Officials Lament Barriers to Monkeypox Treatments, Prevention

Officials Lament Barriers to Monkeypox Treatments, Prevention

Health systems are continuing to struggle with access to testing resources, vaccines, and treatments for monkeypox, according to city-level health officials.

As cases in the U.S. have passed 1,000, infectious disease doctors in New York and Miami are concerned about limited or restricted supply of both post-exposure prophylaxis — a vaccination protocol known as PEP++ — and tecovirimat (TPOXX), the antiviral drug for smallpox, to help combat the virus, they said during a press briefing on Thursday organized by the Infectious Diseases Society of America (IDSA).

“It’s really been striking to me how many of these patients have had difficulty getting the care they need to treat these symptoms,” said Mary Foote, MD, MPH, medical director of New York City’s Office of Emergency Preparedness and Response. “[They are] having to go between clinics, hospitals, urgent cares, sometimes getting referred to us much further on in the course of their illness than we’d like to see.”

Foote also noted that tecovirimat is not approved by the FDA for monkeypox, which means that clinics and physicians are required to complete extensive paperwork in order to prescribe it. She noted that this protocol, including the required forms and lab tests, can take up to 3 hours to complete for one patient, a fact that has limited the number of health systems capable of providing the drug.

“This is nearly impossible to implement,” Foote said.

She noted this limited access has meant that New York City is working to connect patients with clinics that are accepting outside referrals for tecovirimat. Currently, Foote said, only two locations accept such referrals.

“As our infection rates continue to rise, the system as it is now makes it nearly impossible to adequately scale up treatment,” Foote said.

Health systems in Miami are facing similar challenges, according to Lilian Abbo, MD, associate chief medical officer for infectious diseases at Jackson Health System. Abbo said gaining access to diagnostic testing has also been difficult, with a multistep approval process.

“It can take up to eight hours to get approval after multiple layers and phone calls, as you have to send pictures, upload them, call, get approvals from a central health department, and then go through the CDC and then once approved, then we can send the test,” Abbo said.

Foote noted that cases in New York City have nearly tripled in the past week. Cases are still primarily occurring in men who had sex with men at this time, she said. She also cautioned that the current counts are not “reflective of the true burden of disease.”

“We certainly believe there are a lot of cases that are not being diagnosed,” she said.

Foote also observed that while mortality rates still appear to be very low, the rate of morbidity is “much higher than any of us expected here in New York City.” Monkeypox is typically considered a mild and self-limiting infection, but that does not seem to be the case with this outbreak.

“The reality on the ground is that a lot of people with this infection are really suffering and some actually may be at risk of permanent damage and scarring,” Foote said. “We’ve seen many people with symptoms that are so severe that they are unable to go to the bathroom, urinate, or eat without excruciating pain.”

She added that some patients are experiencing severe proctitis and ulcers and inflammation in the anal-rectal area and in the urethra. Scarring in these tissues may ultimately diminish normal function, she said. Large lesions may also lead to severe facial deformities.

“It is so urgent, for those of us that are responding to this outbreak, to have the tools and flexibility to do our jobs,” Foote said. “That includes being able to quickly vaccinate people at high risk to prevent disease and — for those already infected — we need to be able to offer treatment and compassionate care for any patient who needs it.”

  • Michael DePeau-Wilson is a reporter on MedPage Today‚Äôs enterprise & investigative team. He covers psychiatry, long covid, and infectious diseases, among other relevant U.S. clinical news. Follow

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