This current Disease Outbreak News on the multi-country monkeypox outbreak is an update to the previously published Disease Outbreak News of 4 June, with updated data, some further detail on clinical description of cases, measures to increase the safety of gatherings, and again provides summaries of guidance, including on vaccination.
Since 13 May 2022, cases of monkeypox have been reported to WHO from 28 Member States across four WHO regions (the Region of the Americas as well as the European, Eastern Mediterranean, and Western Pacific Regions) where monkeypox is not usual or has not previously been reported (Figure 1). In addition, since the beginning of the year, there are 1536 suspected cases reported from eight countries in the WHO African Region, of which 59 cases have been confirmed and 72 deaths reported.
The continuous detection of the virus and deaths reported in some countries in the African Region highlight the need to better understand the source, transmission dynamics and provide people with the information and support they need to protect themselves and others in a range of different contexts.
Geographic distribution of cases of monkeypox reported to or identified by WHO from official public sources, between 13 May and 8 June 2022, 5 PM CEST
What is Monkeypox?
The illness begins ( Cause) with:
- Swollen in the lymph nodes
- Fever
- Headache
- Muscle aches
- Backache
- Swollen lymph nodes
- Chills
- Exhaustion
Within 1 to 3 days (sometimes longer) after the appearance of fever, the patient develops a rash, often beginning on the face then spreading to other parts of the body.
Epidemiology:
The disease is caused by monkeypox viruses, in the genus Orthopoxvirus. The variola virus, the causative agent of smallpox, was also in this genus.
Lesions progress through the following stages before falling off:
- Macules
- Papules
- Vesicles
- Pustules
- Scabs
The illness typically lasts for 2−4 weeks. In Africa, monkeypox has been shown to cause death in as many as 1 in 10 persons who contract the disease.
There are number of measures that can be taken to prevent infection with monkeypox virus:
- Avoid contact with animals that could harbor the virus (including animals that are sick or that have been found dead in areas where monkeypox occurs).
- Avoid contact with any materials, such as bedding, that has been in contact with a sick animal.
- Isolate infected patients from others who could be at risk for infection.
- Practice good hand hygiene after contact with infected animals or humans. For example, washing your hands with soap and water or using an alcohol-based hand sanitizer.
- Use personal protective equipment (PPE) when caring for patients.
Treatment of Monkeypox:
- Tecovirimat (also known as TPOXX) is an antiviral medication that is approved by the United States Food and Drug Administration (FDA)
for the treatment of smallpox in adults and children.Tecovirimat is available as a pill or an injection. For children who weigh less than 28.6 pounds, the capsule can be opened and medicine mixed with semi-solid food. - Cidofovir (also known as Vistide) is an antiviral medication that is approved by the FDA
for the treatment of cytomegalovirus (CMV) retinitis in patients with Acquired Immunodeficiency Syndrome (AIDS). - Vaccinia Immune Globulin Intravenous (VIGIV) is licensed by FDA for the treatment of complications due to vaccinia vaccination including eczema vaccinatum, progressive vaccinia, severe generalized vaccinia, vaccinia infections in individuals who have skin conditions, and aberrant infections induced by vaccinia virus (except in cases of isolated keratitis).
Vaccination:
On 25 May, disease experts from the NICD in South Africa said they saw no need for mass vaccination, because they believe cases will not explode as they did in the COVID-19 pandemic.
In reaction to the current outbreak of monkeypox, a number of countries have stated they are buying vaccines and/or releasing vaccines from national stockpiles for use in the outbreak. In May 2022, the US, Spain, Germany and the UK all announced purchases of smallpox vaccine.
On 24 May, Centers for Disease Control (CDC) Deputy Director Jennifer McQuiston confirmed the United States is releasing some of their Jynneos vaccine supply from their Strategic National Stockpile for people who are "high-risk".
References
1Petersen BW, Harms TJ, Reynolds MG, Harrison LH. Use of Vaccinia Virus Smallpox Vaccine in Laboratory and Health Care Personnel at Risk for Occupational Exposure to Orthopoxviruses — Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2015. MMWR Morb Mortal Wkly Rep 2016;65:257–262. DOI: http://dx.doi.org/10.15585/mmwr.mm6510a2
2 Jezek Z, Szczeniowski M, Paluku KM, Mutombo M. Human monkeypox: clinical features of 282 patients. J Infect Dis. 1987 Aug;156(2):293-8. doi: 10.1093/infdis/156.2.293. PMID: 3036967.
3Cono J, Cragan JD, Jamieson DJ, Rasmussen SA. Prophylaxis and treatment of pregnant women for emerging infections and bioterrorism emergencies. Emerg Infect Dis. 2006 Nov;12(11):1631-7. doi: 10.3201/eid1211.060618. PMID: 17283610; PMCID: PMC3372351. Mbala PK, Huggins JW, Riu-Rovira T, Ahuka SM, Mulembakani P, Rimoin AW, Martin JW, Muyembe JT. Maternal and Fetal Outcomes Among Pregnant Women With Human Monkeypox Infection in the Democratic Republic of Congo. J Infect Dis. 2017 Oct 17;216(7):824-828. doi: 10.1093/infdis/jix260. PMID: 29029147.
4Ogoina D, Iroezindu M, James HI, Oladokun R, Yinka-Ogunleye A, Wakama P, Otike-Odibi B, Usman LM, Obazee E, Aruna O, Ihekweazu C. Clinical Course and Outcome of Human Monkeypox in Nigeria. Clin Infect Dis. 2020 Nov 5;71(8):e210-e214. doi: 10.1093/cid/ciaa143. PMID: 32052029.
https://en.wikipedia.org/wiki/2022_monkeypox_outbreak
https://www.cdc.gov/poxvirus/monkeypox/treatment.html
https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385
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