Monkeypox Cases Spike 20% Weekly Worldwide
Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing

As the first monkeypox case involving a human-to-dog transmission reported, the World Health Organization (WHO) said more than 35,000 recently confirmed cases of monkeypox were accompanied by 12 deaths in 92 nations and territories, including almost 7,500 from last week alone.

That made for the second consecutive week with a 20% increase, WHO Director-General Dr Tedros Adhanom Ghebreyesus said Wednesday.

Almost all of the cases are being reported from Europe and the Americas and involve men who have sex with men, Tedros told a virtual press briefing, underscoring the importance for all countries to design and deliver services and information tailored to these communities that protect health, human rights and dignity.

“The primary focus for all countries,” said Tedros, “must be to ensure they are ready for monkeypox and to stop transmission using effective public health tools, including enhanced disease surveillance, careful contact tracing, tailored risk communication and community engagement and risk reduction measures.”

Related to the challenge of outreach, Dr Mike Ryan, executive director of WHO’s Health Emergencies Program, said WHO would “follow up directly” with Mexico’s government – when asked by a Mexican journalist why the country has not yet mounted programmes for widespread testing or clear outreach to potentially vulnerable populations of men – despite a fourfold increase in daily reported cases over the past two weeks. 

Tedros said vaccines may also play an important part in controlling the outbreak, and in many countries there is high demand for vaccines from the affected communities.

“However, for the moment, supplies of vaccines and data about their effectiveness are limited. Although, we are starting to receive data from some countries,” he noted. 

“WHO has been in close contact with the manufacturers of vaccines and with countries and organizations willing to share those. We remain concerned that the inequitable access to vaccines we saw during the COVID-19 pandemic will be repeated, and that the poorest will continue to be left behind.”

Bavarian Nordic, the world’s sole manufacturer of US and European-approved monkeypox vaccines has currently closed its manufacturing plant for renovations – and does not expect to reopen until late this year. Meanwhile, a few wealthy countries, led by the United States, have snapped up all available doses. See Health Policy Watch’s exclusive report: 

Exclusive: Closure of World’s Only Manufacturing Plant for Monkeypox Vaccine Raises Questions About World’s Ability to Meet Rising Demand

First case of human to dog transmission

Pet dog in France gets monkeypox from 2 men in same household

WHO officials also confirmed the first case of human-to-dog transmission in Paris, where two men went to a hospital and were confirmed to have monkeypox. Twelve days later, a 4-year-old male Italian greyhound that was allowed to sleep with them also tested positive for the virus, according to a recent  Lancet article.

The case already prompted the U.S. Centers for Disease Control and Prevention to issue new guidance that people with monkeypox should avoid contact with animals, including pets, domestic animals and wildlife to avoid spreading the virus.

“Infected animals can spread monkeypox virus to people, and it is possible that people who are infected can spread monkeypox virus to animals through close contact, including petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food,” stated the CDC guidance.

Dr Sylvie Briand, director of WHO’s Epidemic and Pandemic Preparedness and Prevention department (EPP), said it is important to differentiate between the emergence and reemergence of diseases.

“It’s something that we know, most of the emerging viruses are coming from animals,” she said. “This is the case for monkeypox, and they infect humans. So at the beginning, it’s only sporadic cases,” she said, referring to the fact that the virus was only discovered in 1958, and for decades after that circulated in a mostly self-limiting way between animals and human communities in central and west Africa. .

But if the virus finds the right environment, Briand said, it can evolve to more effectively target humans, resulting in more localized transmission especially in conditions of “high human density, very close contact,” she said. “This is what we have seen with monkeypox. Initially it was in animals, then it went to some humans. And then we had a localized outbreak and now we have a multi-country outbreak.”

In terms of disease reemergence, other factors then play out as well. “It’s often because the vaccine coverage is too low that those diseases reemerge,” she said. “And it’s very important to understand that vaccine coverage is a very, very important indicator of the protection of human beings against disease.”

2020 study predicted heightened monkeypox risk with declining smallpox immunity  

Monkeypox lesions

Ironically, a study published in September, 2020 in the Bulletin of the WHO Health Organization, predicted that Central and West Africa’s monkeypox outbreaks could become more frequent – with eventual mutations of the virus increasing human to human transmission as well. 

Earlier this month, a group of global experts convened by WHO agreed that the virus’s variants will be renamed with Roman numerals.

In a review of historical data on outbreaks of Clade 1 of the monkeypox virus in the Democratic Republic of Congo, the authors from Institut Pasteur contended that transmission had remained self-limiting throughout the 1960s and 1970s because most people in DRC were vaccinated against smallpox – which protects against monkeypox virus too. 

However, after smallpox was declared to be eradicated, and smallpox vaccination ceased in the 1980s – that herd immunity waned: 

“Since then, the Democratic Republic of the Congo has reported increased monkeypox human infections,  and parts of the country have been declared monkeypox-endemic areas,” the report’s authors note. 

“In 2011–2012, the population immunity against orthopoxvirus species was only 60%… among individuals vaccinated against smallpox and 26% …among individuals unvaccinated against smallpox.” 

Due to declining immunity, more frequent outbreaks may occur in endemic countries, triggered initially by contact with infected animals, the authors predicted, but they added that over time monkeypox may begin to undergo more “sustained human-to-human transmission (R > 1).”  

“In either case, repeated circulation of monkeypox in human hosts, particularly immunocompromised hosts, favours pathogen evolution and emergence of newly human-adapted pathogens, depending on R and on the human pathogen fitness landscape.” 

“”This finding may explain the increasing number of monkeypox outbreak reports, resulting in endemic monkeypox in central African countries….  

“Moreover, with declining immunity to orthopoxvirus species, monkeypox can pose an ever-increasing threat for health security.”

A prescient conclusion indeed in light of today’s rapidly evolving global health emergency.  

Elaine Ruth Fletcher contributed to this story

Image Credits: , Tessa Davis/Twitter .

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