Ahead of the World Health Organization (WHO) emergency meeting on Thursday to decide whether the current global outbreak of the monkeypox virus should be declared a public health emergency of international concern (USPPI), the Global Network of Health (WHN), an independent international collaboration of scientists and concerned citizens, said on Wednesday June 22nd, 2022that the monkeypox outbreak met the definition of a pandemic.
The statement reads: “The Global Health Network (WHN) today announced that it is declaring the current outbreak of monkeypox a pandemic as there are now 3,417 confirmed cases of monkeypox reported in 58 countries, and the epidemic is growing rapidly on several continents”.
They explained that without concerted global action, the epidemic would continue and affect vulnerable populations such as children, pregnant women and immunocompromised people. They warned that all people 40 and under who have never been immunized against smallpox remain extremely vulnerable to monkeypox, and spillage on animals such as rodents and pets would potentially make the pathogen endemic to a wide geographic region with significant long-term consequences. .
The WHN statement says: “Even with death rates far below those of smallpox, unless action is taken to stop the ongoing spread – actions that can be practically implemented – millions of people will die, and many more will become blind and crippled”. So far, only one death in Brazil has been attributed to monkeypox.
As of June 24, there have been 4,118 confirmed or suspected cases in at least 65 countries and territories. Yesterday, 461 more cases were added to the growing total. The seven-day rolling average of new infections has risen to 280 per day and continues to rise. Taiwan, Singapore and South Korea are the latest countries in Asia to have confirmed cases. Other non-endemic countries have recently reported cases of monkeypox, including South Africa, Croatia, Bulgaria, Colombia and Gibraltar.
Figure 1: Seven-day average and cumulative cases of monkeypox infections. Source @antonio_caramia gave the WSWS permission to use these numbers. Please follow the Hyperlink to the website.
The case in Singapore involved a British Airways flight attendant who frequented several establishments during his layovers in mid-June. On June 20, he developed flu-like symptoms and pathognomonic rashes, prompting him to seek medical attention. Singapore’s health ministry told reporters the man was being treated at the National Center for Infectious Diseases, 13 close contacts had been identified and a search was ongoing.
The South Korean citizen who reported to the Korea CDC had just returned from Germany, where cases have recently spiked. He was symptomatic on his return flight with headaches, fever, sore throat, fatigue and skin lesions. Another case is also under consideration.
On Thursday, South Africa’s Health Minister Joe Phaahla announced they had confirmed a case of monkeypox in a 30-year-old man from Johannesburg with no travel history, meaning he was of community and the extent of infections remains unknown. The health minister assured the press that contact tracing was ongoing.
With more than 900 cases, Britain leads all other countries in the number of cases. According to the UK Health Security Agency, cases have soared by more than 40% in less than a week. Europe remains the epicenter of the monkeypox outbreak, with Germany overtaking Spain and Portugal. However, in North America, Canada has recorded 267 cases and the United States 173.
Figure 2: Cumulative cases of monkeypox in Europe as of June 24, 2022. Source: @antonio_caramia
Professor Yaneer Bar-Yam, Ph.D., president of the New England Complex System Institute and co-founder of WHN, emphatically stated, “There is no reason to wait for the monkeypox pandemic to grow any further. The best time to act is now. By taking immediate action, we can control the epidemic with the least effort and prevent the consequences from getting worse. Necessary actions now only require clear public communication about symptoms, widely available testing and contact tracing with very few in quarantine. Any delay only makes the effort more difficult and the consequences more serious.
Dr. Eric Feigl-Ding, Ph.D., epidemiologist and health economist, and co-founder of WHN, added, “WHO must urgently declare its own Public Health Emergency of International Concern (PHEIC) – the lessons of not declaring a USPPI immediately in early January 2020 should be remembered as a history lesson of what acting late on an outbreak can mean for the world.
WHO Director-General Dr Tedros Adhanom Ghebreyesus has previously acknowledged that the disease is more widespread than official figures suggest. During the meeting of the emergency committee of the Thursday, he reaffirmed this fact by stating, “Person-to-person transmission is ongoing and is likely underestimated.” His statement implies that public health officials do not clearly understand where these cases are occurring and how widespread they are.
Public health officials have focused on tracing cases among men who have sex with men. The UK Health Security Agency noted that the monkeypox virus appears to be a threat “in the sexual networks of gay, bisexual and other men who have sex with men”.
David Heymann, professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine, present at the WHO emergency conference, told the Washington Post,”We begin to understand how widespread it is. We know it is prevalent in some populations, and we need to know if it is spreading in other populations as well. Evidence is mounting that there are multiple routes of transmission which also include the airways, although it does not spread easily between people and requires close contact.
Figure 3: Monkeypox cases by date and country as of June 24, 2022. Source @antonio_caramia.
Genetic sequencing data puts the origin of the epidemic at a few years. Trevor Bedford, an evolutionary biologist at the Fred Hutchinson Cancer Research Center in Seattle, told the New York Times that “genomic models would suggest this happened around 2018”, when the virus became potentially better at spreading from person to person.
Anthropologist and Adjunct Professor Sagan Friant of Pennsylvania State University, who has studied the zoonotic interactions of monkeypox in Nigeria, said in May in an interview with WPSU Central Pennsylvania state media, “A lot of the export cases we’ve seen in the past have had one or few or no subsequent cases due to human-to-human contact. But now that we see these multiple cases [in] many parts of the globe, you are seeing sustained human-to-human transmission which is very unexpected and which we are monitoring.
She also explained that the zoonotic interaction between humans and animals goes both ways. Spilling the monkeypox virus from humans to animals such as rodents in countries outside previously non-endemic regions would mean that the virus could find a permanent niche around the world, threatening further outbreaks repeatedly.
Genomic analysis of recent cases surprised virologists. Monkeypox is a large double-stranded DNA virus with highly efficient error-correcting mechanisms during replication. It acquires about one or two mutations per year compared to the 20 to 30 mutations of RNA viruses. However, the current monkeypox virus has gained almost 50 mutations compared to the 2018 version, which means that it would have taken several decades for the monkeypox virus to acquire these many changes in its DNA.
Scientists are focusing on a family of enzymes called APOBEC3 based on their analysis of recent cases and the specific type of mutations associated with this enzyme. Enzymes are part of the antiviral defense systems possessed by animals, including humans, that induce mutations in the virus when they encounter it.
Richard Neher, computational evolutionary biologist at the University of Basel, talks to STAT News, explained that “the idea behind such a sabotage plan is that if you trigger enough mutations, some of them will definitely be deleterious. The virus will not be able to replicate and all that will be left is a piece of dead DNA. It would be like rearranging the letters on your enemy’s typewriter so they can’t get a clear message across. However, the process is not foolproof and mutations that result in an advantage can be passed on to the next generation.
Dr Bedford said that while mice carry only one version of the APOBEC3 enzyme, humans have seven. The implication is that the rapid accumulation of mutations may be a product of the monkeypox virus which moved to spread through people rather than rodents to humans. Neher admitted: “We don’t understand enough how this virus interacts with the host. [people]or what these individual mutations might do.
As urbanization, deforestation and climate change have drastically altered the natural habitats of animals and the pathogens that have colonized them, the leap into human hosts is becoming increasingly inevitable unless efforts are made immediately. to study and answer this compelling question. Virologist Dr Michael Malim of King’s College London, who discovered APOBEC3 in 2002, told the Time, “These spillovers from other species, and what that means and what the trajectory is, it’s very unpredictable. And it’s happening more and more.”
#Ahead #emergency #deliberations #Global #Health #Network #declares #monkeypox #pandemic