UK and Netherlands follow Belgium to implement "monkeypox quarantine"

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UK and Netherlands follow Belgium to implement “monkeypox quarantine”

After four cases of monkeypox were diagnosed, the Belgian health department issued a statement requiring confirmed cases of monkeypox to be quarantined for 21 days.

This is the first country in the EU to issue a quarantine order.

The United Kingdom and the Netherlands followed suit. The latest UK advice states that anyone who has been in close contact with or lives with a confirmed case should self-isolate for 21 days and avoid contact with immunocompromised people, pregnant women and children under 12.

In the Netherlands, it is mandatory for doctors to report monkeypox cases in a timely manner so that staff can notify close contacts and isolate them for 21 days.

On May 22, , traces of monkeypox were discovered in Austria and Argentina.

So far, in the past 10 days, nearly 100 confirmed cases and dozens of suspected cases have been reported in 16 “non-monkeypox virus-endemic countries” around the world. No deaths have been reported so far.

UK and Netherlands follow Belgium to implement "monkeypox quarantine" Caption: Statistics of confirmed and suspected cases reported to the World Health Organization by countries not endemic for monkeypox virus from 13:00 to 21 May 2022. /WHO

“Vaccination against smallpox has been proven to prevent monkeypox.” On May 21, local time, the World Health Organization (WHO) released the “Disease Outbreak News” said.

According to the Sunday Telegraph, following the eradication of smallpox in 1980, smallpox vaccinations have been discontinued in various countries.

Up to 70% of the global population is no longer protected by vaccines.

At present, many countries have urgently purchased an improved smallpox vaccine. The vaccine, approved in 2019, can be used to prevent monkeypox and smallpox in people over the age of 18.

The Centers for Disease Control and Prevention (CDC) recommends that vaccination within 4 days of exposure to monkeypox virus can prevent infection, and vaccination within 4-14 days of exposure may reduce symptoms.

Orders in Canada and the United States reached 500,000 doses and 13 million doses, respectively. The first vaccines are expected to be delivered in 2023.

What is the risk of monkeypox infection?

“The monkeypox virus infection is much less severe and the death rate is much lower. Are we really going to vaccinate everyone because of monkeypox? we don’t see any reason to do this now.” Oren Kobiler told The Times of Israel.

WHO information shows that monkeypox viruses have two distinct clades, the Congo clade and the West African clade.

The former has a higher reported mortality rate of 10.6% after infection.

Among the more than ten countries currently reporting cases, all cases confirmed by PCR nucleic acid testing are identified as West African clade infection, and WHO data shows that its case fatality rate is 3.6%.

The “medical community” that even in the Congo clade, the case fatality rate is questionable. “The relevant data comes from the monkeypox outbreak in Congo (Kinshasa) from January to June 1981. At that time, there were 338 cases (67% of the cases were isolated from the virus) , 33 deaths, and the overall case fatality rate was 9.8%. This is also the mainstream saying, The case fatality rate is about 10% at the source.”

In fact, the Congo (DRC) has reported monkeypox cases many times at different times. For outbreaks with more than 10 cases, the case fatality rate ranged from 0% (0/170) to 21.7% (5/23) . Compared with the outbreak period results in 1981, passive surveillance data from 2001 to 2013 showed that the country’s monkeypox case fatality rate was between 0.7% and 3.4%.

Since the currently reported cases are branch infections in West Africa and most of them occur in developed countries, the overall case fatality rate is not expected to be very high.

In addition, the transmission path of the monkeypox virus is relatively easy to cut off.

WHO information shows that the spread of monkeypox virus requires close contact with an infected person, animal or object. “Cases are mainly concentrated in urban areas.”

Susan Hopkins , chief medical adviser to the UK Health Security Agency (UKHSA) , reminded that the risk of monkeypox to the general population remains extremely low and the symptoms are relatively mild.

UK and Netherlands follow Belgium to implement "monkeypox quarantine" Caption: The UK Health and Safety Agency released pictures of different stages of the monkeypox disease process, without specifying the time. /UKHSA

Vaccine against monkeypox, lack of efficacy data

The European Centre for Disease Prevention and Control (ECDC) advises member states to develop strategies for possible vaccination programmes to deal with rising monkeypox cases.

But it also pointed out that at this stage, recommending that people who have been in close contact with people diagnosed with monkeypox get the smallpox vaccine “is not an easy decision.”

One of the reasons is that the modified version of the smallpox vaccine currently ordered by many countries lacks post-vaccination safety and immunogenicity data in immunocompromised persons and children.

The US Food and Drug Administration (FDA) approval and marketing data show that the evidence for the vaccine’s approval of monkeypox indications comes from a number of non-human primate studies.

Whether it was MPV aerosol infection, intravenous infection, or airway infection, on day 63 of vaccination, the survival rate of animals in the vaccine group was 80%-100% and in the control group was 0%-40%.

On the other hand, the protective effect of the smallpox vaccine against monkeypox needs further evaluation.

According to Reuters, CNN and other information, the smallpox vaccine is at least 85% effective in preventing monkeypox. The CDC said the data came from Africa.

This was also during the monkeypox outbreak in Congo (DRC) in 1981, based on the data of the smallpox vaccine used in the country at that time. And all deaths occurred in children under the age of 8.

Whether the transmission ability of monkeypox virus changes due to the discontinuation of the smallpox vaccine or other reasons, and what impact will it have on the protective effect of the vaccine, further research is needed in the follow-up.” S

After vaccination, the effects of different clinical outcomes, immune Persistence, etc., still need more data support.

Human-to-human transmission of monkeypox virus is limited and widespread vaccination is unlikely to be recommended, said Stuart Isaacs , an assistant professor at the University of Pennsylvania School of Medicine . “It’s more likely to be a ring vaccination, where close contacts around an infected person are vaccinated.”

WHO’s Disease Outbreak News noted that available information points to a situation where human-to-human transmission can occur through close physical contact with a symptomatic monkeypox patient. Such close contacts are likely to be the most vulnerable. “Any health worker or family member who has cared for a probable or confirmed case should be vigilant.”

UKHSA said that some high-risk contacts of confirmed cases, including medical staff, have been vaccinated.

WHO proposes ‘Definition of Surveillance’

According to the May 21 “Disease Outbreak News”, in order to facilitate accurate reporting and monitoring of cases, WHO proposed “Monkeypox outbreak monitoring case definition in non-endemic countries”. The relevant “definitions” are updated as needed.

A “confirmed case” by the “definition” is a case that meets the definition of a suspected or probable case and is laboratory-confirmed to be monkeypox virus by PCR testing and/or viral gene sequencing.

A “suspected case” is a person of any age who presents with an acute rash of unknown origin in a country where monkeypox virus is not endemic. The following two conditions must be met at the same time:

First, since March 15, 2022, one or more of the following signs or symptoms, including: headache, acute fever (>38.5°C) , lymphadenopathy (swollen lymph nodes) , muscle and body pain, back pain , weakness (severe weakness) .
Second, the following common causes of acute rash do not explain the clinical presentation: varicella-zoster, herpes zoster, measles, Zika, dengue, chikungunya, herpes simplex, bacterial skin infections, disseminated gonococcus Infections, primary or secondary syphilis, chancroid, lymphogranuloma venereum, inguinal granuloma, molluscum contagiosum, allergic reactions (eg, to plants) , and any other endemic common papules or vesicles.

The WHO reminds that to classify a case as a “suspected case”, it is not necessary to obtain negative laboratory results for the common causes of acute rash listed.

The “definition” also defines a “probable case”, which is a person who meets the definition of a suspected case and meets one or more of the following criteria:

Has epidemiological contact (face-to-face contact, including health workers without glasses and respiratory protection) ; or has direct physical contact with skin or damaged skin, including sexual contact; or within 21 days before the onset of symptoms Items contaminated with possible or confirmed cases of monkeypox, such as clothing, bedding, or utensils.
Travel history to a monkeypox-endemic country within 21 days prior to the onset of symptoms.
Multiple sexual partners within 21 days prior to the onset of symptoms.
Positive orthopoxvirus serological test results in the absence of smallpox vaccination or other known orthopoxvirus exposure.
Hospitalized due to illness.

Sum up:

The monkeypox virus has always existed and is prevalent in the region, without causing too much ‘waves’.

In the past two years, various epidemic prevention measures in various countries have reduced the contact between humans and pathogens, and herd immunity has been damaged.

Today Suddenly ‘letting go’, some zoonotic diseases that were originally endemic have gained the opportunity to spread across regions.

Reference:
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[5] Austria’s first case of monkeypox confirmed, Vienna health authority says. Reuters
[6] Top health official, virus expert call for calm over monkeypox outbreak. The Times of Israel
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[12] Human Monkeypox.Vol.17.Karger AG;Basel,Switzerland:1988.pp.1–140.Monographs in Virology.
[13] Monkeypox hits many countries, what does it mean? . Health News