Anvil's Situation Update - The World Health Organization (WHO) declared Monkeypox a public health emergency of international concern on 23 July 2022 Anvil News & Updates
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SITUATION UPDATE 15 August, 2022 Back

Situation Update - International Monkeypox outbreak Declared Public Health Emergency of Concern by WHO

Ole Bogh

Summary

  • The World Health Organization (WHO) declared Monkeypox a public health emergency of international concern on 23 July 2022
  • An International outbreak of Monkeypox was confirmed in Europe on 19th May 2022.
  • This is the first outbreak without a clear connection to the regions where Monkeypox is endemic.
  • The illness has been spread in mass gatherings in Europe.
  • Human to human transmission occurs through large respiratory droplets (coughing, sneezing) or direct contact with skin lesions or bodily fluids.
  • No travel restrictions have been implemented as of 28th July 2022.

Situation

On 23 July the Director-General of the World Health Organization (WHO) declared the international Monkeypox outbreak to be a Public Health Emergency of International Concern (PHEIC). The decision to declare a PHEIC was made by the WHO after deliberation during International Health Regulations Emergency Committee meeting on 23 July. The decision was split between the committee members. The members who voted for the escalation of the outbreak argued that since the outbreak is an extraordinary event, it constitutes a public health risk to states through the international spread of the disease and it may require a coordinated international response. The members of the committee that opposed the escalation argued that the global risk assessment remained unchanged, the greatest burden is among 12 countries in Europe and the Americas, and the severity of illness is perceived as low.

Between the first recorded case of Monkeypox in the United Kingdom on 7th May and 12th August , there are 31,800 recorded infections according to the United States Centers for Disease Control and Prevention (CDC). Of these, there are 31,425 cases in 75 countries where the illness is not endemic, with 375 cases in seven states where it is endemic.
The Africa Centres for Disease Control and Prevention (Africa CDC) has released different numbers provided by their member states, which state there are 250 confirmed infections within their region, with an additional 2947 suspected cases in 11 countries. They also report 104 fatalities and inform the mortality rate as 3.5 percent.

The first deaths from Monkeypox pox outside Africa were on the 29th July 2022 in Brazil and Spain. There have now been a total of 5 deaths outside Africa, in the countries listed above, India, Peru and Ecuador.

The European Centre for Disease Prevention and Control (ECDC) reports that over 99 percent of the registered patients within the region of their surveillance are male, with 10,604 confirmed cases as of 19 July. Of these 256 required hospitalizations. The worse affected countries are Spain, the United Kingdom, and Germany.
According to the data collected by the ECDC the majority of the patients are connected to the LGBTQ community and the health authorities are advising individuals to be cautious with intimate contact and are providing resource toolkits to event managers where they expect a large number of people to gather.

Monkeypox is a viral zoonosis illness. This means that the infection can be passed from infected animals to humans. It is caused by a virus belonging to the Orthopoxvirus genus. Prior to May 2022, most cases occur in West and Central Africa, where several thousand infections are reported every year. Since 2003 there has been a dramatic increase in the infection rate, and it is now considered endemic to Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Ghana, Ivory Coast, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan. A large proportion of cases are reported in the Democratic Republic of the Congo.

Most infections have previously occurred because of contact between humans and wild animals. The transmission can occur by bite or scratch, bushmeat preparation, direct contact with body fluids or lesion material, or indirect contact with lesion material, such as through contaminated bedding. The source of bushmeat is wild animals, and among these are rodents such as squirrels, rats and mice which are known as carriers of the virus.

Transmission between humans is believed to occur during intimacy, primarily through large respiratory droplets. Respiratory droplets usually can’t travel more than a few feet, so prolonged face-to-face contact is required. Alternative human transmission includes direct contact with body fluids or lesion material, and indirect contact with lesion material, such as through contaminated clothing or linen.

The most common symptoms of the illness are fever, intense headaches, swelling of lymph glands, muscle aches, and fatigue. The symptoms will usually occur between 6 to 13 days following the infection. After 1-3 days after the onset of fever, skin eruptions can begin. The rash starts as raised red spots, which turn into small blisters filled with fluid, usually on the face, groin, hands and feet. The blisters eventually form scabs, which later fall off. In endemic countries without a developed healthcare system Monkeypox has a mortality rate between 3 and 6%. While there are no recorded fatalities recorded outside of Africa between May 2022 and July 2022.

Analysis and Implications

The WHO Director General declared the Monkeypox outbreak an PHEIC on 23 July. This declaration came following deliberation within the WHO, where there was disagreement about the decision. The escalation to PHEIC is expected to increase the attention the outbreak will receive from health authorities and the amount of resources that will be allocated to combat the outbreak. There is already cooperation between regional and international organizations, but this is expected to deepen following the decision made by the Director General.

According to the ECDC there has been no steep rise in the rate of infections, and the number of new infections within Europe has started to decline since the highest number of new infections was registered on 4th July. The ECDC has provided advice to the European states on how to combat the outbreak and the individual states are implementing procedures for individuals who need medical attention following detection of the virus.
Countries in Europe, Asia and the Americas had, prior to the declaration by WHO, already started ordering vaccines to be administered to groups vulnerable and more exposed to the virus. Some countries have already started administering vaccines to individuals who have been in contact with patients diagnosed with Monkeypox.

Following the declaration of Monkeypox outbreak as PHEIC by the WHO, the organization has provided advice based on what situation countries find themselves in and advice regarding international travel. The advice provided includes implementing efficient testing and tracking measures combined with isolation and treatment for infected individuals. For international travel, WHO has advised individuals who have symptoms of the illness not to travel unless it is to seek medical attention. They advise people who have been in contact with positive patients to monitor their own situation. Authorities are advised to facilitate contact tracing and to provide information material at points of entry.

Due to the low mortality rate and declining infection rate, it is unlikely that there will be further escalations in the definition of the Monkeypox outbreak. The way the illness spreads is dependent on close contact or intimacy, making it less likely to infect travellers who are not in contact with an infected person. The advice provided by WHO and other health organizations has not recommended any changes besides monitoring and providing information. This makes it less likely to impact business travellers in the near future.

Advice

  • Travellers are advised to follow good hand hygiene practices, with frequent handwashing using soap and water or using alcohol-based hand sanitisers. Scratches and open wounds should be cleaned and covered.
  • If any of the symptoms of the illness is detected, travellers should contact local health authorities for additional information on local health restrictions.
  • Local rules might apply, but WHO advised people who test positive to self-isolate until symptom-free.
  • Travellers should not touch raw meat, wild animals, or animal products while in areas where Monkeypox is endemic.
  • Food consumed while in areas affected by Monkeypox should be thoroughly cooked and no raw meat or blood should be consumed.
  • Travellers should pay attention to the latest advice and updates from the Governments and International Health organisations.