Countries urged to focus on monkeypox diagnostics, contact tracing as cases increase

As of Monday (23 May), some 90 cases of monkeypox were reported in nine EU Member States: Austria, Belgium, France, Germany, Italy, Portugal, Spain, Sweden, and the Netherlands. [SHUTTERSTOCK/Berkay Ataseven]

Health authorities have been urged to be alert, expand surveillance, and facilitate contact tracing as cases of monkeypox continue to appear in countries that are not used to seeing the virus.

As of Monday (23 May), some 90 cases of monkeypox were reported in nine EU Member States: Austria, Belgium, France, Germany, Italy, Portugal, Spain, Sweden, and the Netherlands. The virus has also been reported in Israel, the US, and Australia, with just under 200 cases confirmed so far.

Monkeypox has been known for around 40 years and is endemic in some of the countries in Africa, but “this is the first time we’re seeing cases across many countries at the same time, in people who have not travelled to the endemic regions in Africa,” said Rosamund Lewis, head of the smallpox secretariat at WHO, on Monday.

Over the past five years, cases of monkeypox outside endemic areas have been seen only in travellers. 

Considering the spread of the virus, the EU Commission is working on a coordinated response, health chief Stella Kyriakides said on Monday: “We all need to remain vigilant, ensure that contact tracing and adequate diagnostics capacity is in place, and ensure that we have the necessary vaccines, antivirals and personal protective equipment for health professionals available”.

On the same day, European Centre for Disease Prevention and Control (ECDC) released the first risk assessment regarding the monkeypox multi-country outbreak. It recommends that EU/EEA countries focus on prompt identification, management, contact tracing, and reporting new monkeypox cases. 

Countries are encouraged to update their contact tracing mechanisms, the diagnostic capacity for orthopoxviruses, and review the availability of smallpox vaccines, antivirals and personal protective equipment for health professionals.

WHO’s emerging diseases and zoonoses lead, Maria Van Kerkhove, said we need to be alert for cases in countries that do not typically experience monkeypox. 

“We need to equip ministries and governments and countries’ health clinics to be able to recognise what monkeypox is and to ensure that people who may be suspected as having monkeypox get the appropriate clinical care. We want to stop human to human transmission,” she said, adding that it can be done in non-endemic countries.

Kerkhove added that the isolation of cases is a way of avoiding further transmission. ECDC recommends that infected persons remain isolated until scabs fall off and avoid close contact with immunosuppressed persons and pets. Avoiding sexual activity and close physical contact is also advised until the rash heals. Most cases can remain at home with supportive care.

She also highlighted a need to protect those who take care of individuals and frontline workers who are taking samples. 

As the virus’s incubation period is usually from six to 13 days but can also reach 21 days, ECDC advises close contacts of monkeypox cases to self-monitor for the development of symptoms for 21 days after the last exposure. 

Mysterious monkeypox reported in 7 EU countries, raising health concerns in the bloc

Cases of the monkeypox virus, first reported in the UK on 7 May, have been spreading: as of Friday (20 May), 60 diagnoses in Europe across seven EU countries have been confirmed.

The risk for the broader population “is very low”

Human-to-human transmission of monkeypox happens through close contact with infectious material from skin lesions of an infected person, respiratory droplets in prolonged face-to-face contact, and fomites.

Andrea Ammon, ECDC director, said that “for the broader population, the likelihood of spread is very low”.

But currently diagnosed human monkeypox cases are primarily among men who have sex with men, suggesting that transmission may occur during intimate relations. 

“The likelihood of further spread of the virus through close contact, for example, during sexual activities among persons with multiple sexual partners, is considered to be high,” Ammon said. 

Monkeypox is not a sexually transmitted disease but, like many other diseases, can also be spread through sexual contact. 

WHO’s strategies advisor at the department of HIV, Hepatitis and STI Programmes, Andy Seale, explained that “you can get a cough or a cold through sexual contact. But it doesn’t mean that it’s a sexually transmitted disease”.

He continued: “the difference is that sexually transmitted infection is caused by sexual, anal, vaginal intercourse, oral sex. And you don’t need to have sexual contact in order to transmit monkeypox”.

On Sunday (22 May) Joint United Nations Programme on HIV/AIDS (UNAIDS) urged media outlets, governments, and communities to respond with a rights-based, evidence-based approach that avoids stigma, as a significant portion of the recently reported monkeypox cases has been identified among gay, bisexual and other men who have sex with men.  

Seale stressed that spread could happen in any group. “We’re seeing some cases amongst men who have sex with men, but this is not a ‘gay disease’, as some people on social media have attempted to label it. That’s just not the case,” he stressed.

Lewis added that “it’s not about discrimination. It’s not about stigma. It’s about saying, where are you seeing the first cases?”

UK worried monkeypox might be spreading among men who have sex with men

Four additional cases of monkeypox were detected in the UK among men who have sex with men leading to concerns about the virus spreading in the community. 

Most seen cases are mild

So far, most cases had mild disease symptoms, but the monkeypox virus may cause severe disease for young children, pregnant women, and immunosuppressed persons, ECDC warned. 

Kyriakides ensured that we are closely monitoring the situation, and whilst currently the likelihood of spread in the broader population is low, the situation is evolving”. 

ECDC warned that if human-to-animal transmission occurs and the virus spreads in an animal population, there is a risk that the disease could become endemic in Europe. 

On Tuesday, the EU Health Security Committee will discuss monkeypox.

[Edited by Alice Taylor]

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