Cases of human monkeypox have been steadily increasing. As of this writing, BNO News reports 639 confirmed, four probable, and 53 suspected for 696. There are no deaths.
It is updatedIn the endemic countries in Africa, these are the number of cases from the WHO.
Monkeypox is usually self-limiting, but there is likely to be little immunity to monkeypox among people living in non-endemic countries since the virus has not previously been identified in those populations.
There are two clades of monkeypox virus: the West African clade and the Congo Basin (Central African) clade. The Congo Basin clade appears to cause severe disease more frequently, with a case fatality ratio (CFR) case fatality ratio (CFR) previously reported of up to around 10%. The Democratic Republic of the Congo currently reports a CFR among suspected cases of about 3%.
The West African clade has been associated with an overall lower CFR of around 1% in a generally younger population in the African setting.
Source: WHO
For the current outbreak, several European countries (Belgium, France, Germany, Spain, the Netherlands, and Portugal) have published full-length or draft genome sequences of the monkeypox virus for the current outbreak.
Preliminary data confirm that the genomes belong to the West African clade of monkeypox virus with lower mortality.
GenBank has the complete monkeypox genome that is causing the outbreak. It is most similar to monkeypox virus genomes collected from a small international outbreak in 2017-18 and only differs from one of these sequences, MT903343.1, by fewer than 100 out of over 197,000 nucleotide bases.
The WHO Risk Assessment
Currently, the overall public health risk at the global level is assessed as moderate, considering this is the first time that monkeypox cases and clusters are reported concurrently in widely disparate WHO geographical areas and without known epidemiological links to non-endemic countries in West or Central Africa.
Cases have been mainly reported amongst men having sex with men (MSM). Additionally, sporadic cases' sudden appearance and broad geographic scope indicate widespread human-to-human transmission. The virus may have been circulating unrecognized for several weeks or longer.
The public health risk could become high if this virus exploits the opportunity to establish itself as a human pathogen and spreads to groups at higher risk of severe diseases, such as young children and immunosuppressed persons.
Many are vulnerable to the monkeypox virus, as smallpox vaccination, which confers some cross-protection, has been discontinued since 1980 or earlier in some countries.
The WHO says the number of cases currently being reported is likely to be an underestimate, in part due to the following:
- In many cases, people may have relatively mild symptoms with localized rash and lymphadenopathy, such that many persons may not present to health care services
- Lack of early clinical recognition of monkeypox by health workers
- Some countries may not have time to establish and scale up new surveillance mechanisms for monkeypox
- Lack of widely available diagnostic tests, reagents, and other supplies.
Health Care Workers Can be at Risk
Health workers are at risk of monkeypox exposure if they are not wearing appropriate personal protective equipment (PPE) to prevent transmission. Though not yet reported in the current outbreak, the risk of healthcare-associated monkeypox infections has happened in the past.
Monkeypox can spread to more vulnerable population groups. Deaths among cases in previous outbreaks have been reported to occur more often among children and immunocompromised individuals like persons with poorly controlled HIV infection and transplant recipients who may be especially at risk of more severe disease.
My Comment:
The pronouncement of the WHO that human-to-human transmission is widespread and may have been ongoing for weeks surprised me. It should be headline news, but it is buried several paragraphs in the report.
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