Smallpox test shows US learned little from COVID-19

USA test for monkey pox Infectious disease experts and advocates fear the slow response to the outbreak has already been insufficient to determine how widespread the virus is and how new cases are occurring, according to infectious disease experts and advocates. 32 countries.

While government labs have the capacity to test 8,000 samples per week, they use only 2% of that capacity, suggesting that around 23 monkeypox tests are being performed each day. James Krellenstein, co-founder of PrEP4All, an HIV advocacy group that has broadened its focus during the pandemic. He said: “Further testing is needed to find out where the pathogen is and how fast it is traveling.

Commonly found in African countries, where most human cases are transmitted from infected animals, monkeypox has been spread by close contact, mainly among men of close contact. same-sex sex. While it’s not moving as quickly as COVID-19, more than 1,600 cases have been reported globally since health officials began tracking it last month, including 72 in the US as of Monday. Three. This situation echoes the early days of COVID-19, when faulty tests by the Centers for Disease Control and Prevention allowed the pandemic to spread undetected in the US, Krellenstein said.

“That has to do with the CDC not promoting this on its own, especially after COVID,” he said in an interview. “This is a critical phase: Outbreaks become more difficult to control as time goes on.”

How many viruses are there?

Monkeypox is diagnosed in designated public health laboratories using a Food and Drug Administration-approved molecular test, known as PCR, that recognizes genetic material of viruses. Currently, all tests run through a government lab network, which experts say is cumbersome, leading to potential delays in identifying new cases and the risk of missing infections. spread in the wider community.

Testing is so limited that it is impossible to know how much of the virus circulating in the United States is being detected. Ranu Dhillon, an infectious disease physician at Harvard Medical School and Brigham and Women’s Hospital in Boston. It could be 90% or just 10%, he said.

“The challenge of scaling up and decentralizing testing in response to outbreaks with widespread, unknown chains of transmission is not new,” said Dhillon. “It’s been a common theme in many recent outbreaks,” including Ebola, Zika virus and of course, COVID.

Read more: There is a smallpox vaccine for monkeys. But not everyone may need it

Experts call for decentralization of testing and support for expanding laboratories and hospitals capable of doing PCR testing, especially in places like sexual health clinics where smallpox patients are high. monkey.

“We absolutely need to make sure that every hospital that has a lab — a molecular virology lab — can test their patients for smallpox,” he said. Michael MinaA former Harvard epidemiologist, now the chief scientific officer of eMed, which sells at-home COVID tests.

Raj Panjabi, the White House senior director of global health security and biosecurity, said on Friday that more than 300 PCR tests for monkeypox have been performed, and that number has increased by 45 % from last week. As of Monday, 556 specimens have been tested, the CDC said.

US health officials say they are working to expand testing to companies and other government labs. The CDC has published instructions online for creating primers — the DNA sequences used in PCR tests — so labs can start creating their own monkeypox test.

Expanding in stages

“We have posted instructions on our website with our test information that anyone can copy if they want to develop their own test,” Jennifer McQuiston, deputy director of the CDC’s Division of Pathogens and High Consequences Pathology. “We also know that some people just want to lift the CDC test and install it in a commercial lab, and we’re looking to help them do that.”

On Friday, the Association of Public Health Laboratories said that if the outbreak continues to evolve, it will support a “phased expansion” of monkeypox testing in the US. The FDA said it is preparing to provide a sample to allow emergency use of the molecule in the event the outbreak is declared a public health emergency.

Health technology company Becton Dickinson and Co. and Zaragosa, based in Spain CerTest Biotec said they are collaborating to develop a PCR test for smallpox in monkeys. Swiss pharmaceutical giant Roche Holding AG said it had developed three different monkeypox trials, while Abbott Laboratories said in late May that it was running one.

Testing giant Labcorp says it is “evaluating all options available to support increased testing for monkeypox,” including partnerships with the CDC, other government organizations and groups such as the American Clinical Laboratory Association. Quest Diagnostics Inc. says it does not offer smallpox testing in monkeys but is exploring options.

Congestion in the system can become a bigger problem when outbreaks flare up. High demand can create delays in test turnaround times at public health laboratories, Bryon Backenson, director of infectious diseases at the New York State Department of Health. A doctor in Washington speak on Twitter that it took him six hours to get a call to his public health lab about a suspected case of monkeypox.

“One thing we’ve learned from COVID is that testing availability is critical,” Backenson said. “Having more labs and more people capable of testing is a good thing.”

U.S. health authorities began planning for a smallpox outbreak after the September 11, 2001 attacks, and mailed anthrax spores raised concerns about biological terrorism. learn. That has helped bolster the health system against emerging diseases like monkeypox, but there are still important gaps that emerged in the early days of the pandemic.

Initial COVID control efforts have been plagued by faulty US testing kits and centralized approaches, along with regulatory hurdles. Possible CDC tests miss One of the earliest infections in the United States, experts say, leads to greater community exposure. Some testing was done in February or March 2020, although the virus was already spreading across the United States by that time.

Other practices may limit recognition of the spread of monkeypox. According to Paul Sax, an infectious disease physician at Harvard and Brigham and Women’s Hospital, most testing is currently only available to people who have the characteristic rash and are men who have sex with men or have recently traveled to the country. outside. Backenson said that most of the people examined by New York’s health department were men. Some people told PrEP4All that their doctor refused them to test for smallpox in monkeys, Krellenstein said.

Health officials say monkeypox can also be confused with some sexually transmitted diseases, such as herpes or syphilis. Some patients in New York who may have had monkeypox, Backenson said, weren’t tested because they were positive for other pathogens. CDC warning This week, doctors are recommending that patients with a rash characteristic of other infections be carefully evaluated for monkeypox, and for the possibility of other infections.

Limited testing can create a blind spot as the virus spreads to other populations. The focus on men can lead to missing infections in women or children, says Harvard’s Dhillon. The US should be over-testing for monkeypox to make sure the full extent of the outbreak is known, he said.

—With support from Jeannie Baumann

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