"Vaccines alone won't end the monkeypox outbreak," the World Health Organiation (WHO) has warned: "At-risk individuals will have to take action too." The alert comes days after WHO Director-General Tedros Adhanom Ghebreyesus declared the global spread of monkeypox a Public Health Emergency of International Concern (PHEIC).
In a statement, WHO Regional Director for Europe, Dr Hans Henri P. Kluge, said that with the declaration: "All WHO Member States, whether they have reported cases or not, must now act with urgency, making the most of every opportunity to anticipate, control and stop the spread of a virus that we still have much to learn about."
The WHO chief had made unprecedented use of his personal prerogative to call monkeypox a PHEIC despite the WHO’s own Emergency Committee, which met on July 21, voting by a narrow majority against doing so. He reportedly made the declaration "to ensure the global community takes the current outbreaks seriously".
Dr Kluge said that the outbreak initially surfaced in WHO's European Region – encompassing 53 countries across Europe and Central Asia – where the vast majority of cases have occurred. The virus extended its reach rapidly, he said, with 37 countries and areas now affected and evidence of continued local transmission. "Solutions to tackle the outbreak must, therefore, also come from the region, without stigma and discrimination towards affected communities and in close partnership with them," he said.
Between May 13 and July 22, almost 12,000 probable or confirmed cases have been reported in the region, primarily among men who have sex with men (MSM). Of the total, 8% have been hospitalised, but there have been no deaths to date.
Five Deaths in Africa This Year
In general monkeypox is a self-limiting, non-life-threatening disease in otherwise healthy persons, Dr Kluge noted. The disease is better known in African countries where it has been observed over decades, and where deaths – just five so far this year – have occasionally been reported, including in children and elderly persons as well as people with underlying conditions.
In Europe, close contact sexual transmission in social and sexual networks of MSM has been the key mode of spread. Some cases have been detected through household transmission, although cases in women and children remain minimal.
"While we acknowledge uncertainties about how this outbreak will play out, we must respond to the epidemiology before us, focusing on the most dominant mode of transmission – skin-to-skin contact during sexual encounters – and the groups at highest risk of infection," Dr Kluge said.
"As such, the responsibility for stopping this outbreak is necessarily a joint responsibility, shared between health institutions and authorities, governments and affected communities, and individuals themselves."
MSM Urged to Consider Limiting Sexual Partners
He expressly urged those at highest risk – men who have sex with men and especially those with multiple sexual partners – to "consider limiting your sexual partners and interactions at this time". He said: "This may be a tough message, but exercising caution can safeguard you and your wider community.
"While vaccination may be available to some people with higher exposure risks, it is not a silver bullet, and we still ask you to take steps to lowering that risk for the time being.
"If you have or think you have monkeypox, you are infectious, so do everything you can to prevent spreading the disease. Isolate if you can, do not have sex while you are recovering, and do not attend parties or large gatherings where close contact will happen."
Other key messages of the statement included:
- Health providers should:
- Remove any and all barriers to testing, medical attention, or vaccination
- Provide clear information on how to access care
- Give certified medical leave to patients for the duration of the infectious period so that they can isolate as needed
- Remove any judgement or stigma from the patient pathway
- Ministries of health and public health authorities, including in countries without reported cases, should:
- Significantly and swiftly boost national capacities for monkeypox surveillance, investigation, diagnostics and contact tracing
- Work together with at-risk groups and communities and their leaders – including organisers of community events such as summertime Pride festivities – to develop and disseminate crucial messages aimed at curtailing transmission and encouraging uptake of health services
- Urgently find ways to address the realities of this outbreak and make sure that the response is laser focused on stopping transmission in the groups and settings where it is happening or likely to
- Governments should:
- Generate evidence to support the use of vaccines and antivirals for monkeypox
- Target them to populations at highest infection risk
'Approach Based on No Regrets'
The WHO Director-General "chose an approach based on no-regrets", Dr Kluge said. As well as sharpening the response in Europe and Central Asia, he hoped it would "boost investments and support to countries in Africa where the disease's spread over the past decade has not been given the international attention it has needed. Increasing surveillance and response in countries where the virus is endemic helps prevent any future outbreaks elsewhere", he said.
The European Medicines Agency (EMA) today responded to the escalation of the outbreak to a PHEIC, which has given it new powers under its extended mandate to trigger additional activities. It said it had already on 22 July approved an indication extension for Imvanex – a live modified vaccinia virus Ankara vaccine developed and manufactured by Bavarian Nordic - to protect adults from monkeypox. It has now initiated a series of additional actions including:
- The EMA Executive Steering Group on Shortages and Safety of Medicinal Products will produce and maintain a formal list of critical medicines for the monkeypox public health emergency
- Marketing authorisation holders of medicines included in the list will be required regularly to update EMA with relevant information on stocks and shortages, forecasts of supply and demand
- Member states will provide regular reports on estimated demand for these medicines at national level
- The EMA’s Emergency Task Force will be formally extended to deal with monkeypox as well as COVID-19, including providing scientific advice on medicinal products and clinical trials, coordinating independent monitoring studies and facilitating trials within the EU, and giving recommendations to member states on the use of unauthorised products
As well as Imvanex, the medicine Tecovirimat SIGA (tecovirimat monohydrate) is authorised for use to treat smallpox, monkeypox and cowpox, the EMA said.
Cases Continue to Rise in the UK
The latest update on monkeypox in the UK from the UK Health Security Agency (UKHSA) showed 2367 confirmed and 65 highly probable monkeypox cases - 2432 in total - up to July 25. The UK’s testing capacity has been expanded, with some NHS laboratories now using an orthopox polymerase chain reaction (PCR) test on suspected monkeypox samples - the monkeypox case definition was expanded on 25 July to recognise those who are orthopox-positive as highly probable cases, in addition to confirmed cases who test positive on a monkeypox PCR test.
Dr Sophia Makki, national incident director at UKHSA, said: "Monkeypox cases continue to rise, with the virus being passed on predominantly in interconnected sexual networks." She urged MSM to check for monkeypox symptoms before having sex or going to a party or event, and if they found any symptoms, including rashes or blisters, to "take a break from attending events or sex until you’ve called 111 or a sexual health service and been assessed by a clinician".
"Vaccination will further strengthen our monkeypox response," she added, urging all those eligible to take it up when offered, but reminding men that: "The vaccine may not provide complete protection against monkeypox, so it is still important to be alert for the symptoms."
In its latest epidemiological overview to July 26, 2022, the UKHSA said that the current case distribution of confirmed plus probable cases between countries was:
- 2325 in England (+210 since July 21)
- 59 were in Scotland (+5)
- 30 in Wales (+6)
- 18 in Northern Ireland (+3)
Demographically there was little change from the last report on July 21, with a majority (73%) of English cases still in London and 99.3% of cases in men, with a median age of 37 (interquartile range 31-43).
Lead Image Credit: iStock/Getty Images
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