Monkeypox Declared Global Health Emergency By WHO

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WHO declares monkeypox a global emergency

The World Health Organisation Saturday sounded its highest level of alarm for monkeypox, declaring it a ‘Public Health Emergency of International Concern’. The same declaration was used for Covid-19 in January 2020.
The threat level, however, is moderate for all regions across the world — barring Europe, where it is assessed to be high.

Cases All over the World

More than 16,000 monkeypox cases have been reported from 75 countries.
Last month, 3,040 cases had been reported from 47 countries.

Cases in India

Kerala has picked up a third case of monkeypox, again in a traveller from United Arab Emirates, who reached the State on July 6.
Health Minister, Veena George, said that monkeypox infection was confirmed in a 35-year-old in Malappuram district.

On January 30, 2020, the organisation had categorised COVID-19 as a PHEIC, when about 7,500 cases of novel coronavirus were reported. On March 11 that year, the agency elevated it to ‘pandemic.’
The latest decision followed a seven-hour meeting on Thursday, July 21, of the International Health Regulations Emergency Committee to discuss the monkeypox outbreak in several countries. It is this Committee of the WHO that decides on the seriousness of a public health crisis.

Guidelines to follow

As part of the PHEIC declaration which is said to be “temporary” and reviewed every three months, countries are expected to follow guidelines.
They are grouped into three categories:
1. those with no reported cases or where the last case was from 21 days ago;
2. those with recently imported cases and experiencing human-to-human transmission and
3. finally, countries where cases are being reported and have a history of the presence of the virus.

The majority of reported cases of monkeypox currently are in males, and most of these cases occur among males who identified themselves as gay, bisexual and other men who have sex with men (MSM), in urban areas, and are clustered in social and sexual networks.
Early reports of children affected include a few with no known epidemiological link to other cases, the WHO stated.
Last year in July 2021, for the first time in nearly two decades, a rare case of human monkeypox was detected in Texas, US. That patient is a US resident who also had returned from Nigeria a couple of days ago.
The last time, there was a monkeypox outbreak – a zoonotic disease – in the US was in 2003, when 47 people were affected by the virus. It was traced to pet prairie dogs in the Midwest that harboured the virus.

What is monkeypox?

Monkeypox is a zoonotic disease – that is transmitted to humans from animals -, most cases of which are found in Africa. According to the World Health Organization (WHO), the monkeypox virus is similar to human smallpox.
Although monkeypox is much milder than smallpox, it can be fatal with a mortality rate of between one and 10 per cent, with most deaths occurring in younger age groups.

Outbreaks

The infection was first discovered in 1958 following two outbreaks of a pox-like disease in colonies of monkeys kept for research — which led to the name ‘monkeypox’.
The first human case was recorded in 1970 in the Democratic Republic of the Congo (DRC) during a period of intensified effort to eliminate smallpox.
According to the WHO, 15 countries on four continents have so far reported confirmed cases of monkeypox in humans.
Locally acquired cases have been confirmed in the DRC (which has the largest incidence of the infection in the world), Central African Republic, Republic of the Congo, Gabon, Cameroon, Nigeria, Côte d’Ivoire, Liberia, and Sierra Leone.
Imported cases have been found in South Sudan and Benin in Africa, and in the United States, UK, Israel, and Singapore.

Symptoms

According to the US Centers for Disease Control and Prevention (CDC), monkeypox begins with a fever, headache, muscle aches, back ache, and exhaustion.
It also causes the lymph nodes to swell (lymphadenopathy), which smallpox does not. The WHO underlines that it is important to not confuse monkeypox with chickenpox, measles, bacterial skin infections, scabies, syphilis and medication-associated allergies.
The incubation period (time from infection to symptoms) for monkeypox is usually 7-14 days but can range from 5-21 days. Usually within a day to 3 days of the onset of fever, the patient develops a rash that begins on the face and spreads to other parts of the body.
The skin eruption stage can last between 2 and 4 weeks, during which the lesions harden and become painful, fill up first with a clear fluid and then pus, and then develop scabs or crusts.
According to the WHO, the proportion of patients who die has varied between 0 and 11% in documented cases, and has been higher among young children.

Transmission

The virus lives in animals, including primates and rodents, but it can sometimes “jump” from animals to people.
The virus spreads from person to person mainly through exposure to respiratory droplets, which can enter the body through mucous membranes in the eyes, mouth and nose.
In addition, monkeypox can also be transmitted when a person has contact with infected lesions or body fluids; indirectly, a person can catch monkeypox from contact with contaminated clothing or linens.

The monkeypox virus is related to the virus that causes smallpox, though monkeypox is a milder illness and does not spread easily between people.

“Ring vaccination” strategy

Ring vaccination proved effective in curbing the smallpox and Ebola outbreaks. As the monkeypox threat continues to loom, scientists view this as the best vaccine approach.
In the 1960s, 20 West African countries launched a smallpox elimination program with USAID and CDC support. The initial emphasis was on mass vaccination. While the mass vaccination approach resulted in overall good vaccination rates, the coverage was low in many groups.
During this period an outbreak in Nigeria’s Ogoja province (and other field observations) changed the course of global smallpox eradication. Prior to this, it was thought that epidemiological surveillance was mainly useful after the outbreaks had been controlled.
But during the Ogoja outbreak in December 1966, the initial smallpox case was reported by a missionary and epidemiological investigation was initiated the same day. With the missionaries’ help, a surveillance system was immediately implemented.
Ring vaccination proved effective in curbing the smallpox and Ebola outbreaks. As the monkeypox threat continues to loom, scientists view this as the best vaccine approach.
In the 1960s, 20 West African countries launched a smallpox elimination program with USAID and CDC support. The initial emphasis was on mass vaccination. While the mass vaccination approach resulted in overall good vaccination rates, the coverage was low in many groups.
This surveillance system rapidly identified the locations with transmission and enabled quick vaccination of family members of cases and village contacts of these family members. The outbreak was successfully controlled.

How it works?

Ring vaccination is also known as “surveillance-containment” strategy.
This strategy required identifying initial cases through surveillance, vaccinating contacts, and contacts of contacts.
The epidemiologist who is most credited with the development of this strategy is Bill Foege who later became CDC director and helped found Carter Center and Gates Foundation.

Its Vaccine

Imvanex, developed by Bavarian Nordic and currently being used against Smallpox, was already cleared for use against Monkeypox by American regulators. It is being sold as Jynneos in the US.
The vaccine contains a weakened form of the vaccinia virus called ‘modified vaccinia virus Ankara’, which is related to the Smallpox virus. It does not cause disease in humans and cannot reproduce in human cells.

Need for vaccine

Doses of the vaccine are extremely limited. Most of the world’s supply has already been bought by countries and regions including Britain, Canada, the EU and the US.
None have gone to Africa, where a more severe version of monkeypox has killed dozens of people. No Monkeypox deaths have been reported in rich countries.
Authorities in numerous countries, including Britain, Germany and the US, have offered the vaccine to health workers and those at high risk of being infected by Monkeypox.