the limitations of one-size-fits-all isolation policies.”

Implementing a testing-based rule requires careful planning and resources but could be more effective in managing isolation duration and reducing the burden on isolated individuals. Public health policies could incorporate these insights into designing more flexible and responsive isolation strategies. Using detailed viral load data and sophisticated modeling, public health authorities can develop more effective isolation protocols that minimize both the risk of prematurely ending isolation and unnecessary extended isolation.

Iwami said, “Although our study was based on clade IIb data, if similar data become available for clade Ib, the variant circulating in the current growing epidemic in Africa, we believe the approach of this study would be a useful tool for planning the optimal duration of infection prevention and control.”

 

Tuesday, September 10, 2024

 

Chinese monkeypox vaccine gets green light for clinical trials

By Wang Xiaoyu | chinadaily.com.cn | Updated: 2024-09-09 


Test tubes labelled "Monkeypox virus positive and negative" are seen in this illustration
 taken May 23, 2022. [Photo/Agencies]

A domestic monkeypox vaccine candidate developed by Chinese drugmaker Sinopharm received clearance from the top drug regulator for clinical trials on Monday, representing the nation's first experimental dose to win the trial approval, said the company.

The vaccine candidate is created by Shanghai Institute of Biological Products administered by Sinopharm and is expected to play an important role in preventing and controlling monkeypox infections, said the company in a statement released on Monday afternoon.

In China, a vaccine candidate typically goes through three phases of clinical trials before gaining a market approval. The process can take years and even decades, but the National Medical products Administration, China's top drug regulator, has launched a number of accelerated or streamlined channels to facilitate applications of novel drugs and vaccines or those in urgent need.

According to the company, the new drug is a replication-deficient vaccine based on a strain called MVA. The description is the same as Jynneos, the world's first monkeypox vaccine approved by the Food and Drug Administration in the United States in 2019.

The company said it has accumulated rich data on the vaccine's safety and efficacy through preclinical studies and production methods for the vaccine are deemed reliable and stable.

"In nonhuman primate models, the vaccine can generate good immune protection against monkeypox virus," it said.

There is currently no approved monkeypox vaccine in China. Globally, a few vaccines have been approved in the United States, Canada, the European Union, Japan and Russia.

The World Health Organization said on Aug 14 that the monkeypox outbreak in Africa constitutes a public health emergency of international concern — its highest form of alert.

Previously in July 2022, the WHO declared a global emergency but then lifted in May 2023 because of a sustained decline in international cases.

So far, more than 120 countries and regions across the world have reported over 100,000 confirmed infections and 226 related deaths.

China classified monkeypox as a Class B infectious disease — on par with COVID-19 and AIDS — in September of last year.

The nation reported the first imported case in September 2022 and the first domestic case in June 2023.

As of the end of July, China reported 2,567 confirmed cases.

Monday, September 02, 2024


Mpox in the Democratic Republic of Congo: Children are at high risk—health expert explains why


Mpox in the DRC: children are at high risk—health expert explains why
A one-month-old baby at an mpox isolation unit in South Kivu province, DRC. 
Credit: UNICEF

The World Health Organization (WHO) has warned that children, pregnant women and people with weak immune systems are at higher risk from the mpox outbreak in the Democratic Republic of Congo. Reports confirm that children under 5 account for 39% of all cases in the country, and babies as young as 2 weeks are being diagnosed with this viral illness.

Nadia Adjoa Sam-Agudu, an expert in pediatric , explains how  can be dangerous for children and what must be done to protect them.

Why is the DRC outbreak affecting children so badly?

Because of conflict,  and insecurity, large parts of the DRC have not had stable, consistent, sustained health responses or health prevention. As a result, it's hard to control infectious diseases like mpox.

In addition, children in any outbreak setting are already vulnerable given their immature and still-developing immune systems, especially under the age of 5.

In a paper on pediatric mpox, my colleagues and I reported that children in Africa were much more vulnerable to monkeypox virus infection than children elsewhere. About 2% of those infected globally were under the age of 18 years, while children in Africa constituted nearly 40% of cases.

These statistics are due to a combination of things: living in a country where mpox is consistently present (endemic), exposure through contact with animals, and not having the benefit of a vaccine. Smallpox vaccine is effective against mpox, but this was discontinued in 1980 after smallpox was eradicated, so anyone born after that in DRC or other African countries has not been vaccinated against mpox. This is still true, even after the global outbreak.

The new variant circulating in the DRC—Clade Ib—has genetic changes that have been linked to sustained human-to-human transmission, which is thought to be driving the current outbreaks in the DRC and east Africa. Furthermore, current WHO reports indicate that Clade Ib is also linked to sexual contact and is affecting mostly adults, especially men who have sex with men and sex workers.

It is Clade Ia, the previously known circulating virus, which is significantly affecting children. Of course, adolescents (those between 10 and 19 years) may be caught in the middle and represented in the case numbers for both Clade Ia and Ib.

But it's important to note that children have been susceptible to mpox since the first ever reported case in the DRC in 1970. That particular case was a 9-month-old boy.

In those days, animal-to-human contact was a more common means of mpox transmission—after all, it is a zoonotic disease. Studies and reports suggest that, historically, children were more susceptible to mpox because of higher exposure to wild animals, for example, different species of monkeys and rodents in rural and forest areas.

Is this unusual? Are there other diseases that children are more susceptible to?

No, it's not unusual.

Children are born with immune systems that are still developing.

It's when they get to around five years of age that they have had enough time and disease exposure (or vaccines) to make their immune systems more robust and build adequate immune protection.

Children in the DRC are particularly vulnerable to  because the country has quite low child vaccination rates. In 2021, approximately 19.1% of children in the DRC between 12 and 23 months had never been vaccinated for diseases such as pertussis (whooping cough); the ideal vaccine coverage is 95%.

This also means that children in the DRC are more susceptible to highly contagious and dangerous diseases, like measles. An outbreak or rise in cases of measles infection is an early indicator that a health system is broken. This is because measles control needs a very high level of herd immunity—when enough people in a population are immune to a disease, making it harder for the disease to spread to those who aren't immune. Once immunization levels drop—like in the setting of conflict or other humanitarian emergency—measles infections start popping up. Containing them requires immense catch-up vaccination efforts.

Chickenpox and malaria are other diseases that children are more susceptible to on account of their immature and still-developing immune systems.

What are the priorities to protect children in this outbreak?

First, children must be specifically targeted for protection. This is because they are a primary population of concern that can develop severe and fatal disease.

Second, the health system and health care workers must make it as easy as possible to get parents or caregivers to bring children in. This includes addressing the inconveniences of leaving their communities to seek care.

Third, the stigma connected to mpox must be addressed. Parents and caregivers may be reluctant to seek care because of the stigma and negative treatment they may receive. The skin lesions are quite noticeable for mpox and unfortunately draw negative attention and treatment by society and health workers. The media, including international media, have been feeding into this—especially for African people with mpox—and it needs to stop.

Finally, a vaccination program focused on children needs to be rolled out to stem transmission. But there are major challenges.

First, the mpox vaccine approved for use by the WHO and in most countries with access during the global 2022 outbreak and to date is the MVA-BN vaccine (Jynneos), which is not approved for children under 18 years. MVA-BN makes up the vast majority of ongoing vaccine donations to African countries. Japan's LC16 vaccine has been used for children as young as 1–7 years, but it may require approvals for use or trials among children outside Japan.

In addition, children urgently need routine vaccines to protect them from other diseases such as measles, chickenpox, meningitis or polio. This will ensure that they aren't struck by multiple illnesses while they are still highly vulnerable. It gives their immune system a better chance at fighting mpox.

What steps should be taken if a child is infected with mpox?

This may be hard to do, especially in the home, but the child should be isolated to minimize human to human transmission. There has been some promise of drugs that directly treat mpox infection, but recent results from tecovirimat and Clade I mpox have been disappointing.

The next step is to treat the symptoms and prevent complications. The most common manifestations in pediatric mpox are rash, fever and enlarged lymph nodes, and the most common cause of complications is secondary bacterial infection.

It's particularly important that  are managed to prevent secondary infection. The danger is in mpox lesion infection. If left unmanaged, the infection can develop into sepsis. This is a potentially fatal bloodstream infection that can affect the function of one or more organs. The reports of mortality among children in the DRC are usually sepsis. Proper wound care and antibiotics are important preventive tools.

In parallel to this, steps must be taken to help improve the overall health and well-being of the child. For instance, if the child is malnourished, they need age-appropriate therapeutic nutrition so that they are better able to fight mpox and other infections.

Children in mpox-endemic African countries are facing outbreaks with little to no access to pediatric vaccines and effective antiviral treatments. In this context, the most important things are nutrition, completion of routine immunizations, and prevention of secondary infection. This requires convenient access to stigma-free, evidence-based care and support for children and their parents or caregivers.

Provided by The Conversation 

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


Congo says it will receive its first mpox vaccines next week to address new global emergency

Sunday, September 01, 2024

 

Posts falsely linking AstraZeneca Covid vaccine to mpox resurface after recent surge

AstraZeneca's Covid-19 vaccine does not contain mpox, contrary to posts shared worldwide that have falsely linked the jab to the recent surge in cases of the viral disease. The posts have misrepresented the AstraZeneca vaccine's chimpanzee adenovirus component, which according to scientists is an "entirely different" virus from mpox and had been weakened so it does not cause disease in humans.

"Do not believe in MPOX," read part of a Tagalog-language Facebook post on August 26, 2024. It included an image showing a list of ingredients for the AstraZeneca Covid-19 vaccine, with "chimpanzee adenovirus" vector highlighted.

"THE ASTRA ZENECA JAB CONTAINED MONKEY POX. WAKE UP VAXXERS!" said text overlaid to the image.

Image
Screenshot of the false post taken August 26, 2024

Formerly known as monkeypox, mpox is a viral disease transmitted from animals to humans that can also be passed from human to human, causing fever, muscle pain and skin lesions.

Its resurgence and the detection in Central Africa of a new strain, dubbed Clade 1b, prompted the World Health Organization to declare its highest international alert level on August 14 (archived link).

Similar posts linking the AstraZeneca Covid-19 vaccine to mpox have also been shared by other social media users in the Philippines as well as in AustraliaSouth Korea, the United States and Brazil.

AFP has previously debunked a similar false claim that had circulated in 2022.

The claim "appears to stem from the idea that chimpanzees are broadly referred to as monkeys, but this is a very ignorant rumour with no basis in fact", Professor Yoo Jin-hong, an epidemiologist at the Catholic University of Korea, told AFP at the time (archived link).

The disease was earlier given the name monkeypox because it was first discovered in a group of macaques in 1958 that were being studied for research purposes but scientists say rodents are the most likely natural reservoir.

The first human case was reported in the Democratic Republic of the Congo in 1970, long predating Covid vaccines (archived link).

'Biologically impossible'

Jose Luiz Modena, a virology professor at Brazil's State University of Campinas, told AFP on August 21, 2024 that mpox and the chimpanzee adenovirus used in the AstraZeneca vaccine have "entirely different origins, evolutionary histories, viral particle complexities, and replication mechanisms".

It is therefore "biologically impossible" for the said vaccine to cause mpox, he said.

Giliane Trindade, a microbiology professor and researcher at Brazil's Federal University of Minas Gerais, separately told AFP the chimpanzee adenovirus component in the AstraZeneca vaccine could not mutate into the virus that causes mpox.

"Mutations do not transform one virus into another. Mutations can lead to differences within the same virus, but not transform it into another already existing virus on the planet," he said on August 19.

Moreover, the vaccine's adenovirus component does not cause disease in humans, according to Oxford University which co-developed the jab (archived link). 

"It has been genetically changed so that it is impossible for it to grow in humans," the vaccine's information page said.

The modified adenovirus is used as a vaccine vector to transport genetic instructions to the body to trigger the production of a spike protein similar to that of the virus that causes Covid-19. This then prompts an immune response so the body can fight a real infection.

Covid-19 vaccines are frequently targeted by misinformation, despite health authorities saying that billions of people worldwide have been safely vaccinated against the disease.

AFP has also debunked false claims swirling around mpox.