NIH experts review monkeypox challenges

Lessons learned from the public health responses to the HIV and COVID-19 pandemics should help guide the response to the current outbreak of monkeypox, National Institutes of Health experts write in an editorial published today in the New England Journal of Medicine. Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), and H. Clifford Lane, M.D., NIAID deputy director for clinical research and special projects, discuss a published case series (JP Thornhill et al.) detailing the symptoms and outcomes of 528 people with monkeypox from 16 countries in five continents.

The authors note that the epidemiologic pattern of the multi-continent outbreak of monkeypox resembles that of the early cases of AIDS in that most cases are among men who have sex with men. They caution, however, that it should not be assumed that cases of monkeypox will remain confined to this population. Monkeypox virus has been known to spread from direct lesion-to-skin contact—in prior outbreaks, such spread was often from an infected child to a caregiver. Data suggest that sexual transmission likely plays a role in the current outbreak, the authors note. They call for detailed observational studies, serosurveys and ongoing surveillance to learn more about the epidemiology of the current outbreak.

Drs. Fauci and Lane also compare monkeypox, HIV/AIDS and COVID-19 regarding the causes of each disease and the countermeasures available to fight them. Fortunately, diagnostics, vaccines and treatments for monkeypox already exist. A challenge for the public health and research communities is ensuring equitable, efficient distribution of these existing countermeasures while simultaneously conducting rigorous clinical research to gather more data on their safety and optimal use, they conclude.