GENEVA, July 23 (Xinhua) -- News analysis: Why monkeypox outbreak has become a "public health emergency of international concern"
Xinhua News Agency reporter Liu Qu
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Tedros Adhanom Ghebreyesus, director general of the World Health Organization, announced on the 23rd that the monkeypox epidemic currently spreading in 75 countries and regions has constituted a "public health emergency of international concern". This is the highest level of alert issued by the organization for a global public health emergency, and it also means that the current COVID-19 outbreak and the monkeypox epidemic are at this level of alert at the same time.
Alert escalation
At the beginning of May this year, the United Kingdom reported confirmed cases of monkeypox, followed by more European and American countries have reported monkeypox cases, and the epidemic has spread rapidly in many parts of the world. Monkeypox was previously mainly endemic in West and Central Africa. WHO experts said in the month that cases of monkeypox that had no direct travel links to endemic areas in multiple "non-endemic countries" were "atypical" conditions.
At the end of June, the WHO Emergency Committee met to assess monkeypox outbreaks in multiple parts of the world. At that time, 47 countries and regions had reported cases, and the number of cases was about 3040. The committee eventually reached a consensus that the monkeypox outbreak did not constitute a "public health emergency of international concern".
This is an exterior view of the World Health Organization headquarters in Geneva, Switzerland, taken on May 20, 2021. Photo by Xinhua News Agency reporter Chen Junxia
On 21 July, the WHO Emergency Committee met again to discuss the monkeypox outbreak. By this time, 75 countries and territories had reported more than 16 000 cases, including five deaths, to WHO. Although the committee ultimately did not reach a consensus, Tedros decided at a press conference on the 23rd to declare that the monkeypox epidemic has constituted a "public health emergency of international concern".
Tedros stressed that the Committee was only responsible for providing advice and reference to the Director General, and the final decision was left to the Director General.
Multiple considerations
According to Tedros, there are five factors to consider when making this decision. First, information provided by countries shows that monkeypox viruses have rapidly spread to many countries where no previous cases have occurred; Second, the three criteria for declaring a "public health emergency of international concern" stipulated in the International Health Regulations have been met, and the monkeypox outbreak has been met; Third, the Emergency Committee, although not in consensus, had provided support for the Director General's decision; Fourth, the scientific principles, evidence and other relevant information about monkeypox are currently insufficient, and many unknowns remain; Fifth, monkeypox poses a risk to human health, which may form international transmission and potentially interfere with international traffic.
On March 11, 2020, in Geneva, Switzerland, WHO Director-General Tedros Adhanom Ghebreyesus spoke at a regular press conference. Photo by Xinhua News Agency reporter Chen Junxia
Tedros said that while he declared the monkeypox outbreak to constitute a "public health emergency of international concern," "for now, this is an outbreak concentrated among men who have sex with men, particularly men with multiple sexual partners." Therefore, the outbreak can be stopped with appropriate strategies.
WHO data shows that the virus is spreading in many countries that have not previously reported monkeypox cases, with whose countries in the European and American regions have reported the highest number of cases, and the majority of cases are male-male sex, but also include a small number of children who have no known epidemiological link to the case. In addition, in West and Central Africa, where cases have been frequent in the past, the number of cases has increased significantly, with the majority of women and children.
Currently, WHO assesses monkeypox outbreaks as being at high risk in Europe and moderate in all regions of the world and beyond.
Prevention and control recommendations
Monkeypox is a viral zoonotic disease whose pathogen, monkeypox virus, is endemic mainly in West and Central Africa. In 1970, the first case of human infection with monkeypox was detected in the Democratic Republic of the Congo. Since then, most of the reported cases worldwide have been in African countries such as the Democratic Republic of the Congo (DRC), Congo (Brazzaville), the Central African Republic, Nigeria, and Cameroon.
Monkeypox virus can be transmitted from animal to person through close contact and, although it is not easily transmitted from person to person, it can also be infected in close contact with an infected person. The initial symptoms of monkeypox infection include fever, headache, muscle aches, back pain, lymphadenopathy, etc., which can then develop into a widespread rash on the face and body. Most infected people recover within a few weeks, but some will develop serious illness or even death.
People wait for monkeypox vaccination at a vaccination site in New York, USA, on July 14. Xinhua News Agency (Photo by Guo Ke)
However, WHO notes that in this outbreak, the incidence of some cases is different from the past, and the rash lesions are limited to the genital, perineal, perianal or perioral areas, usually do not spread further, and then develop symptoms such as lymphadenopathy, fever, pain and other symptoms associated with the lesion.
WHO currently classifies endemic countries and regions into four categories, including those that have not reported or have not reported cases for more than 21 days; Countries and regions where there have been recent imports of monkeypox cases and human-to-human transmission; Countries and regions where monkeypox viruses are transmitted between animals and humans, as well as countries and regions with diagnostic, vaccine and therapeutic drug manufacturing capabilities.
WHO has given a series of specific recommendations for epidemic prevention and control in four countries and regions, including recommendations for coordinated response measures to stop the spread of the epidemic, involve affected communities in prevention and control, strengthen surveillance and public health measures, strengthen clinical management and infection prevention and control in hospitals and clinics, and accelerate research on the use of vaccines, treatments and other tools.