New monkeypox infections appear to be declining in some areas of the world, the Biden administration finalized an $11 million deal to package the monkeypox vaccine at a U.S. facility, and more in this week's roundup of monkeypox news.

The best-case (and worst-case) scenarios for monkeypox

• The World Health Organization (WHO) on Thursday released a report that found that worldwide cases of monkeypox dropped 21% between Aug. 15-21. While the data indicates that cases in Europe are declining, the report noted that "[t]he number of cases reported in the Region of the Americas shows a continuing steep rise, confirming trends seen over the last several weeks." According to the report, 23 countries saw increases in their weekly number of cases, with the largest increase in the United States. However, CDC Director Rochelle Walensky on Friday said she was "cautiously optimistic" following early reports of declining new cases in some areas of the United States, including New York City, Chicago, and San Francisco. While health officials have said it is still too early to determine whether the U.S. outbreak is reversing course, many have noted the waning cases in some cities—along with data about vaccines and precautionary measures against the virus—are encouraging signs. "Our numbers are still increasing, [but] the rate of rise is lower," Walensky said. "We're really hopeful that many of our harm reduction messages and our vaccines are getting out there and working." (Saric, Axios, 8/25; Choi, The Hill, 8/26; Stone/Huang, "Shots," NPR, 8/26)

• The Biden administration on Monday finalized an $11 million deal to package Jynneos at a U.S. facility—a move aiming to improve the supply of the monkeypox vaccine. Danish company Bavarian Nordic, which manufactures Jynneos, last month signed a deal with Grand River Aseptic Manufacturing (GRAM) in Michigan "to establish the first fill and finish line" for vaccine vials in the United States. HHS' Biomedical Advanced Research and Development Authority (BARDA) will provide $11 million to help GRAM purchase necessary equipment, and recruit and train additional workers, to fast-track the packaging of the vaccine vials. "We continue to build on our efforts to secure and make safe and effective vaccines readily available," said HHS Secretary Xavier Becerra. "This new agreement solidifies a domestic manufacturing capability that will bring us more vaccine sooner to end this outbreak," he added. "BARDA's support helps ensure success in doubling the capacity available to fill and finish this vaccine, improves preparedness for smallpox bioterrorism, and strengthens the security of the US supply chain," added Dawn O'Connell, assistant secretary at HHS for preparedness and response. (Saric, Axios, 8/29)

• The Biden administration's strategy for boosting the limited supply of monkeypox vaccines has led to a decline in vaccination rates and could also worsen racial health inequalities, Politico reports. Last week, the administration cut the number of vials each state received as part of its new strategy, which allows five people to be vaccinated with a single vial. However, health officials in half a dozen states reported that they were only able to extract three or four doses per vial, meaning they were not able to vaccinate as many people as they would have been able to if the federal government did not change the vaccination strategy. While the federal government last week increased the number of available vials for states to order, many states have reported that they still do not have enough doses to contain the spread of the virus. "The federal government has patted themselves on the back for how they're accelerating the delivery of vaccines," said Patrick Ashley, senior deputy director at Washington, D.C.'s Department of Health. "What they did is they moved numbers around." Separately, Marcus Plescia, CMO at the Association of State and Territorial Health Officials noted that "[t]his week has been frustrating just because you think you're getting a certain amount, it's not that much, and then you can't get as many doses out of the vial." Ultimately, he added, "[t]his is probably going to result in some chaos out in the field where people are getting turned away because they run out." (Messerly/Mahr, Politico, 8/24)

• FDA recently issued a safety alert warning patients and health care providers that the monkeypox virus could spread through fecal microbiota transplantation (FMT) products. According to the alert, additional safety precautions are necessary to prevent the potential spread. Recent evidence suggests that the virus' DNA was found in infected individuals' rectal swabs and stool samples. In particular, one study detected viral DNA in rectal swabs from three asymptomatic individuals—and two of those swabs contained viable traces of the virus. "This information suggests that monkeypox virus may be transmitted through FMT products, although the risk of such transmission is unknown," the agency wrote in the alert. (Hamza, MedPage Today, 8/24)

• A small cohort study found that oral tecovirimat (Tpoxx) for monkeypox was well tolerated and almost all patients reported that their symptoms resolved after 2 weeks of treatment. According to Angel Desai and colleagues from the University of California Davis Medical Center, among the 25 patients who received the antiviral on a compassionate use basis, 40% no longer had lesions after one week, and 93% no longer lesions or pain 21 days after receiving the treatment. However, the researchers noted that it was not possible to definitively say whether the patients' improvements resulted from treatment or from the natural course of the infections. "In this preliminary study, oral tecovirimat was well tolerated by all patients with monkeypox infection, with minimal adverse effects," the researchers wrote. Still, the patients reported several side effects, including fatigue in seven patients, headache in five, nausea in four, itchiness in two, and diarrhea in two. "Adverse effects could not always be differentiated from symptoms related to the infection," the researchers added. (Hein, MedPage Today, 8/24)