The ongoing outbreak of monkeypox, an emerging contagious rash illnesses caused by the monkeypox virus, has increased demand for treatment options everywhere.

But since there are no specific monkeypox treatments approved by the U.S. Food and Drug Administration (FDA), accessing experimental treatments in the U.S. remains uneven.

Across the U.S., some patients reportedly had to wait days for shipments or opted to travel to find medical centers that can provide Tecovirimat. Sold under the brand name Tpoxx, this antiviral medication is approved for treating smallpox.

Recently, the U.S. Centers for Disease Control and Prevention (CDC) has made the drug available from the Strategic National Stockpile through an expanded access program for treating
monkeypox cases.

VCU Medical Center, Central Virginia’s only comprehensive academic medical center, participates in the expanded access program.

VCU Health News spoke with Akira A. Shishido, M.D., infectious disease specialist at VCU Medical Center and assistant professor in the Division of Infectious Diseases at VCU’s School of Medicine, about VCU’s role in caring for communities during the monkeypox outbreak.

Why is access to monkeypox treatments not the same everywhere?

There is no officially approved treatment for monkeypox, which makes it more difficult for health care providers to obtain. The process of participating in the CDC expanded access program has similarities to running a clinical trial, which takes time and expertise not every medical facility has. To start, you need to work with your state health department, which then requests Tpoxx from a national stockpile.

What role do hospitals play in creating access to treatment?

They are an important access point when patients need the medication quickly. While there is no prospective data supporting Tpoxx’s effectiveness against the disease in humans, anecdotal evidence suggests that patients who receive the drug recover faster and stop spreading the virus sooner. In short, it may help people feel better sooner and reduce the spread of the virus.

It is also about anticipating community needs. We monitor cases in Central Virginia closely and work in collaboration with the CDC and state health department. As a community resource for all Virginians, we need to prepare for current and future health care needs. Since we are participating in the expanded access program, we obtain and administer the antiviral medication quickly, if needed.

Who is eligible to receive Tpoxx?

Patients with severe disease, a high risk of developing severe disease and those with infections in areas where the monkeypox virus may be a special hazard, such as the eye or mouth area or private areas.

At VCU Medical Center, we care for many immunocompromised patients, whether they are awaiting a transplant, undergo cancer care or are seeking prenatal care. If infected with monkeypox, they would likely be in the high-risk category and we would recommend treatment. Children and pregnant women also fall in the high-risk group.

What else is important for the community to know?

If you think you may have monkeypox, isolate yourself and contact your health care provider. They may ask you a few screening questions to determine next steps, including testing you for monkeypox.

Not everyone who has symptoms is recommended to take treatments. The VDH has up-to-date resources, including isolation guidelines and fact sheets.