The World Health Organization (WHO) has reported several hundred confirmed cases of monkeypox in more than 20 countries outside Africa in recent weeks with more suspected cases being evaluated. WHO now says, “Monkeypox presents moderate risk to public health.”
“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,” WHO said.
WHO added that it “expects more cases to be reported as surveillance in endemic and non-endemic countries expands.”
Complicating determinations of risk is the fact that, as WHO explains, “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.”
Africa is the localized site for the rare disease, but a recent spread to Europe, the U.K., Australia, the Middle East and the U.S. has put WHO and other health agencies like the Centers for Disease Control and Prevention (CDC) on alert.
During a webinar on May 30, Dr. Sylvie Briand, director of Pandemic and Epidemic Diseases Department at WHO, said, “It’s an unusual situation. Before, we had [monkeypox] only in certain countries. Now it’s out of the box.”
WHO states that in addition to non-endemic countries reporting cases, WHO continues to receive updates on the status of ongoing outbreaks for cases in endemic countries in the African region. There are, for example, over 1,000 cases reported in the Democratic Republic of Congo.
The majority of the non-African cases are among gay and bisexual men and men who have sex with other men (MSM), which has prompted concerns about stigmatization of the disease in its current form as a “gay disease,” as PGN previously reported.
The monkeypox outbreak has also impacted Pride celebrations in hot spots for the disease like Spain, which currently has the highest number of cases outside of the African continent — 98 confirmed and another 127 suspected, according to WHO.
WHO has focused on the origin of the cases in Spain as likely being a 10-day gay pride event held in the Canary Islands in early May. That event had more than 80,000 people in attendance. Cases are then thought to have been transmitted at a sauna in Madrid, which has since been closed. About two dozen cases were traced there. On May 30, Spain’s Health Ministry recommended smallpox vaccines for close contacts of those already infected, suggesting that the vaccine given within four days of exposure can minimize monkeypox symptoms and thus also limit possible spread.
There have been no fatalities in the current outbreak thus far.
Madrid’s Gay Pride celebration is expected to be huge this year after two years with COVID-19 restrictions scaling back or canceling events. In 2019, Madrid’s last pre-pandemic Pride celebration, over a million people were in attendance, spawning fears of further monkeypox outbreaks at this year’s Pride. “Pride is a huge party, it is a moment to make our voice be heard, that brings lots of people together,” Mario Blázquez, coordinator of health programs for the LGBTQ group COGAM in Madrid, told The Associated Press.
“We don’t know what will happen. We don’t know what the level of transmission of the virus will be or what legal measures could be taken. And then what stigma could be generated by these legal measures that sometimes are discriminatory,” Blázquez said.
“It’s not a gay disease — the transmission could have happened at a business conference or a political rally,” Dr. Roger Paredes, chief of the Infectious Diseases Department at Barcelona’s Germans Trias i Pujol Hospital, told Yahoo News. It is being transmitted through close skin contact, Paredes added, and is just as likely to be passed by heterosexuals.
In the U.K. the monkeypox warnings are stark. On May 30, the U.K. Health Security Agency issued a directive that people who test positive for monkeypox abstain from sexual activity while they are symptomatic, to have no contact with pets due to known human-to-animal transmission, and to not leave their homes for a month. The symptoms typically last for several weeks, but there is an asymptomatic incubation period of up to as many as three weeks.
As of May 30, the U.K. had confirmed 183 monkeypox cases. Most cases are in England, but cases have also been identified in Scotland, Wales and Northern Ireland. The first cases in the U.K. were identified in a non-gay nuclear family in London.
According to WHO, “Monkeypox virus is transmitted from one person to another by close contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding. The incubation period of monkeypox is usually from 6 to 13 days but can range from 5 to 21 days.”
WHO says, “Monkeypox is usually self-limiting but there is likely to be little immunity to monkeypox among people living in non-endemic countries since the virus has not previously been identified in those populations.”
Also at issue in the U.S., U.K. and Europe is the age of those getting infected. As WHO explains, vaccination against smallpox had been shown to be cross-protective against monkeypox. But immunity from the smallpox vaccinations is to people over 45, as smallpox has been eradicated globally due vaccines and thus the vaccination is no longer given. This makes people under 45 especially vulnerable in outbreaks.
CDC cites the initial symptoms as fever, malaise, headache, weakness and body aches; symptoms which are similar to those for COVID-19, which may hamper diagnosis and isolation.
The U.K. Health Security Agency said, “People with possible, probable or confirmed monkeypox should avoid contact with other people until their lesions have healed and the scabs have dried off.”
In its guidance, the agency said, “Cases [people with monkeypox] should also abstain from sex while symptomatic, including the period of early symptom onset, and while lesions are present.”
The U.K. Health Security Agency explained, “Monkeypox is primarily spread through prolonged skin-to-skin contact with an infectious person — not just sexual. It typically causes lesions to form on an individual’s face and body.”
The agency also said that there is “no available evidence of monkeypox in genital excretions,” but advised that condoms still be used for eight weeks after infection as a “precaution.” An individual who contracts monkeypox is generally considered to no longer be infectious once their skin lesions scab over and are fully healed.
WHO asserts that “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.”
WHO also notes that “Cases have been mainly reported amongst MSM,” but stresses that “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.”
Capt. Jennifer McQuiston, DVM, MS, Deputy Director, Division of High Consequence Pathogens and Pathology Vaccines at CDC has stressed that vaccines and antivirals considered to be effective against monkeypox have been mobilized and that more will become available in the coming weeks.