Fireplace at first glance
Since 13 May 2022, cases of smallpox have been reported to the WHO from 12 Member States that are not endemic for the smallpox virus in three WHO regions. Epidemiological investigations are ongoing, but no reported cases have been identified to travel to endemic areas. Based on currently available information, cases have been identified mainly, but not exclusively, among men who have sex with men (MSM) seeking care in primary care and sexual health clinics.
The purpose of this disease epidemic news is to raise awareness, inform preparedness and response efforts, and provide technical guidance for immediate recommended action.
The situation is evolving and the WHO expects that there will be more cases of monkeypox identified with the expansion of surveillance in non-endemic countries. Immediate action focuses on informing those who may be most at risk of monkeypox infection with accurate information to stop further spread. The available evidence suggests that those most at risk are those who have had close physical contact with someone with monkeypox while they are symptomatic. The WHO is also working to provide guidance to protect frontline health care providers and other health professionals who may be at risk, such as cleaners. The WHO will provide more technical recommendations in the coming days.
Description of the hearth
As of 21 May, 13:00, 92 laboratory confirmed cases and 28 suspected cases of monkeypox with ongoing investigations have been reported to the WHO by 12 non-endemic monkey Member States in three WHO regions ( Table 1, Figure 1). No related deaths have been reported so far.
Table 1. Cases of monkeypox in non-endemic countries reported to the WHO between 13 and 21 May 2022 at 13:00.
Figure 1. Geographical distribution of confirmed and suspected cases of monkeypox in non-endemic between 13 and 21 May 2022, at 13:00.
To date, no reported cases of endemic travel have been established. Based on currently available information, cases have been identified mainly, but not exclusively, among men who have sex with men (MSM) seeking care in primary care and sexual health clinics.
To date, all cases whose samples have been confirmed by PCR have been identified as infected with West African treasure. The genomic sequence of a swab sample from a confirmed case in Portugal shows a close coincidence of the monkeypox virus causing the current epidemic with the cases exported from Nigeria to the United Kingdom, Israel and Singapore in 2018 and 2019.
The identification of confirmed and suspected cases of smallpox without direct links to travel to an endemic area is an extremely unusual event. Surveillance is currently limited in non-endemic areas, but is now being expanded. The WHO expects more cases to be reported in non-endemic areas. The available information suggests that human-to-human transmission occurs in people in close physical contact with cases that are symptomatic.
In addition to this new outbreak, the WHO continues to receive updates on the status of current monkeypox reports through established monitoring mechanisms (Integrated Surveillance and Response) for cases in endemic countries. [1]as summarized in Table 2.
[1] Endemic countries for monkeypox are: Benin, Cameroon, Central African Republic, Democratic Republic of the Congo, Gabon, Ghana (identified only in animals), Côte d’Ivoire, Liberia, Nigeria, Republic of the Congo, Sierra Leone and South Sudan.
Table 2. Cases of monkeypox in endemic countries between 15 December 2021 and 1 May 2022
For more information, please see the WHO AFRO Weekly Bulletin on Outbreaks and Other Emergencies.
Epidemiology of the disease
Monkeypox is a viral zoonosis (a virus transmitted to humans from animals) with symptoms very similar to those seen in the past in patients with smallpox, although it is clinically less severe. It is caused by the monkeypox virus, which belongs to the genus orthopoxvirus of the family Poxviridae. There are two groups of monkeypox virus: the West African log and the Congo (Central African) log pool. The name monkeypox comes from the initial detection of the virus in monkeys in a Danish laboratory in 1958. The first human case was identified in a child in the Democratic Republic of the Congo in 1970.
The monkeypox virus is transmitted from one person to another through close contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding. The incubation period of monkeypox is usually 6 to 13 days, but can vary from 5 to 21 days.
Various animal species have been identified as susceptible to the monkeypox virus. Uncertainty remains about the natural history of the monkeypox virus and further research is needed to identify the exact reservoir (s) and how the virus is circulating in the wild. Eating inadequately processed meat and other animal products from infected animals is a possible risk factor.
Monkeypox is usually self-limiting, but can be severe in some people, such as children, pregnant women, or people with immune suppression due to other health conditions. Human infections with West African logs cause less severe disease than Congo Basin logs, with a mortality rate of 3.6% compared to 10.6% for Congo Basin logs.
- Further public health investigations are ongoing in non-endemic countries that have identified cases, including extensive case detection and contact tracing, laboratory testing, clinical management and isolation provided with supportive care.
- Genomic sequencing, where available, was performed to determine the monkeypox virus stock (s) in this outbreak
- Vaccination against monkeypox, where available, is used to manage close contacts, such as health professionals. The WHO is convening experts to discuss vaccination recommendations.
The WHO has developed case definitions for the current monkeypox epidemic in non-endemic countries.
(case definitions will be updated as necessary)
Assuming case:
A person of any age who presents himself in a country that is not endemic for monkeypox[2] with unexplained acute rash
And
One or more of the following signs or symptoms from March 15, 2022:
- headache
- Acute fever (> 38.5oC),
- Lymphadenopathy (swollen lymph nodes)
- Myalgia (muscle and body pain)
- Back pain
- Asthenia (deep weakness)
And
for which the following common causes of acute rash do not explain the clinical picture: varicella zoster, herpes zoster, measles, zika, dengue, chikungunya, herpes simplex, bacterial skin infections, disseminated gonococcal infection, primary or secondary syphilis, chancroid, lymphogranuloma , molluscum contagiosum, allergic reaction (eg to plants); and any other locally significant common causes of papular or vesicular rash.
NB It is not necessary to obtain negative laboratory results for the listed common causes of rash disease in order to classify a case as suspicious.
[2] The endemic countries of monkeypox are: Benin, Cameroon, Central African Republic, Democratic Republic of the Congo, Gabon, Ghana (identified only in animals), Côte d’Ivoire, Liberia, Nigeria, the Republic of the Congo and Sierra Leone. Benin and South Sudan have documented imports in the past. The countries currently reporting cases of West African treasure are Cameroon and Nigeria. With this definition of the case, all but four of these countries need to report new cases of monkeypox as part of the current epidemic in several countries.
Probable case:
A person who meets the definition of a suspect case
And
One or more of the following:
- there is an epidemiological link (face-to-face exposure, including healthcare workers without eye and respiratory protection); direct physical contact with the skin or skin lesions, including sexual contact; or contact with contaminated materials such as clothing, bedding or utensils until a probable or confirmed case of monkeypox 21 days before the onset of symptoms
- reports a history of travel to an endemic country for monkeypox1 21 days before the onset of symptoms
- had multiple or anonymous sexual partners in the 21 days prior to the onset of symptoms
- has a positive serological test for orthopoxvirus in the absence of smallpox vaccination or other known orthopoxvirus exposure
- was hospitalized due to illness
Confirmed case:
A case that meets the presumptive or probable case and has been laboratory confirmed for monkeypox virus by detecting unique viral DNA sequences or by real-time polymerase chain reaction (PCR) and / or sequencing.
Discarded case:
Presumptive or probable case for which laboratory testing by PCR and / or sequencing is negative for monkeypox virus.
Additional cases are likely to be identified and further disseminated in the countries currently reporting cases and in other Member States. Any patient with suspected monkeypox should be examined and, if confirmed, isolated until the lesions form a crust, the crust falls off, and a new layer of skin forms underneath.
States should be alert to alerts to patients with an atypical rash that progresses to successive stages – macules, papules, vesicles, pustules, scabs, at the same stage of development on all affected areas of the body – that may be related. with fever, swollen lymph nodes, back pain and muscle aches. These individuals can be represented in a variety of communities and health facilities, including, but not limited to, primary care, fever clinics, sexual health services, infectious disease wards, obstetrics and gynecology, urology, emergency departments, and dermatology clinics. Raising awareness among potentially affected communities, as well as health care providers and laboratory workers, is essential to identify and prevent further secondary cases and effectively manage current …
Add Comment