WHO weighs in declaring monkeypox a global emergency as European cases rise

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LONDON — The World Health Organization is considering declaring monkeypox an international emergency – a move that could come as early as Friday. A declaration could step up the global response as cases rise rapidly in Britain despite efforts to contain it. Britain, where nearly 800 cases of the virus have been recorded in the past month, has the highest number of reported infections outside of central and west Africa – and case trends here are worrying experts from across Europe, the epicenter of the outbreak, weighing the best approach amid the years-long coronavirus pandemic.

Cases of monkeypox have risen by almost 40% in Britain in less than five days, according to data shared by the UK Health Security Agency. As of June 16, 574 cases had been recorded and by June 20 the number had risen to 793.

After Great Britain, Spain, Germany and Portugal have the most recorded cases. And it’s a growing threat outside of Europe: More than 3,200 cases have been confirmed in 48 countries in the past six weeks, according to the WHO, which releases monkeypox data at weekly intervals. As of June 15, one death had been reported.

The WHO’s International Health Regulations Emergency Committee met on Thursday to discuss whether the monkeypox outbreak should be classified as a “public health emergency of international concern”, which would mobilize new funding and spur governments to act. The novel coronavirus, which causes covid-19, was labeled PHEIC following a similar meeting in January 2020.

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So far, the response in most European countries has been to focus on raising awareness of at-risk communities, contact tracing and isolating known cases of monkeypox. That could change if the WHO, which first sounded the alarm over monkeypox infections in countries where the virus is not endemic in May, raises the threat level of the outbreak.

“The emergency committee then the [WHO] the chief executive’s announcement will raise the political level of it,” David Heymann, a professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine who attended the meeting as an adviser, told The Washington Post.

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Monkeypox is transmitted through close contact and has so far primarily affected men who have sex with men. It begins with flu-like symptoms before fluid-filled lumps or lesions appear on the skin, which can leave permanent scars. Health officials say the latest outbreak has caused genital rashes frequently, and while most cases are mild and patients recover in three weeks, the virus can be deadly and poses greater risks to pregnant women. or those with weakened immune systems.

To contain the outbreak, a broader understanding of its origins as well as vaccination of at-risk groups and contact tracing are imperative, experts say, although they note that some patients may be unwilling to disclose information about people with whom they have been intimate – which can complicate the public health response.

“One of the challenges people have in implementing screening is actually getting a full list of people’s sexual contacts,” said Paul Hunter, professor of medicine at the University of East Anglia. “This is exactly the problem we faced when we were dealing with HIV/AIDS in the early [1990s].”

And, like at the start of the coronavirus outbreak, it’s unclear if cases in some countries are going undetected. Some experts believe Britain could have higher figures because its extensive public health surveillance network allows it to identify more infections.

WHO Director-General Tedros Adhanom Ghebreyesus acknowledged at the start of Thursday’s meeting that monkeypox is probably more prevalent than official figures indicate. “Person-to-person transmission is ongoing and is likely underestimated,” he told members of the emergency committee.

The UK has proactively tracked people with known cases of monkeypox and in some cases distributed smallpox vaccines, which are known to protect against monkeypox infection, to their close contacts and risk groups. In theory, this approach — which Hunter described as a “ring vaccination” — “should have worked,” he said.

But as infections rose and authorities struggled to “find case contacts early enough to have an impact”, Hunter said he had become “less confident”.

“Unless we turn the page on this very soon, I think we will probably have to start thinking about what’s next,” he added.

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British health officials said on Tuesday that some gay and bisexual men, considered to be at higher risk of exposure, will be offered vaccines to help curb the outbreak of monkeypox. The UK Health Security Agency has pointed out that although the virus is more of a threat “in the sexual networks of gay, bisexual and other men who have sex with men”, anyone can contract the disease through close contact. with an infected person.

Scientists are studying this outbreak and will know more once the virus is sequenced. “We are beginning to understand how [monkeypox] really is,” Heymann said. “We know it’s prevalent in some populations, and we need to know if it’s spreading in other populations as well.”

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Two years after treating Germany’s first coronavirus patient, Clemens Wendtner treated Germany’s first monkeypox patient in May. The man, who has not been identified, was a Brazilian sex worker, said Wendtner, chief physician for infectious diseases at Munich’s Schwabing Clinic.

A handful of other monkeypox patients have been treated in his department in recent weeks, Wendtner said. Some have reported “very painful” rectal lesions, for which intravenous painkillers are given to relieve discomfort. Wendtner and his colleagues have been closely recording their findings amid this outbreak, recently documenting their discovery of monkeypox virus DNA in semen and blood.

Most patients were discharged after around a day and were asked to self-isolate for 21 days at home – in accordance with German infectious disease law. The majority of cases have been reported in Berlin, one of Europe’s party hotspots, which is set to host Pride events next month.

“Summer season is party season,” he warned, adding that more cases in the coming week are likely and the current outbreak may not have peaked yet.

While men are significantly more at risk, Wendtner warned that sex workers could also be at risk. “The risk factor is a pattern of unprotected sex,” he explained.

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Outside of Europe, other countries are also grappling with new cases.

The first case of monkeypox in the United States was detected on May 17. In the past five weeks, more than 100 cases have been added, according to data from the Centers for Disease Control and Prevention. California, New York and Illinois are listed as the states with the highest level of infection.

Some experts in the United States are calling on the White House to implement extensive testing to avoid failures from the coronavirus pandemic.

Singapore confirmed a case of monkeypox in a Briton on Tuesday, the first in Southeast Asia. South Korea also confirmed its first case of monkeypox on Wednesday. The patient is a South Korean national who entered the country from Germany, health officials said. South Africa also announced its first case of monkeypox on Thursday, Reuters reported. The 30-year-old has no travel history, health experts said, meaning his illness would not have been contracted outside of South Africa.

It’s important to remember, experts say, that this is not a new disease. Monkeypox has been circulating in Africa for decades, leading some to point to a double standard in Europe’s response to the outbreak.

“It’s a disease that’s been overlooked,” Heymann said. After the eradication of smallpox in 1980, the world stopped routinely administering smallpox vaccines. Monkeypox, which is less contagious than smallpox, continued to spread in West and Central Africa, but outbreaks there were not thoroughly investigated due to lack of resources, a he added.

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The WHO’s Tedros said on Thursday that nearly 1,500 suspected cases of monkeypox and some 70 deaths have been reported in central Africa this year. “Although the epidemiology and viral clade in these cases may be different, this is a situation that cannot be ignored,” he warned.

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