• The World Health Organisation (WHO) declared monkeypox a global public health emergency of international concern.
• The WHO label - a ‘public health emergency of international concern’ (PHEIC) - is designed to trigger a coordinated international response and could unlock funding to collaborate on sharing vaccines and treatments.
• WHO Director-General Tedros Adhanom Ghebreyesus said a month ago, he had convened the Emergency Committee under the International Health Regulations (IHR) to assess whether the multi-country monkeypox outbreak represented a public health emergency of international concern (PHEIC). At the time, 3,040 cases of monkeypox had been reported to the WHO from 47 countries.
• Since then, the outbreak has continued to grow, and there are now more than 16,000 reported cases from 75 countries and territories, and five deaths reported.
• Although monkeypox has been established in parts of central and west Africa for decades, it was not known to spark large outbreaks beyond the continent or to spread widely among people until May, when authorities detected dozens of epidemics in Europe, North America and elsewhere.
• The emergency declaration mostly serves as a plea to draw more global resources and attention to an outbreak.
• WHO now has three active public health emergencies of international concern: COVID-19, polio and monkeypox.
What are the International Health Regulations (IHR)?
• The International Health Regulations (2005) represents a binding international legal agreement involving 196 countries across the globe, including all the Member States of WHO. Their aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide.
• The purpose and scope of the IHR (2005) is to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade.
• Members of an IHR Emergency Committee are drawn from the IHR Experts Roster, established by the Director-General, and, where appropriate, from other WHO expert advisory panels.
• The Emergency Committee provides technical advice to the WHO Director-General in the context of a ‘public health emergency of international concern’ (PHEIC).
What is PHEIC?
A PHEIC is defined in the IHR (2005) as, “an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response”.
This definition implies a situation that is:
i) Serious, sudden, unusual or unexpected.
ii) Carries implications for public health beyond the affected State’s national border.
iii) May require immediate international action.
WHO has to consider five elements to decide whether an outbreak constitutes a public health emergency of international concern.
1) Information provided by countries – which in this case shows that the virus has spread rapidly to many countries that have not seen it before.
2) The three criteria for declaring a public health emergency of international concern under the International Health Regulations — being an extraordinary event, a public health risk to other States and a potential need to require a coordinated international response.
3) The advice of the Emergency Committee — which did not reach a consensus.
4) Scientific principles, evidence and other relevant information – which are currently insufficient.
5) The risk to human health, international spread, and the potential for interference with international traffic.
Recommendations to fight monkeypox
In order to fight the monkeypox outbreak, WHO recommends countries to:
• Implement a coordinated response to stop transmission and protect vulnerable groups.
• Engage and protect affected communities.
• Intensify surveillance and public health measures.
• Strengthen clinical management and infection prevention and control in hospitals and clinics.
• Accelerate research into the use of vaccines, therapeutics and other tools.
What is monkeypox?
• Monkeypox is a rare disease that is caused by infection with monkeypox virus.
Monkeypox virus belongs to the Orthopoxvirus genus in the family Poxviridae. The Orthopoxvirus genus also includes variola virus (which causes smallpox), vaccinia virus (used in the smallpox vaccine), and cowpox virus.
• Monkeypox has symptoms similar, but less severe, to smallpox. While smallpox was eradicated in 1980, monkeypox continues to occur in countries of central and west Africa.
• Monkeypox is zoonosis: a disease that is transmitted from animals to humans.
• Monkeypox was first discovered in 1958 when outbreaks of a pox-like disease occurred in monkeys kept for research, hence the name ‘monkeypox’.
• The first human case was recorded in 1970 in the Democratic Republic of the Congo (then known as Zaire), and since then the infection has been reported in a number of central and western African countries. Most cases are reported from Congo and Nigeria.
• In 2003, monkeypox was recorded in the United States when an outbreak occurred following importation of rodents from Africa. Cases were reported in both humans and pet prairie dogs. All the human infections followed contact with an infected pet and all patients recovered.
• Monkeypox does not spread easily between people.
• Spread of monkeypox may occur when a person comes into close contact with an animal (rodents are believed to be the primary animal reservoir for transmission to humans), human, or materials contaminated with the virus.
• The virus enters the body through broken skin (even if not visible), the respiratory tract, or the mucous membranes (eyes, nose, or mouth).
Person-to-person spread is very uncommon, but may occur through:
• Contact with clothing or linens (such as bedding or towels) used by an infected person.
• Direct contact with monkeypox skin lesions or scabs.
• Coughing or sneezing of an individual with a monkeypox rash.
Initial symptoms include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion. A rash can develop, often beginning on the face, then spreading to other parts of the body. The rash changes and goes through different stages before finally forming a scab, which later falls off.
• Detection of viral DNA by polymerase chain reaction (PCR) is the preferred laboratory test for monkeypox.
• Monkeypox, in most cases, is a mild condition which will resolve on its own and have no long-term effects on a person’s health. Most people recover within a few weeks. However, severe illness can occur in some individuals.
• Treatment of monkeypox patients is supportive dependent on the symptoms. Various compounds that may be effective against monkeypox virus infection are being developed and tested.
• Prevention and control of human monkeypox rely on raising awareness in communities and educating health workers to prevent infection and stop transmission.