Monkeypox cases on the rise, Tobacco quit attempts, and COVID-19 updates
August 5, 2022
Monkeypox cases continue to rise
The Centers for Disease Control and Prevention (CDC) reports that as of August 3 there are 6327 cases of monkeypox in the US; globally, there are over 25,000 cases. (Note - global over 41,000 and US over 14,000 as of 8/21.) See OurWorld in Data.
Large case series have been published in the New England Journal of Medicine and BMJ. These show that the overwhelming majority of cases continue to be in men who have sex with men, and the transmission is largely through close skin-on-skin contact, which is sometimes, but not always, associated with sex. It doesn’t appear that monkeypox is spread easily from respiratory secretions or surfaces like countertops or toilet seats, but the virus can be found in the air and on these surfaces. The US has reported the first cases of monkeypox among children, and the disease could spread in daycare settings. The US has also reported the first case of monkeypox in pregnancy. Those who are immunocompromised or pregnant are at highest risk from complications, and monkeypox has been associated with pregnancy loss.
Implications for employers:
- The risk of occupational transmission of monkeypox is very low, although employers should be prepared for how to address exposures if an employee is diagnosed with monkeypox or if someone had an exposure in the community.
- The Jynneos vaccine for smallpox and monkeypox is in very short supply and is being distributed through state and local health departments. Employers will not be able to offer monkeypox vaccination at onsite events.
- The Jynneos vaccine and available antiviral medications are distributed by the federal government through state and local health departments, so the only cost employers bear at this point is administrative fees.
COVID-19 boosters and Paxlovid rebound
- Second COVID-19 boosters:
- The US says it will offer vaccination targeted at variants next month - substantially earlier than we expected based on previous statements from Moderna and Pfizer.
- A study of almost 30,000 health care workers in Israel showed that second boosters decreased COVID-19 infection rates among those vaccinated by 65%. This provides strong evidence for second booster shots.
- Paxlovid rebound
- Paxlovid is highly effective at preventing hospitalization and death in high risk patients with COVID-19, but the initial studies were performed in unvaccinated patients. Many high profile patients, including President Joe Biden and Dr. Anthony Fauci, have reported rebound positive COVID-19 rapid antigen tests after they completed courses of Paxlovid.
- Mayo Clinic reported that rate of rebound infections in almost 500 high risk patients treated with Paxlovid and found that the rebound rate was <1%. Most of these patients (93%) were vaccinated.
- Paxlovid is available from the federal government at no cost, and PBMs may charge a small administration fee. My personal experience was that I had a terrible taste in my mouth for the entire five days but no other adverse effects.
- A preprint showed that the rebound of virus was 12% among those who did not take Paxlovid.
Tobacco cessation attempts decline
Researchers from the American Cancer Society reported that the proportion of smokers that tried to quit in 2020 has decreased compared to previous years. The researchers used data from the Behavioral Risk Factor Surveillance System, which surveys over 750,000 smokers annually. Researchers also found that over-the-counter sales of tobacco cessation aids decreased in 2020.
Prevalence of Past Year Quit Attempts
Source: Bandi, et al, JAMA Network Open, 8/1/22 LINK
- Implications for employers
- Smoking remains the largest cause of preventable premature death in the US, and tobacco is a major cause of decreased productivity and quality of life. The pandemic led to many disruptions, and it’s not surprising that quit attempts were down in 2020. However, employers should continue to vigorously encourage tobacco cessation, which can decrease serious illness and lower medical costs.