The lack of available doses in Spain of the vaccine from the Bavarian Nordic company against traditional smallpox, the only one approved in Europe and which is also effective against monkey pox, has led the experts from the Ministry of Health’s Vaccine Conference to propose a restrictive use of the 200 units that Spain has managed to acquire from a third country not made public. This is stated in the document presented on Tuesday to the Public Health Commission, which will hold a new meeting today, Thursday, in which it will presumably approve the proposal.
Experts propose two scenarios depending on the availability of doses pending completion of the joint purchase through the European Commission, which will allow Spain to access more roads in the coming weeks. The first, which will be applied shortly, plans to offer vaccination only to close “high-risk” contacts, as confirmed by health sources and the magazine has advanced. Medical Writing. These are “people with immunosuppression, including HIV infection” with T-lymphocyte levels below 200. Health and laboratory personnel who have been in close contact with an infected person or their samples without personal protective equipment (PPE) or has had any incidence in its use.
In the second scenario, with greater availability of doses, vaccination will later be offered to all close contacts, which Health defines as those people who have been less than a meter away from a positive case in a closed room, especially ” cohabitants, health personnel who have treated the patient and contacts in the workplace and social”. Those responsible for contact tracing must place “particular emphasis on collecting information on people who may have had sexual relations” with the patient.
Close contact will also be considered to be those people who have had direct contact with clothes or other objects used by a confirmed case during the infectious period. This includes “from the moment of appearance of the first symptoms [fiebre, dolores, cansancio…]which usually precedes the appearance of the rash between one and five days”, until the fall of the dry crusts that follow the pustules that develop on the skin.
The proposal of the Vaccine Conference comes at a time when confirmed cases continue to grow at a sustained rate when three weeks have elapsed since the detection of the first cases in Spain. Health has reported eight new diagnoses this Wednesday, up to a total of 233. The real confirmed cases are more (Madrid has notified 250 and there are thirty in other communities), since those offered by Health have to wait for confirmation from the Center National Microbiology.
“Vaccinate between two and four positive contacts”
The monkeypox virus requires close contact with skin rash wounds, body fluids, or large droplets of saliva to be transmitted, so contagion from a person during normal daily activities is very difficult.
The Community of Madrid, which has about 90% of the cases detected in Spain, calculates that “it would be convenient to vaccinate between two and four positive contacts”, which would raise the needs of the region to between 500 and 1,000 doses, many more than Spain has available. The vaccine is used after a person has been exposed to the virus. If it is administered in the first four days, it is possible to prevent the development of the disease, although if it is done later (up to 13 days) the symptoms suffered by the patient are milder. Monkeypox has a long incubation period, usually six to 14 days, although it can be as long as 21. This means that the vast majority of contacts of confirmed cases could still benefit from its use.
A Community spokesperson explained that “the epidemic curve, according to the date of onset of symptoms, marked a maximum peak between May 13 and 15.” From then on, Madrid continues “diagnosing cases in a sustained manner, a stable number, which indicates that there are sources of exposure (probably cases with few undiagnosed symptoms) that transmit monkeypox”-
The European Commission reported this Wednesday that it is still processing the joint purchase of the Bavarian Nordic vaccines, which admits having received an avalanche of requests from the affected countries and assures that it is trying to increase its production.
Countries like the United Kingdom and France, which had vaccines before the outbreak, have opted for now to offer the vaccine to all close contacts, although they are finding that not everyone decides to get it. A recent study revealed that “only 69% of exposed health workers (169 of 245) and 14% (15 of 107) of contacts had accepted the possibility of being vaccinated on May 24”.
The United Kingdom is, ahead of Spain, the country most affected by the outbreak, with 321 confirmed cases. They are followed by Portugal (191), Germany (113) and Canada (101). The World Health Organization (WHO) reported on Wednesday that governments have reported more than 1,000 confirmed cases, in what is the largest outbreak ever recorded outside the endemic countries of West and Central Africa. The general director of the organization, Tedros Adhanom Ghebreyesus, has warned that the “community transmission [del virus] is already underway” in some countries.
Antoni Trilla, head of the preventive medicine service at the Hospital Clínic (Barcelona), considers that “the urgent thing is to vaccinate immunosuppressed contacts, who are the ones at greatest risk”. “Fortunately, we are seeing that the confirmed cases so far are now mild and there are hardly any infections outside of risky practices. This gives us some time to make good use of available vaccines, but efforts in contact tracing, rapid case identification, and isolation enforcement must be redoubled to contain the outbreak,” he explains.
Jesús Rodríguez Baño, head of the infectious diseases service at the Virgen de la Macarena Hospital (Seville), considers that “having sufficient doses of the vaccine is convenient to be prepared for future events, although for now the fact that it is not available is reassuring. there are only secondary cases [contagios a partir de uno confirmado]which rules out that the virus has mutated and is more transmissible than we knew”.
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