The WHO says Monkeypox  spreads with close contacts, cases in non-endemic countries

GENEVA, May 21 (The CONNECT) – The World Health Organisation (WHO) is keeping a close watch on monkeypox which as the disease outbreak has been reported a cross 11 countries, including UK, affecting at least 80 people so far.

Another 50 cases are pending investigations and the WHO and its partners are working to better understand the extent and cause of the infection. The virus is endemic in some animal populations in a number of countries, leading to occasional outbreaks among local people and travellers, WHO said.

WHO Director General Dr Tedros Adhanom Ghebreyesus, meanwhile, told global media that the UN health body is not just fighting COVID-19. There is an Ebola outbreak in the Democratic Republic of the Congo, an unknown hepatitis affecting children around the world and monkeypox affecting a number of countries.  The organisation is working with national authorities to respond quickly and effectively to these outbreaks. 

“The last few years have taught us about our own collective fragility and the threat to economies and security of not working together,” he remarked.

The recent outbreaks of monkeypox reported across 11 countries so far are atypical, as they are occurring in non-endemic countries, the WHO said.

“We continue to convene meetings of experts and technical advisory groups (such as the meeting today of the Strategic & Technical Advisory Group on Infectious Hazards with Pandemic and Epidemic Potential [STAG-IH]) to share information on the disease and response strategies,” WHO said in a media statement.

Monkeypox spreads differently from COVID-19. WHO encourages people to stay informed from reliable sources, such as national health authorities, on the extent of the outbreak in their community (if any), symptoms and prevention.

As monkeypox spreads through close contact, the WHO said, the response should focus on the people affected and their close contacts. People who closely interact with someone who is infectious are at greater risk for infection: this includes health workers, household members and sexual partners.

Stigmatizing groups of people because of a disease is never acceptable. It can be a barrier to ending an outbreak as it may prevent people from seeking care, and lead to undetected spread. 

As the situation is evolving, WHO will continue to provide updates we learn more, the UN health body said.

On 13 May 2022, WHO was notified of two laboratory confirmed cases and one probable case of monkeypox, from the same household, in the United Kingdom. On 15 May, four additional laboratory confirmed cases have been reported amongst Sexual Health Services attendees presenting with a vesicular rash illness and in gay, bisexual, and other men who have sex with men (GBMSM). 

As response measures, an incident team has been established to coordinate contact tracing efforts. 

In contrast to sporadic cases with travel links to endemic countries (see Disease outbreak news on Monkeypox in the United Kingdom published on 16 May 2022), no source of infection has been confirmed yet. Based on currently available information, infection seems to have been locally acquired in the United Kingdom. The extent of local transmission is unclear at this stage and there is the possibility of identification of further cases. 

Description of the cases

On 13 May 2022, the United Kingdom notified WHO of two laboratory confirmed cases and one probable case of monkeypox to WHO. All three cases belong to the same family. 

The probable case is epidemiologically linked to the two confirmed cases and has fully recovered. The first case identified (index case) developed a rash on 5 May and was admitted to hospital in London, the United Kingdom on 6 May. On 9 May, the case was transferred to a specialist infectious disease centre for ongoing care. Monkeypox was confirmed on 12 May. Another confirmed case developed a vesicular rash on 30 April, confirmed to have monkeypox on 13 May, and is in a stable condition. 

The West African clade of monkeypox was identified in the two confirmed cases using reverse transcriptase polymerase chain reaction (RT PCR) on vesicle swabs on 12 May and 13 May. 

On 15 May, WHO was notified of four additional laboratory confirmed cases, all identified among GBMSM attending Sexual Health Services and presenting with a vesicular rash. All four were confirmed to have the West African clade of the monkeypox virus.

Epidemiology of the disease

Monkeypox is a sylvatic zoonosis with incidental human infections that usually occur in forested parts of Central and West Africa. It is caused by the monkeypox virus which belongs to the orthopoxvirus family. Monkeypox can be transmitted by droplet exposure via exhaled large droplets and by contact with infected skin lesions or contaminated materials. The incubation period of monkeypox is usually from 6 to 13 days but can range from 5 to 21 days.  The disease is often self-limiting with symptoms usually resolving spontaneously within 14 to 21 days. Symptoms can be mild or severe, and lesions can be very itchy or painful. The animal reservoir remains unknown, although is likely to be among rodents. Contact with live and dead animals through hunting and consumption of wild game or bush meat are known risk factors.

There are two clades of monkeypox virus: the West African clade and Congo Basin (Central African) clade. Although the West African clade of monkeypox virus infection sometimes leads to severe illness in some individuals, disease is usually self-limiting. The case fatality ratio for the West African clade has been documented to be around 1%, whereas for the Congo Basin clade, it may be as high as 10%. Children are also at higher risk, and monkeypox during pregnancy may lead to complications, congenital monkeypox or stillbirth.

Milder cases of monkeypox may go undetected and represent a risk of person-to-person transmission. There is likely to be little immunity to the infection in those travelling or otherwise exposed, as endemic disease is normally geographically limited to parts of West and Central Africa. Historically, vaccination against smallpox was shown to be protective against monkeypox. While one vaccine (MVA-BN) and one specific treatment (tecovirimat) were approved for monkeypox, in 2019 and 2022 respectively, these countermeasures are not yet widely available, and populations worldwide under the age of 40 or 50 years no longer benefit from the protection afforded by prior smallpox vaccination programmes.