The World Health Organization (WHO) declared monkeypox (renamed mpox to avoid stigma among those who suffer from it) a public health emergency of international concern on Wednesday. A variant of the virus that causes it is spreading across Africa, apparently with greater transmissibility and lethality than the one that caused the 2022 outbreak. Here’s what’s known about the virus and the action the WHO has taken.
How is the virus spreading?
The outbreak is occurring in Africa, where 15,000 cases and 461 deaths from MPOX have been recorded so far this year. The number of detected infections is much higher (160%) than last year at this time and is most likely only a small fraction of those that have actually occurred. Most of these cases are concentrated in the Democratic Republic of Congo, although the virus is already spreading to other countries such as Uganda, Kenya and Rwanda.
Who is the population at risk?
In this wave of transmission in RCD, children are the main victims: 70% of positive cases are among children under 15 years of age, and 39% are among children under five years of age, who account for 62% of deaths. However, the WHO wants to strengthen surveillance to fully understand how the virus is behaving, its epidemiological patterns and how and where infections are occurring.
What is known about the new variant?
The most worrying clade (variant) is 1b, which has recently emerged in the Democratic Republic of the Congo (DRC). It appears to be more virulent and have higher mortality, especially among children. It is also showing a greater capacity for human-to-human transmission. Clade 2, responsible for the global outbreak in 2022, continues to circulate, albeit with lower virulence, in regions of West Africa and other countries.
Is it more lethal?
Monkeypox has a fatality rate of between 0% and 11%. In the 2022 outbreak, the fatality rate was very low, usually among people with pre-existing illnesses. In this case, it seems higher, around 3% in Africa, and may reach 10% in some groups. It should be noted that surveillance and health systems are much more deficient on that continent, so it is difficult to know to what extent the virus is intrinsically more deadly. It is also known that it is more dangerous in children, who are making up a high percentage of those infected.
What are the symptoms?
MPox presents with fever, a widespread rash, and usually swollen lymph nodes. The WHO warns that it can be confused with other diseases such as chickenpox, measles, bacterial skin infections, scabies, syphilis, and drug-related allergies. The incubation period for MPox can range from 5 to 21 days. The febrile phase of the disease usually lasts 1 to 3 days, with symptoms including fever, severe headache, lymphadenopathy (swollen lymph nodes), back pain, myalgia (muscle pain), and severe asthenia (lack of energy). The febrile phase is followed by the rash phase, which lasts two to four weeks. Lesions progress from macules (flat-based lesions) to papules (firm, raised, painful lesions), to vesicles (filled with clear fluid), to pustules (filled with pus), followed by crusts or scabs.
How is it spread?
In the 2022 outbreak, the disease was spread through very intimate contact, so much so that most cases were transmitted through sexual relations. This new variant appears to be more transmissible. Transmission can occur from person to person through close contact with someone infected: being face to face, talking or breathing near an infected person, skin-to-skin contact, mouth-to-mouth or mouth-to-skin.
How effective are vaccines against mpox?
Initially, the traditional smallpox vaccine was used, which in the past has shown 85% effectiveness. A Spanish study showed 79% effectiveness in the 2022 outbreakNew vaccines that are better targeted at mpox have been developed with very promising results, but their concrete effectiveness in real life will have to be measured more precisely.
Should the entire population be vaccinated?
No, only the population considered at risk. International health authorities are studying the patterns of contagion of the new variant of the virus in Africa to determine which populations are at risk.
In Spain, pre-exposure prophylaxis is indicated for people who engage in risky sexual practices, especially – but not exclusively – gays, bisexuals and men who have sex with men, people at occupational risk such as healthcare personnel in specialist STI/HIV clinics who care for people with high-risk practices and laboratory personnel who handle samples potentially contaminated with the virus or personnel in charge of disinfecting surfaces in specific premises where risky sexual relations take place, provided that the adequate use of personal protective equipment cannot be guaranteed. Post-exposure prophylaxis is indicated for all close contacts who have not had the disease.
The Spanish Ministry of Health counted 40,610 immunized people and Last week he warned that only half of them had received the second dose, calling on the rest to go to their medical centers to request them.
Is there a treatment?
Most treatments are aimed at mitigating symptoms. An antiviral developed to treat smallpox (tecovirimat) was approved in January 2022 by the European Medicines Agency for the treatment of mpox in exceptional circumstances. Experience with these treatments in the context of a monkeypox outbreak is growing, but is still limited and mostly confined to trials.
What is a health emergency of international concern?
This is the highest level of alert that the WHO has for a disease. It has been used eight times in history. The last time was to declare it in the outbreaks of MPOX that spread throughout the world, with a strong focus in Spain. It lasted from July 2022 to May 2023. Covid was also declared in this way on January 12, 2020, an emergency that officially lasted until May 5, 2023 after claiming more than 20 million lives, according to the WHO’s own calculations. Although the emergency does not entail any obligation for countries, it facilitates their coordination and the purchase of vaccines by countries, with less bureaucratic procedures that slow down the process.
Why has this emergency been declared?
The decision was unanimous among the members of the WHO Emergency Committee. Several circumstances converge: the rapid spread of a new variant, the detection in countries that had never previously recorded cases of mpox, the fact that it affects vulnerable people such as children and pregnant women, and the risk that the WHO sees in the spread beyond Africa.
Are we facing a pandemic?
There is no official definition in international health regulations of what a pandemic is. It is not a technical term, but it is used to refer to an epidemic disease that spreads to many countries. On March 11, the WHO classified Covid as a pandemic, but this was a simple nomination that served to draw attention to the extent, not a scale of severity.
Could we be facing a situation similar to that of Covid?
There are many differences with the coronavirus. Although the transmission mechanisms of the new mpox variant are not yet fully understood, what is known so far is that infection occurred through very intimate contact, especially sexual, while Covid is transmitted through the air. The mpox virus has been known for years, while the Covid virus was new, and there is already a vaccine for this disease. In addition, mpox outbreaks have already been contained, which had not happened with SARS-CoV-2 when it began to spread.
How much risk is there outside Africa?
According to the latest assessment by the European Centre for Disease Control The ECDC (ECDC) has assessed the risk posed by the new variant in Europe as “very low”. In a statement dated 29 July, its director, Pamela Rendi-Wagner, said: “I would like to emphasise that the risk to the European population remains very low. ECDC is working with our partners in Africa in their efforts to contain this outbreak for the benefit of all those affected, to prevent this new variant from spreading further and to strengthen future preparedness and response capacities.” However, the agency is preparing another risk assessment which will be published in the coming days.
Has the new variant been detected in Spain?
No. Since April 2022, when the first cases were detected, 8,100 cases of mpox infection have been reported, of which 260 have been reported in 2024, but none of them belong to the variant that is spreading in the DRC.
#international #monkeypox #alert #worrying #mpox