With more than 16,000 cases of monkeypox reported in 75 countries around the world since the beginning of May 2022, the Director-General of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, declared on Saturday that the monkeypox outbreak is “ a public health emergency of international concern”. On January 30, 2020, the WHO had made the same decision regarding the COVID-19 disease, when the coronavirus infection had already been detected in patients from China and 15 other countries.
Despite the fact that today monkeypox and COVID-19 are global public health emergencies, medical experts believe that there is a better chance that it will be controlled sooner rather than later. COVID-19 has already affected more than 565 million people and several have been reinfected, and has caused the death of 6,373,739 people. But there are scientific and medical researchers who observe differences between the two infections and their impact.
In the case of monkeypox, Dr. Tedros said that globally, the risk of monkeypox is moderate, except in the European region. In Europe, the risk of the spread of smallpox is high. He also noted that “there is a clear risk of further international spread, although the risk of interference with international traffic remains low for the time being.”
Dr Hugh Adler, from the Department of Clinical Sciences at the Liverpool School of Tropical Medicine in the UK, clarified that the WHO statement does not mean that “monkeypox is a serious disease or that it causes high mortality rates, nor does it meet the criteria for a pandemic. It does mean that this outbreak is extraordinary/unprecedented, that it is affecting multiple countries and that a coordinated international response is required.”
By declaring itself a “public health emergency of international concern,” according to Adler, it added “political weight and urgency to this situation, to ensure that this outbreak can be prioritized when there are multiple priorities competing for government attention and funding.” The expert stated: “The WHO believes, as do I, that this outbreak is controllable (that is, that it can be prevented from spreading widely among the population) with public health measures that include a concerted vaccination campaign, but that this opportunity is closing fast.”
Meanwhile, Dr. Tomás Orduna, head of the Regional Pathologies and Tropical Medicine Service of the Muñiz Hospital in the city of Buenos Aires and former president of the Latin American Society of Travel Medicine, told Infobae: “I don’t think monkeypox has the expansion of the COVID-19 disease, but we are going to continue to see new cases. For a time -although we cannot predict its duration-, there will be more cases and we will see how we can work hard with the current knowledge about the disease”.
Among the reasons that the reported cases of monkeypox so far are not considered to present a serious threat to the general public is that it is a known virus. Instead, in December 2019, the coronavirus had not yet been described by scientific research.
The name of the disease “monkeypox” originated from the initial discovery of the virus in monkeys in a Danish laboratory in 1958. In 1970, it was diagnosed in a human. He was a 9-month-old baby in Zaire (which is now the Democratic Republic of the Congo). Since then, monkeypox has become endemic in that country and has spread to other African nations, mainly in Central and West Africa. So it is known how the monkeypox virus works and how it is transmitted.
Different studies have provided evidence showing that the main vectors of the disease are rodents and not monkeys. According to the WHO, most of the animals susceptible to contracting the disease and then infecting people are rodents, such as the Gambian giant rats, dormouse or prairie dogs. “There are no data indicating that the native monkey populations of our country are or have been infected with the monkeypox virus,” explained Martín Kowalewski, who is also part of the Argentine Association of Primatology and is a Conicet researcher at the Center for Applied Ecology of the Coast and coordinator of the National Plan for the Conservation of Primates of the Ministry of Environment of the Nation.
In the current outbreak of monkeypox, most patients are men who have sex with men. But it is known that it can affect people at any age and with different sexual orientations. At the moment there is no evidence that the virus has mutated to a form of sexual transmission, which was not known until now.
“Although the World Health Organization has reported that most cases have been reported in men in close contact with other men through sexual intercourse, it must be taken into account that monkeypox is a pathology that can affect anyone, regardless of their sexual orientation, their gender identity and their age”, explained Dr. Orduna.
Being a known virus, vaccines and treatments have been developed over the past decades. As the monkeypox virus is closely related to the one that causes human smallpox, the vaccine against that infection – which was eradicated – has also been shown to be effective for both diseases. According to the United States Centers for Disease Control and Prevention (CDC), as a treatment for monkeypox, there are drugs such as cidofovir, ST-246 and an immunoglobulin that may be indicated for monkeypox.
There is also a smallpox vaccine called JYNNEOSTM (also known as Imvamune or Imvanex) and it is produced by the Danish pharmaceutical company Bavarian Nordic. In Africa, there were studies that revealed that this vaccine was at least 85% effective in preventing monkeypox. In addition, there is another smallpox vaccine, ACAM2000, made by Emergent Product Development, which is also believed by medical authorities to offer some protection. It was used in an outbreak reported in 2003 in the US.
The WHO notes that some people who received smallpox vaccines may also have certain levels of immunity, although in many countries this vaccination was stopped almost 40 years ago when the disease was considered eradicated. At the moment, monkeypox vaccines are only licensed for people over 18 years of age who are considered to be at high risk of contracting the disease in some countries.
“At the moment, vaccines and treatments are not available in Latin America. All human beings are susceptible to the monkeypox virus. The population has to consult before the symptoms of monkeypox and rest in isolation. So far, there have been no serious conditions in most cases,” Dr. Orduna told Infobae, who participated as a co-author in a paper published in The Lancet Regional Health magazine.
According to the UK Health Security Agency, monkeypox does not spread easily between people, like other infections, such as COVID-19. In previous outbreaks, an infected person transmitted the virus, on average, between zero and one person, so the levels of contagion have been very low.
To spread, the virus needs very close contact, sometimes skin-to-skin, with an individual who is infected to become infected. According to the WHO, the case fatality rate for monkeypox has ranged from 0 to 11% in the general population and has been higher among young children.
The spread of monkeypox can occur when a person comes into close contact with an animal, human, or material contaminated with the virus, which enters the body through broken skin (even if not visible), the respiratory tract, or mucous membranes (eyes, nose or mouth).
Prior to the 2022 outbreak and outside of Africa, cases of monkeypox had been reported in recent years in the United States, United Kingdom, Israel, and Singapore. In the United Kingdom, where the first case of the current outbreak was detected, patients with the disease were also registered in 2018, 2019 and 2021.
However, the health agencies of several countries have commented that they will closely monitor the evolution of new cases, because it cannot yet be categorically affirmed that the transmission of the monkeypox virus is the same as in the cases of previous years. Never before have so many cases of monkeypox been recorded in the world simultaneously and without establishing a potential link between infected people with travel to Africa.
To control transmission – Orduna recommended – it should be disseminated that “sexual practices between men who have sex with men or are bisexual, individually or in groups, with multiple partners or contacts, are the high-risk situations identified in almost all from the patients. Intimate contact with a person who has the infection can promote transmission. Therefore, work should be done with groups of the LGBTQ+ community to provide reliable information and thus provide guidance on how to prevent infection. No person with a fever, skin lesion, or other symptom should have sexual intercourse, but should consult a doctor and respect isolation until recovery.”
