Avian Flu Diary: WHO Updated Risk Assessment On Monkeypox

#16,791

Eight days after issuing their first Risk Assessment on the global spread of Monkeypox in non-endemic nations (see WHO Monkeypox Update & Risk Assessment - May 21st) the World Health Organization today has posted a detailed, and lengthy epidemiological report, and a revised risk assessment.

As of this update, the WHO reports a total of 257 laboratory confirmed cases and around 120 suspected cases being reported outside of endemic regions of Africa. Some media sources are reporting closer to 400 cases, but it isn't certain what criteria they are using for `confirmed'.

In any event, the number of cases continues to rise, and more cases are expected.

The WHO in this update has declared `. . . the overall public health risk at global level is assessed as moderate' but adds, `. . . The public health risk could become high if this virus exploits the opportunity to establish itself as a human pathogen and spreads to groups at higher risk of severe disease . . . '.

Due to its length, I've only posted the link, and a few excerpts. Follow the link to read this update in its entirety.

Multi-country monkeypox outbreak in non-endemic countries: Update
29 May 2022

Outbreak at a glance

Since 13 May 2022, monkeypox has been reported to WHO from 23 Member States that are not endemic for monkeypox virus, across four WHO regions. Epidemiological investigations are ongoing. 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. Early epidemiology of initial cases notified to WHO by countries shows that cases have been mainly reported amongst men who have sex with men (MSM). 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.

The current publication of Disease Outbreak News is an update to the previously published Disease Outbreak News of 21 May. This edition provides information on recently published WHO guidance for the outbreak. The background information, such as the description of the epidemiology of the disease, remains mostly unchanged.

(SNIP)

WHO risk assessment

Currently, the overall public health risk at global level is assessed as moderate considering this is the first time that monkeypox cases and clusters are reported concurrently in widely disparate WHO geographical areas, and without known epidemiological links to non-endemic countries in West or Central Africa. Cases have been mainly reported amongst MSM. Additionally, the sudden appearance and wide geographic scope of many sporadic cases indicates that widespread human-to-human transmission is already underway, and the virus may have been circulating unrecognized for several weeks or longer.

The public health risk could become high if this virus exploits the opportunity to establish itself as a human pathogen and spreads to groups at higher risk of severe disease such as young children and immunosuppressed persons; a large part of the population is vulnerable to monkeypox virus, as smallpox vaccination, which confers some cross-protection, has been discontinued since 1980 or earlier in some countries.

There is currently limited epidemiological and laboratory information, and the number of cases currently being reported is likely to be an underestimate, in part due the following:

the relatively mild symptoms in many cases with localized rash and lymphadenopathy, such that many persons may not present to health care services
lack of early clinical recognition by health workers of an infection previously known in only a few countries;
the time required by Member States to establish and scale up new surveillance mechanisms.
and a lack of widely available diagnostic tests, reagents and other supplies.
There is a potential risk to health workers if they are not wearing appropriate personal protective equipment (PPE) to prevent transmission. Though not reported in the current outbreak, the risk of health care associated monkeypox infections has been documented in the past.

There is the potential for greater health impact with wider spread to vulnerable population groups, as deaths among cases in previous outbreaks have been reported to occur more often among children, and immunocompromised individuals, including persons with poorly controlled HIV infection, who may be especially at risk of more severe disease.

Furthermore, there is the high likelihood of identification of further cases with unidentified chains of transmission, including potentially in other population groups. With a number of countries in several WHO regions reporting cases of monkeypox, it is highly likely that even more countries will identify cases. As monkeypox lesions commonly occur on the skin over many or all parts of the body, as well as in the mouth, there is a high risk of further spread of the virus through close physical contact within families or with sexual partners, including face-to-face, skin-to-skin, or mouth-to-skin contact, or contact with contaminated materials (e.g., linen, bedding, clothing or utensils).

However, at present, the risk for the general public appears to be low. Nonetheless, immediate action from countries is required to control further spread among groups at risk, prevent spread to the general population and avert the establishment of monkeypox as a clinical condition and public health problem in currently non-endemic countries.

(Continue . . . )

We have vaccines, and in theory - between the isolation of those infected and rigorous contact tracing - this outbreak should be containable, assuming public health can throw enough resources at it.

But Monkeypox is behaving in ways we've not seen before, and until we understand why, it is hard to predict what will happen next.

But based on what we've seen so far, this isn't something we can afford to ignore and hope it goes away. For more on this outbreak, you may wish to revisit: