Monkeypox cases are continuing to rise globally, suggesting that the rare viral illness has been spreading undetected outside of Africa, in non-endemic countries, for quite some time, the World Health Organization said Wednesday.
But despite that indication, health officials assured that the disease that has plagued African countries for decades is unlikely to become a pandemic and mass vaccination is not necessary.
“Right now this is an outbreak and outbreaks can be stopped so that’s our effort right now,” Dr. Rosamund Lewis, WHO’s monkeypox technical lead, said at a press conference that outlined the agency’s efforts to stop the virus’ global spread and also support endemic countries that she reminded “live with this disease day in and day out.”
WHO has counted at least 550 cases in 30 non-endemic countries as of this week. In the U.S., the Centers for Disease Control and Prevention has tallied 18 cases in nine states as of Tuesday, though health officials expect there may be far more. New York City on Wednesday reported two new potential cases with contact tracing underway.
“We do expect to see more because people who have been infected in the last few weeks may have continued to transmit during a period of time when they didn’t know what they had, when they had not had an opportunity to have a diagnosis, when this spread had not been detected yet,” Lewis said.
The risk of catching monkeypox is low and most people who do become infected recover from monkeypox within a few weeks, WHO said.
The illness first begins with fever, headache, muscle aches and exhaustion and follows with a rash, often starting on the face and then spreading to other parts of the body. These lesions progress through five stages before falling off.
The virus spreads through direct contact with infectious sores, scabs or body fluids. Most cases outside of Africa have been reported among men who had sex with other men, WHO said, leading health officials in the U.K. on Monday to recommend anyone infected with the virus to use condoms for eight weeks after and abstain from sex while symptomatic.
These are precautionary measures, subject to change, as it is not yet known if monkeypox can spread through semen or vaginal fluids.
The U.K.’s health advisory follows England, Scotland, Wales and Northern Ireland reporting more cases combined than any other region outside of Africa, with the U.K.’s health agency confirming 190 cases as of Tuesday. Portugal has seen the second highest amount with 49 confirmed cases as of last week, followed by Canada and then Spain, according to WHO.
Professor David Heymann, who chairs a WHO expert group on infectious threats to global health, recently told The Guardian that it’s possible that the virus has been quietly spreading in the U.K. for two to three years before flaring up.
The first human case of monkeypox was first recorded in 1970 in the Democratic Republic of the Congo and in the years since it has mostly been reported in rural, rainforest regions of the Congo Basin where animals are capable of transmitting it to humans.
The first outbreak outside of Africa was in the U.S. in 2003 and linked to infected pet prairie dogs. Those prairie dogs were believed to have been infected from imported African rodents that they had contact with while with an Illinois animal distributor.
“The reasons for these spikes are not fully known but may be due to deforestation and the encroachment of people into the habitats of monkeypox animal hosts.”
– World Health Organization
“For decades only a few cases were reported sporadically,” WHO said Tuesday of prior outbreaks in Africa. “Then in 2017, there was a sudden spike, with more than 2,800 suspected cases reported in five countries.”
The most seen was in 2020 when there were more than 6,300 suspected cases. Last year, Africa saw around half that amount, the agency said.
“The reasons for these spikes are not fully known but may be due to deforestation and the encroachment of people into the habitats of monkeypox animal hosts,” WHO said.
So far this year, there have been nearly 1,400 monkeypox cases in seven African countries where the disease is endemic, WHO’s regional office for Africa reported Tuesday.
There, health officials have expressed frustration over the new rush to offer vaccines and antivirals to non-endemic countries as the endemic ones struggle.
“It’s a bit uncomfortable that we have a different attitude to the kinds of resources we deploy depending on where cases are,” Dr. Jimmy Whitworth, a professor of international public health at the London School of Hygiene and Tropical Medicine, told The Associated Press. “It exposes a moral failing when those interventions aren’t available for the millions of people in Africa who need them.”
Lewis reiterated Wednesday WHO’s belief that mass vaccination is not necessary to stop the virus’ spread, though the agency is working to help increase vaccine production and supply.
Health workers who risk coming into contact with cases of monkeypox in select clinical settings, such as emergency rooms, sexual health clinics and dermatology clinics, may be an exception for those who should get vaccinated, she said, though educating about preventing transmission remains WHO’s main goal.
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