Monkeypox: A Global Public Health Emergency

Within days of the World Health Organization declaring monkeypox an international health emergency, the United States has overtaken Spain as the world’s leading country with monkeypox cases. There have been 2,891 monkeypox cases reported by the Centers for Disease Control and Prevention (CDC) since May. Three thousand eight hundred and forty-six had been registered by Monday, a staggering jump of 33%. Two of those cases involve children.

With 3,125 cases reported worldwide, Spain is next, followed by Germany with 2,352.
To prevent the virus from spreading and potentially escalating into a pandemic, the WHO views the outbreak as a significant threat to global health.

Viruses that cause monkeypox are rare and rarely fatal. A CDC study found that the incubation period can range anywhere between five and 21 days between exposure and the onset of symptoms.

Few weeks ago, the CDC upgraded its monkeypox travel alert to Level 2, meaning to take enhanced precautions. As part of the guidance, travelers should wear face masks while traveling and stay away from sick animals and people that have skin lesions, especially those with lesions on their faces.

Monkeypox spread through travelers

Two British travelers and one Israeli had monkeypox exposure in Nigeria in September and October 2018. Another healthcare worker in the UK who wasn’t travelling but had contact with an ill international traveler was infected.

The two UK travelers had no epidemiological link to one another: one was a Nigerian naval officer training in the UK and the other had returned from a holiday in Nigeria. One traveler reported eating wild animal meat (bushmeat) and being contacted by an ill individual at a family gathering before leaving Nigeria.

In October 2018, GeoSentinel reported a third traveler from Israel with travel-related illnesses and other conditions. One week after returning home from Nigeria, the Israeli traveler sought medical attention. He likely contracted monkeypox after he was exposed to dead rodents in his home in Port Harcourt, Nigeria; no other animal exposures were reported.

Monkeypox cases worldwide

The United States reported 30 cases, while the United Kingdom reported 302 and Spain reported 198. A CDC report released the week before said the majority of confirmed cases in the U.S. were gay, bisexual or sexually active men.

A total of 681 monkeypox cases have been reported in Canada, making it the seventh most affected country. While traveling abroad, Canadians should be aware of the risks associated with monkeypox. It is possible that you will be subjected to isolation procedures at your destination if you contract monkeypox during your travels. “If you become ill, you may not have timely or appropriate access to health care, and returning home may be delayed,” says the Canadian health department. Recently, there have been some calls for concern at home from U.S. health experts. U.S. Health and Human Services Secretary Xavier Becerra said Monday that he is “10 out of 10 concerned about monkeypox spreading.”

Danish biotech Bavarian Nordic received permission from the European Commission on Monday to add monkeypox protection to its smallpox vaccine, Imvanex in Europe. The vaccine is currently being marketed as Jynneos and Imvamune in the US and Canada to protect against monkeypox.

According to Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, approximately 99% of cases are linked to men who have had sex with men. It seems that this group is the most vulnerable. Close contact between skin and skin is almost certainly the means of transmission.” 800,000 doses of monkeypox vaccine will soon be distributed by the government to address some issues that Dr. Fauci said have been a concern within the community. “It’s a serious problem, and we must do better than we have.”

Monkeypox Travel Precautions

During travel abroad, travelers also play an important role in preventing monkeypox infection. It is recommended that travelers to Nigeria and other countries with monkeypox wash their hands often with soap and water in order to prevent a monkeypox infection;

• Keeping your hands away from your eyes, nose, and mouth;
• Keeping a safe distance from sick people;
• Animals that are sick or dead in areas where monkeypox occurs should not be handled. Wild animal products and meat that may contain the virus should also be avoided.
• Use bedding that has not been in contact with sick people or animals, and avoiding materials that may have been contaminated.
• Travelers with compromised immune systems, including pregnant women, should avoid monkeypox outbreak areas.

General Public at low risk of Monkeypox

The monkeypox outbreak in Nigeria, which affected international travelers and health care workers treating sick patients, should remind us to remain vigilant against emerging zoonoses as Monkeypox.

According to CDC:

The general public is at low risk, but those who develop new, unexplained skin rashes should seek medical attention immediately and avoid contact with others if they develop fever and chills.

Prior to visiting a healthcare facility, call ahead if possible. As soon as you arrive, notify a staff member that you are worried about monkeypox if you can’t call ahead. Consult your doctor if you experienced any of the following in the month prior to developing symptoms:

• A monkeypox-infected person came into contact with you.
• An intimate relationship (including sex) has occurred between you and another male.
• Have you been in an area where monkeypox has been reported? Such as: the Democratic Republic of the Congo, Republic of the Congo, Nigeria, Central African Republic, Cameroon, Liberia, Sudan, etc.
• Wait until a healthcare professional or public health official has cleared you before traveling by public transportation if you have monkeypox.