#16,779
With most of the Monkeypox cases to date being reported from 9 EU member states (Austria, Belgium, France, Germany, Italy, Portugal, Spain, Sweden, and the Netherlands), the ECDC's take on the situation is of particular interest.
Today they have published a 22-page Rapid Risk Assessment, based on a preliminary analysis of the data available. As of today, 68 confirmed cases have been reported to the ECDC by EU/EEA member states, with another 48 suspected.
While the risk to the general public is considered low at this point (see table below), some occupations (HCWs, Lab Workers, etc.) and groups (people with multiple sexual partners) may be at considerably higher risk.
As we've come to expect from the ECDC, today's report is quite detailed and contains a great deal of background information on Monkeypox. You'll want to download and read the full report.
I'll have a brief postscript after the break.
Risk assessment: Monkeypox multi-country outbreak
Risk assessment
23 May 2022
Cases of monkeypox (MPX) acquired in the EU have recently been reported in nine EU Member States (Austria, Belgium, France, Germany, Italy, Portugal, Spain, Sweden, and the Netherlands).
Executive summary
Key messages
Monkeypox (MPX) does not spread easily between people. Human-to-human transmission occurs through close contact with infectious material from skin lesions of an infected person, through respiratory droplets in prolonged face-to-face contact, and through fomites. The predominance, in the current outbreak, of diagnosed human MPX cases among men having sex with men (MSM), and the nature of the presenting lesions in some cases, suggest transmission occurred during sexual intercourse.
Based on ECDC’s epidemiological assessment, the likelihood of MPX spreading in persons having multiple sexual partners in the EU/EEA is considered high. Although most cases in current outbreaks have presented with mild disease symptoms, monkeypox virus (MPXV) may cause severe disease in certain population groups (young children, pregnant women, immunosuppressed persons). However, the likelihood of cases with severe morbidity cannot be accurately estimated yet. The overall risk is assessed as moderate for persons having multiple sexual partners (including some groups of MSM) and low for the broader population.
Treatment is mainly symptomatic and supportive, including prevention and treatment of secondary bacterial infections. Smallpox vaccine can be considered for post-exposure prophylaxis of close contacts at increased risk for severe disease, however careful benefit/risk assessment should be performed for the exposed individual. Important information on the use of currently available smallpox vaccines is missing for groups at increased risk for severe disease. In addition, antivirals are potential treatment options for severe cases.
EU/EEA countries should focus on prompt identification, management, contact tracing and reporting of new MPX cases. Countries should update their contact tracing mechanisms, their diagnostic capacity for orthopoxviruses and review the availability of smallpox vaccines, antivirals and personal protective equipment (PPE) for health professionals.
An interim case definition is proposed for case reporting. Guidance for the management of MPX cases and close contacts is also included. Cases should remain isolated until their rash heals completely, avoiding contact with immunosuppressed persons and pets. Abstaining from sexual activity and close physical contact is also advised until the rash heals. Most cases can remain at home with supportive care.
Close contacts of MPX cases should self-monitor for the development of symptoms up to 21 days from the last exposure to a case.
Healthcare workers should wear appropriate PPE (gloves, water-resistant gown, FFP2 respirator) when screening suspected cases or caring for a MPX case. Laboratory personnel should also take precautions to avoid occupational exposure.
Close contacts of a MPX case should be deferred from blood, organ or bone marrow donations for a minimum of 21 days from the last day of exposure.
Proactive risk communication and multiple community engagement activities should be carried out to increase awareness, provide updates and guidance to those at increased risk and the wider public. Risk communication messages should stress that MPXV is spread through close contact between people, especially in the same household, potentially including the sexual route. A balance should be kept between informing those most at risk but also communicating that the virus does not spread easily between people the risk to the broader population is low.
There is a potential risk of human-to-animal transmission in Europe, therefore close intersectoral collaboration between human and veterinary public health authorities working from a ‘One Health’ perspective is needed to manage exposed pets and prevent the disease from being transmitted in wildlife. EFSA is not aware to date of any reports on infections in animals (pets or wild animals) in the EU.
Several unknowns still exist regarding this outbreak and ECDC will continue to monitor developments closely and update the risk assessment as new data and information become available.
As mentioned above, this is a preliminary assessment based on very limited information. This report includes a sobering list of known limitations (there may be others), which help to illustrate how much we don't yet know.
Limitations
This assessment is undertaken based on facts known to ECDC at the time of publication and has several key limitations. In particular, there are many scientific uncertainties and knowledge gaps regarding human MPX, including:
• This is the first outbreak of MPX outside Africa suggesting transmission during sexual contact/intercourse as the primary route of transmission of the disease. No comprehensive data are available on severity of illness and on transmission dynamics as well as on effective response measures.
• A lack of clear understanding of the epidemiological situation since countries are in the case-finding stage.
• A lack of understanding of the route of introduction of MPXV in MSM communities.
• Lack of sequencing results of MPXV to identify chains of transmission and connections among cases. Sequencing may also provide clues regarding a possible time and mode of introduction of MPXV in Europe. Look-back studies may also be useful in leftover samples from STI clinics to study this question.
• More accurate estimates of the risk of transmission associated with different sorts of contacts with clinical cases are needed in European settings.
• Information is needed on the current residual cross protection from smallpox vaccination in the EU/EEA population.
• Efficacy data of the currently available smallpox vaccine(s) against MPX are lacking, and safety data for the use of the smallpox vaccine in young children, pregnant women and immunocompromised are also lacking.
• Efficacy data and safety profile of the available antiviral agents for the treatment of potential severe cases are also lacking. A common treatment protocol is proposed by EMA and should be adopted.
• More information is needed on the clinical presentation of cases and their outcome, to establish the severity (morbidity and mortality) of the disease in Europe.
• More information is also needed on possible contact with animals. In addition, studies are needed to assess the vulnerability of European rodent and other mammal species to MPXV.
