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?”