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    Will Monkeypox be declared an Emergency of International Concern?

    HealthWill Monkeypox be declared an Emergency of International Concern?
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    Will Monkeypox be declared an Emergency of International Concern?

    A WHO meeting is due on 23 June to assess if the outbreak of Monkeypox is public health emergency of international concern. So far this year, more than 1,600 confirmed cases and almost 1,500 suspected cases of Monkeypox have been reported from 39 countries.

    The head of the World Health Organization (WHO), Tedros Adhanom Gebreyesus announced on Tuesday that the International Health Regulations Emergency Committee has been convened due to the spread of the Monkeypox virus to 32 non-endemic countries.

    The experts will meet on June 23 to assess whether the continuing outbreak represents a Public Health Emergency of International Concern, the highest level of global alert, which currently applies only to the COVID-19 pandemic and polio.

    So far this year, more than 1,600 confirmed cases and almost 1,500 suspected cases of Monkeypox have been reported to WHO, across 39 countries – including seven countries where monkeypox has been detected for years, and 32 newly-affected nations.

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    At least 72 deaths have been reported from previously affected countries. No deaths have been registered so far from the newly affected countries, but the agency is seeking to verify news reports of a related death in Brazil.

    “The global outbreak of Monkeypox is clearly unusual and concerning”, said WHO director Tedros Adhanom Gebreyesus, calling to step up the response and international coordination.

    Ibrahima Socé Fall, WHO Deputy Director for Emergency Response, explained that the risk of spread in Europe is considered “high” while in the rest of the world “moderate” and that there are still knowledge gaps regarding how the virus is being transmitted.

    “We don’t want to wait until the situation is out of control”, he said.

    Case detection and control

    WHO has published recommendations for governments regarding case detection and control.

    Speaking to journalists in Geneva, WHO Smallpox expert Rosamund Lewis, said it was crucial to raise awareness in the population about the level of risk and explain the recommendations to avoid infecting close contacts and family members.

    Monkeypox is a rare but dangerous infection similar to the now eradicated smallpox virus.

    Dr. Lewis explained that, although the disease sometimes only produces mild symptoms, such as skin lesions, it can be contagious for two to four weeks.

    “We know that it is very difficult for people to isolate themselves for so long, but it is very important to protect others. In most cases, people can self-isolate at home and there is no need to be in the hospital,” she added.

    Monkeypox is transmitted through close physical contact with someone who has symptoms. The rash, fluids, and scabs are especially infectious. Clothing, bedding, towels, or objects such as eating utensils or dishes that have been contaminated with the virus can also infect others.

    However, it is not clear whether people who do not have symptoms can spread the disease, the expert reiterated.

    Studies outdated

    Smallpox, the closest known viral infection to monkeypox might show the way, but, Dr. Lewis explained most of the data on the smallpox vaccine is old or from animal studies. “There aren’t a lot of [current] clinical studies”, she said.

    WHO underlined the importance of vaccination programs being supported by comprehensive surveillance and contact tracing, and accompanied by information campaigns and robust “pharmacovigilance”, ideally with collaborative studies on vaccine efficacy.

    Tedros also said the agency was working with partners on renaming Monkeypox and its variants, and also to put in place a mechanism to help share available vaccines, more equitably, as the need arises.

    Vaccination Guidelines

    WHO also published on Tuesday new guidelines on vaccination against Monkeypox.

    While some countries have maintained strategic supplies of older smallpox vaccines – a virus eradicated in 1980 – these first-generation vaccines held in national stockpiles are not recommended for Monkeypox at this time, because they do not meet the current safety and manufacturing standards.

    Newer and safer (second and third generation) smallpox vaccines are also available, some of which may be useful for Monkeypox and one of which (MVA-BN) has been approved for the prevention of the disease.

    The supply of these new vaccines is limited, and access strategies are being discussed, WHO informed.

    “At this time, the World Health Organization does not recommend mass vaccination. Decisions about the use of smallpox or Monkeypox vaccines should be based on a full assessment of the risks and benefits in each case,” the guidelines indicate.

    For the contacts of sick patients, post-exposure prophylaxis with a second- or third-generation vaccine is recommended, ideally within four days of first exposure to prevent disease onset.

    Pre-exposure prophylaxis is recommended for healthcare workers at risk, laboratory personnel working with orthopoxviruses, clinical laboratory personnel performing diagnostic tests for Monkeypox, and others who may be at risk.

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