Experts have warned that the outbreak of smallpox in the UK is not yet under control, and some suggest that vaccines may be offered to all men who have sex with men.
Smallpox, which has been renamed by the World Health Organization (WHO), is commonly found in West and Central Africa, but an unprecedented outbreak in recent weeks has led to the emergence of cases in many countries, from France to Canada and Australia. It is understood that the WHO will hold a meeting next week to decide whether to describe the outbreak as a public health emergency of international interest.
As of June 12, 470 cases had been identified in the UK, including an increase from 104 cases reported in England last Monday. Experts warn that more measures may be needed to curb the rise.
“At the moment there is no clear evidence that the current epidemic is under control,” said Paul Hunter, a professor of medicine at the University of East Anglia.
So far, cases have been found predominantly between gay or bisexual men or those who have sex with men in other ways, although experts have raised concerns about the stigmatization of particular communities, stressing that anyone can contract smallpox of the monkey and which is transmitted between humans through close contact.
A smallpox vaccine is available that also provides protection against monkeypox, with current guidelines advising that ideal contact should be given to close contacts within four days of exposure to smallpox. monkey to prevent or lessen the impact of the infection, although in some circumstances it may occur. to people up to 14 days after exposure to reduce symptoms in case of infection.
“I guess if we don’t see this being controlled very soon, we’re looking to offer vaccinations to all men who have sex with men, and possibly sex workers,” Hunter said.
Professor Jimmy Whitworth of the London School of Hygiene and Tropical Medicine also expressed concern. “These new case figures suggest that we are not yet in control of the monkeypox epidemic,” he said, although he warned that the trend of cases should be looked at over a longer period, while one or two weeks could pass. before. the number of new cases decreased once the transmission was controlled.
But Whitworth said it was clearly a very difficult outbreak to control. “There appear to have been some overpopulation events that have allowed infections to spread rapidly to many different countries, and there are chains of transmission that suggest there may be some cases with no obvious signs of infection that have allowed a greater spread than not. detected, “he said.
Hunter said there were probably many factors at stake. “What worries me most is that for a disease whose transmission may have a significant stigma for some, people may not be completely honest about their contacts, and if that’s the case, they may not. be a public education approach and a ring vaccination strategy. be sufficient, “he said, adding that another concern was the degree of adherence of contacts to the period of self-isolation.
“For someone who is not openly gay, having to isolate themselves for 21 days would be tantamount to going out,” Hunter said, noting that the situation was delicate and complex, especially for bisexual men who have not spoken to their female couples.
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According to the UK Health Safety Agency (UKHSA), people who have been tested are usually informed of their outcome within 24 hours, with contacts identified and followed up as soon as possible, and ‘offer vaccination if necessary.
However, the agency has noted the challenges with the outbreak, noting that “most cases reported having sex with new or casual partners, sometimes in the context of cruise camps or during chemical sex, often where contact details were not available for tracking “.
Dr. Michael Head, a senior researcher in global health at the University of Southampton, said that public health teams in the UK and internationally had done an excellent job, both with tracking and contact reports and with messages from accurate and sensitive public health.
Head said there was a small signal in the UK that the outbreak was slowing, although this was not yet certain, while the lack of infections in the wider community showed that the transmission was based on a very close contact.
“This is less complex to address than, say, a Covid-19 outbreak, and it encourages the outbreak to end in the next few weeks or months,” he said.
Dr Hugh Adler of the Liverpool School of Tropical Medicine said there could be a positive view of the increase in the number of cases. “It simply came to our notice then [reflecting] that public health messages are coming out and people are showing up for the assessment, ”he said.
Adler said the vaccination was not appropriate for all contacts in the cases, especially if they had no close or intimate contact. Instead, these individuals can be monitored for possible symptoms.
“Their risk is so low that vaccination would not be right for them anyway, due to our limited supply of vaccine as well as side effects,” he said.