Monkeypox Global Outbreak Update

There is currently a global outbreak of monkeypox involving countries that do not usually have the
disease and without apparent links to endemic countries.

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On 23 July the Director General of the World Health Organization (WHO) declared monkeypox a
Public Health Emergency of International Concern (PHEIC).

The emergency committee that met to review whether the outbreak was a PHEIC were unable to
reach a conclusion, with the Director General himself taking the decision. The reasons for declaring
the current monkeypox outbreak were the rapid spread of the outbreak through new modes of
transmission which, are not fully understood.

This declaration is aimed to help countries to act in a timely and effective manner in responding to
the outbreak. Temporary recommendations have been issued for four groups of countries – those
which have not yet reported a case, those which have reported imported cases and are experiencing
human-to-human transmission, countries which report monkeypox transmission from animals to
humans and countries with the capacity to manufacture medications and vaccines.

Response measures should include surveillance, testing, provision of self-isolation support, clear
messaging especially to most at risk groups and targeted vaccination.

The first monkeypox case was reported on 7 May, in the United Kingdom. This case was an imported
case from Nigeria where the disease is endemic. Other unrelated cases with no links to countries
where the virus is present were subsequently identified and the outbreak has now grown to over
16,000 cases in 75 countries. The majority of cases are in men who have sex with men.

Monkeypox is caused by a virus that belongs to the same group as the smallpox virus. It is usually
present in some countries in Central and West Africa (“endemic countries”). It causes fever,
headache, swollen lymph nodes, fatigue and distinctive rashes on the face, palms, the soles of the
feet and genitalia. In many cases the presentation of symptoms has been different to those
previously documented with some people presenting with a single lesion or lesions on the genitals,
anus and surrounding area, lesions to the mouth and anal or rectal pain or bleeding.

Most cases are mild or moderated, and people usually recover in 2 to 4 weeks. The disease can be
severe and is sometimes fatal. Children and people with immune deficiency are at higher risk of
severe disease. There have been very few children infected in this outbreak.

Monkeypox can spread by human-to-human and animal to human transmission. Healthcare workers,
household members and other close contacts are at higher risk of infection. An infected person can
spread the disease to others in several ways. Through close, direct contact with a symptomatic
person – the rash, body fluids (including saliva) and skin lesions and scabs are infectious. Contact
with contaminated objects such as bedding, clothing or utensils and through infected respiratory
droplets that people release when they laugh, cough or sneeze. Typically, this occurs during direct
and prolonged face-to-face contact with a sick person.

Animal to human transmission has been a common mode of transmission in outbreaks in endemic
countries through contact with an infected animal, from an animal bite or contact with its blood or
other bodily fluids. Infection can also occur if a person touches the rash on an infected animal’s skin –
which sometimes happens during food preparation. In endemic countries, monkeypox virus is found
among rodents and non-human primates, but it is assumed that any mammal can catch the disease.
Most people are able to isolate at home with treatment to relieve symptoms. Several antiviral
medications can be used but are not widely available. A vaccine that protects against smallpox and
monekypox is available in some locations.

Prevention is through observing good personal hygiene – washing hands well and often. Avoiding
close contact with sick people, avoiding touching potentially contaminated objects, not sharing items
and taking extra precaution when caring for a sick person, and cleaning areas / items that have been
used by them.

The WHO assesses the risk of monkeypox as moderate globally and in all WHO regions, except in the
European region, where the risk was assessed as high. The risk of further international spread
continues; however, the risk of impact on international travel remains low.

Dr Katherine O’Reilly, GBTA Risk Committee