The World Health Organization believes that the situation with the spread of monkeypox in areas unusual for the disease is controllable, but it is necessary to take measures to ensure that things do not get out of control, as with the coronavirus.
“This is not a disease that the public should be afraid of. It’s not like COVID-19,” said Sylvie Brian, head of the WHO’s Pandemic and Epidemic Division.
With 220 cases in 20 countries, the WHO still convened its members on Friday to brief them on how to prepare for the growing epidemic.
So far, the highest number of cases is in Europe – 118, where 14 EU countries, as well as Switzerland and Britain, have confirmed the infection. Measles has also been found in Australia, Canada, the United States, and Argentina, with some people recently traveling to Europe. However, such a link cannot be confirmed everywhere, so epidemiologists suspect that smallpox has long since emerged from areas where it is endemic – in Africa.
“We expect more cases to be detected. We ask countries to step up surveillance,” said WHO technical director Maria Van Kerkhove, adding that “the situation is manageable in non-endemic countries.”
The WHO recommends that national health authorities first check the availability of smallpox vaccines and report quantities, monitor the disease, and isolate contact persons. Dermatologists and infectious disease specialists should anticipate the possibility of monkeypox infection when diagnosing patients with rash and pruritus.
The UN Health Agency expects most infections to be mild – with nausea, fever, rash, and itching, but still urges authorities to inform the public about the risks to pregnant women, children, and people with weak immune systems, where the severe disease is likely higher.
Information campaigns advising people at risk to wear masks and maintain personal hygiene are recommended.
“We don’t know if what we’re seeing now is just the tip of the iceberg, or if there are many more unidentified cases,” Brian admitted. She added that the reasons for the spread of the infection outside Africa are still unclear.
When do the first cases of monkeypox appear?
Officially in Europe, the first two cases were registered in the UK on 14 May 2022 in a family. These cases have nothing to do with a case submitted by Nigeria, which was reported back to the United Kingdom on 7 May. In the coming days, several other countries reported cases of monkeypox that were not related to travel to endemic countries.
As of May 25, the confirmed cases are 118, most of them in Spain – 51 and Portugal – 37.
The clinical picture is usually presented with lesions on the genitals or perinatal area, which indicates that the transmission probably occurred in close physical contact during sexual activity, according to the European Health Agency (ECDC). This is the first time transmission chains have been reported in Europe without known epidemiological links to West or Central Africa, where the disease is endemic.
What is monkeypox?
Monkeypox is a variant of smallpox. It is a zoonotic virus that is transmitted from animals to humans. Practice shows that cases usually occur near tropical rainforests.
The monkeypox virus is from the orthopoxvirus family and has two genetic strains – from Central Africa (Congo Basin) and West Africa. The Congo strain is known to spread more easily and cause more severe symptoms.
Currently, monkeypox is the most common orthopox virus infection in humans since the eradication of smallpox in 1980 and the end of universal smallpox vaccination in Europe (in the United States in 1970).
The first human case was registered in 1970 in the Congo.
In endemic areas, the disease is transmitted to humans through bites or direct contact with blood, meat, body fluids, or skin / mucosal lesions of an infected animal.
What are the symptoms of monkeypox?
The symptoms and signs of smallpox are similar to smallpox and include headache, skin rash, fever, body aches, chills, swollen lymph nodes, and fatigue.
The incubation period – the time for the onset of symptoms – is from five to 21 days. The disease usually resolves in two to four weeks.
Severe cases are more common among people with immune deficiencies and young children. According to Medical News Today, the death rate from monkeypox is about 3-6%.
How is the infection transmitted?
Transmission of the monkeypox virus among humans occurs through close contact with the skin, airborne droplets, body fluids, and virus-contaminated items such as clothing, bedding, and more.
Most recent cases of monkeypox in the United Kingdom and Canada have been reported among men who have sex with men.
However, WHO Assistant Director-General for Emergency Response Ibrahim Soce Fal says the dynamics of transmission in Europe among homosexuals and bisexuals are new and need further research to find out if the disease is also sexually transmitted.
The reason experts are relatively reassured that monkeypox will not repeat COVID-19’s nightmare is that human-to-human transmission is limited. The longest documented chain of transmission is 6 six people who became infected from the original patient.
How is the disease confirmed?
With a positive PCR test specific to the monkeypox virus or with a positive result from orthopoxvirus specific PCR analysis, which is then confirmed by determining the nucleotide sequence of the detected virus.
The WHO says the best diagnostic samples are directly from the rash – skin, fluid, or crusts, or a biopsy where possible. Methods for detecting antigens and antibodies are not suitable because they do not distinguish between different orthopoxviruses.
On Wednesday, the Swiss company Roche announced that it had developed three types of tests to diagnose the disease. One of them detects orthopoxviruses, the other only monkeypox viruses, in particular strains from West Africa and Central Africa. The third is for researchers and detects both orthopoxviruses and monkeypox virus.
Also this week, the American Abbott Laboratories announced that it was actively developing a test for monkeypox.
The European Health Agency identifies as probable cases people with unexplained rashes, one or two symptoms (see above), traveling to endemic countries in the last 21 days, having contact with patients, people of all sexual orientations, having much anonymous sexual intercourse 21 days before the onset of symptoms.
Can vaccines limit the spread?
Due to the endemic nature of the disease, there is no specialized vaccine for it, but smallpox prevention vaccines are about 85% effective against monkeypox.
The problem is that smallpox has been considered an eradicated disease in Europe and the United States in recent decades, and some countries do not seem to support vaccines. For now, most countries that intend to administer vaccines say they will offer them first to medical personnel who are at the highest risk of infection. The UK already offers vaccines to doctors in infectious diseases wards.
As compulsory smallpox vaccination was discontinued in most countries in the early 1980s, people under the age of 40-50 are at higher risk of infection, but older people could also get sick because of the weakening protection against vaccination over time.
The treatment of patients is symptomatic and antiviral. The European Union is already negotiating with manufacturers of vaccines and antivirals for a common supply.
What are smallpox vaccines?
The smallpox vaccine is made from a virus called vaccinia, which is a pox virus similar to smallpox but less harmful. It contains a live vaccine virus, not a killed or weakened virus like many other vaccines. For this reason, people who have been vaccinated should take precautions when caring for the area of their arms where they have been vaccinated so that they can prevent the spread of the vaccine virus. The vaccine does not contain the smallpox virus and cannot cause smallpox.
The scar from the vaccine is wide, flat, and below the level of the skin, with a characteristic surface.
The effectiveness of the vaccine is 95%. The vaccine has been shown to prevent or significantly reduce infection when given within a few days of being exposed to the smallpox virus.
For most people with a healthy immune system, live virus vaccines are effective and safe. Such vaccines are currently used to prevent measles, mumps, rubella, and chickenpox.
Vaccination against smallpox can protect against the disease for about 3 to 5 years, and according to the American Centers for Disease Prevention and Control, a booster vaccination every three years may be needed for long-term protection.
Smallpox vaccines are not publicly available and are not sold freely in pharmacies. Several smallpox vaccines have been approved in the EU: Tecovirimat (TPOXX) is approved for the treatment of smallpox, monkeypox, and smallpox. Imvanex of Bavarian Nordic is licensed to prevent smallpox. In the United States the treatment of smallpox was approved in 2021 another vaccine -Tembexa.
