On May 18 this year, the United States confirmed the first case of monkeypox this year. In less than 3 months, the number of monkeypox cases in the United States has exceeded 10,000.
The United States is currently the country with the largest number of confirmed monkeypox cases in the world. According to the statistics of the US Centers for Disease Control and Prevention (CDC), as of August 10, local time, the Cumulative Number of MonkeyPox cases reported in the United States was 10,392. With the exception of Wyoming, monkeypox outbreaks have occurred in all 49 other U.S. states and Washington, D.C.
On July 29, the U.S. state of New York declared a state of emergency due to the monkeypox outbreak. On August 1, California and Illinois declared states of emergency. On August 4, the US Biden administration declared the monkeypox outbreak a "public health emergency."
The COVID-19 epidemic is still not completely over, and the arrival of the monkeypox epidemic has aroused the vigilance and concern of many people. According to CDC statistics, including the United States, a total of 89 countries and regions around the world have reported monkeypox outbreaks, and the cumulative number of cases has exceeded 30,000. As early as 23 July, the World Health Organization (WHO) had declared the monkeypox outbreak a "Public Health Emergency of International Concern".
Monkeypox outbreaks are rarely spreading globally, will it become another global pandemic after COVID-19?
Why has this year's monkeypox epidemic attracted attention?
Monkeypox is not a newly discovered virus. As early as 1958, researchers discovered the virus in monkeys used in a danish laboratory for research, hence the name Monkeypox. But it wasn't until 1970 that the Dr. Congo discovered and reported its first case of human monkeypox infection.
CCTV News reported that monkeypox is a viral zoonotic disease that used to be endemic mainly in West and Central Africa. After the first case was confirmed in 1970, most of the reported cases of monkeypox worldwide were concentrated in African countries such as the Democratic Republic of the Congo (DRC), Congo (Brazzaville), the Central African Republic, Nigeria, and Cameroon.
An important reason why the monkeypox epidemic this year has aroused global vigilance is that its transmission range has broken through the historical endemic area and begun to circulate in many countries and regions around the world.
On July 16, 2022, local time, Chennai, Tamil Nadu, India, a local airport screened inbound passengers from high-risk countries for monkeypox virus. Figure/IC photo
According to the U.S. Center for Disease Control and Prevention, of the 31,800 monkeypox cases currently reported worldwide (as of August 9), 31,425 cases have been reported by countries and regions that have not had monkeypox outbreaks in history. In terms of outbreak sites, of the 89 countries and regions that reported monkeypox outbreaks, 82 had not previously had a monkeypox outbreak.
In fact, although the earliest outbreak of monkeypox this year occurred in Africa, the Americas and Europe are the most severely affected regions at present. The United States has reported more than 10,000 cases so far, followed by Spain with more than 5,100 cases, and Germany, the United Kingdom, France, Brazil and other countries have all reported more than 2,000 cases.
WHO also notes that since early May, some non-historical endemic countries and territories have reported monkeypox cases, and most confirmed cases with a history of travel have gone to Europe and North America, rather than West or Central Africa, where monkeypox is endemic. According to WHO, this is the first time since the monkeypox virus was discovered that many cases of monkeypox have been reported simultaneously in non-historically endemic and historically endemic countries in different geographical regions.
Edwin Michael, an epidemiologist at the Center for Global Health and Infectious Diseases at the University of South Florida, said in an interview with the Beijing News that it is not clear why monkeypox cases spread widely in countries and regions outside the West African region. However, he believes that this may be related to the fact that under the new crown epidemic, the health systems of various countries are more sensitive to some abnormal symptoms such as rashes and pus-filled lesions, so they have stepped up testing.
In addition, Michael believes that this year's monkeypox outbreak has spread more widely, and another reason may be that after humans declared the eradication of smallpox in 1980 and gradually stopped vaccinating smallpox, the community transmission of monkeypox increased, which made the monkeypox virus more likely to spread beyond West Africa.
The smallpox virus, once a long-term nightmare for human beings, is highly contagious and pathogenic, and is one of the oldest and most mortal infectious diseases that humanity has ever faced. Until 1980, smallpox became the only human viral disease currently eradicated.
Monkeypox virus and smallpox virus belong to the same family of viruses. According to WHO, monkeypox virus is mainly divided into two tax groups, Congolese type and West African type, of which Congo type has stronger transmission capacity and pathogenicity than West African type. The monkeypox virus, which was transmitted in non-historical endemic countries and regions, belongs to the West African type.
The Washington Post reported that there is currently an unprecedented outbreak of monkeypox around the world, and this historical regional epidemic is triggering a new global crisis.
The monkeypox outbreak has raised concerns about the stigmatization of monkeys. In Brazil, where monkeypox is most severe in South America, there have been a number of monkey poisoning incidents in the past period of time. In this regard, WHO stressed at a regular press conference on 9 August that the high incidence of monkeypox has nothing to do with monkeys and that no animals or infected persons should be harmed, discriminated against or stigmatized.
Will monkeypox become a new global pandemic?
On 23 July, WHO Director-General Tedros Adhanom Ghebreyesus declared that the monkeypox outbreak constituted a "Public Health Emergency of International Concern" (PHEIC). This is WHO's highest level of alert for a global public health emergency and the latest PHEA released by WHO following the announcement of COVID-19 as a PHEIC in January 2020.
For a world still in the shadow of COVID-19, this alarm raises widespread concerns: Will monkeypox become another pandemic that will coexist with COVID-19?
On July 26, 2022 local time, Paris, France, the Ile de France region (Greater Paris region) officially opened a large monkeypox vaccination center, and authorized all medical school students to participate in monkeypox vaccination. Figure/IC photo
Michael thinks it's unlikely. He noted that the WHO statement itself was controversial, with 9 of the 15 members of the organization's Emergency Committee believing that monkeypox should not be declared PHIC at this time, but the Director-General, Dr Tedros Adhanom Ghebreyesus, ultimately decided to issue the statement. Michael believes that WHO may not want to repeat its previous mistakes and wants to be more proactive in dealing with monkeypox.
"There has been uncertainty about the severity of the spread of monkeypox outbreaks outside of West Africa." Michael said monkeypox is a long-spread disease with intermittent outbreaks. ”
Although monkeypox outbreaks are mainly endemic in West and Central Africa, there have also been local outbreaks in the United States. According to the U.S. Centers for Disease Control and Prevention, in 2003, 47 cases of monkeypox were reported in the United States, involving 6 states. This is the first time in history that monkeypox outbreaks have been reported outside of Africa.
The outbreak is also linked to Africa. The survey showed that all infected patients fell ill after contact with their pet prairie marmots. These pets were previously housed near small mammals imported from Ghana that brought the monkeypox virus into the United States.
In addition, the United Kingdom, Israel, Singapore and other countries have reported a small number of cases, but the infected people have a history of travel to African countries.
Michael believes that although the monkeypox epidemic has spread to many countries and regions that are not historically endemic, it is unlikely to become a pandemic like the new crown virus. "First of all, from the perspective of the monkeypox virus itself, its infectivity is much lower than that of the currently circulating strain of the new crown virus." Michael explained that monkeypox is usually transmitted through close contact with infected people, and this human-to-human transmission is less contagious than transmission through the respiratory tract. "As you can see from the long history of monkeypox transmission in West Africa, there have never been large-scale outbreaks there."
According to CCTV News, monkeypox virus can be transmitted to humans through close contact with animals, which is not easily transmitted from person to person, but it can also be infected in close contact with infected people. 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.
In addition, most of the current cases are concentrated in the group of men who have sex with men. A WHO report released on 3 August showed that 97.5% of cases with detailed information reported having male sex. However, it is important to note that monkeypox is not a sexually transmitted disease (STD).
On June 27, 2022, local time, seoul, South Korea, the National Central Medical Center in Jung-gu, Seoul, began to vaccinate medical staff against monkeypox. Figure/IC photo
Judging from the current epidemic situation of monkeypox, the cases are mainly concentrated in Europe and the United States, and relatively few cases have been reported in Africa, Asia and the Pacific. CDC statistics show that the 10 countries in the United States and Europe have reported monkeypox cases accounting for nearly 90% of the cumulative monkeypox cases in the world.
It is also very important to note that the case fatality rate of monkeypox is much lower than that of COVID-19. Historically, monkeypox has seen a case fatality rate of between 0 and 11%, and in recent years it has been around 3%-6%. From both taxa, the case fatality rate for the Congolese type can reach 10 per cent and the West African type is less than 1 per cent.
Therefore, "although we must pay close attention to the global spread of monkeypox outbreaks, combined with the situation of the monkeypox virus itself and its historical epidemic, we do not need to worry too much at present." Michael said.
However, it is worth noting that many countries such as the United States, France, and Germany have reported cases of monkeypox infection in children. According to WHO on 4 August, there are currently few cases of monkeypox in children worldwide, but children infected with monkeypox virus are more likely to develop severe diseases than adolescents and adults, and vigilance is needed to ensure that monkeypox virus does not spread among groups such as children.
According to CCTV News, on August 10, Dong Xiaoping, chief expert of virology at the Chinese Center for Disease Control and Prevention, said at a press conference of the joint prevention and control mechanism of the State Council that no cases of monkeypox have been found in the mainland. In June, the National Health Commission and the State Administration of Traditional Chinese Medicine jointly issued the "Guidelines for the Diagnosis and Treatment of Monkeypox (2022 Edition)", which provides guidance for the diagnosis and treatment of monkeypox in various places. In the next step, we will continue to further strengthen the prevention and control of monkeypox.
Global vaccine distribution is unfair or repeated?
Cody Ahrens' third attempt to get the monkeypox vaccine ended in failure.
CNN reported on Aug. 5 that Aarons, 31, is a medical worker who has been living in New York. After the monkeypox outbreak, he tried unsuccessfully to get vaccinated in New York, and then he came to San Francisco in hopes of getting vaccinated there.
But he failed again. He lined up hours in advance at the entrance of San Francisco General Hospital, but 45 minutes after the hospital opened, a staff member told those still waiting that the vaccine had been vaccinated today.
On August 9, 2022, local time, in Los Angeles, USA, medical staff prepared monkeypox vaccine. Figure/IC photo
Unlike at the beginning of the COVID-19 outbreak, when the monkeypox outbreak suddenly broke out this year, humans already had a vaccine against monkeypox. According to cnbc, the U.S. Food and Drug Administration (FDA) approved the Jynneos monkeypox vaccine produced by Danish biotechnology company Bavarian Nordics in 2019, and the European Union also approved the vaccine in 2013.
In addition, the smallpox vaccine is also effective in preventing monkeypox. Zhang Wenhong, director of the Department of Infectious Diseases at Huashan Hospital affiliated to Fudan University, pointed out on August 7 that monkeypox viruses are closely related to viruses that cause smallpox, so smallpox vaccines can protect people from monkeypox to a large extent. He said past data from Africa showed that the smallpox vaccine was at least 85 percent effective in preventing monkeypox.
The CDC uses the smallpox vaccine ACAM2000 as a vaccine to prevent monkeypox, but because of the side effects of ACAM2000, the CDC recommends the Jynneos vaccine first.
The White House said on Aug. 9 that since May, the U.S. Department of Health and Human Services (HHS) has promised states to distribute 1.1 million doses of monkeypox vaccine, and about 620,000 doses have been delivered so far. However, the problem of vaccines outstripping demand remains acute, with many Americans queuing for hours without being vaccinated.
On August 9, 2022, local time, in San Francisco, California, a large number of people lined up to receive monkeypox vaccine. Figure/IC photo
In order to alleviate this situation, the US FDA announced on the 9th that the emergency use of intradermal injection of monkeypox vaccine is authorized. Since intradermal injection requires only a smaller dose, this change will increase the current vaccine supply by a factor of five.
Robert Fenton, head of the Monkeypox outbreak response team at the White House in the United States, said that this method is safe and effective, and will greatly improve the vaccination range. U.S. Assistant Secretary of HHS Toon O'Connell said the government currently has 440,000 doses of monkeypox vaccine in stock, which is equivalent to 2.2 million doses under this new injection method. Those who have been vaccinated still need to receive a second dose after four weeks.
The Associated Press called the move "very unusual" while reflecting a severe shortage of monkeypox vaccines in the United States. But in fact, the United States is the country that orders the most monkeypox vaccines.
Bavarian Nordic Company can reportedly produce around 30 million doses of monkeypox vaccine this year, with around 16 million doses in stock. The United States has ordered 13 million doses of vaccines from the company, of which 1.4 million doses have been delivered. In May, bavarian Nordic asked the United States to distribute about 215,000 doses of vaccines that had been scheduled to be delivered in response to "international requests." But the U.S. only agreed to delay deliveries and made no other commitments to share vaccines.
In addition to this, the EU also signed a procurement contract with the Bavarian Nordic Company in June, planning to purchase about 109,000 doses of vaccine to ensure that all EU member states, as well as Norway and Iceland, get the vaccine as soon as possible. According to the Financial Times, the UK monkeypox vaccine is about to run out, and there are currently only more than 8,300 doses in stock. As of 9 August, there were nearly 3,000 monkeypox cases in the UK.
On July 30, 2022, local time, in London, England, people lined up to get the monkeypox vaccine. Figure/IC photo
Xinhua News Agency reported on August 9 that in this round of monkeypox epidemic, some rich Western countries have purchased vaccines in large quantities, while vaccines and testing tools in Africa are in short supply. Some public health experts have expressed concern that the health divide, such as the global misallocation of vaccines exposed by the COVID-19 pandemic, may be repeated.
Science also pointed out that the current global supply of monkeypox vaccines is limited, most of which are ordered by European and American countries, which have begun to promote domestic vaccination. However, in Africa, a region long affected by monkeypox outbreaks, most countries do not receive any monkeypox vaccine.
"For all infectious diseases, social injustice is an inherent problem in the level of disease transmission and the outcome of development." Michael said that this is why relying solely on biomedical tools such as vaccines cannot completely stop the further evolution and spread of the virus. In his view, reducing social injustice can improve society's resilience to infectious diseases such as COVID-19.
Michael believes that for the current situation of increasing monkeypox cases, the most important thing is to enhance surveillance so that the public, especially people with high-risk infections, can recognize monkeypox and learn to protect themselves. In addition, it is also critical to increase the production of monkeypox vaccines and ensure the fair distribution of vaccines.
"A pandemic is not doomed: effective action to address inequality can defeat HIV, monkeypox and COVID-19." UNAIDS said on Aug. 10.
Beijing News reporter Xie Lian
Edited by Bai Shuang proofread by Chen Diyan