(24 July 2022)
Overview:
Monkeypox is a rare viral infection. The virus that causes the disease belongs to the Orthopoxvirus genus in the family Poxviridae, which also includes the Variola virus that causes the extinct smallpox, the vaccinia virus (used in the smallpox vaccine), and the cowpox virus.
Monkeypox first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, hence the name ‘monkeypox’. The first human case of monkeypox was recorded in 1970 in the Democratic Republic of Congo during a period of intensified effort to eliminate smallpox. Since then monkeypox has been reported in humans in other central and western African countries.
It is noteworthy that Monkeypox is endemic in some African countries, and can kill as many as 1 in 10 people who contract the disease. Monkeypox cases in people have occurred outside of Africa linked to international travel or imported animals, including cases in Europe, America, and East Asia.
Outbreaks:
- Monkeypox is endemic - in particular - in the Democratic Republic of the Congo, and to a lesser extent in Cameroon, Central Africa and Nigeria.
- On 7 May 2022, the UK Health Security Agency (UKHSA) confirmed that an individual had been diagnosed with monkeypox in England. The patient has a recent travel history from Nigeria, where he is believed to have contracted the infection before returning to the UK.
- On 14 May 2022, two more people have been diagnosed with monkeypox in London. The pair live in the same household and are not linked to the previous confirmed case that was announced on 07 May. The following week, four additional cases were confirmed, all unrelated to the previous confirmed cases announced on May 14, as well as those announced on May 7.
- In its reports released on June 4th, 2022, WHO confirmed that 780 cases were reported in 27 countries. The cases are distributed in some European countries, in addition to Australia, Canada, and the United States of America. Most of monkeypox cases are concentrated in the United Kingdom, Portugal, and Spain. The cases are largely, but not exclusively, associated with gay men.
- Until the last report from WHO on June 27, 2022, and since the beginning of the reporting of cases on January 1, 2022, 3,413 laboratory confirmed cases were recorded in 50 countries, according to the following table from the Organization.
- It is to be noted that 98% of the cases were registered during the month of May 2022. Most of the cases were in the European continent (86%), and then the Americas with 11%. The vast majority (99%) of those infected were males, with an average age of 37 years, and most of them were men who have sex with other men. One death was reported in Nigeria during the second quarter of 2022 and on July 7, 2022, two deaths were reported in other African regions not specified by the organization.
- Unusually, in the majority of cases rashes and blisters appeared in the anal area only. It may be a single pimple and does not spread to the rest of the body. This may not be preceded or accompanied by any of the known symptoms, such as: fever, swollen lymph nodes, and weakness.
WHO Emergency Committee Recommendations:
- On June 23, 2022, the International Health Regulations Emergency Committee (2005) declared that the monkeypox outbreak does not currently constitute a global public health concern. At the same time, the committee stressed that the disease’s rate of spread is high, and that member states have to commit to transparency and cooperation in exchanging data, and imposing the necessary preventive measures to prevent further spread of disease, and to provide the necessary resources for epidemiological surveillance, diagnosis and healthcare.
- On July 23, 2022, the World Health Organization declared the global monkeypox outbreak represents a public health emergency of international concern. The current risk of monkeypox is moderate globally and in all regions, except in the European region where the risk is high. It added that there is also a clear risk of further international spread, although the risk of interference with international traffic remains low for the moment.
- The Organization is also issuing recommendations, which it hopes will spur countries to take action to stop transmission of the virus and protect those most at risk.
1.
| Spain
| 3,125
|
|---|
2.
| United States of America
| 2,890 |
|---|
3.
| Germany
| 2,268 |
|---|
4.
| United Kingdom
| 2,208 |
|---|
5.
| France
| 1,567 |
|---|
6.
| Netherlands
| 721 |
|---|
7.
| Canada
| 681 |
|---|
8.
| Brazil | 592 |
|---|
9.
| Portugal | 588 |
|---|
10.
| Italy
| 407 |
|---|
11.
| Belgium
| 311 |
|---|
12.
| Switzerland
| 216 |
|---|
13.
| Peru
| 143 |
|---|
14.
| Democratic Republic of Congo
| 107
|
|---|
15.
| Palestine
| 105 |
|---|
16.
| Nigeria | 101 |
|---|
17.
| Austria | 99 |
|---|
18.
| Sweden
| 77 |
|---|
19.
| Ireland
| 69 |
|---|
20.
| Mexico
| 52 |
|---|
21.
| Denmark
| 51 |
|---|
22.
| Norway
| 46 |
|---|
23.
| Australia
| 42 |
|---|
24.
| Poland | 40 |
|---|
25.
| Hungary
| 33 |
|---|
26.
| Slovenia
| 27 |
|---|
27.
| Greece
| 20 |
|---|
28.
| Chile
| 20 |
|---|
29.
| Ghana
| 19 |
|---|
30.
| Romania
| 19 |
|---|
31.
| Argentine | 18 |
|---|
32.
| Malta
| 17
|
|---|
33.
| Czech | 15 |
|---|
34.
| Luxemburg
| 14 |
|---|
35.
| UAE | 13 |
|---|
36.
| Finland
| 13 |
|---|
37.
| Columbia | 10 |
|---|
38.
| Island
| 9 |
|---|
39.
| Republic of Central Africa
| 8 |
|---|
40.
| Croatia
| 8 |
|---|
41.
| Cameron
| 6 |
|---|
42.
| Singapore
| 6 |
|---|
43.
| Gibraltar
| 5 |
|---|
44.
| Serbia | 5 |
|---|
45.
| Estonia
| 4 |
|---|
46.
| Lebanon
| 4 |
|---|
47.
| Benin
| 3 |
|---|
48.
| Bulgaria
| 3 |
|---|
49.
| Dominican Republic
| 3 |
|---|
50.
| Latvia
| 3 |
|---|
51.
| South Africa
| 3 |
|---|
52.
| Kingdom of Saudi Arabia | 3 |
|---|
53.
| Ecuador
| 2 |
|---|
54.
| India
| 2 |
|---|
55.
| New Zealand | 2 |
|---|
56.
| Taiwan | 2 |
|---|
57.
| Bahamas
| 1 |
|---|
58.
| Barbados | 1 |
|---|
59.
| Bosnia | 1 |
|---|
60.
| Costa Rica | 1
|
|---|
61.
| Georgia | 1
|
|---|
62.
| Jamaica | 1
|
|---|
63.
| Martinique | 1
|
|---|
64.
| Morocco | 1 |
|---|
65.
| New Caledonia | 1
|
|---|
66.
| Panama | 1
|
|---|
67.
| Qatar | 1
|
|---|
68.
| Russia | 1
|
|---|
69.
| South Korea
| 1
|
|---|
70.
| Thailand
| 1
|
|---|
71.
| Turkey
| 1
|
|---|
72.
| Venezuela
| 1
|
|---|
Total
| 16,836 |
|---|
U.S. Centers for Disease Control and Prevention, Latest Update:
As shown in the table below, and until July 24, 2022 AD, the total number of confirmed cases globally reached 16,836 cases in 74 countries, including Saudi Arabia, which announced the registration of 3 confirmed case coming from a European country.
Countries with recorded Monkeypox cases
| 243
| 6
|
Countries with no recorded cases prior to the current outbreak
| 16,593
| 68
|
Total
| 16,836
| 74
|
Transmission:
The monkeypox virus is mostly transmitted to people from wild animals such as rodents and monkeys and other primates, though human-to-human transmission also occurs. monkeypox virus is transmitted from one person to another by respiratory droplets, close contact with body fluids, contaminated materials, and skin lesions of an infected person.
The incubation period for monkeypox is usually 7−14 days, and may be up to 21 days.
Symptoms:
In humans, the symptoms of monkeypox are similar to but milder than the symptoms of smallpox. Monkeypox begins with fever, headache, muscle aches, and exhaustion. The main difference between symptoms of smallpox and monkeypox is that monkeypox causes lymph nodes to swell (lymphadenopathy) while smallpox does not.
Within 1 to 3 days (sometimes longer) after the appearance of fever, the patient develops a rash, often beginning on the face then spreading to other parts of the body. The illness typically lasts for 2−4 weeks.
Treatment and Vaccine:
- Currently there is no specific treatment approved for monkeypox virus infections. However, several recently developed antivirals can be uses such as (Brincindofovir), (Tecovirimat), (Vaccinia immunisation globulin), to help control the spread of the disease.
- The previous vaccine against smallpox has been proven to be 85% effective in preventing monkeypox, but it is no longer available regularly since the global eradication of traditional smallpox. The vaccine can help prevent or reduce the severity of the disease.
- In 2019 and 2022, the (Tecovimat) drug and the (MVA-BN) vaccine, respectively, were approved as the first choice for treatment and prevention, but they are not widely available.
Public Health Response:
- WHO continues to support sharing of information it receives from member states. It urges them to double their efforts, to coordinate comprehensive case finding, contact tracing, laboratory investigation, care for infected persons and implementation of infection and prevention and control measures.
- Many of the countries that have announced confirmed cases are investigating genome sequences of the monkeypox virus. Preliminary data indicate that the monkeypox virus genes detected belong to the West African clade.
- The ACAM-2000 and MVA-BN vaccines are being deployed by some Member States to manage close contacts.
- Interim guidance is being or has been developed to support Member States with case finding, contact tracing, laboratory diagnostics and testing, clinical management and infection prevention and control.
WHO Risk Assessment:
- Currently, the public health risk at the global level is assessed as moderate considering this is the first time that monkeypox cases and clusters are reported concurrently in many countries outside the African continent, balanced against the fact that mortality has remained low in the current outbreak. On next Thursday June 23 WHO emergency committee will meet to consider whether it should declare the growing, multinational monkeypox outbreak a public health emergency of international concern (PHEIC).
- Although we know which group is most targeted, or affected by this disease (men who have sex with men), we should not disregard its potential impact in other population groups.
- The disease has not been detected among health workers during this outbreak, but it had occurred in the past in Africa. Therefore, readiness and awareness must be raised among them. Also, the disease may cause serious complications on low immunity groups such as aids disease, pregnant women, children, older persons and those with chronic diseases.
WHO Advice:
- Preparing and updating a definition of cases, based on the latest developments announced by the countries with outbreaks, as well as reports released by WHO competent committees, especially the non-traditional symptoms of the cases.
- Activating epidemiological surveillance to search for cases and identify contacts, to carryout preventive interventions in a timely manner.
- Providing diagnostic laboratory tests for suspected cases.
- Raising community awareness, focusing on target groups, health service providers and laboratories.
- Developing protocols for dealing with cases, determining appropriate isolation sites for advanced cases, and providing the necessary preventive equipment for them and health service providers. As for mild cases, they can be isolated at home to ensure application of the necessary preventive measures.
- Maintaining confidentiality of data; to avoid unnecessary stigmatization of individual and communities potentially affected by Monkeypox.