Monkeypox and Public Health Emergency

Monkeypox and Public Health Emergency

With more than 1,600 confirmed cases and almost 1,500 suspected cases of Monkey pox reported this year across 39 countries – including seven countries and the infection spreading to more countries, the relevant question is if it is time to declare it as a global public health emergency just like Covid 19.

The World Health Organisation said that the International Health Regulations Emergency Committee has been convened and the experts will meet on June 25 to assess if the continuing outbreak represents a Public Health Emergency of International Concern, the highest level of global alert, which currently applies only to the COVD-19 pandemic and polio.

CONCERNS

Calling to step up the response and international coordination, WHO director Tedros Adhanom Gebreyesus said that the global outbreak of Monkeypox was clearly unusual and concerning.

WHO Deputy Director for Emergency Response Ibrahima Socé Fall pointed out that the risk of spread in Europe is considered “high” while in the rest of the world “moderate” and that there are still knowledge gaps regarding how the virus is being transmitted.

“We don’t want to wait until the situation is out of control”, he said

CASE DETECTION AND CONTROL

The WHO has published recommendations for governments regarding case detection and control.

WHO Smallpox expert Rosamund Lewis, said it was crucial to raise awareness about the level of risk and explain the recommendations to avoid infecting close contacts and family members.

Dr. Lewis explained that, although the disease sometimes only produces mild symptoms, such as skin lesions, it can be contagious for two to four weeks.

“We know that it is very difficult for people to isolate themselves for so long, but it is very important to protect others. In most cases, people can self-isolate at home and there is no need to be in the hospital,” she added.

Monkeypox is transmitted through close physical contact with someone who has symptoms. The rash, fluids, and scabs are especially infectious. Clothing, bedding, towels, or objects such as eating utensils or dishes that have been contaminated with the virus can also infect others.

However, it is not clear whether people who do not have symptoms can spread the disease, the expert reiterated.

VACCINATION GUIDELINES

WHO also published on Tuesday new guidelines on vaccination against Monkeypox.

While some countries have maintained strategic supplies of older smallpox vaccines – a virus eradicated in 1980 – these first-generation vaccines held in national Stockpiles not recommended for Monkeypox at this time, because they do not meet the current safety and manufacturing standards.

Newer and safer (second and third generation) smallpox vaccines are also available, some of which may be useful for Monkeypox and one of which (MVA-BN) has been approved for the prevention of the disease.

The supply of these new vaccines is limited, and access strategies are being discussed, WHO informed. “At this time, the World Health Organization does not recommend mass vaccination. Decisions about the use of small pox or Monkeypox vaccines should be based on a full assessment of the risks and benefits in each case,” the guidelines indicate. For the contacts of sick patients, post-exposure prophylaxis with a second-or third-generation vaccine is recommended, ideally within four days of first exposure to prevent disease onset.

Pre-exposure prophylaxis is recommended for healthcare workers at risk, laboratory personnel working with orthopoxy viruses, clinical laboratory personnel performing diagnostic tests for Monkeypox, and others who may be at risk.

STUDIES

Dr. Lewis explained that most of the data on the smallpox vaccine is old or from animal studies. “There aren’t a lot of current] clinical studies”, she said.

WHO underlined the importance of vaccination programs being supported by comprehensive surveillance and contact tracing, and accompanied by information campaigns and robust “pharmacovigilance”, ideally with collaborative studies on vaccine efficacy. Tedros also said the agency was working with partners on renaming Monkeypox and its variants, and also to put in place a mechanism to help share available vaccines, more equitably, as the need arises.

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