The Latest MPV News

• Welcome declines in MPV diagnoses obscure spikes in parts of the U.S.: As of September 16, 23,499 people had been diagnosed with MPV in the U.S. Since early August, MPV diagnoses have fallen by 40% nationally. In Georgia, one of the states most affected by MPV, new diagnoses fell by 38% in one week. However, CDC notes that new diagnoses are still on the rise in parts of the U.S. It is unclear whether trends in new diagnoses align with trends in actual infections (see story on MPV research agenda below).
• Racial and ethnic disparities in vaccination persist: Distrust of the medical and public health establishment is one of many factors contributing to low MPV vaccination rates in Black communities, according to an article in the Washington Post.  
• Various strategies are being used to improve vaccine uptake and equity: Demand for MPV vaccination is softening, leading CDC to launch a pilot project to bring vaccination to community clinics and smaller events. This project, which specifically focuses on improving access among Black and Latinx gay/bisexual men, is now accepting applications. A new analysis by the Kaiser Family Foundation finds considerable variation in state MPV vaccine eligibility requirements across the U.S.
• Questions about MPV treatment remain: Federal officials say that the MPV strain currently circulating in the U.S. is only a single mutation away from potentially rendering TPOXX ineffective as a treatment. Out of concern about the possibility of drug resistance, CDC issued guidance recommending that TPOXX, the only available treatment for MPV, be reserved for people at risk of severe complications, including people with compromised immune systems from unsuppressed HIV infection. Some HIV community advocates disagreed with the CDC’s guidelines, arguing instead that TPOXX should be made broadly available. A new NIH clinical trial has launched to evaluate the effectiveness of TPOXX for the treatment of MPV; TPOXX has been approved by the FDA for the treatment of smallpox and is believed to be effective for MPV, although no study of TPOXX’s effectiveness for MPV has previously been conducted.
• New evidence emerges about the health consequences of getting MPV: Los Angeles health officials reported the first MPV-related death confirmed in the U.S. CDC reported on two individuals in whom MPV infection was linked to neurological complications. As one CDC epidemiologist notes: “This is a reminder that this is not a mild illness. It can be quite serious.” MPV cases in North America, Latin America and Europe are experiencing symptoms that often differ from those reported among people diagnosed in African countries where MPV has long been present.
• Data gaps undermine our public health response to MPV: An extensive story by the New York Times describes the under-investment in public health and a lack of coordination on data exchange between federal, state and local health agencies. Without timely, granular data, including information on the race/ethnicity of people who are getting vaccinated, health leaders are often flying blind when trying to respond to MPV.
• Isolation after an MPV diagnosis is necessary but challenging: People who are diagnosed with MPV not only can experience considerable pain and discomfort as a result of the disease, but the need to isolate until all lesions are healed can result in a loss of income, sometimes for weeks.

What is your MPV story?
Do you have a story you’d like to share with NMAC and our wider community about MPV? Have you had MPV or have you gotten the vaccine? Are you a gay/bisexual man who is trying to reduce his risk for getting MPV? Are you a provider who is working to help gay/bisexual men of color with information and assistance in getting the services they need? We’re inviting you to make a quick video and share it with us, so that we can include it on https://monkeypoxtruth.org. Please forward your video to Communications@nmac.org.

Key research issues for the fight against MPV
Greg Millett, vice president and director of public policy for amfAR, is heartened by recent declines in new MPV diagnoses. But he cautions that we aren’t out of the woods in the effort to bring MPV under control.

Greg is especially concerned about the substantial racial and ethnic disparities in MPV diagnoses and in access to MPV testing, treatment and vaccination. Unless these trends are reversed, MPV, like HIV, could well become a chronic problem concentrated among gay/bisexual men of color. Greg says gay/bisexual men of color who have gotten vaccinated must be educated regarding the need to get their second dose. He also emphasizes the need for community education to help gay/bisexual men understand that getting a shot does not immediately make one immune to MPV, but that the vaccine takes time to protect against getting MPV.

Among gay/bisexual men of color who are living with HIV but are not virally suppressed, Greg says we are “in the midst of a viral storm. Not only are we dealing with [MPV] but we’re also dealing with COVID-19, HIV, polio and meningitis. Among HIV-positive men, we are seeing evidence that all of these things are happening at the same time.” A key action step to address this multi-faceted crisis, Greg says, is to engage men who are out of HIV care or only sporadically in care to ensure that they receive the treatment services they need. In other words, redoubling efforts to meet the 95-95-95 targets for HIV testing and treatment in the National HIV/AIDS Strategy is a critically important strategy for fighting MPV as well.

The MPV outbreak in the U.S. is still young, and Greg says there is much we still don’t know. “With surveillance, are we going to see the same lag with MPV that we saw with COVID, where testing didn’t actually reflect the amount of virus” circulating in the population? He wonders whether gay/bisexual men who have friends who have had relatively minor cases of MPV might believe that MPV testing is unnecessary and that they can soldier through an infection without seeking care.

There are also questions about the JYNNEOS vaccine that’s being used for MPV which researchers need to answer. Greg notes that the vaccine has never before been used in the field and that more research is needed to obtain a clearer understanding of the effectiveness of different ways of administering the vaccine (such as intradermal vs. subcutaneous). Focused research is also needed, he says, to understand the effect of MPV on people who are immune-compromised. Understanding how social and sexual networks affect the spread of MPV is also an important research priority.

In the U.S., MPV symptoms are strikingly different from those reported in the African countries where MPV has long been endemic. “We are not seeing as many lesions [in U.S. cases] compared to cases in Africa,” Greg notes. “In some cases, MPV is presenting more like a mosquito bite or pimple. Some people get no lesions at all but are still able to transmit [MPV].”

These differences point towards a critical area of research and underscores the need for public health vigilance. “Because this virus mutated this quickly, virologists need to be taking a good look at this. What other mutations might we expect? Are these mutations that might evade the vaccine?”