WHO issues warning on Monkeypox as more cases get reported from UK, Portugal, Spain,US

London: The World Health Organisation (WHO) has issued a warning about the outbreak of monkeypox, suspected and confirmed cases are being investigated in parts of the countries including the UK, Canada, Spain, Portugal and the US.

The first case of Monkekpox was reported on 7 May 2022 in an individual who travelled from the United Kingdom to Nigeria and subsequently returned to the United Kingdom. 

On 13 May 2022, WHO has notified of two laboratory confirmed cases and one probable case of monkeypox, from the same household, in the United Kingdom. On 15 May, four additional laboratory confirmed cases have been reported amongst Sexual Health Services attendees presenting with a vesicular rash illness and in gay, bisexual, and other men who have sex with men (GBMSM).As of 19th May the total number of cases stands at 8. 

An investigation is underway by British health officials to detect the cause of the outbreak which has hit mainly London, now affecting nine people, Xinhua news agency reported.

"Based on currently available information, the infection seems to have been locally acquired in the United Kingdom. The extent of local transmission is unclear at this stage and there is the possibility of identification of further cases," the WHO added.

Susan Hopkins, the chief medical adviser at UKHSA, said these latest cases and reports of cases in countries across Europe confirmed their initial concerns that there could be a spread of monkeypox within the communities.

"We are contacting any identified close contacts of the cases to provide health information and advice," said Hopkins.

There is a monkeypox outbreak in the United Kingdom, Portugal and Spain. The outbreak is quite small — just 36 suspected cases spread across the three countries, including eight in England and 20 in Portugal. A case in the U.S. has also been reported.

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Monkeypox is a sylvatic zoonosis with incidental human infections that usually occur sporadically in forested parts of Central and West Africa. It is caused by the monkeypox virus which belongs to the orthopoxvirus family. Monkeypox can be transmitted by contact and droplet exposure via exhaled large droplets.

The incubation period of monkeypox is usually from 6 to 13 days but can range from 5 to 21 days. The disease is often self-limiting with symptoms usually resolving spontaneously within 14 to 21 days.

Symptoms can be mild or severe, and lesions can be very itchy or painful. The animal reservoir remains unknown, although is likely to be among rodents. Contact with live and dead animals through hunting and consumption of wild game or bush meat are known risk factors.

Milder cases of monkeypox may go undetected and represent a risk of person-to-person transmission. There is likely to be little immunity to the infection in those travelling and exposed as endemic disease is geographically limited to parts of West and Central Africa.

While a vaccine has been approved for prevention of monkeypox, and traditional smallpox vaccine also provides protection, these vaccines are not widely available and populations worldwide under the age of 40 or 50 years no longer benefit from the protection afforded by prior smallpox vaccination programmes.  

In response WHO has issued a warning, any illness during travel or upon return from an endemic area should be reported to a health professional, including information about all recent travel and immunization history. Residents and travelers to endemic countries should avoid contact with sick animals (dead or alive) that could harbour monkeypox virus (rodents, marsupials, primates) and should refrain from eating or handling wild game (bush meat).

The importance of hand hygiene by using soap and water, or alcohol-based sanitiser should be emphasized. While a vaccine and specific treatment have recently been approved for monkeypox, in 2019 and 2022 respectively, these countermeasures are not yet widely available.

A patient with monkeypox should be isolated and provided with supportive care during the presumed and known infectious periods, that is during the prodromal (early signs) and rash stages of the illness, respectively.

Timely contact tracing, surveillance measures and raising awareness of imported emerging diseases among health care providers are essential for preventing further secondary cases and effective management of monkeypox outbreaks.

Health workers caring for patients with suspected or confirmed monkeypox should implement standard, contact and droplet infection control precautions. This includes all workers such as cleaners and laundry personnel who may be exposed to the patient care setting, bedding, towels, or personal belongings.

Samples taken from people with suspected monkeypox or animals with suspected monkeypox virus infection should be handled by trained staff working in suitably equipped laboratories.