Editorial: Notes on the Monkeypox

Editorial
Editorial

ON July 23, the World Health Organization (WHO) declared Monkeypox a global emergency after more than 80 countries reported having the disease.

WHO said Monkeypox "is a viral zoonosis (a virus transmitted to humans from animals) with symptoms similar to those seen in the past in smallpox patients, although it is clinically less severe."

"Monkeypox virus is transmitted from one person to another by close contact with lesions, body fluids, respiratory droplets, and contaminated materials such as bedding," WHO said.

The health organization the monkeypox virus may be transmitted "to humans through close contact with an infected person or animal, or with material contaminated with the virus."

WHO's fact sheet on the disease states that the incubation period -- interval from infection to onset of symptoms -- of monkeypox is usually from six to 13 days but can range from five to 21 days.

According to the Department of Health (DOH), some symptoms of monkeypox include fever, rashes, and swollen lymph nodes.

"Monkeypox is usually a self-limited disease with the symptoms lasting from 2 to 4 weeks. Severe cases can occur. In recent times, the case fatality ratio has been around 3 to 6 percent," WHO said.

The disease was first identified in 1970 in the Democratic Republic of the Congo. Since its discovery, it only affected west and central African countries. However, in 2003, the first case reported outside of Africa "was in the United States of America and was linked to contact with infected pet prairie dogs. These pets had been housed with Gambian pouched rats and dormice that had been imported into the country from Ghana."

However, in recent years, cases have continued to increase around the globe.

"In May 2022, multiple cases of monkeypox were identified in several non-endemic countries. Studies are currently underway to further understand the epidemiology, sources of infection, and transmission patterns," WHO said.

“We have an outbreak that has spread around the world rapidly through new modes of transmission, about which we understand too little,” WHO Director-General Tedros Adhanom Ghebreyesus was quoted saying in an AP report on July 23, 2022.

The report states that "Ghebreyesus made the decision on calling monkeypox a global emergency despite a lack of consensus among experts on the U.N. health agency's emergency committee."

The declaration is seen to "spur further investment in treating the once-rare disease and worsen the scramble for scarce vaccines."

Despite being declared a global emergency, there are treatments and vaccines against monkeypox, unlike Covid-19. However, these remain to be limited.

"Vaccination against smallpox was demonstrated through several observational studies to be about 85 percent effective in preventing monkeypox. Thus, prior smallpox vaccination may result in milder illness" WHO said.

There is also a "newer vaccine based on a modified attenuated vaccinia virus (Ankara strain) was approved for the prevention of monkeypox in 2019." However, there is a limited supply of the two-dose vaccine.

In an AP report on July 30, some health experts have expressed concern over the moves of rich countries to buy large quantities of monkeypox vaccine. A move that could put millions unprotected from the disease, especially in Africa.

“If we’re not safe, the rest of the world is not safe,” Ahmed Ogwell, Africa Centers for Disease Control and Prevention acting director, said.

In terms of medication, WHO said there is "an antiviral agent known as tecovirimat that was developed for smallpox was licensed by the European Medicines Agency (EMA) for monkeypox in 2022 based on data in animal and human studies." However, it is not yet widely available.

"If used for patient care, tecovirimat should ideally be monitored in a clinical research context with prospective data collection," WHO said.

For prevention, WHO said, "raising awareness of risk factors and educating people about the measures they can take to reduce exposure to the virus is the main prevention strategy for monkeypox."

Individuals are also urged to be vigilant with their sexual activities.

In an AP report on July 30, 2022, experts suspect the "monkeypox outbreaks in North America and Europe may have originated in Africa long before the disease started spreading via sex at two raves in Spain and Belgium. Currently, more than 70% of the world’s monkeypox cases are in Europe, and 98% are in men who have sex with men."

In another AP report on July 23, 2022, some health experts in the United States are seeing monkeypox as a new sexually transmitted disease like gonorrhea, herpes, and HIV. The same report states that 99 percent of the reported 2,800 cases when the report was published, are men who reported having sex with other men.

Meanwhile, the Philippines reported its first case on July 29, 2022.

According to the Department of Health Undersecretary, Beverly Ho said the patient was a 31-year-old returning overseas Filipino. The patient, who was tested and confirmed on July 28, has already been tagged as recovered.

Ho said the case’s 10 close contacts are not showing any symptoms of the disease but they are in quarantine. She said the quarantine period is between 14 to 21 days.

“Our surveillance systems immediately detected Monkeypox. We immediately took care of and isolated the patient to keep the disease from spreading. Fast contact tracing has identified the close contacts, to halt transmission. Let us continue to be vigilant, to follow our health protocols, and to get the right information only from DOH and its partner agencies," said Dr. Maria Rosario Singh-Vergeire, DOH Officer-in-Charge, in a press statement on July 29, 2022.

WHO states that "monkeypox is less contagious than smallpox and causes less severe illness." Also, being declared a global emergency does not necessarily mean it may reach the levels of Covid-19. A report from AP states that "similar declarations were made for the Zika virus in 2016 in Latin America and the ongoing effort to eradicate polio, in addition to the Covid-19 pandemic and the 2014 Ebola outbreak in West Africa."

However, we have to remain vigilant as the virus jumps from one country and another.

DOH reminds Filipinos to "minimize close sexual contact with suspected cases, especially those with rashes or open wounds. Keep hands clean. Wear a face mask; cover coughs using the elbow, and choose areas with good airflow."

"If you have a travel history to countries with Monkeypox, and then have symptoms like fever, lymphadenopathy or “kulani”, and rashes, seek immediate medical attention. This will help hasten recovery," DOH said.

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