WHO sees world emergency with monkeypox; Circumstances are rising within the UK and elsewhere in Europe

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LONDON – The World Health Organization is considering whether to declare monkeypox an international emergency – a decision that could come as early as Friday. A statement could escalate the global response as cases in the UK are rising rapidly despite efforts to contain them. The UK, which recorded nearly 800 cases of the virus last month, has the highest reported number of infections outside of central and west Africa – and case trends here are worrying experts across Europe, the epicenter of the outbreak, who are weighing the best approach amid the years coronavirus pandemic.

Monkeypox cases rose nearly 40 percent in Britain in less than five days, according to data from the UK Health Security Agency. By June 16, 574 cases had been recorded, and by June 20 the number had risen to 793.

After the UK, Spain, Germany and Portugal have the most registered cases. And it’s a growing threat outside Europe: More than 3,200 cases have been confirmed in 48 countries in the past six weeks, according to the WHO, which releases monkeypox data weekly. As of June 15, one death was reported.

The Emergency Committee of the WHO International Health Regulations met Thursday to discuss whether the monkeypox outbreak should be labeled a “Public Health Emergency of International Concern,” which would mobilize new resources and spur governments to act. The novel coronavirus that causes Covid-19 was named PHEIC after a similar meeting in January 2020.

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So far, the response in most European countries has been to focus on outreach to vulnerable communities, contact tracing and isolating known monkeypox cases. That could change if the WHO, which first sounded the alarm about monkeypox infections in countries where the virus is not endemic in May, raises the threat level of the outbreak.

“The Emergency Committee and then this [WHO] The Director-General’s announcement will raise the political level,” David Heymann, a professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine, who attended the meeting as an adviser, told The Washington Post.

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Monkeypox is transmitted through close contact and has so far mostly affected men who have sex with men. It begins with flu-like symptoms before fluid-filled lumps or lesions appear on the skin that can leave permanent scars. Health officials say the recent outbreak has often resulted in genital rashes, and while most cases are mild and patients recover within three weeks, the virus can be fatal and poses a greater risk to pregnant women or those with compromised immune systems.

A broader understanding of its origins, along with vaccinating high-risk groups and contact tracing, is essential to containing the outbreak, experts say, although they note some patients may not want to share information about who they’ve been intimate with – which can complicate the response of public health.

“One of the difficulties people have in implementing control is actually getting a complete list of people’s sexual contacts,” said Paul Hunter, professor of medicine at the University of East Anglia. “This is exactly the problem we faced when we first started dealing with HIV/AIDS [1990s].”

And as in the early days of the coronavirus outbreak, it’s unclear whether cases in some countries are going undetected. Some experts are speculating that the UK may have higher numbers because its extensive public health surveillance network allows it to identify more infections.

WHO Director-General Tedros Adhanom Ghebreyesus conceded at the start of Thursday’s meeting that monkeypox is likely to be more widespread than official figures suggest. “Person-to-person transmission is ongoing and likely underestimated,” he told emergency committee members.

The UK has been proactive in following people with known cases of monkeypox and, in some cases, has distributed smallpox vaccines known to protect against monkeypox infection to their close contacts and at-risk groups. In theory, this approach — which Hunter dubbed “ring vaccination” — “should have worked,” he said.

But as infections rose and authorities struggled to “trace the contacts of cases early enough to make an impact,” Hunter said he had become “less confident”.

“Unless we turn the corner from here very soon, we’ll probably have to start thinking about what’s next,” he added.

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British health officials said on Tuesday some gay and bisexual men considered at higher risk of exposure will be offered vaccines in a bid to stem the monkeypox outbreak. The UK Health Security Agency stressed that while the virus is more of a threat “in the sexual networks of gay, bisexual and other men who have sex with men”, anyone can contract the disease through close contact with an infected person.

Scientists are studying this outbreak and will know more once the virus is sequenced. “We are beginning to understand how widespread [monkeypox] really is,” said Heymann. “We know it’s widespread in certain populations, and we need to know if it’s spreading to other populations.”

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Two years after treating Germany’s first coronavirus patient, Clemens Wendtner treated Germany’s first monkeypox patient in May. The unidentified man is a sex worker from Brazil, said Wendtner, chief physician for infectiology at Munich’s Schwabing Clinic.

A handful of other monkeypox patients have been treated at his ward in recent weeks, Wendtner said. Some have reported “very painful” rectal lesions that require intravenous painkillers to relieve discomfort. Wendtner and his colleagues have closely recorded their discoveries during this outbreak and recently documented their discovery of monkeypox virus DNA in both semen and blood.

Most patients were discharged after around a day and advised to isolate at home for 21 days – in line with Germany’s Infectious Diseases Act. Most cases have been reported in Berlin, one of Europe’s party hotspots that will host Pride events next month.

“Summer season is party season,” he warned, adding that more cases are likely in the coming week and that the current outbreak may not have peaked yet.

While men are significantly more at risk, Wendtner warned that sex workers could also be at risk. “The risk factor is a pattern of unprotected sex,” he explained.

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Outside of Europe, other countries are also struggling with new cases.

The first case of monkeypox in the United States was detected on May 17th. More than 100 cases have been added in the past five weeks, according to the Centers for Disease Control and Prevention. California, New York and Illinois are listed as the states with the highest rates of infection.

Some experts in the United States are urging the White House to conduct thorough testing to avoid the fallout from the coronavirus pandemic.

Singapore on Tuesday confirmed a case of monkeypox in a Briton, the first in Southeast Asia. South Korea also confirmed its first case of monkeypox on Wednesday. The patient is a South Korean citizen who entered Germany from Germany, health officials said. South Africa also reported its first case of monkeypox on Thursday, Reuters reported. The 30-year-old has no travel history, health experts said, meaning his illness would not have emerged outside of South Africa.

It’s important to remember, experts say, that this is not a new disease. Monkeypox has been circulating in Africa for decades – leading some to point to a double standard in responding to the outbreak in Europe.

“It’s a neglected disease,” said Heymann. After the eradication of smallpox in 1980, the world stopped routinely giving smallpox vaccines. Monkeypox, which is less contagious than smallpox, continued to spread in west and central Africa, but outbreaks there have not been thoroughly investigated due to a lack of resources, he added.

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The WHO’s Tedros said Thursday that nearly 1,500 suspected cases of monkeypox and about 70 deaths have been reported in central Africa this year. “Although the epidemiology and virus group may differ in these cases, this is a situation that cannot be ignored,” he warned.

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