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A new framework was recently released by the World Health Organization (WHO) that will guide health authorities, communities, and other stakeholders in preventing and controlling mpox outbreaks, eliminating human-to-human transmission of the disease, and reducing spillover of the virus from animals to humans.
Mpox is a viral illness caused by the monkeypox virus (MPXV).
There are two different clades of the MPXV: clade I and clade II. Clade I outbreaks are deadlier than clade II outbreaks.
In the United States, clade II cases were reported to have a fatality rate of .002%.
A significant outbreak of the clade I virus in the Democratic Republic of the Congo (DRC) continues today, where cases have been detected for decades. Since the beginning of 2024, over 6,500 cases and 345 deaths have been reported in the DRC.
This data reflects a fatality rate of .05%.
As of May 26, 2024, most U.S. mpox cases continue to be in people who are not vaccinated or have only received one dose of the JYNNEOS® (MVA-BN®, IMVAMUNE®) vaccine. The U.S. CDC recommends that persons at risk for mpox exposure complete the 2-dose vaccination.
In the U.S., the JYNNEOS vaccine is offered at clinics and pharmacies in select cities.
The World Health Organization (WHO) today announced that UNICEF successfully delivered over 43,000 doses of the R21/Matrix-M™ malaria vaccine to Bangui, Central African Republic.
As of May 24, 2024, 122,000 additional R21 doses are scheduled for delivery, funded by Gavi, the Vaccine Alliance.
The Central African Republic, with a population of over 5 million, is the first country to receive the R21 vaccine for routine childhood immunization. This marks another step forward in preventing the disease and saving children's lives.
The WHO says that along with the earlier WHO recommendation of the RTS,S vaccine, there is now sufficient vaccine supply to scale up malaria vaccination in Africa.
Chad, Cote d'Ivoire, Democratic Republic of Congo, Mozambique, Nigeria, South Sudan, and Uganda are preparing to receive R21 shipments.
Director of UNICEF Supply Division Leila Pakkala commented in a press release, "Previous concerns about supply meeting demand are firmly behind us. Our priority is for the vaccines to reach every child at risk."
The Central African Republic has one of the highest rates of malaria incidence globally. In 2022, an estimated 1,733,000 malaria cases were reported in the country, averaging about 4747 cases a day.
The disease also claimed around 5180 lives over the year, or 14 deaths each day.
Dr. Sania Nishtar, CEO of Gavi, the Vaccine Alliance, stated, "That is what matters most – that countries, where our vaccines can be most impactful, can access them, saving thousands of lives each year and offering relief to families, communities, and entire health systems."
On October 2, 2023, the WHO recommended R21 vaccination to prevent malaria in children. R21 is a protein-based vaccine developed by the University of Oxford, using Novavax AB's Matrix-M™ adjuvant technology.
"The R21/Matrix-M™ vaccine is a vital new tool to help stop the devastating health and economic impact of malaria on nearly half of the world's population, including the tragic loss of 1,300 children every single day," said John C. Jacobs, President and Chief Executive Officer, Novavax, on May 20, 2024.
The U.S. Centers for Disease Control and Prevention (CDC) recently reported that three additional measles cases were confirmed in 2024.
As of May 23, 2024, the CDC confirmed a total of 142 measles cases were reported by 21 jurisdictions: Arizona, California, Florida, Georgia, Illinois, Indiana, Louisiana, Maryland, Michigan, Minnesota, Missouri, New Jersey, New York City, New York State, Ohio, Pennsylvania, Vermont, Virginia, Washington, West Virginia, and Wisconsin.
Recently, the city of Philadelphia reported another measles case after managing an outbreak earlier in 2024.
About 44% of these cases are in unvaccinated children under five years of age, with 63% hospitalized.
Ten measles outbreaks (3+) were reported in 2024, compared to four outbreaks in 2023.
Globally, about 50 countries have reported measles outbreaks in the past year.
The CDC says it is uncommon for someone fully vaccinated to develop measles. In 2024, the number of breakthrough infections (approximately 5%) was consistent with previous years' reports.
Two doses of MMR vaccine are 97% effective at preventing measles, and one dose is 93% effective. Measles vaccines are available at most clinics and pharmacies in the U.S.
The Inflation Reduction Act (IRA) eliminated cost sharing for vaccines covered by Part D beginning in January 2023 to improve the affordability of vaccines for Medicare beneficiaries.
To help determine if the impact matches the IRA's intent, a team led by Dima Qato—Hygeia Centennial Chair and Associate Professor at the USC Mann School of Pharmacy and Pharmaceutical Sciences—evaluated the policy removing patient out-of-pocket costs for the uptake of shingles vaccinations, the most commonly administered vaccine covered by Part D.
A Research Letter published by the JAMA Network evaluated the association of this zero cost-sharing policy on the use of shingles vaccinations, which account for more than 90% of Part D vaccinations.
Following the implementation of the new policy, total Part D shingles vaccinations dispensed increased by 46%.
Between January 2022 and December 2023, 16.3 million shingles vaccines (8.3 million to individuals with Part D and 8 million to those with commercial insurance) were dispensed at retail pharmacies.
These researchers wrote, 'The implementation of the IRA policy eliminating out-of-pocket costs for Part D–covered vaccinations was associated with substantial increases in shingles vaccinations dispensed to Part D enrollees compared with commercially insured individuals at retail pharmacies.'
"Policy matters," said Qato in a press release on May 23, 2024, who also directs the Mann School's Program on Medicines and Public Health and is a senior fellow at the USC Schaeffer Center for Health Policy & Economics. "And when these policies eliminate the costs, they remove barriers in accessing essential medications and preventive services, including vaccinations."
Recently, a long-term study revealed that the leading shingles vaccine delivers extensive value.
In April 2024, GSK plc announced that data from a long-term follow-up phase III trial showed that the Shingrix® vaccine, also known as Recombinant Zoster Vaccine, remained effective against shingles for more than a decade in adults over 50.
As of May 24, 2024, the Shingrix vaccine is available at most pharmacies in the U.S.
According to the U.S. CDC's MMWR 73(20);460–466, JYNNEOS® (MVA-BN®, IMVAMUNE®) vaccination does prevent mpox; however, infection in fully vaccinated persons can occur.
On May 23, 2024, the CDC disclosed that mpox virus infection after receipt of two JYNNEOS doses is estimated to have occurred in <1% of fully vaccinated persons.
Among persons who experienced infection after having received a complete 2-dose series and for whom complete data were available, mpox infections have been milder than those among unvaccinated persons.
In 2024, mpox cases have been reported in urban centers such as New York City, which confirmed 42 mpox cases from April 7, 2024, to May 4, 2024.
The CDC says that to optimize protection, persons recommended to receive mpox vaccination should complete Bavarian Nordic's JYNNEOS vaccination series. Estimates suggest that about two million U.S. individuals are eligible for mpox vaccination.
Furthermore, the CDC does not recommend additional vaccine doses at this time.
Regarding the current clade 1 mpox outbreak in Africa, on March 14, 2024, Agam Rao, MD CAPT, US Public Health Service, stated, 'JYNNEOS vaccination is expected to be effective regardless of mpox clade.
Since the global mpox outbreak began in May 2022, cases have continued to occur in the United States in 2024.
According to the U.S. CDC's Notes from the Field published on May 23, 2024, after the peak in late 2022, mpox cases declined sharply and remained significantly lower, about 59 cases per week from October 2023 to April 30, 2024.
Most mpox cases in the U.S. are reported in urban centers.
In New York City, there have been 42 mpox cases from April 7, 2024, to May 4, 2024.
The CDC says most new mpox cases occur in unvaccinated persons. However, vaccine breakthrough cases have been confirmed.
Since October 2023, five people have died from mpox infection.
CDC recommends that persons at risk for mpox exposure who have not previously recovered from mpox complete the 2-dose JYNNEOS® (MVA-BN®, IMVAMUNE®) vaccination.
A meta-analysis of 16 studies published on April 26, 2024, revealed that the JYNNEOS vaccine effectiveness (VE) for one pre-exposure prophylactic vaccination ranged from 35% to 86%, and VE ranged from 66% to 90% (n=5) for two doses.
Bavarian Nordic's JYNNEOS was co-developed with the U.S. Government (BARDA, BioShield) to ensure adult populations can be protected from smallpox.
As of May 2024, healthcare providers in the U.S. can order JYNNEOS through their preferred wholesaler and distribution partners.
