WHO warns of ‘real’ risk of monkeypox establishing itself outside of Africa

World Health Organization Director-General Tedros Adhanom Ghebreyesus warned on Wednesday that the window to contain the global monkeypox outbreak could be shrinking.

“The risk of monkeypox becoming established in non-endemic countries is real,” he told a press briefing in Geneva.

Since early May, the WHO has confirmed more than 1,000 cases of monkeypox in 29 countries outside West and Central Africa, where the virus is endemic.

If outbreaks are not contained and the virus takes hold in new areas, it could simmer at low levels indefinitely. It is also possible that cases could reach epidemic proportions in some places, meaning that large numbers of people would fall ill in a short period of time.

“As you continue to move forward and more and more people get infected, you start to worry,” said Amira Albert Roess, professor of global health and epidemiology at George Mason University. . “Is this going to become something that’s going to keep moving from person to person and then we won’t be able to control it anymore?”

Multiple outbreaks around the world would constitute a pandemic. But experts aren’t betting on that outcome – WHO leaders and disease experts agree it’s not too late to reverse the tide.

“There is still a window of opportunity to prevent the spread of monkeypox to those most at risk right now,” said Dr Rosamund Lewis, WHO technical lead on monkeypox, during the briefing.

Two smallpox vaccines — both approved by the Food and Drug Administration — may be key to the prevention effort. The US government’s favorite shotcalled Jynneos, is specifically approved for use against monkeypox.

“It’s one of the few diseases in which you can vaccinate someone after they’ve been infected, before they show symptoms, and block the disease,” said Johns principal investigator Eric Toner. Hopkins Center for Health Security.

“You really would have to fuck everything up to not be able to contain this,” he added.

Could monkeypox become endemic in new countries?

Historically, monkeypox is not easily transmitted from person to person. The largest outbreak in the Western Hemisphere so far was a cluster of 47 cases of monkeypox in the United States in 2003. But there was no documented person-to-person transmission at that time; all of those infected had been in contact with sick prairie dogs.

In the current epidemic, the primary driver of transmission appears to be skin-to-skin contact between people, often involving exposure to the rashes or lesions of infected people.

“Right now, we are at greater risk of the virus becoming endemic due to ongoing human-to-human transmission and our inability to stop the cycle of transmission,” Roess said.

Several factors are involved in this cycle. For one thing, some cases of monkeypox are difficult to identify. Patients develop rashes that can be mistaken for chickenpox, syphilis, or herpes, but in some cases they may be limited to the genital area, making them harder to detect.

Second, disease experts are concerned that the United States is not processing tests quickly enough to identify new cases in a timely manner.

“It still takes a few days from when someone is identified to when we can confirm their diagnosis,” Roess said.

Dr Stuart Isaacs, an associate professor of medicine at the University of Pennsylvania, said the virus could have “epidemic potential” in the United States – meaning there would be a large increase in cases – if a single infected person transmitted monkeypox to more than one other person on average. This has not been the case in the past, and the United States has registered less than 40 cases so far.

“We are still too early to really say definitively that this [outbreak] is not going to explode, although the probability is still very low,” Isaacs said.

“The reason it’s endemic in Africa is that there are animal reservoirs,” he added. “The virus spreads and spreads among animals, then it occasionally jumps into humans or non-human primates.”

Debates over the declaration of monkeypox as a pandemic

In the past, Roess said, countries outside Africa quickly halted outbreaks of monkeypox through testing and contact tracing, but the current outbreak is unprecedented in scope and scale.

Experts don’t yet know if its scale is a clue that monkeypox has evolved to improve in human-to-human transmission or if countries are simply discovering the extent of an outbreak that has gone undetected for some time.

Already, the monkeypox epidemic could respond to formal definition of a pandemic: The virus is spreading person-to-person in at least two countries, and there are community-level outbreaks in several parts of the world.

“But generally when we talk about pandemics, we’re talking about diseases in which everyone is significantly at risk in almost every country,” Toner said. “So far it hasn’t reached that threshold, and I don’t think it will ever happen.”

Roess said the fact that the Covid-19 pandemic is not over likely makes world health leaders wary of declaring an emergency.

“There’s a lot of hesitation in declaring this a pandemic,” she said.

One reason for optimism, however, is that this version of monkeypox is generally not life threatening. Although monkeypox rashes can be painful and cause scarring, experts say doctors know how to treat them with smallpox antivirals and supportive care. No deaths have been reported in non-endemic countries so far.

“We should sound the alarm, study this and figure this out,” Isaacs said. “But we’re not at the panic stage yet.”

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