The WHO follows what's called "International Health Regulations" (IHR) that guides the response to emerging threats. Under this they can issue a
PHEIC - âPublic Health Emergency of International Concernâ.
On June 23rd they decided that Monkeypox didn't fit the criteria for a PHEIC. But now, even though the panel did not come to a consensus, the Director General has issued a PHEIC. Many are divided over this decision.
Monkeypox in all probability
will not escalate into a pandemic situation even though the case numbers are increasing. This is because
Monkeypox does not spread as fast as SARS-Cov2 and the community spread can be controlled.
Monkeypox virus belongs to the
Poxviridae, a family of viruses that also includes cowpox virus, variola virus (smallpox), and vaccinia virus (the source of the modern smallpox vaccine). Although it was found in primates, it is believed that even some rodents can carry it.
Human to human transmission of monkeypox is only thought to be transmitted while symptomatic. (Unlike Covid which is transmitted while asymptomatic). Hence the efficiency of transmission is much less than of Covid.
Also even though the spread was reported among the gay community, there's no evidence that the pathogen is present in sexual body fluids. Hence the spread is because of close contact.
The incubation period for monkeypox virus can range from 5 to 21 days, with an average of one week between infection and onset of symptoms.
There are two licensed
smallpox-specific vaccines that can also prevent monkeypox.
ACAM2000 - replication-competent live-attenuated vaccinia virus developed by Sanofi Pasteur Biologics Co. It's very effective but associated with pretty severe side effects, including sore arm, fever, body aches, and occasional myocarditis.
MVA-BN (marketed as
âJynneosâ ) is a
highly attenuated replication-incompetent vaccinia virus produced by Bavarian Nordic. MVA-BN/Jynneos is delivered by injection under the skin, is much better tolerated than ACAM2000, and is approved to be used as a monkeypox-specific vaccine.
Note that, because of the long incubation period, it is possible to be vaccinated shortly after an exposure to monkeypox virus and still be protected.
There are also several FDA-approved antiviral drugs that could be effective against monkeypox virus infection. Tecovirimat, (oral drug), prevents release of newly formed viral particles from infected cells, thus blocking transmission.
Cidofovir (infusion into the vein) and its derivative Brincidofovir (taken orally), disrupt replication of smallpox virus and could thus also be used for treating monkeypox.
Some countries (Canada, US & the UK) have adopted the so called "Ring Vaccination" strategy. - administering the vaccine to contacts and contacts of contacts of an infected person.
The CDC recently reported genomic data showing that there are at least
two strains of the monkeypox virus responsible for the outbreaks. The current outbreak is from the West African clade (which is less severe with CFR 3.6%) compared with the Congo Basin Clade (CFR 10.6%)
The WHO is concerned that this time the outbreak presents with
atypical clinical symptoms. Unlike before, this time there are cases with -
Presentation of only a few or even just a single lesion
Absence of skin lesions in some cases, with anal pain and bleeding
Lesions in the genital or perineal/perianal area which do not spread further
Lesions appearing at different (asynchronous) stages of development etc
Hence a worry that there could be many undetected cases which has led to an underestimation of the actual count. Hence the alert and the need for health professionals to be more watchful.
PS: I wrote the following on a different thread...
"The waning population immunity associated with discontinuation of smallpox vaccination has established the landscape for the resurgence of monkeypox. The smallpox vaccine provided the
cross protection for
monkeypox."