Global Monkeypox Outbreak Calls for Action From WHO Leaders

GENEVA, Switzerland — The World Health Organization reported that as of May 21 more than 92 monkeypox cases have been confirmed, and 28 suspected cases are under investigation within 12 member states that are not endemic for monkeypox virus.

“Monkeypox is not a new disease, it’s been described for at least 40 years and it’s been well studied in the African region,” said Rosamund Lewis, who serves as the head of the WHO Smallpox Secretariat and WHO Health Emergencies Program, during a live Q&A session held this week.

“We’ve seen a few cases in Europe over the last five years just in travelers, but this is the first time we are seeing cases across many countries at the same time in people who have not traveled to the endemic regions in Africa,” continued Lewis. 

The U.S. is included on the list of 12 member states that are not endemic for monkeypox virus, with 1-5 cases of confirmed or suspected monkeypox.

Monkeypox is a zoonotic disease which is commonly found in Central and West Africa, and is transmitted mainly through direct or indirect contact with blood, body fluids, skin, or mucosal lesions of infected animals.

According to WHO leaders, there are no specific treatments for monkeypox, and the symptoms will naturally resolve. 

Smallpox vaccination has helped to prevent or attenuate the disease with an efficacy rate of 85%, but these vaccines are no longer available on the market since the disease was declared eradicated in the 1980s.

The WHO is currently coordinating with the manufacturer of the vaccine MVA-BN which was developed for monkeypox in 2019, also known as Imavune, Imvanex, or Jynneos, to improve access for those in need. No universal vaccination will be warranted as monkeypox is rare. 

“Because these [vaccines] are relatively newly discovered products, they are not yet widely available. They are available to some Ministries of Health in national stockpiles, but they’re not yet widely available commercially,” said Lewis.

“We want to stop human to human transmission, and we can do this in non-endemic countries. We can use public health tools of early identification, isolation of cases… talking with communities… to be part of the solution,” said Maria Van Kerkhove, who serves as the COVID-19 technical lead, emerging diseases and zoonoses lead at the WHO Health Emergencies Program, during the Q&A. 

“There are antivirals, there are vaccines, but we have to utilize these most appropriately for those who are most at risk, in an equitable fashion… we will be making recommendations on who should be prioritized for this,” said Van Kerkhove.

The Joint United Nations Program on HIV/AIDS expressed concerns on May 22 that public reporting and commentary on monkeypox has used language and imagery, particularly portrayals of LGBTI and African people, to reinforce homophobic and racist stereotypes and exacerbate stigma which blames certain groups for the outbreak. 

“Yesterday we issued some interim public health guidance for gay bisexual and other men who have sex with men,” said Andy Seale, an adviser at World Health Organization’s Global Programs for HIV, viral hepatitis and sexually transmitted infections, during the Q&A. 

To help health departments better facilitate surveillance of those infected with monkeypox, the Pan American Health Organization also released a brief on monkeypox in non-endemic countries on May 20. 

According to the brief, the incubation period for monkeypox typically ranges from six to 16 days, and infection can be divided into two periods. 

The first five days an individual will likely experience symptoms of fever, headache, swollen lymph nodes, lower back pain, muscle pain, and severe asthenia. 

Between day one and three, an individual is likely to develop a rash after the onset of a fever, typically in the face and then spreading to the rest of the body. The rash will evolve from flat-based lesions to fluid-filled blisters and bursting can occur in about 10 days. It could take three weeks before there is a complete removal of the scabs.

Secondary transmission usually occurs from coming into close contact with the infected respiratory secretions or skin lesions of an infected person, or with objects that have been contaminated with fluids from an infected person or materials from the lesion. 

The WHO recommends contact tracing for any individual who has come into close contact with an infected person and to receive a clinical examination to be evaluated as a suspected case. Individuals should isolate if they develop a rash, and isolation should continue until the rash has resolved.

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