Monkeypox Virus - Credit CDC PHIL
Thought to be spread mainly by `direct contact' and `large droplets', Monkeypox - on paper, at least - doesn't appear to have strong pandemic potential. But viruses can evolve over time - particularly after being introduced into a new host population - making it wise never to say `never'.
Even if we take a pandemic scenario off the table for now, the relatively low-level global spread of the Monkeypox virus could have significant, and unpredictable, impacts on economies, travel, and global health. And if it becomes well-entrenched, it could be very difficult to eradicate.
While I have greater concerns over new, more dangerous COVID variants emerging - or the sudden rise of a novel avian or swine flu virus - there is enough uncertainty surrounding this Monkeypox outbreak to make it worthy of our attention and respect.
Yesterday the WHO posted a comprehensive update and risk assessment (based, admittedly, on incomplete data), excerpts from which you'll find below. You'll want to follow the link to read it in its entirety.
I'll return with a postscript after the break.
Multi-country monkeypox outbreak in non-endemic countries
21 May 2022
Outbreak at glance
Since 13 May 2022, cases of monkeypox have been reported to WHO from 12 Member States that are not endemic for monkeypox virus, across three WHO regions. Epidemiological investigations are ongoing, however, reported cases thus far have no established travel links to endemic areas. Based on currently available information, cases have mainly but not exclusively been identified amongst men who have sex with men (MSM) seeking care in primary care and sexual health clinics.
The objective of this Disease Outbreak News is to raise awareness, inform readiness and response efforts, and provide technical guidance for immediate recommended actions.
The situation is evolving and WHO expects there will be more cases of monkeypox identified as surveillance expands in non-endemic countries. Immediate actions focus on informing those who may be most at risk for monkeypox infection with accurate information, in order to stop further spread. Current available evidence suggests that those who are most at risk are those who have had close physical contact with someone with monkeypox, while they are symptomatic. WHO is also working to provide guidance to protect frontline health care providers and other health workers who may be at risk such as cleaners. WHO will be providing more technical recommendations in the coming days.
(SNIP)
WHO risk assessment
Endemic monkeypox disease is normally geographically limited to West and Central Africa. The identification of confirmed and suspected cases of monkeypox without any travel history to an endemic area in multiple countries is atypical, hence, there is an urgent need to raise awareness about monkeypox and undertake comprehensive case finding and isolation (provided with supportive care), contact tracing and supportive care to limit further onward transmission.
Cross-protective 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 programmes. There is little immunity to monkeypox among younger people living in non-endemic countries since the virus has not been present there.
Historically, vaccination against smallpox had been 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.
Based on currently available information, cases have mainly but not exclusively been identified amongst men who have sex with men (MSM) seeking care in primary care and sexual health clinics. No deaths have been reported to date. However, the extent of local transmission is unclear at this stage, as surveillance has been limited. There is a high likelihood of identification of further cases with unidentified chains of transmission, including in other population groups. With a number of countries in several WHO regions reporting cases of monkeypox, it is highly likely that other countries will identify cases.
The situation is evolving and WHO expects there will be more cases of monkeypox identified as surveillance expands in non-endemic countries. So far, there have been no deaths associated with this outbreak. Immediate actions focus on informing those most at risk for monkeypox infection with accurate information, stopping further spread and protecting frontline workers.
WHO advice
Identification of additional cases and further onward spread in the countries currently reporting cases and other Member States is likely. Any patient with suspected monkeypox should be investigated and if confirmed, isolated until their lesions have crusted, the scab has fallen off and a fresh layer of skin has formed underneath.
Countries should be on the alert for signals related to patients presenting with an atypical rash that progresses in sequential stages – macules, papules, vesicles, pustules, scabs, at the same stage of development over all affected areas of the body – that may be associated with fever, enlarged lymph nodes, back pain, and muscle aches. These individuals may present to various community and healthcare settings including but not limited to primary care, fever clinics, sexual health services, infectious disease units, obstetrics and gynecology, urology, emergency departments and dermatology clinics. Increasing awareness among potentially affected communities, as well as health care providers and laboratory workers, is essential for identifying and preventing further secondary cases and effective management of the current outbreak.
A little over 11 years - and 12,000 blogs ago - I wrote an essay called The Third Epidemiological Transition, based on the works of the late (May 22, 1936 - May 15, 2014) anthropologist and researcher George Armelagos of Emory University.
The gist of his theory is that since the mid-1970s the world has entered into an age of newly emerging infectious diseases, re-emerging diseases and a rise in antimicrobial resistant pathogens.
And of course, the deadliest pandemic in 100 years due to SARS-CoV-2, believed to have come from bats.
COVID won't be the last global health threat we'll face, and it may be far from the worst that nature can throw at us. Past performance is no guarantee of future results.
The future is - by definition - uncharted territory.
Where - if we go into it unprepared - we can expect to pay a heavy price.
