Monkeypox: 72 deaths reported, with 2,821 cases confirmed, suspected so far this 2022

What's the best way to fight the global spread of monkeypox viral infection?

Sharing of information.

So stressed the World Health Organisation (WHO) as the agency continues to receive updates on the status of ongoing monkeypox outbreaks and newly-reported cases. 

On Saturday (June 10), the WHO published an "interim rapid response" guidance for the clinical management and infection prevention and control of monkeypox for health care and community settings.

The WHO, headquartered in Geneva, has established a surveillance network, which serves as an early warning system to detect disease outbreaks quickly before they spread, cost lives and become difficult to control, evaluate the impact of an intervention, and track progress.

The agency said the disease is "usually self-limiting" but stressed that it may be "severe in some individuals, such as children, pregnant women or persons with immune suppression due to other health conditions".

Monkeypox virus mostly transmitted from one person to another by close contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding.

In its latest update, WHO stated it has received reports of a total of 2,821 confirmed and suspected cases of monkeypox from both “non-endemic" and “endemic” countries.

As of June 8, WHO reported 1,285 monkeypox cases among 28 “non-endemic” countries. The number covers the period from May 13 to June 8, 2022.

In several African countries, where monkeypox is endemic, there were 1,536 suspected cases and 59 confirmed cases reported. These were in eight countries: Cameroon, Central African Republic, Republic of Congro, DR Congo, Liberia, Nigeria, Sierra Leone, Ghana.

The WHO monkeypox tally in Africa, which covers the period from January 2022 to June 8, 2022, recorded 72 deaths from the illness within in the region.

“WHO continues to support sharing of information,” the health body said in its latest guidance. “Clinical and public health incident response has been activated to coordinate comprehensive case finding, contact tracing, laboratory investigation, clinical management, isolation, and implementation of infection prevention and control measures,” it added.

The key to information sharing is genomic sequencing of monkeypox viral DNA, which is being undertaken where available, the WHO said.

Several European countries (Belgium, Finland, France, Germany, Israel, Italy, the Netherlands, Portugal, Slovenia, Spain, Switzerland, the United Kingdom of Great Britain and Northern Ireland) and the US have published full-length or partial genome sequences of the monkeypox virus found in the current outbreak. 

In general, real-time polymerase chain reaction (PCR) may be used on lesion material to diagnose a potential infection with monkeypox virus. While investigations are ongoing, preliminary data from PCR assays indicate that the monkeypox virus genes detected belong to the West African “clade”, WHO reported.

In virology, viruses are placed in “clades” based on phylogenetic trees constructed from their genome sequences.

WHO said human infections with the West African clade appear to cause less severe disease compared to the Congo Basin clade, with a case fatality rate of 3.6% compared to 10.6% for the Congo Basin clade, the agency stated in a report.

The WHO stated that two types of vaccines (ACAM-2000 and MVA-BN) are being deployed by some member states to serve as prophylaxis for close contacts.

Other countries may hold supplies of other types of vaccines, such as LC16.

ACAM-2000

ACAM-2000 is licensed by the FDA for smallpox (Vaccinia) for active immunisation against smallpox disease for persons determined to be at high risk for smallpox infection. The vaccine is manufactured by Sanofi Pasteur Biologics Co.

MVA-BN

Modified vaccinia Ankara-Bavarian Nordic (MVA-BN) is a highly attenuated vaccinia virus. MVA-BN is a non-replicating smallpox vaccine distributed in liquid-frozen formulation suitable for use against smallpox. The vaccine is approved in Europe for use in the general adult population. Bavarian-Nordic stated on its website that MVA-BN, an injectable, is not yet approved in the US, though it is currently stockpiled by the US Government for emergency use in people for whom replicating smallpox vaccines are contraindicated.

Because MVA-BN virus is highly attenuated, it is thus incapable of replicating in the body, yet is still capable of eliciting a potent immune response and does so without producing the post-vaccination complications, the vaccine maker said.

LC16

Studies cited in 2006 in the scientific journal Vaccine, states that LC16m8 administered in two different animal models demonstrated protective efficacy equivalent to that of the only FDA-licensed smallpox vaccine.

Meanwhile, the WHO has said that interim guidance is being or has been developed to support member states with raising awareness, surveillance, laboratory diagnostics and testing, case investigation and contact-tracing, clinical management and infection prevention control, vaccines and immunisation, and risk communication and community engagement.

The guidance outlines considerations for community care, patients with moderate to severe disease, sexually active persons, pregnant or breastfeeding women, children and young persons.