However, WHO Director-General Tedros Adhanom Ghebreyesus said he was “deeply concerned” about the growing threat of monkeypox, which he said has reached more than 50 countries.
There have been more than 4,100 confirmed cases globally, including at least 13 in Australia.
The WHO also acknowledged that there were many unknowns about the outbreak.
Here are three things we know about monkeypox and three things we wanted to know.
3 things we know 1. Monkeypox is caused by a virus Monkeypox is a large DNA virus that belongs to the orthopoxvirus family. Unlike the related smallpox virus, variola, which affects only humans, the monkeypox virus is found in part in rodents and other animals.
We know of two clusters (virus group), and it is the less severe of the two groups currently circulating outside Africa.
Orthopoxviruses are stable viruses that do not mutate much. However, several mutations have been described in the virus leading to the current outbreak.
In the United States, at least two different strains are circulating, suggesting multiple introductions into the country.
2. You may be infected for more than a week and undetected. Infection takes an average of 8.5 days to show symptoms, such as enlarged lymph nodes, fever and a rash, which usually looks like fluid-filled blisters explode. People are contagious when they have a rash, and usually remain contagious for about two weeks.
Children are most affected and are at high risk of dying from the disease. Historically, in Africa’s endemic countries, almost all deaths have occurred in children.
The European epidemic is mostly in adult males, so this, along with better access to care, may explain the low rate of death in these countries.
3. We have vaccines and treatments. Vaccines work. Previous vaccination against smallpox provided 85% protection against monkeypox. Smallpox was declared eradicated in 1980, so most mass vaccination programs stopped in the 1970s.
There has never been a mass smallpox vaccination in Australia. However, an estimated 10% of Australians have been vaccinated in the past, mostly expatriates.
Vaccines protect for many years but immunity is reduced. A decline in population-level protection is therefore likely to account for the resurgence of monkeypox seen since 2017 in Nigeria, one of Africa’s seven endemic hot spots.
Mass vaccination is not recommended. But vaccines can be given to contacts of confirmed cases (known as post-exposure prophylaxis) and to people at high risk of contracting the virus, such as certain lab or health workers (pre-exposure prophylaxis).
There are also treatments such as vaccinia immune globulin and antivirals. These were developed against smallpox.
3 things we want to know 1. How much do these new mutations matter? The virus causing the current outbreak has many more mutations than the versions of the virus that have spread in Africa. However, we do not know whether these mutations affect clinical prognosis and how the virus is transmitted.
The genome of the monkeypox virus is much larger, so it is more complex to study than the smaller
Experts wonder whether the mutation made it more contagious or changed the clinical pattern like a sexually transmitted infection. A study from Portugal suggests that the mutations possibly make the virus more transmissible.
2. How does it spread? Is it changing? Monkeypox has not been described as a sexually transmitted infection in the past. However, the current transmission pattern is unusual. Sexual contact is followed by a very short incubation period (24 hours) in some cases, but not in all cases.
It is a respiratory virus, so aerosol transmission is possible. But historically most transmission has occurred from animal to human. When transmission did occur between humans, it usually involved close contact.
However, the rapid development of the epidemic in non-endemic countries in 2022 is due to the spread among humans. There may be many more cases than are officially reported.
We do not know why the pattern has changed, whether it is sexually transmitted or transmitted only through intimate contact in specific and globally connected social networks, or whether the virus has become more contagious.
The virus is found in skin rash, pimples and semen, but this does not prove that it is sexually transmitted.
3. How far will it spread? Does COVID make a difference? Will it spread more widely in the community? Does the COVID pandemic increase the risk? Maybe, yes.
We should not ball or stigmatize surveillance in the wider community
With low immunity to the smallpox vaccine globally and with monkeypox already spreading in many countries, we may see the epidemic spreading more widely.
If this happens and starts infecting children in large numbers, we could see more deaths as children get more severe infections.
That’s why we should be monitoring fever and rash clusters globally, and misdiagnosing them as smallpox, hand foot and mouth disease, herpes simplex, or other diseases with a rash.
Another factor is COVID. As people recover from COVID, their immune system degrades. So people who have had COVID may be more vulnerable to other infections.
We see the same with measles infection. This weakens the immune system and increases the risk of other infections after two to three years.
If an epidemic becomes established in countries outside endemic areas, it can infect animals and create new endemic areas in the world.
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