Monkeypox now in 25 countries

THE WORLD Health Organization has reported that monkeypox is now present in at least 25 countries, and warned the public that there will be more cases as the virus continues to spread.

 A monkeypox infection. (Nigeria Centre for Disease Control)

Initial symptoms of monkeypox include fever, body aches, and fatigue. The disease is similar to the smallpox virus, but much less deadly. The disease can result in a rash that leads to red bumps on the skin. 

As of last month, there have been over 1,600 cases and around 120 suspected cases, although no deaths have been reported. “The situation is evolving rapidly and WHO expects that there will be more cases identified as surveillance expands in non-endemic countries, as well as in countries known to be endemic who have not recently been reporting cases,” it said. 

Since May 13, monkeypox has been reported to WHO from 23 member states that are not endemic for monkeypox virus, across four (WHO) regions. It said epidemiological investigations are ongoing, adding the vast majority of reported cases so far have no established travel links to an endemic area and have presented through primary care or sexual health services. 

The identification of confirmed and suspected cases of monkeypox with no direct travel links to an endemic area is atypical, according to WHO, saying early epidemiology of initial cases notified to WHO by countries shows that cases have been mainly reported among men who have sex with men and just one case of monkeypox in a non-endemic country is considered an outbreak. 

“The sudden appearance of monkeypox simultaneously in several non-endemic countries suggests that there may have been undetected transmission for some time as well as recent amplifying events,” WHO said. 

It said immediate actions should focus on the following: Providing accurate information to those who may be most at risk of monkeypox; stopping further spread among groups at risk and protecting frontline health workers. 

In addition to non-endemic countries reporting cases, WHO said it continues to receive updates on the status of ongoing outbreaks through established surveillance mechanisms for cases in endemic countries in the African region. 

Zoonotic disease

Monkeypox is a viral zoonosis (a virus transmitted to humans from animals) with symptoms very similar to those seen in the past in smallpox patients, although it is clinically less severe. It is caused by the monkeypox virus which belongs to the Orthopoxvirus genus of the Poxviridae family. 

The name monkeypox originates from the initial discovery of the virus in monkeys in Statens Serum Institute in Copenhagen, Denmark, in 1958. The first human case was identified in a young child in the Democratic Republic of the Congo in 1970. 

Monkeypox virus is transmitted from one person to another by close contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding. The incubation period of monkeypox is usually from 6 to 13 days but can range from 5 to 21 days. 

Various animal species have been identified as susceptible to the monkeypox virus, according to WHO. “Uncertainty remains on the natural history of the monkeypox virus and further studies are needed to identify the reservoir(s) and how virus circulation is maintained in nature. Eating inadequately cooked meat and other animal products of infected animals is a possible risk factor,” it said. 

Monkeypox is usually self-limiting but there is likely to be little immunity to monkeypox among people living in non-endemic countries since the virus has not previously been identified in those populations. 

There are two clades of monkeypox virus: the West African clade and the Congo Basin (Central African) clade. 

The Congo Basin clade appears to cause severe disease more frequently with case fatality ratio (CFR) previously reported of up to around 10%. Currently, the Democratic Republic of the Congo is reporting a CFR among suspected cases of around 3%. 

The West African clade has in the past been associated with an overall lower CFR of around 1% in a generally younger population in the African setting. Since 2017, the few deaths of persons with monkeypox in West Africa have been associated with young age or an untreated HIV (Human immunodeficiency virus) infection. 

Historically, vaccination against smallpox had been shown to be cross-protective against monkeypox. However, immunity from smallpox vaccination will be limited to older persons since populations worldwide under the age of 40 or 50 years no longer benefit from the protection afforded by prior smallpox vaccination programs. In addition, protection may have waned over time since vaccination. 

While one smallpox vaccine and one specific treatment (tecovirimat) were approved for monkeypox in different countries, in 2019 and 2022 respectively, these countermeasures are not yet widely available in most countries and not at all in some. 

Countries with monkeypox cases 

The countries with reported monkeypox cases are Cameroon, Canada, Central African Republic, Congo, French Guiana, United States, United Arab Emirates, Sudan, Austria, Belgium, Czechia, Denmark, Finland France, Germany, Israel, Italy, Netherlands, Nigeria, Portugal, Slovenia, Spain, Sweden, Switzerland, and United Kingdom of Great Britain and Northern Ireland, Australia.  

Health Secretary Francisco Duque III said although there is not a single case of monkeypox in the country, they are closely monitoring the latest developments about the virus and has intensified screening in all the country’s borders. He said the Research Institute for Tropical Medicine will be the main isolation facility for suspect, probable, and confirmed monkeypox cases.

The Private Hospitals Association of the Philippines, Inc. (PHAPI) said it is also preparing for a possible outbreak of the virus. PHAPI president Rene Jose de Grano said although no case has so far been reported in the country, their members and the Department of Health are now on high alert. “Binabantayan po natin diyan ay fever, muscle pain, pagkakaroon ng kulani at rashes na typical sa supposedly na monkeypox,” he said. (Mindanao Examiner, Zamboanga Post)