Monkeypox – We need to understand more about the transmission dynamics.
The views of experts and health professionals on the monkeypox outbreak.
The views of experts and health professionals on the monkeypox outbreak.
First published in May 2022.
Question: WHAT DO WE KNOW ABOUT THE MONKEYPOX OUTBREAK?
Xtra | Monkeypox
“Symptoms of monkeypox include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion. A rash can develop, often beginning on the face, then spreading to other parts of the body including the genitalia. The rash then changes and goes through different stages – and can resemble chickenpox – before finally forming a scab, which later falls off.”
(Source: The Guardian)
What the experts say...
Dr Tom Frieden, US Infectious Disease and Public Health Physician, President and CEO of Resolve to Save Lives:
“Detection of monkeypox is a timely reminder that preparedness is crucial. A new health threat could emerge anywhere in the world at any time. Countries need to respond quickly and effectively. Here’s what you should know now.
“Monkeypox is a rare viral disease endemic in West and Central Africa. It spreads mostly through direct contact with infected animals and can spread from person to person. It may also be able to be transmitted through the respiratory route.
“Symptoms of monkeypox can include fever, swollen lymph nodes and a rash that can mimic other diseases, such as chickenpox. The monkeypox rash can be itchy or painful. In some current cases, the rash has been in the anal or genital area, mimicking sexually transmitted diseases.
“If you have symptoms of monkeypox, including rashes, reach out to your health provider — especially if you’ve traveled recently to West or Central Africa or to places where cases have been reported.
“Many detected cases appear to have been among men who have sex with men, but anyone can become infected if exposed through close contact. It may be spreading through sexual networks, or sexual health providers may have been more alert to detection.
“The CDC issued a health advisory on monkeypox that provides guidance for clinicians, health departments and the public. Based on what we know now, the risk to the public is low.
“Although monkeypox can be serious, it’s a disease we’ve seen before. This isn’t similar to when COVID emerged. There are decades of experience containing monkeypox outbreaks in Africa — including Nigeria in 2019. We have also had cases in the US, including a cluster in 2003.
“We can apply lessons learned to the current outbreak, as Resolve To Save Lives outlined in our report on this last year.
“We also have good diagnostics for monkeypox, which enabled quick confirmation of cases, as well as the smallpox vaccine, which can prevent monkeypox infections even if given several days after exposure. Early detection and quick response can contain this and future outbreaks.
“All countries can aim for the Resolve To Save Lives’ 7-1-7 goal: every outbreak detected within 7 days, public health notified and investigation started within 1 day, and all essential control measures established in the next 7 days.
“We need to be humble. We don’t yet know much about the new monkeypox cluster, including whether the virus has changed. This type of virus tends not to be able to change rapidly, which I find reassuring. It’s inevitable that we’ll continue to see health threats emerge.
“What’s not inevitable is that we’ll continue to be underprepared. COVID, monkeypox, and much, much more make it imperative that we increase global investment and country action to strengthen public health. We’ll all be safer.”
Dr Charlotte Hammer, Applied Infectious Diseases Epidemiologist and Researcher, Cambridge University:
“I am certain that we are going to see more cases.
“First, health authorities are now – very actively – looking for cases, so we are more likely to spot people with mild versions which we might previously have missed or misdiagnosed.
“In addition, monkeypox has an incubation period of between one and three weeks so it is likely we will see new infections among those who were in early contact with the outbreak’s first cases.
“Essentially, we face two options. Either the virus is inherently different now or perhaps our susceptibility to it has changed. Alternatively, it could just be that we have encountered a perfect storm of conditions that have allowed the virus to spread this way. I think the latter scenario is the more likely one.”
Monkeypox. | Adobe Stock/Berkay
Professor Sir Peter Horby, Professor of Emerging Infectious Diseases and Global Health, Director of the Pandemic Sciences Institute, University of Oxford:
“It’s transmitted by close person-to-person contact, and in the past, we have not seen [monkeypox] being very infectious.
“What’s unusual about what we’re seeing now is that we’re seeing transmission occurring in the community in Europe and now in other countries, so it’s an unusual situation where we seem to have had the virus introduced but now have ongoing transmission within certain communities.
“It would appear that there is some element of sexual transmission, perhaps with just the very close contact between people and the skin lesions, because a large proportion of the current cases are being detected in gay and bisexual men.
“So it’s very important that we get the message across that if people have unusual skin lesions that they do seek attention quickly so that we can control this.
“The important thing is that we interrupt transmission and this doesn’t become established in the human population in Europe.”
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Dr Michael Head, Senior Research Fellow in Global Health, University of Southampton:
“I think it’s possible that some of these outbreaks will be driven by superspreading events. For example, the Spanish health authorities are looking at a sauna as a site of single exposure that resulted in many secondary cases. The reportedly mild presentations of several cases may also be a factor, in that people will be more mobile and potentially likely to socialise. However, we do still need to understand more about the transmission dynamics.”
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What the experts say...
Professor Keith Neal, Emeritus Professor in the Epidemiology of Infectious Diseases, University of Nottingham:
“Has the virus changed? Well, it does not actually appear to be any more lethal, though something may have affected its transmissibility. And don’t forget this is a DNA virus and is unlikely to mutate at the rates that RNA viruses do, including those that cause COVID or HIV. Overall, I am not too worried.”
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Dr Michael Head, Senior Research Fellow in Global Health, University of Southampton:
“The monkeypox outbreak continues to escalate, and is undoubtedly worrying. The extent of the community transmission of monkeypox, being observed here in the UK and now in several other countries around the world, is concerning.
“However, it is important to highlight that whilst it is understandable to compare monkeypox with COVID-19, it’s important to remember they are two different viruses with their own characteristics. A big monkeypox outbreak like this is still a very different situation to a COVID-19 pandemic.
“Given 11 further cases have been announced today, it’s likely there will be more cases to come in the UK. There certainly will be further cases confirmed in other countries. The contact tracing efforts by public health teams will be crucial in containing the outbreak.
“We may at some point see the use of the smallpox vaccine recommended for close contacts, as part of a ‘ring vaccination’ approach. For example, this was used successfully during an Ebola outbreak in Democratic Republic of Congo in 2018/19, where close contacts were vaccinated as part of the public health response (e.g. as opposed to a wider vaccination of the entire population).”
Dr Susan Hopkins, Epidemiologist, Infectious Diseases Consultant, Chief Medical Advisor Transition Lead, UKHSA:
“We are detecting more cases on a daily basis.
“We know there has been a period of restrictions across Europe, and we don’t know where this infection has come from and how it has come into Europe.
“There is no obvious connection in our cases in the UK to a single event.
“The risk to the general population remains extremely low at the moment but people need to be alert to it.
“We are saying to people if you’ve got symptoms, avoid close contact with others and seek medical attention.”
Dr Muge Cevik, Clinical Lecturer in Infectious Diseases and Medical Virology, University of St Andrews:
“This is the biggest outbreak outside of Africa, and there will be more cases to come. The concern is not necessarily a global pandemic like what we’ve seen with coronaviruses or influenza. But a growing and large monkeypox epidemic is a concern especially if public health measures are delayed.
“Especially given the apparent symptoms of monkeypox and transmission mostly after symptoms suggest that isolation + contact tracing can be very effective to control monkeypox. With the help from smallpox ring vaccination, I hope that it very much can be contained.
“However, the biggest challenge in my opinion is the delayed identification of cases, which may have profound implications not only on communities, but on healthcare workers, from risk of exposure or prolonged isolation, adding strains on healthcare systems during outbreaks.”
GOING FURTHER:
- Monkeypox: The epidemiology, symptoms, diagnosis and management of monkeypox virus infections | UKHSA
- Monkeypox: case definitions | UKHSA
- Epidemiological update: Monkeypox outbreak | ECDC
- Monkeypox | CDC
- Multi-country monkeypox outbreak in non-endemic countries | WHO
— AUTHORS —
▫ PMP News reporting.
Sources
- Text: This piece was first published in PMP Magazine on 22 May 2022. The experts write in a personal capacity.
- Cover: Adobe Stock/bluebay2014.
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