Only 14 Mena monkeypox cases but worldwide action critical, WHO says

Infections continue to rise with 780 confirmed patients in 27 non-endemic countries

Monkeypox cases in countries where the disease is not typically found tripled between May 29 and June 2. Reuters

A total of 14 monkeypox cases have been reported in the Middle East and North Africa, 13 in the UAE and one in Morocco, the World Health Organisation said on Wednesday.

But cases of the disease in non-endemic countries around the world “continue to rise” and the spread must be contained rapidly, said Dr Ahmed Al Mandhari, WHO regional director for the Eastern Mediterranean (Emro) at a press briefing in Cairo.

“Right now, these outbreaks can be stopped,” he said. "But it is critically important for countries to support health services and to stop onward transmission from the cases."

A total of 780 confirmed cases have been reported in 27 countries where the disease is not typically found, but no deaths. Cases tripled between May 29 and June 2.

Seven endemic countries in central and West Africa have reported more than 1,400 suspected cases and 44 confirmed infections, including 66 deaths.

The WHO has assessed the overall public health risk as moderate at both global and regional levels, with the mortality rate in endemic countries at about 3 per cent.

The virus was discovered in laboratory monkeys in 1958 and was first identified in humans in 1970. The latest outbreak in non-endemic countries last month is atypical and suggests there may have been undetected transmission for months or possibly years, the WHO has said.

“The situation is evolving rapidly and epidemiological investigations are still ongoing,” Dr Al Mandhari said.

The disease has symptoms similar — but less severe — to smallpox, which was eradicated in 1979. Both present themselves with a “fever, general unwellness, aches and pains” and a “blister-type rash” on the skin, said Dr Richard Brennan, regional emergency director for Emro.

Human-to-human transmission occurs mainly through close physical contact with infectious ulcers, lesions or sores on the skin or in the mouth or throat.

Dr Brennan said: “It doesn’t typically spread through respiratory droplets, like measles or Covid. It spreads with very close physical contact."

Recovery takes about two to four weeks and usually does not require hospital treatment. People who are more at risk include children, pregnant women and those who are immunocompromised.

Dr Rana Hajjeh, director of programme management at Emro, said: “Monkeypox is a limited disease in regards to its dangerous aspects and transmissibility to others."

Only one treatment called Tecovirimat has been approved by the WHO but is recommended for use only in severe cases.

There are some vaccines against monkeypox but they are available in “very small amounts” and are not currently the recommended method by which to control the virus, Dr Hajjeh said.

Smallpox vaccines can be used in certain instances but the stockpile comprises only about 5 million doses and features a high complication rate for people with weaker immune systems, Dr Brennan said.

“Our risk-benefit ratio suggests that it’s not the right thing to be using right now,” he said.

Measures to stop the spread include raising public awareness about the disease and its symptoms, improving surveillance measures, using contact tracing, quickly isolating suspected cases and increasing laboratory capacity.

In response to a question about the possibility of a monkeypox outbreak at Hajj next month, Dr Brennan said it is not a high risk as long as the necessary public health measures are put in place.

“The Saudi health system is very well-attuned to the potential of disease outbreaks,” he said. "If there is an outbreak, we believe the Saudi health system will respond effectively."

The emergence of infectious diseases has become the “new normal” over the last couple of decades, Dr Brennan said.

“About 70 per cent of the new infectious diseases that we have identified spill over from the animal kingdom to humans,” he said.

“We saw with Covid that the world was not prepared. We know the next disease is somewhere down the track. We know the next pandemic is somewhere down the track. This is why we absolutely have to take this seriously.”