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Monkeypox outbreak reaches 257 confirmed cases worldwide, WHO says

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In the United States, the Centers for Disease Control and Prevention has reported 12 cases in eight states as of Friday afternoon.

In five African countries where monkeypox is commonly found, the WHO said it has received reports of 1,365 cases and 69 deaths due to the virus. These illnesses were reported in various periods ranging from mid-December to late May.

No deaths have been reported in nonendemic countries.

“Since 2017, the few deaths of persons with monkeypox in West Africa have been associated with young age or an untreated HIV infection,” the WHO said in Sunday’s report.

The agency said the global public health risk level is moderate, “considering this is the first time that monkeypox cases and clusters are reported concurrently in widely disparate WHO geographical areas, and without known epidemiological links to non-endemic countries in West or Central Africa.”

The WHO also said in its update: “The public health risk could become high if this virus exploits the opportunity to establish itself as a human pathogen and spreads to groups at higher risk of severe disease such as young children and immunosuppressed persons.”

The agency is urging health care providers to watch closely for possible symptoms such as rash, fever, swollen lymph nodes, headache, back pain, muscle aches and fatigue, and to offer testing to anyone who has these symptoms.

However, given that most initial cases in this outbreak have been reported among men who have sex with men, “all efforts should be made” to avoid stigmatizing affected people and communities, the WHO said.

Monkeypox is an extremely rare viral disease that is similar to smallpox, but it is considered clinically less severe, according to the WHO. The disease eventually progresses into a rash and lesions that blister and scab over. This can happen all over the body. The illness usually lasts two to four weeks.

Monkeypox is not a sexually transmitted disease, but it can spread through intimate contact during sex when someone has an active rash.

Scientists are sequencing the genetic code of viral samples from patients in this outbreak to learn more about its origins, but “preliminary data confirm that the genomes belong to the West African clade of monkeypox virus,” according to the WHO.

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Monkeypox presents moderate risk to public health, WHO says

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Test tubes labelled “Monkeypox virus positive” are seen in this illustration taken May 22, 2022. REUTERS/Dado Ruvic/Illustration

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May 29 (Reuters) – The World Health Organization said on Sunday that monkey pox constitutes a “moderate risk” to overall public health at global level after cases were reported in countries where the disease is not typically found.

“The public health risk could become high if this virus exploits the opportunity to establish itself as a human pathogen and spreads to groups at higher risk of severe disease such as young children and immunosuppressed persons,” WHO said.

As of May 26, a total of 257 confirmed cases and 120 suspected cases have been reported from 23 member states that are not endemic for the virus, the health agency said in a statement. There has been no reported fatalities so far.

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WHO also said that the sudden appearance of monkeypox at once in several non-endemic countries suggests undetected transmission for some time and recent amplifying events.

The agency added that it expects more cases to be reported as surveillance in endemic and non-endemic countries expands.

Monkeypox is an infectious disease that is usually mild, and is endemic in parts of west and central Africa. It is spread by close contact, so it can be relatively easily contained through measures such as self-isolation and hygiene. See EXPLAINER: read more

Most of the cases reported so far have been detected in the UK, Spain and Portugal.

“The vast majority of reported cases so far have no established travel links to an endemic area and have presented through primary care or sexual health services,” the U.N. agency said.

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Reporting by Ann Maria Shibu in Bengaluru; Editing by Daniel Wallis and Grant McCool

Our Standards: The Thomson Reuters Trust Principles.

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Multi-country monkeypox outbreak in non-endemic countries: Update

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Identification of additional cases and further onward spread in currently affected and other Member States is likely. Countries should be on the alert for signals related to patients presenting with a rash that progresses in sequential stages – macules, papules, vesicles, pustules, scabs, at the same stage of development over all affected areas of the body – that may be associated with fever, enlarged lymph nodes, headache, back pain, muscle aches or fatigue. During this current outbreak, many individuals are presenting with localized rash – oral, peri-genital and/or peri-anal distribution associated with painful regional lymphadenopathy – sometimes with secondary infection. These individuals may present to various community and health care settings including but not limited to primary care, fever clinics, sexual health services, travel health clinics, infectious disease units, emergency departments, dermatology clinics, obstetrics and gynaecology, and dental services. Increasing awareness among potentially affected communities, as well as health care providers and laboratory workers, is essential for identifying and preventing further secondary cases and effective management of the current outbreak.

Any individual meeting the definition for a suspected case should be offered testing. The decision to test should be based on both clinical and epidemiological factors, linked to an assessment of the likelihood of infection. Due to the range of conditions that cause skin rashes and because clinical presentation may more often be atypical in this outbreak, it can be challenging to differentiate monkeypox solely based on the clinical presentation, particularly for cases with an atypical presentation. Any patient with suspected monkeypox should be investigated and if confirmed, isolated until their lesions have crusted, the scab has fallen off and a fresh layer of skin has formed underneath. Isolation can occur either in a health care facility or at home, provided the infected individual can be isolated and cared for appropriately. All efforts should be made to avoid unnecessary stigmatization of individuals and communities potentially affected by monkeypox.

Considerations relating to surveillance and reporting

For further details please refer to; WHO Surveillance, case investigation and contact tracing for Monkeypox: Interim guidance, 22 May 2022. 

Surveillance

The key objectives of surveillance and case investigation for monkeypox in the current context are to rapidly identify cases and clusters of infection and the sources of infection as soon as possible in order to provide clinical care and isolate cases to prevent further transmission; and to tailor effective control and prevention measures based on most commonly identified routes of transmission. In non-endemic countries, one case is considered an outbreak. Because of the public health risks associated with a single case of monkeypox, clinicians should report suspected cases immediately to their local or national public health authorities according to national reporting protocols, regardless of whether they are also exploring other potential diagnoses. Cases should be reported immediately, according to the case definitions (link shared above, under public health response) or nationally tailored case definitions. Probable and confirmed cases should be reported immediately to WHO through IHR national focal points (NFPs) under the International Health Regulations (IHR 2005).

Countries should be on the alert for signals related to patients presenting with unusual rash, vesicular or pustular lesions or lymphadenopathy, often associated with fever, in a range of community and health care settings, including but not limited to primary care, fever clinics, sexual health services, travel health clinics, infectious disease units, emergency services, obstetrics and gynaecology, and dermatology clinics. Surveillance for rash-like illness should be intensified and guidance provided for collection of skin lesion samples for confirmatory PCR testing. Clinicians should be on the alert for any patient with relevant symptoms and signs who may have recently travelled or been in contact with someone who has recently travelled. This includes but is not limited to travel from endemic countries, and particularly Nigeria at this time, or travel from other countries where monkeypox has recently been reported. Persons who have recently had close personal contact with multiple sexual partners, whether locally or in connection with recent travel, may be at risk. Outreach activities should be put in place for communities identified to be at risk as the outbreak unfolds. At the present time, this includes outreach to social networks of MSM and their close contacts. It is important to note that the first case of monkeypox identified in any community may have acquired infection through close personal contact locally. In limited circumstances, recent preparation or consumption of wild game or bushmeat may also represent a risk.

Reporting

Case reports should include at a minimum the following information: date of report; reporting location; name, age, sex and residence of case; date of onset of first symptoms; recent travel history including location and dates of travel; recent exposure to a probable or confirmed case; relationship and nature of contact with probable or confirmed case (where relevant); recent history of multiple and/or anonymous sexual partners; smallpox or monkeypox vaccination status; presence of rash; presence of other clinical signs or symptoms as per case definition; clinical diagnosis and date of laboratory confirmation (where done); method of confirmation (where done); genomic characterization (if available); other relevant clinical or laboratory findings, particularly to exclude common causes of rash as per the case definition; whether hospitalized; date of hospitalization (where relevant); and outcome at time of reporting.

A global case reporting form is under development.

Considerations related to case investigation

Rationale

During human monkeypox outbreaks, close physical contact with infected persons is the most significant risk factor for monkeypox virus infection. If monkeypox is suspected, the investigation should consist of (i) clinical examination of the patient using appropriate infection prevention and control (IPC) measures, (ii) questioning the patient about possible local or travel-related sources of infection and the presence of similar disease in the patient’s community and contacts, and (iii) collection and dispatch of specimens for monkeypox laboratory examination. The minimum data to be captured are included above under ‘Reporting’. Exposure investigation should cover the period up to 21 days prior to symptom onset. Any patient with suspected monkeypox should be isolated during the presumed and known infectious periods, that is during the prodromal and rash stages of the illness, respectively. Laboratory confirmation of suspected cases is important but should not delay public health actions. Suspected presence of similar disease in the patient’s community or contacts should be further investigated (also known as “backwards contact tracing”).

Retrospective cases found by active search may no longer have the clinical symptoms of monkeypox (they have recovered from acute illness) but may exhibit scarring and other sequelae. It is important to collect epidemiological information from retrospective cases in addition to active ones.

Samples taken from people with suspected monkeypox or animals with suspected monkeypox virus infection should be safely handled by trained staff working in suitably equipped laboratories. National and international regulations on transport of infectious substances should be strictly followed during the sample packing and transportation to the testing laboratories. Careful planning is required to consider laboratory testing capacity. Clinical laboratories should be informed in advance of samples to be submitted from persons with suspected or confirmed monkeypox, so that they can minimize risk to laboratory workers and, where appropriate, safely perform laboratory tests that are essential for clinical care. See further information below: Considerations for laboratory testing and sample management.

Retrospective cases cannot be laboratory confirmed; however, serum from retrospective cases can be collected and tested for anti-orthopoxvirus antibodies to aid in their case classification.

Considerations related to contact tracing

Rationale

Contact tracing is a key public health measure to control the spread of infectious disease pathogens such as monkeypox virus. It allows for the interruption of transmission and can also help people at a higher risk of developing severe disease to more quickly identify their exposure, so that their health status can be monitored, and they can seek medical care more quickly if they become symptomatic. In the current context, as soon as a suspected case is identified, contact identification and contact tracing should be initiated. Case patients should be interviewed to elicit the names and contact information of all such persons. Contacts should be notified within 24 hours of identification. 

Definition of a contact

A contact is defined as a person who, in the period beginning with the onset of the source case’s first symptoms, and ending when all scabs have fallen off, has had one or more of the following exposures with a probable or confirmed case of monkeypox:

  • direct physical or intimate personal contact, including any sexual contact
  • face-to-face exposure (including health workers without appropriate PPE)
  • contact with contaminated materials such as clothing or bedding

Contact identification

Case-patients can be prompted to identify contacts across different contexts, including their household, intimate partners and sexual contacts,  as well as events and social gatherings where extended networks of individuals may engage in activities involving physical contact that may put participants at risk, festivals, sports, bars or restaurants and other gathering places, transportation or travel in a closed vehicle, health care (including laboratory exposure), the workplace, houses of worship, school/nursery, and any other recalled interactions. Attendance lists and, passenger manifests, for example, can be further used to identify contacts.

Contact monitoring

Contacts should be monitored at least daily for the onset of signs/symptoms for a period of 21 days from last contact with a patient in the infectious period. Signs/symptoms of concern include feeling unwell, headache, fever, chills, sore mouth or throat, malaise, fatigue, rash, and lymphadenopathy (swollen or inflamed lymph nodes). Contacts should monitor their temperature twice daily. Contacts without any symptoms should not donate blood, cells, tissue, organs, breast milk, or semen while they are self-monitoring or being monitored for symptoms. Contacts without symptoms can continue routine daily activities such as going to work and attending school (i.e., no quarantine is necessary), but should remain close to home for the duration of the period of monitoring. It may, however, be prudent to exclude pre-school children from day care, nursery or other group settings.

Options for monitoring by public health authorities are dependent on available resources. Contacts can self-monitor or be monitored actively, or directly. For self-monitoring, identified contacts are provided with information on the signs/symptoms to monitor, permitted activities, and how to contact the public health department if signs/symptoms develop. Active monitoring is when public health officials are responsible for checking at least once a day to see if a person under monitoring has self-reported signs/symptoms. Direct monitoring is a variation of active monitoring that involves at least daily home visiting or attendance at a health facility or public health unit if this can be done safely, or visually examining the person under monitoring via video for signs of illness.

A contact who develops initial signs/symptoms other than rash should be isolated and closely watched for signs of rash for the next seven days. If no rash develops, the contact can return to temperature monitoring for the remainder of the 21 days. If the contact develops a rash, they must be isolated or self-isolate as appropriate, they must be fully evaluated as a suspected case, and a specimen should be collected for laboratory analysis to test for monkeypox.

Monitoring exposed health workers and caregivers

Any health worker or household member who has cared for a person with probable or confirmed monkeypox, including management of potentially contaminated materials even without direct patient contact, should be alert to the development of symptoms that could suggest acquisition of monkeypox infection, especially within the 21-day period after the last date that care was provided. Health workers should notify infection control, occupational health, and public health authorities to be guided about a medical evaluation.

Health workers who have unprotected exposures (i.e., not wearing appropriate PPE) to patients with monkeypox or contact with possibly contaminated materials do not need to be excluded from work duty if they are without symptoms during the monitoring period but should undergo monitoring for symptoms, which includes measurement of temperature at least twice daily for 21 days following the exposure. Prior to reporting for work each day, the health worker should be interviewed regarding evidence of any relevant signs/symptoms as above.

Health workers who have cared for or otherwise been in direct or indirect contact with monkeypox patients while adhering to recommended infection control precautions may undergo self-monitoring or active monitoring as determined by local public health authorities.

Vaccination of contacts and /or health personnel

Some countries may hold monkeypox or smallpox vaccine which could be considered for use according to national guidance. Where feasible, countries could consider timely vaccination of close contacts as post-exposure prophylaxis. Post-exposure vaccination with locally available monkeypox or smallpox vaccine (ideally within 4 days of exposure) may be considered by some countries for higher risk contacts, such as family living in the same household, intimate personal or sexual contacts, or health workers exposed while not wearing appropriate PPE. Decisions on vaccination and which vaccine to use should be based on national guidance. Individual decisions on vaccination for contacts of patients with monkeypox should be based on public health guidance, risk-benefit assessment and shared clinical decision-making between a health care provider and a patient contact. Pre-exposure vaccination may also be considered for certain health workers, including laboratory personnel, or other persons at risk.

Any request for vaccines should be directed through health authorities at national level.

Travel-related contact tracing

Public health officials should work with travel operators and public health counterparts in other locations to assess potential risks and to contact passengers or others who may have had contact with an infectious patient while in transit.

A global contact tracing form will be made available shortly.

Considerations related to risk communication and community engagement

Communicating monkeypox related risks and engaging with at-risk and affected communities, civil society organizations, and health care providers, including sexual health clinics, on prevention, detection and care, is essential for preventing further secondary cases and effective management of the current outbreak. Providing public health advice on how the disease transmits, its symptoms and preventive measures and targeting community engagement to the population groups who are most at risk, is critical to minimize spread.

Anyone who has direct contact with an infected person, including intimate or sexual contact can get monkeypox. Steps for self-protection include avoiding physical contact with the person. It is also critical to avoid intimate or sexual contact with someone with a localized anogenital rash and/or oral ulcers. During the early phase of this outbreak while information is still being collected, it would be prudent to limit the number of sex partners, keep hands clean with water and soap or alcohol-based gels, and maintain respiratory etiquette and hand hygiene.

If people develop a rash, accompanied by fever or a feeling of discomfort or illness, they should contact their health care provider and get tested for monkeypox. If someone is suspected or confirmed as having monkeypox, they should isolate at home or in an appropriate facility until the scabs have fallen off, and abstain from sex, including oral sex. During this period, patients must be offered supportive medical care to ease monkeypox symptoms such as pain or itchiness. Patients should be monitored for early detection of any medical complications of the illness. Anyone caring for a person sick with monkeypox should use appropriate personal protective measures.

Any rash-like illness during travel or upon return should be immediately reported to a health professional, including information about all recent travel, sexual history and smallpox immunization history.

Residents and travelers to monkeypox-endemic countries should avoid contact with sick mammals such as rodents, marsupials, non-human primates (dead or alive) that could harbour monkeypox virus and should refrain from eating or handling wild game (bush meat).

Considerations related to clinical management and infection prevention and control in health care settings

These precautions are applicable in any health facility including outpatient services and hospitals.
Health workers caring for patients with suspected or confirmed monkeypox should implement standard, contact and droplet precautions. These precautions are applicable in any health facility including outpatient services and hospitals. Standard precautions include strict adherence to hand hygiene, appropriate handling of contaminated medical equipment, laundry, waste and cleaning and disinfection of environmental surfaces

WHO advises that contact and droplet transmission-based precautions be implemented at a minimum for any suspected or confirmed case of monkeypox. This includes:

  • All health workers should perform hand hygiene according to the WHO 5 moments of hand hygiene, including prior to putting on and after removing PPE.
    • Place patient in a well-ventilated single patient room with dedicated bathroom or toilet. If single patient rooms are not available, consider cohorting confirmed cases, maintaining a distance of 1-metre between patients.
    • Designated patient room/area should have signage posted at the entrance indicating contact/droplet precautions. 
    • Anyone entering the patient room should wear personal protective equipment (PPE) including gloves, gown, a well-fitting medical mask and eye protection
    • Instruct the patient to wear a well-fitting medical mask and follow respiratory hygiene and cough etiquette and cover exposed lesions when others are in the room and when transport is necessary. 
    • Avoid unnecessary movement of persons with suspected or /confirmed monkeypox. If the patient must be moved or transported within or beyond the facility, ensure risk-based precautions are maintained, and place a well-fitting medical mask on the patient (provided the patient is able to tolerate).
    • The receiving facility/ward/unit should be aware of transmission-based precautions required in order to inform the staff and prepare the isolation or designated area. 
    • Should any aerosol-generating procedures be required for patient care and cannot be deferred, health workers should take all the necessary precautions to avoid aerosolization of patient secretions or other material and don the appropriate PPE necessary to protect themselves during the procedure.

PPE should be disposed of prior to leaving the isolation area where the patient is admitted. Areas within the health care facility frequently used by the patient or where patient care activities occur, and patient care equipment should be cleaned and disinfected as per national or facility guidelines.  Linens, hospital gowns, towels and any other fabric items should be handled and collected carefully to avoid shaking.

Full interim guidance on infection prevention and control will be published shortly.

Clinical management and treatment

Clinical care for patients with monkeypox is supportive. All symptoms should be attended to including fever, painful sores or skin lesions, discomfort related to swollen lymph nodes or any other concerns. Patients should have plenty of rest and fluids, as systemic symptoms (e.g., fever) may lead to dehydration and localized symptoms (e.g., sores in the mouth or swollen lymph nodes) may result in difficulty eating or drinking enough liquids. Care should be taken to avoid touching mucous membranes such as the eyes and secondary infections of lesions must be prevented or treated according to local medical protocols. Proper eye and skin care will help to reduce complications and sequelae such as scarring. Patients should also be monitored to ensure that swelling of lymph nodes or abscesses in the mouth or throat do not compromise the ability to breath or lead to respiratory obstruction. All underlying conditions or associated infections due to other causes should be promptly and fully treated.

Deployment of pharmaceutical countermeasures including specific antivirals (i.e., tecovirimat, which is approved for monkeypox, but not yet widely available) can be considered under investigational or compassionate use protocols particularly for those who have severe symptoms or who may be at risk of poor outcomes (such as those with immune suppression due to other medical conditions or young children).  

Full interim guidance on clinical care and therapeutics for monkeypox will be published shortly.

Considerations related to laboratory testing and sample management

For more details, please refer to WHO Laboratory testing for the monkeypox virus: Interim guidance, 23 May 2022. 

Monkeypox virus (MPXV) is a double-stranded DNA virus, a member of the Orthopoxvirus genus within the Poxviridae family. Poxviruses cause disease in humans and many other animals; infection typically results in the formation of lesions, skin nodules or disseminated rash. Other orthopoxvirus (OPXV) species pathogenic to humans include cowpox virus, and variola virus (causing smallpox, which has been eradicated). Vaccinia virus is also an OPXV that has been used to produce vaccines for immunizing people and was a key tool for the eradication of smallpox, achieved in 1980.

The recommended specimen type for laboratory confirmation of monkeypox is skin lesion material, including swabs of lesion surface and/or exudate, roofs from more than one lesion, or lesion crusts. Alternatively, swabs placed in viral transport media (VTM) can also be used. Specimens should be stored refrigerated or frozen within an hour of collection and transported to the laboratory as soon as possible after collection. If transport exceeds seven days for the sample to be tested, specimens should be stored at -20 celsius or lower.

All specimens being transported should have appropriate triple packaging, labelling and documentation and be shipped in compliance with applicable national and/or international regulations. Shipping requires a dangerous goods certified shipper. For information on infectious substances shipping requirements, please see the WHO Guidance on regulations for the transport of infectious substances 2021-2022.

Confirmation of monkeypox infection is based on nucleic acid amplification testing (NAAT), using real-time or conventional PCR, for detection of unique sequences of MPXV viral DNA. If a MPXV specific test (preferable) is not available, an orthopoxvirus positive PCR can be considered confirmation in non-endemic countries, as there is little circulation of other orthopoxviruses in humans. PCR can be used alone, or in combination with sequencing.

Antibody detection from plasma or serum should not be used alone for diagnosis of monkeypox. However, IgM detection from recent acutely ill patients or IgG in paired serum samples, collected at least 21 days apart, with the first being collected during the first week of illness, can aid diagnosis if tested samples yield inconclusive results. Recent or previous smallpox vaccination may interfere with serological testing.

Electron microscopy can be used to visualize potential poxvirus in the sample, but with the availability of molecular assays and the high technical skills and facility required, this method is not routinely used for laboratory confirmation.

Virus isolation is not recommended as a routine diagnostic procedure and should only be performed in laboratories with appropriate experience and containment facilities. Confirmation of monkeypox infection should consider clinical and epidemiological information. All test results, positive or negative, should be immediately reported to national authorities. Access to timely and accurate laboratory testing of samples from cases under investigation is an essential part of the diagnosis and surveillance of this emerging infection. All countries should have access to reliable testing either nationally or through referral to laboratories in other countries that are willing and able to undertake OPXV or MPXV detection. WHO, through its Regional Offices, can assist Member States to access testing through referral. Countries are encouraged to undertake and share their sequence data through publicly accessible databases for a better understanding of the epidemiology and monkeypox evolution in the current outbreak.

Based on available information at this time, WHO does not recommend that Member States adopt any international travel-related measure for either incoming or outgoing travelers.

WHO will be providing additional interim guidance on case management and infection, prevention and control; vaccines and immunization, and risk communication and community engagement in the coming days.

WHO urges all Member States, health authorities at all levels, clinicians, health and social sector partners, and academic, research and commercial partners to respond quickly to stop the multi-country outbreak of monkeypox. Rapid action must be taken before the virus can be allowed to establish itself as a human pathogen with efficient person-to-person transmission in both endemic and non-endemic contexts. Lessons learned from the eradication of smallpox and from the management of other emerging zoonotic diseases must be urgently considered in the light of these rapidly evolving events.

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CDC Raises Travel Alert for Monkeypox

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The Centers for Disease Control and Prevention (CDC) recently revised its travel advisory from Level 1 to Level 2 due to the recent monkeypox outbreak around the world.

An update posted to the agency’s website wrote: “Cases of monkeypox have been reported in Europe, North America, and Australia,” adding that cases were reported among homosexual males. “Some cases were also reported in people who live in the same household as an infected person.”

“None of these people reported having recently been in central or west African countries where monkeypox usually occurs, including the Democratic Republic of the Congo and Nigeria, among others,” the advisory continues to say.

Travelers should avoid close contact with sick people, namely those with skin lesions. They are advised to avoid contact with dead or living wild animals such as small mammals, rodents, and primates. The CDC also says that people should not eat or prepare meat from wild game in Africa.

“Contact with contaminated materials used by sick people (such as clothing, bedding, or materials used in healthcare settings) or that came into contact with infected animals” is also not recommended, the CDC adds.

The agency concluded that the risk to the general population still remains low, but people should seek immediate medical care if they have developed new and unexplained skin rashes and lesions with or without fever and chills. Those people are urged to avoid contact with others as well.

Officials with the World Health Organization (WHO) have said that there are more than 200 monkeypox cases worldwide, although Sylvie Briand, the WHO’s epidemic and pandemic preparedness and prevention chief, said on May 27 that “we don’t know if we are just seeing the peak of the iceberg [or] if there are many more cases that are undetected in communities.”

“We are still at the very, very beginning of this event,” Briand added. “We know that we will have more cases in the coming days,” she said, adding: “This is not a disease the general public should be worried about. It is not COVID or other diseases that spread fast.”

Monkeypox, a relative to smallpox, is generally only seen in West and Central African countries. Initial symptoms include swollen lymph nodes, chickenpox-like rash, and a fever. U.S. officials have said that the smallpox vaccine can be effective in preventing the spread and transmission of the virus.

Those pox-like lesions start out as dark spots on the skin before turning into bumps that fill with fluid. They will eventually scab over and fall off, possibly leaving people with scars or skin discoloration.

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Jack Phillips is a breaking news reporter at The Epoch Times based in New York.

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Israel reports second case of monkeypox, in 30-year-old man

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Israel has confirmed a second case of the rare monkeypox virus, in a 30-year-old man who recently returned from an overseas trip.

The man was hospitalized on Friday at the Sheba Medical Center in Tel Aviv, and was released after a short while. He was confirmed to be infected with the virus on Saturday.

The new infection came just over a week after Israel discovered its first case of the virus, in a man in his 30s who had returned from a trip to western Europe.

Last Sunday, the Health Ministry announced that two additional suspected cases were ruled out by doctors.

Symptoms of the disease include fever, muscle aches, swollen lymph nodes, chills, exhaustion and a chickenpox-like rash on the hands and face.

Since the United Kingdom reported its first case on May 7, the World Health Organization has reported 200 cases across several countries around the world. The virus is endemic across west and central Africa.

Sylvie Briand, Director of Pandemic and Epidemic Diseases Department at the World Health Organization, outside the UN agency’s headquarters on May 12, 2020 in Geneva (Fabrice COFFRINI / AFP)

Addressing the World Health Assembly on Friday, Sylvie Briand, director of the Pandemic and Epidemic Diseases Department at the WHO, said experts did not know if the outbreak had reached the “peak of the iceberg [or] if there are many more cases that are undetected in communities.”

While warning that more cases were likely on the way, she urged the public not to panic, explaining that the condition was “not a disease the general public should be worried about. It is not COVID or other diseases that spread fast.”

On Thursday, a top epidemiologist at the WHO said more cases are expected to be detected in countries where monkeypox does not usually circulate.

Dr. Maria Van Kerkhove said in a Q&A on social media: We expect more cases to be detected. We are asking countries to increase surveillance. This is a containable situation. It will be difficult, but it’s a containable situation in the non-endemic countries.”

She urged countries to “increase surveillance” but affirmed that the outbreak is a “containable situation.”

“It will be difficult, but it’s a containable situation in the non-endemic countries,” Van Kerkhove explained.

Israeli health officials have also played down the risk of the virus. In a phone briefing last Sunday, the Health Ministry’s head of public health services, Dr. Sharon Alroy-Preis, urged calm and said the recent outbreak of the virus was not a major risk to public health.

Monkeypox usually clears up after two to four weeks, according to the WHO.

A case of the virus was diagnosed in Israel in 2018, and no known community infections resulted from it.

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A local epidemiologist says we shouldn’t ‘wait and see’ with monkeypox

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Dr. Michael Mina says inaction didn’t work for COVID-19 — and it won’t work for monkeypox.

A local immunologist and epidemiologist is urging aggressive action to address the monkeypox virus outbreak, which has infected more than 400 people worldwide.

Dr. Michael Mina, a former Brigham and Women’s epidemiologist and Chief Science Officer of eMed, warned Friday against a “wait and see” approach when it comes to monkeypox. 

“If we wait and see … then by the time we are seeing, it’s too late,” Mina said on Twitter. 

The virus, which has symptoms similar to but milder than smallpox, has been diagnosed in 12 cases in eight states, including Massachusetts. A man suffering from the virus was treated at Massachusetts General Hospital from May 12 to May 20, according to The Boston Globe. He was the first person in the nation known to have the virus in this recent outbreak.  

The pox-like virus has also been found in New York, California, Colorado, Florida, Utah, Virginia, and Washington.

A prominent advocate for the widespread use of at-home COVID-19 antigen tests, Mina warned against being “timid” in the face of pandemics, and urged health officials to be proactive with monkeypox testing. Otherwise, the nation could find itself in a situation similar to that of early 2020. 

“For one — let’s make sure that people can be diagnosed ON TIME. Sure, send a specimen to CDC. But if it’s going to take weeks to return, do not limit testing to CDC or DPHs,” said Mina. “Trust academic / hospital / clinical labs w deep experience in molecular virology to set up PCR assays.”

He warned against limiting who gets tested for monkeypox based on “arbitrary decisions,” such as people who may constitute a high-risk exposure. 

“Don’t limit it to ‘Have you been to Africa?’ that would be idiotic, but we are already seeing it happen,” he said. “Don’t limit it to ‘Do you have a known contact.’ Also unwise.”

According to the Centers for Disease Control (CDC), monkeypox was discovered in 1958, in African monkey colonies. The first human case was recorded in 1970, in the Democratic Republic of Congo. Since then, the virus has been diagnosed in humans in central and various western African countries.

To get ahead of the spread, Mina recommended that public health officials focus on where cases currently are, or may be, and adjust the response accordingly. 

“In COVID, we made remarkably bad decisions about who warranted a work up for COVID. That was deadly. Let’s be more efficient and data driven this time around,” said Mina. “To facilitate timely diagnosis and reporting, we absolutely cannot limit testing to CDC, like we did in 2020, and Must NOT require every hospital lab to go through the FDA before testing their patient like we did in COVID.” 

Mina said that scenario “would be disastrous.”

The key to protecting the nation from a COVID-19-like situation with monkeypox is to diagnose it quickly, according to Mina.

“…With fast moving viruses… speed trumps perfection,” he said. “It’s true w COVID. It’s true with Monkeypox.”



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New monkeypox case suspected in Colorado

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The number of reported monkeypox cases in the United States is now up to 12 as a second presumptive case has been identified in Colorado.

The Colorado Department of Public Health and Environment said Friday that the new case involves a “young adult male who sought care in the Denver area and is improving and isolating at home.”

The young male was in close contact with a man who recently traveled to Canada and is believed to have come down with the first case of monkeypox in Colorado.

Both cases are awaiting confirmation from the Centers for Disease Control and Prevention.

Two cases each have also been reported in the states of California. Florida and Utah. 

New York, Washington, Massachusetts, and Virginia each have one reported case.

Monkeypox produces skin lesions and typically leaves patients with flu symptoms.
CDC/Getty Images

Meanwhile, Ireland confirmed its first case on Saturday, according to Reuters. A separate suspected case there is also being investigated.

The World Health Organization says around 200 cases of monkeypox have been reported in more than 20 countries not usually known to have outbreaks of the disease.

Monkeypox produces skin lesions and typically leaves patients with flu symptoms. It was first identified in monkeys and rarely spreads outside of Africa, which has made the latest rash of cases alarming to health officials.

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Nearly 200 Cases Of Monkeypox Have Been Found In More Than 20 Countries

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LONDON (AP) — The World Health Organization says nearly 200 cases of monkeypox have been reported in more than 20 countries not usually known to have outbreaks of the unusual disease, but described the epidemic as “containable” and proposed creating a stockpile to equitably share the limited vaccines and drugs available worldwide.

During a public briefing on Friday, the U.N. health agency said there are still many unanswered questions about what triggered the unprecedented outbreak of monkeypox outside of Africa, but there is no evidence that any genetic changes in the virus are responsible.

This 2003 electron microscope image made available by the Centers for Disease Control and Prevention shows mature, oval-shaped monkeypox virions, left, and spherical immature virions, right, obtained from a sample of human skin associated with the 2003 prairie dog outbreak.

Cynthia S. Goldsmith, Russell Regner/CDC via AP

“The first sequencing of the virus shows that the strain is not different from the strains we can find in endemic countries and (this outbreak) is probably due more to a change in human behaviour,” said Dr. Sylvie Briand, WHO’s director of pandemic and epidemic diseases.

Earlier this week, a top adviser to WHO said the outbreak in Europe, U.S., Israel, Australia and beyond was likely linked to sex at two recent raves in Spain and Belgium. That marks a significant departure from the disease’s typical pattern of spread in central and western Africa, where people are mainly infected by animals like wild rodents and primates, and outbreaks haven’t spilled across borders.

Although WHO said nearly 200 monkeypox cases have been reported, that seemed a likely undercount. On Friday, Spanish authorities said the number of cases there had risen to 98, including one woman, whose infection is “directly related” to a chain of transmission that had been previously limited to men, according to officials in the region of Madrid.

U.K. officials added 16 more cases to their monkeypox tally, making Britain’s total 106, while Portugal said its caseload jumped to 74 cases. And authorities in Argentina on Friday reported a monkeypox case in a man from Buenos Aires, marking Latin America’s first infection. Officials said the man had traveled recently to Spain and now had symptoms consistent with monkeypox, including lesions and a fever.

Doctors in Britain, Spain, Portugal, Canada, the U.S. and elsewhere have noted that the majority of infections to date have been in gay and bisexual men, or men who have sex with men. The disease is no more likely to affect people because of their sexual orientation and scientists warn the virus could infect others if transmission isn’t curbed.

WHO’s Briand said that based on how past outbreaks of the disease in Africa have evolved, the current situation appeared “containable.”

Still, she said WHO expected to see more cases reported in the future, noting “we don’t know if we are just seeing the peak of the iceberg (or) if there are many more cases that are undetected in communities,” she said.

As countries including Britain, Germany, Canada and the U.S. begin evaluating how smallpox vaccines might be used to stem the outbreak, WHO said its expert group was assessing the evidence and would provide guidance soon.

Dr. Rosamund Lewis, head of WHO’s smallpox department, said that “there is no need for mass vaccination,” explaining that monkeypox does not spread easily and typically requires skin-to-skin contact for transmission. No vaccines have been specifically developed against monkeypox, but WHO estimates that smallpox vaccines are about 85% effective.

She said countries with vaccine supplies could consider them for those at high risk of the disease, like close contacts of patients or health workers, but that monkeypox could mostly be controlled by isolating contacts and continued epidemiological investigations.

Given the limited global supply of smallpox vaccines, WHO’s emergencies chief Dr. Mike Ryan said the agency would be working with its member countries to potentially develop a centrally controlled stockpile, similar to the ones it has helped manage to distribute during outbreaks of yellow fever, meningitis, and cholera in countries that can’t afford them.

“We’re talking about providing vaccines for a targeted vaccination campaign, for targeted therapeutics,” Ryan said. “So the volumes don’t necessarily need to be big, but every country may need access to a small amount of vaccine.”

Most monkeypox patients experience only fever, body aches, chills and fatigue. People with more serious illness may develop a rash and lesions on the face and hands that can spread to other parts of the body.

Ashifa Kassam in Madrid, and Daniel Politi in Buenos Aires, Argentina, contributed to this report.

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US monkeypox cases climb, another reported in Colorado

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The number of monkeypox cases in the U.S. has climbed to 12, with a second case reported in Colorado. 

In a press release from the state’s Department of Public Health and Environment, the state assured Friday that the risk of catching the virus remains low. 

“The Colorado Department of Public Health and Environment Public Health Laboratory has confirmed a second presumptive monkeypox case and is awaiting CDC confirmation,” it wrote. “The person who acquired the virus was a close contact of a person known to public health as a presumptive case of monkeypox and is cooperating with state and local public health epidemiologists who are investigating and notifying people who may have been exposed.”

The case is in a young adult male who sought care in the Denver area and is reportedly isolated and improving at home.

WHO: NEARLY 200 CASES OF MONKEYPOX VIRUS ACROSS MORE THAN 20 COUNTRIES

The first presumptive case of monkeypox was found in a man who had recently traveled to Canada.

The Centers for Disease Control and Prevention (CDC) tracker shows two cases across the country, including two in Colorado, California. Florida and Utah. 

An image created during an investigation into an outbreak of monkeypox, which took place in the Democratic Republic of the Congo (DRC), 1996 to 1997, shows the hands of a patient with a rash due to monkeypox, in this undated image obtained by Reuters on May 18, 2022. 
(CDC/Brian W.J. Mahy/Handout via REUTERS)

Washington, Massachusetts, New York and Virginia all have one case, according to agency data. 

The World Health Organization (WHO) said Friday that nearly 200 cases of monkeypox have been recorded worldwide, with cases found in more than 20 countries not usually known to have outbreaks of the virus.

VIRGINIA HAS ITS FIRST PRESUMED MONKEYPOX CASE: REPORT

Traditionally, monkeypox virus is spread by touching or getting bitten by infected wild animals in western and central Africa.

However, the former World Health Organization’s (WHO) emergencies department leader told The Associated Press earlier this week that cases in Europe appear to have spread due to sexual activity at raves in Spain and Belgium. 

While it is not a sexually transmitted infection, it can be transmitted in both personal and sexual contact, with a notable fraction of recorded cases occurring among gay and bisexual men.

To treat monkeypox, some smallpox vaccines and therapeutics are available – no vaccines have been specifically developed against monkeypox – and the WHO proposed creating a stockpile to equitably share what was available. 

The CDC said last week that there are vaccine doses to prevent the monkeypox virus in the Strategic National Stockpile and that production will “ramp up” quickly in the coming weeks. 

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Symptoms of the virus – which is from the same family of viruses as smallpox – include fever, chills, rash and aches, before lesions develop. 

The majority of patients recover within several weeks without requiring hospitalization.

The Associated Press contributed to this report.

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Stop scolding people for worrying about monkeypox

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In the past few weeks, more than 350 cases of monkeypox — a viral disease that’s a much milder cousin of smallpox — have been reported in more than 20 countries worldwide. That’s a surprise, and an unpleasant one. Monkeypox has surfaced periodically in the Congo Basin and in West Africa since its discovery in the 1950s, but past outbreaks haven’t involved cases in this many countries, or this degree of apparent person-to-person spread.

Still, because as far as we know from past outbreaks monkeypox usually isn’t very contagious and a good vaccine already exists, it ought to be possible to contain even this apparently larger outbreak. Hence many public health officials have emphasized, in their communications about monkeypox, that people shouldn’t worry or overreact.

Panic is never a good public health strategy, but in attempting to preemptively tamp down public fear, I think experts are failing to learn one of the most important lessons of Covid-19: that we’re too afraid of “alarmism” when outbreaks hit, and should spend less time telling people not to overreact and more time telling them what’s actually going on.

The impulse on the part of the public health community to try to manage public emotion — rather than provide the public with facts — has dogged us throughout the pandemic, often making it harder to make good decisions. Assurances that people didn’t need masks, meant to protect the supply for health care workers, lastingly damaged trust and masking rates. The CDC’s initial decision not to track breakthrough infections — seemingly meant to show confidence in the vaccines — made it harder to tell how long vaccine-based immunity lasted.

There are some solid epidemiological reasons to conclude that monkeypox doesn’t pose the same threat to the world that Covid-19 did in 2020. But instead of condemning alarmism, experts should acknowledge the many reasons for that alarm. The world is horribly vulnerable to the next pandemic, we know it will hit at some point, and the undetected spread of monkeypox around the world until there were dozens of cases in non-endemic countries — despite the fact it typically has low transmissibility — shows how profoundly we’ve failed to learn the lessons from Covid-19 we need to avoid a catastrophic repeat.

Experts should focus more on communicating what they know about monkeypox, pandemics, and the fragility of our current system, aiming to tell people what they can do and the policies they can support in response to their justified fear — instead of preemptively warning against “panic.”

Monkeypox, explained

Monkeypox was first identified in research animals in the 1950s, and can cause flu-like symptoms and a characteristic rash with round red blisters all over the body when it infects unprotected humans. The fatality rate has historically ranged from zero to 11 percent, according to the World Health Organization.

For decades, outbreaks among humans were rare, in significant part because the smallpox vaccine protects against monkeypox, and smallpox vaccination was common. In recent years, though, monkeypox cases have been on the rise as vaccination against smallpox, which was eradicated in 1979, began to wane. According to the CDC, Nigeria has reported 450 monkeypox cases since 2017 — not a lot, but a significant increase from case rates in previous decades.

Despite that rise and the more recent spread to new countries, there’s reason for optimism that we can prevent a large-scale pandemic of monkeypox. While the variant causing the current outbreaks isn’t fully understood, and we should not rule out that the virus is substantially more transmissible than we’re used to, the disease in general is a known quantity. Even under pessimistic assumptions about the transmissibility of this new variant, it is much less transmissible than the coronavirus that causes Covid-19, which originally had an R0 of 2-3 and now has an R0 of 8-10 for people without preexisting immunity. Unlike Covid-19, monkeypox is thought to be only contagious while patients are symptomatic, which provides additional reason for optimism about containment.

But optimism should not equal complacency.

A large international outbreak of a disease that was previously thought to be very hard to transmit person-to-person is bad news, period. There are still a lot of unknowns here, and until we know exactly what happened and have slowed the growth of new cases, the chance of this variant of monkeypox being substantially more transmissible — and hard to contain — is not so low that we can confidently assert that everything will be fine.

The lessons of Covid-19

Writing this article, I had an eerie sense of déjà vu. I wrote a similar one in early February of 2020, when Americans were just starting to hear about Covid-19. In that article, I rounded up some takes on the then very novel coronavirus that were in the headlines at the time:

“Don’t worry about the coronavirus. Worry about the flu,” BuzzFeed argued. The flu “poses the bigger and more pressing peril,” the Washington Post said. “Why should we be afraid of something that has not killed people here in this country?” an epidemiologist argued in the LA Times. Other outlets have agreed. An ex-White House health adviser has told Americans to “stop panicking and being hysterical.”

Bad call, I argued at the time. We didn’t know yet how transmissible the coronavirus was. We didn’t know if the early numbers out of China, where the first cases were recorded, were misleading. (It’s now believed they almost certainly were.) “That’s just far too much uncertainty to assure people that they have nothing to worry about,” I wrote. “And misleadingly assuring people that there’s nothing to worry about can end up doing harm.”

Obviously, Covid-19 has done quite a lot of harm, to the tune of more than 1 million dead in the US alone. But we’re at risk of forgetting some of those major lessons from early 2020.

Last week, CNN quoted the CDC’s Jennifer McQuiston, deputy director of the Division of High Consequence Pathogens and Pathology, as saying: “There really aren’t that many cases that are being reported — I think maybe a dozen, a couple dozen — so, the general public should not be concerned that they are at immediate risk for monkeypox.”

This seems true, technically. Most Americans are not at immediate risk of exposure to monkeypox, just like in early February 2020 they weren’t at immediate risk of exposure to the coronavirus (there may have only been a few dozen cases in the US at that time). But this neglects the factor of exponential growth. The thing that’s scary about infectious disease is that a few cases can rapidly become more cases, and eventually become lots of cases. Monkeypox probably isn’t very transmissible, but until we’ve actually contained it, we don’t know how easy it will be to contain, and the fact there aren’t very many cases yet just isn’t that reassuring.

“‘No reason for alarm’ is bad science as well as bad risk communication,” I quoted risk communications expert Peter Sandman as saying in that 2020 story. “Telling people not to worry about an emerging infectious disease because it isn’t a significant risk here and now is foolish. We want people to worry about measles when there’s very little measles around, so they will take the precaution of vaccinating their children before it’s imminently necessary. We want people to worry about retirement when they’re years away from retiring, so they will start saving now.”

Yet the impulse to focus on assuring Americans they shouldn’t panic about monkeypox is very much on display.

“There’s certainly no reason to panic,” Daniel Bausch, president of the American Society of Tropical Medicine & Hygiene, told CNN. Reason ran an article titled Don’t Panic Over Monkeypox. “Don’t worry — at least about this,” Geoffrey Smith, a University of Cambridge poxvirus virologist, told the Washington Post.

I agree with the more nuanced opinions each of these experts share when they’re given a bit more space to expound on their views. It’s straightforwardly true that monkeypox should be easier to contain with contact tracing and vaccination than Covid-19 was.

But everyone’s insistence on prefacing that nuance by telling me not to worry drives me nuts, and I think reflects a mistake in our thinking about pandemics.

Being alarmed about pandemics is completely reasonable

A fact that should not need saying in 2022: Pandemics cause immense human suffering and death. Even if a disease kills only one in 1,000 people who get sick with it, if it hits a billion people worldwide, that’s a million dead. Infectious disease has killed more people than any war in history, and experts keep on warning us that a pandemic much, much worse than Covid-19 is very much possible and really could happen.

The 1918 flu was deadlier than Covid-19, and deadly in particular to healthy young people. A repeat would be devastating, and the world isn’t particularly prepared. Smallpox, when it existed, had an estimated 30 percent mortality rate. The US has vaccines stockpiled in case a lab accident, terrorist act, or bioweapon ever unleashes it on the world again, but vaccinating the whole world against a disease — as we’ve seen with Covid-19 — is hard to do as quickly as a contagious disease can move.

It’s not just diseases from nature, either. With rapid advances in biological engineering, it’s now entirely possible to make diseases that could put smallpox and the flu to shame. “Gain of function” work on making deadly diseases deadlier is ongoing. A small group of bad actors could unleash a virus that kills millions of people — and the systems in place to prevent that are limited, underresourced, and inadequate for the stakes.

In that light, all the focus on telling people not to worry about monkeypox seems a little silly. There are genuine concerns about not crying wolf, about preserving credibility so that when you tell people ‘this is the big one’, they listen. But institutions that initially failed to say “this is the big one” about Covid-19 in February 2020 — and told us, instead, to worry about the flu — aren’t going to repair their damaged credibility by maintaining the same course.

The course I’d like to see them take instead is the one Sandman, the risk communications expert, recommended with Covid-19: “Instead of deriding people’s fears about the Wuhan coronavirus,” he wrote, “I would advise officials and reporters to focus more on the high likelihood that things will get worse and the not-so-small possibility that they will get much worse.”

Taking “worry” off of center stage

Many of the biggest missteps of the last few years have happened when our public health and communications institutions have tried to manage public reactions to what they have to say: from Fauci saying that he dismissed mask-wearing early on in the pandemic out of fears of causing mass panic, to worries that endorsing booster shots (even as the evidence grew they were needed) would make the vaccines look bad, to the FDA’s earlier seeming reluctance to authorize vaccines for children under age 5, despite data justifying it, out of concerns that authorizing Pfizer and Moderna at different times would confuse the public.

In general, I’d like to see public health officials step back entirely from trying to manage our feelings about outbreaks. Don’t tell us to worry or not to worry, or not to worry yet. Don’t tell us to worry about something else instead. Tell us what measures are being taken to contain the monkeypox outbreak, and prevent the next monkeypox outbreak, and prevent the next outbreak of something much, much worse than monkeypox. By all means, explain the reasons to think monkeypox is likely not very transmissible; that’s important information you have relevant expertise on, unlike trying to manage the public’s feelings.

And for its part, the media should stop asking public health officials “should I worry?” instead of asking them the questions they are much more equipped to answer: What policies would have prevented this outbreak? What measures need to be in place to contain it? What scenarios are plausible from here?

In many cases, “don’t worry” is just being used as shorthand for “there’s good reason to think monkeypox won’t cause a global pandemic” — which, to be clear, is a true claim. But I think it’s worth spelling out the longer claim, rather than treating worry as the key consideration. People shouldn’t be encouraged to view outbreaks through the lens of “should I be scared?” but rather through the lens of “will this be contained, what will it take to contain it, and if it’s not contained, what effects will it have on the world?”

Once you have the accurate facts about monkeypox — and about the risk of pandemics generally — whether you’re worried by those facts isn’t really a question for the CDC.

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