Currently, the risk to public health worldwide is assessed as moderate, given that this is the first time that cases and groups of monkeypox have been reported simultaneously in many countries in very different WHO geographical areas. and no known epidemiological links with countries where monkeypox has been reported. many years. Cases have been identified primarily, but not exclusively, among men who self-identify as part of extended sexual networks. The sudden appearance and wide geographical scale indicate that there is widespread human-to-human transmission, at the moment still mainly in a demographic and social group, and the virus may have been present and undetected for several years. weeks or more. In addition, there is currently limited epidemiological and laboratory information, and the actual number of cases is probably underestimated. This may be due in part to the lack of early clinical recognition of an infection that was previously known to occur primarily in West and Central Africa, limited surveillance, and a lack of early diagnosis.
Currently, transmission to newly affected countries is mainly related to recent sexual intercourse. There is a high probability that more cases will be found without identified transmission chains, potentially included in other population groups. Given the number of countries in various WHO regions reporting cases of smallpox, it is very likely that other countries will identify cases and that the virus will spread further. Person-to-person transmission occurs through close or direct physical contact with infectious lesions or mucocutaneous sores (through face-to-face, skin-to-skin, mouth-to-mouth, mouth-to-skin transmission), included during the activity. sexual. , respiratory drops (and possibly short-range aerosols) or contact with contaminated materials (e.g., sheets, bedding, and clothing).
While the current risk to human health and the general public remains low, the risk to public health would be greater if this virus seized the opportunity to establish itself as a widespread human pathogen. There is also a risk to health care workers if they do not wear adequate personal protective equipment (PPE) to prevent infection; Although not reported in this current outbreak, the risk of healthcare associated infections has been documented in the past. There is a potential increase in the impact on health with a wider spread in vulnerable groups, as it is recognized that the risk of serious illness and mortality is higher among children and immunocompromised people, including people with Poorly controlled HIV. Monkeypox infection during pregnancy is poorly understood, although limited data suggest that the infection may cause adverse outcomes for the fetus or baby.
To date, all cases identified in recently affected countries whose samples were confirmed by PCR have been identified as infected with the West African clade. There are two known monkeypox clades, one identified in West Africa (WA) and another in the Congo Basin region (CB). In the past, clade WA has been associated with an overall mortality of less than one in 100 cases, while clade CB appears to cause more serious disease with a mortality rate (CFR) of up to one in every ten; both estimates are based on infections among a generally younger population in the African environment.
Smallpox vaccination has been shown to be cross-protective against smallpox in the past. However, any smallpox vaccination immunity will only be present in people over the age of 42 to 50 or older, depending on the country, as smallpox vaccination programs ended worldwide in 1980 after the smallpox vaccination program. smallpox eradication. Original (first-generation) smallpox vaccines in the eradication program are no longer available to the general public. In addition, protection for those who were vaccinated may have diminished over time.
Smallpox and smallpox vaccines, when available, are being rolled out in a limited number of countries to manage close contacts. Although smallpox vaccines have been shown to be protective against smallpox, there is an approved vaccine for the prevention of smallpox. This vaccine is based on a strain of the vaccinia virus (generically known as the Bavarian Nordic modified Ankara strain or MVA-BN). This vaccine has been approved for the prevention of smallpox in Canada and the United States. In the European Union, this vaccine has been approved for the prevention of smallpox in exceptional circumstances. An antivirus to treat orthopoxviruses, tecovirimat, has been approved by the European Medicines Agency, the United States Food and Drug Administration, and Health Canada. The WHO has convened experts to review the latest data on smallpox and smallpox vaccines and to provide guidance on how and under what circumstances they should be used.
The advice provided by WHO below on the actions needed to respond to the multinational smallpox outbreak is based on its technical work and is based on frequent consultations with the following existing WHO advisory bodies: the Strategic Advisory Group and Infectious Risk Technician (STAG-IH); the ad hoc working group of the Strategic Advisory Group of Experts on Immunization (SAGE) on smallpox and smallpox vaccines; the Emergency Social Sciences Technical Working Group; the Smallpox Virus Research Advisory Committee; Consultation of WHO research and development plans (R&D): monkeypox research; the Scientific Advisory Group on the Origins of New Pathogens (SAGO); as well as the outcome of ad hoc expert meetings.
All countries should be alert to signs related to patients with a rash that progresses in sequential stages (macules, papules, vesicles, pustules, scabs, at the same stage of development or in all affected areas of the body). associated with fever, enlarged lymph nodes, back pain, and muscle aches. During this current outbreak, many individuals present with localized rashes that may be in different stages of development (which is atypical for monkeypox) with perigenital and / or perianal distribution associated with local inflamed and painful lymph nodes. Some cases may have secondary bacterial infections, including sexually transmitted infections. These individuals may be present in a variety of community and health care settings, including, but are not limited to, primary and secondary care, fever clinics, sexual health services, infectious disease units, obstetrics and gynecology, emergency services. and dermatology clinics.
Raising awareness among potentially affected communities, as well as among health care providers and laboratory workers, is essential to identifying and preventing new cases and effectively managing the current outbreak.
Anyone who meets the definition of a suspicious case must be offered proof. The decision to test should be based on both clinical and epidemiological factors, linked to an assessment of the likelihood of infection. Due to the variety of conditions that cause rashes and because the clinical presentation may be more often atypical in this outbreak, it may be difficult to differentiate smallpox from the monkey based solely on the clinical presentation.
Care for patients with suspected or confirmed smallpox by monkeys requires early recognition through screening protocols adapted to the local environment, rapid implementation, isolation, and appropriate infection, prevention, and control (CPI) measures. (standard, transmission-based precautions), physical examination of the patient. , tests to confirm the diagnosis, symptomatic treatment of patients with mild or uncomplicated smallpox and follow-up and treatment of life-threatening complications and conditions, such as progression of skin lesions, secondary infection of skin lesions and, rarely, severe dehydration, pneumonia severe or sepsis. .
Precautions (isolation) should be maintained until the lesions have formed a crust, crusts have fallen, and a new layer of skin has formed underneath.
The information should reach those who need it most during the next small and large meetings, especially between social and sexual networks where there may be close, frequent or prolonged physical or sexual contact, especially if there is more than one partner. . Every effort should be made to avoid unnecessary stigmatization of individuals and communities potentially affected by monkeypox.
WHO is closely monitoring the situation and supporting international coordination by working with member states and partners.
For WHO-related documents, see the Public Health Response section above. Key updates to these documents and highlights from the development guides are provided below for ease of reference.
Surveillance and reporting
A separate case investigation and contact tracking form for Member States’ own use is currently being finalized and will be shared as soon as it is available.
Laboratory testing and sample management
Risk communication and community participation
Communicating the risks associated with monkeypox and involving at-risk and affected communities, community leaders, civil society organizations, and health care providers, including those in sexual health clinics, in prevention, detection, and care is essential. to prevent secondary cases and effective management. of the current outbreak. Providing public health advice on how the disease is transmitted, its symptoms and preventive measures, and targeting community participation to the most at-risk population groups, is critical to minimizing the spread. Communication must be direct, explicit and attractive to the target audience.
Anyone who has direct contact (for example, face-to-face, skin-to-skin, mouth-to-mouth, mouth-to-skin), including, but is not limited to, sexual contact with an infected person may suffer from monkeypox. Steps for self-protection include …