WHO says monkeypox risk assessed as ‘moderate’

The World Health Organization (WHO) said Monday that the international monkeypox virus outbreak is assessed as “moderate” – even as the agency noted the actual number of cases “is likely to be underestimated.”

The United Nations (UN) health agency said in a release that, since June 22. 2022, there have been more than 3,400 laboratory-confirmed cases and one death reported to WHO from 50 countries and territories.  

The majority of those cases were reported from the WHO European Region, with the region of the Americas making up 11%. 

The death was reported in Nigeria in the second quarter of 2022. 

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“The overall risk is assessed as moderate at [the] global level considering this is the first time that cases and clusters are reported concurrently in five WHO Regions,” the WHO said. “At the regional level, the risk is considered to be high in the European Region due to its report of a geographically widespread outbreak involving several newly-affected countries, as well as a somewhat atypical clinical presentation of cases. In other WHO Regions, the risk is considered moderate with consideration for epidemiological patterns, possible risk of importation of cases and capacities to detect cases and respond to the outbreak.” 

It highlighted that, for newly affected countries, this is the first time that cases have mainly been confirmed among men who have had recent sexual contact with a new or multiple partners.  

In addition, the WHO said the unexpected appearance of monkeypox worldwide indicates that the virus may have been circulating below levels detectable by the surveillance systems and that “sustained human-to-human transmission might have been undetected for a period of time.” 

The presentation of monkeypox cases associated with the outbreak has been “atypical,” including the presentation of only a few or even just a single lesion, the absence of skin lesions with anal pain and bleeding, lesion in the genital or perineal area that do not spread, lesions appearing at different stages of development and the appearance of lesions before fever, malaise and other constitutional symptoms.

“The actual number of cases is likely to be underestimated, in part due to the lack of early clinical recognition of an infection previously known in only a handful of countries and limited enhanced surveillance mechanisms in many countries for a disease previously ‘unknown’ to most health systems,” the WHO said, noting that health care-associated infections “cannot be ruled out.” 

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To respond, smallpox vaccines have received authorization in the U.S., Europe and Canada to treat monkeypox. 

Following a June 23, 2022, meeting, the International Health Regulations Emergency Committee advised the WHO director-general that the outbreak did not constitute a Public Health Emergency of International Concern at this stage. 

However, the committee advised the event should be closely monitored and reviewed again. 

The WHO does not recommend that measures to restrict international traffic be adopted, but advised that any person who is considered a suspected or confirmed case of monkeypox avoid non-essential travel and that those who have developed a rash-like illness during travel or upon return should immediately report to a health professional.

Data from the Centers for Disease Control and Prevention (CDC), shows there are now more than 240 confirmed monkeypox and orthopoxvirus cases in the U.S.