Monkeypox Outbreak: Stay Vigilant but Let’s Not Get Too Anxious

The General Director of World Health Organization (WHO), Tedros Adhanom Ghebreyesus declared a Public Health Emergency of International Concern (PHEIC) over the emerging monkeypox epidemic in many countries. He set it on Saturday 23 July 2022.

In his decision last Saturday, Tedros said he was aware of the complexities and uncertainties surrounding the monkeypox outbreak in the world today. He finally established that state of emergency. Adhering to the views among the Committee Members and Advisors, as well as other factors in line with the International Health Regulations, Tedros then published the so-called Temporary Recommendations.

Recommendations are detailed differently for the four WHO member country groups. The first group is countries that have no history of monkeypox in humans or have not detected it in the last 21 days.

The second recommendation is for countries that have recently imported cases of the disease in their population or of human-to-human transmission, including in their population groups that are at high risk. It includes health surveillance and travel bans for certain individuals.

The third group is countries with known or suspected cases of zoonotic transmission (virus jumps from animals to humans) at present or in the past, those with cases of monkeypox in their animals — both now and in the past. Finally, the recommendation is addressed to countries that have the capacity to manufacture drugs.

Current Situation

According to data presented by the WHO Secretariat, so far this year until July 20, 14,533 confirmed and suspected cases have been reported from 75 countries in all six WHO work areas. The figure, which includes 3 deaths in Nigeria and 2 in the Central African Republic, is up from 3,040 cases from 47 countries as of early May.

Transmission occurs in many countries where monkeypox was not previously known, and the highest number of cases are currently reported in European and American countries. The majority of monkeypox cases recorded by the WHO have affected men who claim to be gay, bisexual, and other men who have multiple partners. Many cases are urban and clustered in social and sexual networks.

There was also a significant increase in cases in countries in West and Central Africa. Cases from this region have a different demographic profile than those observed in Europe and the Americas, where there are more infected women and children.

Clinical symptoms of monkeypox that appear in outbreaks outside Africa are generally mild and not widespread in the body. More often localized in the genital, perineal/perianal, or peri-oral areas. Usually also precede the symptoms of lymphadenopathy, fever, malaise, and pain in the wound.

The average incubation period of monkeypox is estimated to be 7.6 to 9.2 days based on observational data from the Netherlands, England, Northern Ireland, and the United States. A small number of cases come from among health workers.

However, this isn’t the first time WHO declared PHEIC. There had been six other similar PHEIC declarations in the past years.

• 2009 Swine flu
• 2014 Polio
• 2014 Ebola
• 2015 Zika
• 2018 K. Ebola
• 2019 COVID

Some of you might not realize it because at that time things didn’t escalate this big. Not all PHEICs become pandemics. But it’s the right precautionary step by WHO.

According to Faheem Younus, a Chief of Infectious Diseases from the University of Maryland UCH said that “COVID is peculiar because it is a novel viral strain, easily transmissible through the respiratory route, attacks a vital organ (lungs) and is deadly”. He also added,

If COVID is like a snake bite, Monkeypox is like bed bugs. Important and concerning, but not the same.

He reminded us to not fall for fear mongering about monkeypox because it is harder to transmit than COVID. Monkeypox is transmitted to humans through close contact with lesions and body fluids of infected person or animal, or with material contaminated with the virus. Respiratory droplets can also transmit the virus, but only in rare cases. Transmission via droplet respiratory particles usually requires prolonged face-to-face contact.

What should we do now?

According to the tips from Harvard Health, there some steps that we can do to help stop this outbreak:

1. Recognize early symptoms

• Not like COVID, monkeypox often shows early symptoms that are flulike, including fatigue, fever, headache, and enlarged lymph nodes.
• After symptoms occur, the rash usually appears after a few days, changing from small flat spots to tiny blisters similar to chickenpox, then to larger, pus-filled blisters.
• The rash often starts on the face and then appears on the palms, arms, legs, and other parts of the body. If may show up near genitals if it’s is spread by sexual contact.

2. Take steps to stop the spread

• Anyone who has been diagnosed with monkeypox, or who suspects they might have it, should avoid close contact with others. Once the sores scab over, the infected person is no longer contagious.
• Health care workers and other caregivers should wear standard infection control gear, including gloves and a mask.
• In the current outbreak, many cases began with sores in the genital and rectal areas among men who have sex with men, so doctors suspect sexual contact spread the infection. As a result, experts are encouraging abstinence when monkeypox is suspected or confirmed.

3. Use vaccination to help break the chain

• Monkeypox is closely related to smallpox. People who received a smallpox vaccine in the past may have some protection from monkeypox.
• Stockpiled smallpox vaccinations and newer vaccines that can be used for monkeypox or smallpox are also available.

Ring vaccination

Monkeypox usually is contagious after symptoms begin, which can help limit its spread. One reason COVID-19 spread so rapidly was that people could spread it before they knew they had it.

This means it’s possible to vaccinate a “ring” of people around them rather than vaccinating an entire population. This selective approach is called ring vaccination.

Ring vaccination has been used successfully to contain smallpox and Ebola outbreaks. It may come in handy for monkeypox as well. Here’s how it works:

• As soon as a case of monkeypox is suspected or confirmed, the patient and their close contacts are interviewed to identify possible exposures.
• Vaccination is offered to all close contacts.
• Vaccination is also offered to those who had close contact with the infected person’s contacts.

Ideally, people should be vaccinated within four days of exposure.

It’s really good to stay vigilant, but let’s not get too anxious about monkeypox. We don’t need Google experts, fear-mongering, turning this into business, politicizing this virus, or stigmatizing any group. Stay Healthy!