August 8, 2022

Medical Trend

Medical News and Medical Resources

WHO declares monkeypox a public health emergency of international concern

WHO declares monkeypox a public health emergency of international concern



 

WHO declares monkeypox a public health emergency of international concern.


On July 23, 2022, the World Health Organization declared the monkeypox outbreak a Public Health Emergency of International Concern (PHEIC).

 

On July 21, the WHO organized its second emergency meeting on the monkeypox outbreak, almost a month after the first emergency meeting on June 23.

The need to define monkeypox as a PHEIC was discussed in the first meeting, and ultimately it was not recommended to declare a PHEIC.

The second meeting still did not reach an agreement on PHEIC, but WHO Director-General Tedros Adhanom Ghebreyesus believed that there was enough evidence to support it, so he made the announcement of PHEIC.

 

WHO declares monkeypox a public health emergency of international concern

 

 

At the WHO emergency meeting on June 23, a total of 3,040 global cases have been reported since May, involving 47 countries [1 ] .

The rate of increase is very fast, but the severity of the disease shown is not high, and 1 death occurred in an immunosuppressed population.

And the simulation of R0 shows that it is higher than 1 in the gay population and 0.8 in the general population, which means that monkeypox is not very transmissible and the risk of spreading in the general population is not that high.

It is also in line with the fact that the vast majority of cases are now concentrated in the gay population.

 

In this context, although there is a need to strengthen international cooperation and increase efforts in testing, outbreak surveillance, and case management, the definition of PHEIC does not seem to be so critical and may seem excessive.

Therefore, WHO did not designate monkeypox as PHEIC after the first emergency meeting.

 

But by the time of the second meeting on July 21, monkeypox had spread further over the course of a month.

As of July 20, 72 countries have recorded 14,533 confirmed and probable cases in 2022, with a total of 5 deaths (3 in Nigeria and 2 in the Central African Republic) [2].

 

Apart from the increase in cases, not much has changed. And even with the increase in cases, there are no countries with exponential outbreaks, and there appear to be signs of slowing or even peaking in some areas.

 

The vast majority of cases are still among gay men, with R0 above 1 in this group and below 1 in other groups.

Cases observed outside Africa are still relatively mild, and the vast majority are self-limiting.

In addition, there have been a small number of cases of infection among health care workers, but whether the infection occurred in the work environment is still under investigation.

 

Based on these results, it is understandable that the second emergency meeting for monkeypox still could not agree on PHEIC.

Apart from a further increase in cases, the basic picture of the outbreak seen by the two meetings has not changed much.

 

From the perspective of the infected population, except Nigeria, 99% of the cases occurred in gay men, and a few cases of female children can also be traced back to close contact with gay men.

This means that although monkeypox has appeared in many countries, a large population spread has not yet occurred .

The R0 simulation results also point to the virus’s ability to spread is still limited.

There were a small number of cases of infection among medical staff, but they did not spread widely, and it was not even certain whether they were infected in the work environment (10 cases of infection among medical staff were reported at the first meeting on June 23, and 9 cases were excluded from the possibility of infection at work. sex).

And there are no signs of transmission among healthcare workers.

 

In terms of disease severity, there was also no trend to become heavier .

No deaths have been seen outside Africa. Some serious cases have been observed in countries such as the UK, but they are still very few – only 2 ICU admissions have been reported.

 

Judging from genome sequencing, cases in many countries have some variations from the original West African virus strain, but whether these variations have actual effects, such as transmission speed, immune escape, and drug resistance, is still under study.

 

Although there are many “constants”, some real-world conditions also make it difficult to control monkeypox.

According to some modelling in Europe, monkeypox can still be brought under control through measures such as isolating infected cases and tracing close contacts.

However, after the large-scale blockade measures of the COVID-19, it is difficult to implement these public health measures.

The vast majority of cases occurred in the gay group, which has suffered discrimination for a long time and has many concerns about close contact investigations.

 

Based on these circumstances, it is not difficult to find that the announcement of PHEIC may raise the awareness of monkeypox and promote international cooperation.

But on the other hand, even if PHEIC is not announced, the international attention to monkeypox may have reached a very high level, and it may not be able to be raised any further, including cooperation among various countries.

Due to historical reasons, announcing PHEIC may increase discrimination against LGBTQ people, and it is not conducive to encouraging the gay men who are currently the hardest hit by monkeypox to assist in epidemiological investigations.

 

In short, each has its pros and cons, which is why the emergency meeting of the WHO could not reach an agreement.

But in the end, as the director-general of the WHO, Tedros still believed that announcing PHEIC was a better choice.

 

Another consideration of PHEIC may be that WHO can take advantage of the situation to issue relatively comprehensive recommendations.

While declaring monkeypox as PHEIC, WHO divided countries into four categories according to the degree of influence of monkeypox, and put forward targeted recommendations.

 

The first category is countries with no cases at present. China belongs to this category.

What needs to be done is to strengthen relevant monitoring, in fact, to prevent it from being spread.

 

The second category is countries that already have transmission, which requires preventing further transmission.

In addition to isolating infected people and tracing close contacts, it is also necessary to use targeted smallpox vaccines that are also effective against monkeypox – such as therapeutic use for infected people, and preventive vaccination for close contacts and medical staff.

 

The third category is countries and regions where monkeypox is transmitted from animals to people, such as some countries in Africa.

These countries also need to pay attention to the transmission between animals and people, whether there is any transmission from people to animals, etc.

 

The last category is countries that have the ability to develop and produce related medical materials, such as countries with smallpox vaccine production capacity.

These countries need to coordinate the provision of medical resources.

 

Many people may think that monkeypox has become PHEIC, is it a little closer to the specific threat to each of us? Personally, I think this kind of thinking is too much panic and there is no need.

 

The PHEIC of monkeypox is more about strengthening cooperation, hoping that countries can respond in a relatively unified way.

In fact, at a stage where the spread of the epidemic can still be controlled at a relatively small cost, it is encouraged to assist various countries to respond scientifically , which is very different from the declaration of the COVID-19 as PHEIC in March 2020.

 

First, monkeypox is a known virus, while COVID-19 was an emerging infectious disease when PHEIC was declared.

This means that monkeypox is far less uncertain in terms of pathogens. Although some mutations in the monkeypox genome have been observed, there are no major surprises in terms of incubation period, transmission speed, or disease severity.

It can be seen that this is not as unknown as the COVID-19 when it first came out.

 

Second, monkeypox is still very concentrated in the infected population. The vast majority of cases are among gay men, especially those with multiple sexual partners.

Not spreading widely among more people means that there is still a good chance of control on the one hand, and it also means that it is not a threat to most people on the other hand.

In fact, although the WHO announced PHEIC, it has not changed in the risk assessment of various regions.

Except for Europe, which is considered to be at high risk of transmission, other regions are only moderate.

In other words, the PHEIC for monkeypox was not declared because the risk of transmission suddenly became severe, but in the hope of better control.

 

Third, according to various data, monkeypox is still not an infectious disease that can cause a big storm .

Although global cases have increased significantly, half of 2022 has passed, and the total number of cases is still only more than 16,000, such as 2,891 in the United States [3], and the spread is not fast.

This is also reflected in the modeled R0, which is less than 2 in the UK and other European countries, even in the most heavily spread male homosexual population. All other groups are below 1.

The incubation period is also long, more than a week, leaving a considerable window for timely isolation and treatment.

 

As a comparison, the R0 of the original virus strain of the new coronavirus was above 2 when it came out, and the R0 was between 5-6 by the time of Delta, and the median incubation period was shortened to 3-4 days. Some literatures reported that the R0 was between 8-9. T

he median incubation period was closer to 3 days. The transmission capacity far exceeds that of monkeypox, and since the emergence of the COVID-19 alpha mutant, the replacement of mainstream mutants has been very fast, which has greatly increased the difficulty of COVID-19 prevention and control and the uncertainty of the epidemic.

 

In short, the WHO declared monkeypox as PHEIC, hoping that countries can have a more reasonable response. Ordinary people do not need to panic about this. Monkeypox is still very far away from you.

 

 

 

 

 

 

 

References:

https://www.who.int/news/item/25-06-2022-meeting-of-the-international-health-regulations-(2005)-emergency-committee–regarding-the-multi-country-monkeypox -outbreak

https://www.who.int/news/item/23-07-2022-second-meeting-of-the-international-health-regulations-(2005)-(ihr)-emergency-committee-regarding-the- multi-country-outbreak-of-monkeypox

https://www.npr.org/2022/07/23/1113183728/monkeypox-global-health-emergency-who

WHO declares monkeypox a public health emergency of international concern

(source:internet, reference only)


Disclaimer of medicaltrend.org