Monkeypox as an international health emergency?

The current outbreak of monkeypox has been declared a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO). It is the highest global alert level, a distinction currently shared only by Covid-19 and polio.

It is the seventh time in the past 13 years that such a statement has been made. In 2009 it was due to the H1N1 virus (swine flu) pandemic, in 2014 due to poliomyelitis, in the period 2013-2016 due to the Ebola outbreak in West Africa, in 2015 and 2016 due to the Zika epidemic, in 2018-2020 due to the Ebola epidemic in Kivu and the penultimate due to the Covid-19 pandemic.

The WHO official statement defines a public health emergency of international concern as “an extraordinary event which, as determined by the international spread of the disease, poses a risk to the public health of other countries and which may require an international response.” .

This decision is made when a serious, sudden, unusual or unexpected situation occurs which has public health implications beyond the national borders of the affected state and which may require immediate international action. And it seems that this is the case. The recommendations are temporary and must be reviewed every three months.

The WHO has reported that the risk of monkeypox is moderate worldwide but high in Europe, where most infections have occurred since the outbreak began last spring. From May 6 to July 22, 2022, more than 16,500 cases of monkeypox were confirmed in at least 74 different countries.

As this monkeypox outbreak spreads, we are offering the virus an unprecedented opportunity to establish itself in non-African species. This could lead to recurrent human outbreaks in different countries and continents. And in the worst case, promote the development of more dangerous variants of the virus. Many reasons to take the WHO statement into account in good time.

Who and how are they infected?

For now, this is an outbreak focused on men who have sex with men, particularly those with multiple partners. That means we can stop it if we use the right strategies in high-risk communities, which can vary by context and include gay, bisexual, and other men who have sex with men, at high risk of exposure. Of course, while avoiding stigmatization of those most affected.

At the same time, the protection of vulnerable groups (immunocompromised people, children, pregnant women) who may be at risk of contracting severe monkeypox must not be lost sight of.

From the moment symptoms appear, the monkeypox virus can spread from person to person. This occurs through direct contact with the infectious rash, scabs, or bodily fluids. But also in the event of contact with respiratory secretions during prolonged face-to-face contact or intimate physical contact, such as e.g. B. Sexual contact. In addition, touching clothing or bedding that has previously been in contact with the infectious rash or body fluids of an infected person is enough for contagion to occur.

Pregnant women can transmit the virus to the fetus via the placenta. It’s also possible for people to get monkeypox from infected animals, either by being scratched or bitten by the animal, or by preparing or eating meat or products from an infected animal.

It is currently unknown whether monkeypox can be transmitted through semen or vaginal fluid, but monkeypox DNA has been detected in semen up to day 11 after acute infection in males. Because of this, some health authorities have taken a cautious approach, recommending that confirmed cases use condoms during intercourse for up to 12 weeks after full recovery from the infection. The illness usually lasts 2 to 4 weeks.

Risk communication and case isolation, among other measures

Measures suggested by the WHO include targeted risk communication and community engagement, case detection, case isolation and supportive treatment, contact tracing and even targeted immunization for people at high risk of exposure to monkeypox.

The declaration aims to expand technical, financial and human resources as much as possible and to maintain mutual accountability for the actions of affected communities. Moreover, it puts additional pressure on governments to take action.

There is still time to control the current outbreak and prevent the possibility of people infected with the virus spreading it to wildlife outside of Africa. Let’s not miss this opportunity, it could be the last.