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Monkeypox: An outbreak to watch out for


Text by Henrylito D. Tacio

Photo: WHO

“This isn’t going to cause a nationwide epidemic like COVID-19 did, but it’s a serious outbreak of a serious disease – and we should take it seriously.” – Jimmy Whitworth, a professor of international public health at the London School of Hygiene and Tropical Medicine

Another outbreak – that of monkeypox – is happening in other parts of the world and Filipino health experts are very much aware of it.

“We will monitor and prepare for it, but the same minimum public health measures to prevent it would apply,” Dr. Ted Herbosa, an infectious disease expert and National Task Force Against Covid-19 advisor, said during the ‘Laging Handa’ briefing.

Amid increasing monkeypox cases abroad, he is not yet recommending border closure. “Ako (I), as an advisor, will not recommend closing our borders just because there are 85 reported cases of monkeypox,” he said.

As of May 21, the Geneva-based World Health Organization (WHO) reported 92 laboratory confirmed cases and 28 suspected cases.

“The situation is evolving and WHO expects there will be more cases of monkeypox identified as surveillance expands in non-endemic countries,” said WHO in a statement. “Immediate actions focus on informing those who may be most at risk for monkeypox infection with accurate information, in order to stop further spread.”

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

According to the United Nations health agency, monkeypox is caused by the monkeypox virus, of which there are two clades: the West African clade and the Congo Basin (Central African) clade.

The name monkeypox originates from the initial discovery of the virus in monkeys in a Danish laboratory in 1958. The first human case was identified in a child in the Democratic Republic of the Congo in 1970.

Monkeypox is endemic in these countries: Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Ghana (identified in animals only), Ivory Coast, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan.

Monkeypox virus is transmitted from one person to another by close contact with lesions, body fluids, respiratory droplets, and contaminated materials such as bedding. The incubation period is usually from 6 to 13 days but can range from 5 to 21 days.

“Based on currently available information, cases have mainly but not exclusively been identified amongst men who have sex with men seeking care in primary care and sexual health clinics,” the WHO said.

Various animal species have been identified as susceptible to the monkeypox virus. This includes rope squirrels, tree squirrels, Gambian pouched rats, dormice, non-human primates, and other species.

“Eating inadequately cooked meat and other animal products of infected animals is a possible risk factor,” the WHO said.

In a press release, WHO gave some insights on suspected, probable, and confirmed cases of monkeypox:

A person from a non-endemic country is said to be suspected of monkeypox if he or she has an unexplained acute rash and has one or more of the following signs or symptoms: headache, acute onset of fever, swollen lymph nodes, muscle and body aches, back pain, and profound weakness.

It’s considered a probable case if the person has or more of the following: has an epidemiological link (face-to-face exposure, including health workers without eye and respiratory protection); direct physical contact with skin or skin lesions, including sexual contact; or contact with contaminated materials such as clothing, bedding or utensils to a probable or confirmed case of monkeypox in the 21 days before symptom onset.

In addition, it’s also a probable cause if the person has a travel history to a monkeypox endemic country in the 21 days before symptom onset, has had multiple or anonymous sexual partners in the 21 days before symptom onset, and is hospitalized due to the illness.

A confirmed case is either a suspected or probable case and is laboratory confirmed for monkeypox virus by detection of unique sequences of viral DNA either by real-time polymerase chain reaction (PCR) and/or sequencing.

“Monkeypox is usually self-limiting but may be severe in some individuals, such as children, pregnant women or persons with immune suppression due to other health conditions,” the WHO said.

Meanwhile, concerns have been raised by the media with regard to the amplification of the spread of the monkeypox virus in the context of large gatherings.

“Large gatherings may represent a conducive environment for the transmission of monkeypox virus as they entail close, prolonged and frequent interactions among people, which in turn can expose attendees to contact with lesions, body fluids, respiratory droplets and contaminated materials,” the WHO said.

While the exact mechanisms of transmission of the present monkeypox outbreak are still being investigated, and they likely differ from those of SARS-CoV-2, “it is important to remind that the general precautionary measures recommended against COVID-19 are also expected to largely protect from monkeypox virus transmission,” the WHO urged.

In addition, any person meeting the suspected, probable, and confirmed case definition detailed above should refrain from close contact with any other individual and should not attend large gatherings.

“During human monkeypox outbreaks, close physical contact with infected persons is the most significant risk factor for monkeypox virus infection,” the WHO reminded.

If monkeypox is suspected, the investigation should consist of the following:

* clinical examination of the patient using appropriate infection prevention and control (IPC) measures,

* questioning the patient about possible sources of infection and the presence of similar disease in the patient’s community and contacts, and

* safe collection and dispatch of specimens for monkeypox laboratory examination.

An ounce of prevention is better than a pound of cure. “Steps for self-protection include avoiding skin to skin or face to face contact with anyone who has symptoms, practicing safer sex, keeping hands clean with water and soap or alcohol-based hand rub, and maintaining respiratory etiquette,” the WHO said.

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