- Confirmed monkeypox cases cross 1,000 mark worldwide.
- WHO and CDC outline precautions for preventing infection and transmission, especially in healthcare settings.
- Expert urges increased surveillance, adherence to protocols on isolation, patient placement, personal protective equipment, among others.
At least 1,038 cases of monkeypox virus has been reported globally, with 32 more cases suspected awaiting lab-confirmation. The cases are mostly in Europe, North America and, increasingly, Latin America.
Update: UAE reports 5 new monkeypox cases
As of Tuesday (June 7), the UK has reported the most number of monkeypox infections — with 302 cases confirmed, followed by Spain, with 198 confirmed cases, Portgular, with 153 cases, Canada with 81 and Germany with 80.
Confirmed, suspected cases in 36 “non-endemic” countries
At least 36 countries have reported confirmed or suspected cases of monkeypox infections as of Tuesday, according to BNO, a Dutch tracking site.
This makes monkeypox the biggest outbreak of the virus so far in recent years, with 1,071 confirmed/suspected infections reported so far in the “non-endemic” countries — meaning, the outbreak is not regularly found in these geographical areas.
Earlier this week (Sunday, June 5), the WHO said it had received lab-confirmed reports of 780 cases of monkeypox from 27 non-endemic countries.
This represents a 203% jump (+ 523 lab confirmed cases) from the cases reported on May 29, when a total of 257 cases were confirmed in 27 countries.
Latin America, Europe
The latest suspected cases — including 6 in Brazil and 4 in Uruguay — are undergoing lab tests for confirmation.
On June 1, Paraguay reported a suspected case, with the Ministry of Public Health reporting a person with a history of travel to Africa who then experienced conspicuous skin lesions upon return.
On June 3, Latvia confirmed its first case of monkeypox, according to the the Netherlands-based BNO monkeypox tracker.
WHO on key actions
As cases rise, the World Health Organisation (WHO) has released a new set of guidelines and preventive measures to curb the virus’ spread.
Dr. Maria Van Kerkhove, a senior WHO epidemiologist, detailed a list of key measures to stop monkeypox based on the virus epidemiology, sources of infection, and transmission patterns.
She outlined ways to stop the virus’ spread. Among the recommendations:
(1) Increased surveillance and treatment
Dr. Van Kerkhove suggested heightened surveillance in outbreak countries, especially where the virus is not endemic. This, however, requires better testing capacity in national health authorities.
She urges increased surveillance, adherence to protocols on isolation, patient placement, waste management and personal protective equipment especially in healthcare settings, among others.
(2) Awareness: stop human-to-human transmission
In order to curb the spread of this virus, she highlighted the need to creating greater awareness about what monkeypox is and how it spreads, especially in non-endemic countries.
A key step: stop human-to-human transmission. The WHO experts said this can be achieve by using public health tools — such as early identification, isolating cases and talking and listening to communities to find solutions.
The WHO official called on governments to ensure that people who are expected to be affected can get appropriate clinical care.
The recommendations also include environmental infection control standards, such as the use of hospital-grade disinfectant.
(4) Protecting frontliners
Furthermore, Dr. Van Kerkhove said that the protection of frontline workers is also important because they are the ones who work at ground level and directly provide services to the public.
“It is crucial to supply them with accurate information and appropriate personal protective equipment. Counter measures against this virus should be utilised properly by providing antivirals and vaccines appropriately to those who are more at risk in an equal manner,” Dr. Kerkhove told an online forum.
WHO is hosting a research and development meeting to cover everything from epidemiology to diagnostics, treatments, and vaccinations, since it is essential to understand what monkeypox is.
Meanwhile, genetic analysis of recent monkeypox cases suggests there are two distinct strains in the US. Many of the US cases were caused by the same strain as recent cases in Europe — but a few samples show a different strain, federal health officials said.
CDC on how monkeypox spreads
The CDC said monkeypox spreads between people, primarily through direct contact with infectious sores, scabs, or body fluids.
> It is not a sexually transmitted disease.
> The virus can spread through any kind of sustained skin-to-skin contact with an infected person who has a lesion.
> It can spread through contaminated bed sheets and clothing,
> It can also spread via respiratory droplets, if a person has a lesion in their mouth.
> One study also shows monkeypox virus is airborne.
The WHO noted that the "sudden and unexpected appearance of monkeypox simultaneously in several non-endemic countries suggests that there might have been undetected transmission for some unknown duration of time".
Scientists also agree to the theory that the monkeypox virus may have been quietly circulating for years before its sudden emergence worldwide.
"There may have been undetected transmission for a while," said Dr. Rosamund Lewis, the WHO technical lead for monkeypox during a recent briefing. “What we don;t know is how long that may have been. We don’t know if it’s weeks, months or possibly a couple of years,” she told international media.
Understanding 'human-to-human transmission'
Human-to-human transmission of monkeypox virus occurs usually by direct or “close contact” with lesion material of an infectious person. Exposure to respiratory secretions is also most common route of transmission, according to the US Centres for Disease Control and Prevention. Transmission in healthcare settings is “rarely”, the agency added.
The CDC has described practices and outlined recommendations in a guideline in a healthcare setting when providing care for any patient with infectious disease, including those with monkeypox infection.
Caring for suspected monkeypox patient
Part of standard precaution for all patient care, include protocols for those with suspected monkeypox infection.
In case patient presents a suspected case, infection prevention and control personnel should be notified immediately.
The agency stressed that activities that could “resuspend” dried material from lesions — such as the use of portable fans, dry dusting, sweeping, or vacuuming — should be avoided.
A patient with suspected or confirmed monkeypox infection should be placed in a single-person room; special air handling is not required, according to the CDC.
Dedicated bathroom, transport
In this single-person room setting, the door should be kept closed (if safe to do so). The patient should have a dedicated bathroom. Transport and movement of the patient outside of the room should be limited to medically essential purposes.
Mask for patients, cover for lesions
If the patient is transported outside of their room, they should use well-fitting source control (e.g., medical mask) and have any exposed skin lesions covered with a sheet or gown.
Intubation and extubation, and any procedures likely to spread oral secretions should be performed in an airborne infection isolation room.
Personal protective equipment (PPE)
PPE used by healthcare personnel who enter the patient’s room should include:
> Eye protection (i.e., goggles or a face shield that covers the front and sides of the face)
> NIOSH-approved particulate respirator equipped with N95 filters or higher.
Waste management (i.e., handling, storage, treatment, and disposal of soiled PPE, patient dressings, etc.) should be performed in accordance with existing national protocols.
Environmental infection control
CDC recommends the use of standard cleaning and disinfection procedures to be performed using an registered, hospital-grade disinfectant with an emerging viral pathogen claim.
Soiled laundry, dusting, sweeping
Handling of solid laundry — such as bedding, towels, personal clothing — should be handled in accordance with recommended standard practices, avoiding contact with lesion material that may be present on the laundry.
Soiled laundry should be gently and promptly contained in an appropriate laundry bag and never be shaken or handled in manner that may disperse infectious material.
More importantly, activities such as dry dusting, sweeping, or vacuuming should be avoided. Wet cleaning methods are preferred.
Management of food service items should also be performed in accordance with routine procedures.
Duration of precautions
In general, CDC prescribes that isolation precautions should be maintained until all lesions have crusted — those crusts have separated, and a fresh layer of healthy skin has formed underneath. As per protocol, local or state health authorities must be consulted on decisions regarding discontinuation of isolation precautions in a healthcare facility.