Risk of monkeypox becoming established in non-endemic countries is real, WHO warns

La World Health Organization has received notifications of more than a thousand cases of monkeypox in 29 countries out of Africa.  

“The risk of monkeypox becoming established in non-endemic countries is real. WHO is particularly concerned about the risks of this virus to vulnerable groups, including children and pregnant women," said WHO Director Dr Tedros Adhanom Gebreyesus.

«This scenario can be avoided. We ask affected countries to make an effort to identify all cases and contacts in order to control this outbreak and stop its spread," he said.

selective vaccination

WHO is evaluating available monkeypox vaccines for distribution to people at risk. With over a thousand cases reported outside of Africa, community transmission has already occurred.

Cases continue to occur predominantly among men who have sex with men, although cases have been reported in women.

“There are approved antivirals and vaccines for monkeypox, but their supply is limited. WHO is developing a coordination mechanism for distribution of supplies based on public health needs and equityTedros added.

The UN agency does not recommend mass vaccination against monkeypox. In the few places where vaccines are available, they are being used to protect those who may be exposed, such as health workers and laboratory personnel.

Some countries, Tedros said, may consider post-exposure vaccination, ideally within four days of the event, for higher-risk close contacts, such as sexual partners, family members living in the same household, and health workers.

In addition to specific vaccines, those designed against smallpox, a related and more dangerous virus that the world eradicated in 1980, are also effective.

The WHO is in contact with the countries, to find out how many are available, and with the manufacturers.

“We have different generations of vaccines and the amount of each varies. We are also seeing if they have been tested, as their potency needs to be checked regularly, ”explained the director of Epidemics and Pandemics, Sylvie Briand. “The doses of smallpox vaccines are sufficient for current needs, but we anticipate that we will need more if this continues to spread,” he added, insisting on the importance of “preventing the amplification of cases” and that the available tools are used, reducing the close contacts so that there are no more.

contagion by close contact

Rosamund Lewis, the WHO's technical director for monkeypox, said the “close interpersonal contact” is the main way of spread of monkeypox. "Face to face, skin to skin. Other modes of transmission can be through rashes on the skin, in the eyes, in the mouth and on the mucous membranes around the genital area”, he specified.

The risk of aerosol transmission is not yet fully understood. The WHO recommends that health workers caring for monkeypox patients wear a mask. "Clearly, in medical settings, if you do procedures that generate aerosols, this contributes to aerosol transmission," Lewis said.

“Another possibility is what we call fomites. Materials such as towels, bedding... that become contaminated. It is possible for someone to inhale (virus) particles when handling contaminated sheets.”

The virus in Africa

Dr. Tedros lamented that this disease is receiving attention only after it has left Africa.

So far this year there have been more than 1400 suspected cases of monkeypox in Africa, with 66 deaths. “This virus has been circulating and killing in Africa for decades. It is an unfortunate reflection of the world we live in that the international community only pays attention to monkeypox because it has appeared in high-income countries,” said Tedros. "The communities that live with the threat of this virus every day deserve the same concern, the same attention and the same access to tools to protect themselves."

hepatitis in children

WHO also continues to monitor reports of hepatitis of unknown cause in children. Already reported more than 700 probable cases from 34 countries, and a further 112 cases are under investigation.

At least 38 of these children have required liver transplants, and 10 have died.

So far, the five viruses that usually cause hepatitis have not been detected in any of these cases.

The WHO receives reports of unexplained hepatitis in children every year, but some countries have indicated that the rates they are seeing are higher than expected.

The COVID-19 pandemic is not over

Monkeypox has shifted media attention from the COVID-19, but the director of the WHO insisted that the pandemic is not over and called for caution.

Worldwide, the number of cases and deaths from COVID-19 continues to decline.

During the week of May 30 to June 5, 2022, more than three million cases were reported, which represents a decrease of 12% compared to the previous week. The number of new weekly deaths also continues to decline, with more than 7600 reported fatalities, a 22% decrease.

At the regional level, the number of new weekly cases increased by 19% in the Eastern Mediterranean region (21.000 cases) and 1% in the South-East Asia region (almost 51.000 infections), while it decreased in the other four regions of the WHO. In America, the region with the most cases in absolute figures (1,1 million), the decrease was 1%, while in Asia-Pacific (one million infections) the decrease was 19%, and in Europe (744.000) 18%.

"This is clearly a very encouraging trend - increasing vaccination rates are saving lives - but the WHO continues to urge caution," Tedros insisted. “Globally, there is not enough testing, not enough vaccination.”  

Almost 18 months after administration of the first vaccine, 68 countries have not yet reached 40% coverage.  Vaccine supply is now sufficient, but demand is lacking in many countries with the lowest vaccination rates. WHO and its partners are working with countries to boost uptake of the vaccine, bringing it into communities through mobile units, door-to-door campaigns and the mobilization of community leaders.

“The perception that the pandemic is over is understandable, but wrong. A new, even more dangerous variant may emerge at any time., and a large number of people remain unprotected,” he concluded.

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