In a run-up to the World Health Organization (WHO) emergency meeting on Thursday to decide whether the current global outbreak of the monkeypox virus should be declared a public health emergency of interest (PHEIC), the World Health Network (WHN), an independent international collaboration of concerned scientists and citizens, said on Wednesday, June 22, 2022 that the smallpox outbreak was in line with the definition of pandemic.
The statement said: “The World Health Network (WHN) announced today that it is declaring the current smallpox outbreak of the monkey as a pandemic, as there are now 3,417 confirmed cases of smallpox in 58 countries and the outbreak is is rapidly expanding to several continents “.
They explained that without concerted global action, the outbreak would continue and move to vulnerable populations such as children, pregnant women and immunocompromised people. They warned that all people 40 years of age or younger who have never been previously immunized against smallpox remain extremely vulnerable to monkeypox, and that shedding on animals such as rodents and domesticated pets could make the pathogen endemic in a wide geographical region with important long-term consequences. .
The WHN statement says: “Even with much lower mortality rates than smallpox, unless action is taken to stop the spread, actions that can be implemented virtually, millions of people will die and many more will go blind. and disabled. ” So far, only one death in Brazil has been attributed to monkeypox.
As of June 24, there have been 4,118 confirmed or suspected cases spanning at least 65 countries and territories. Yesterday 461 more cases were added to the growing total. The seven-day average of new infections has grown to 280 per day and is increasing. Taiwan, Singapore and South Korea are the latest Asian countries to have confirmed cases. Other non-endemic countries that have recently reported cases of smallpox include South Africa, Croatia, Bulgaria, Colombia and Gibraltar.
Figure 1: Average seven days and cumulative cases of monkeypox infections. Source @antonio_caramia gave WSWS permission to use these figures. Please follow the hyperlink to the website.
The case in Singapore involved a British Airways flight attendant who had attended several establishments at its stops in mid-June. On June 20, he developed flu-like symptoms and pathognomonic rashes, which led him to seek medical attention. The Singapore health ministry told the press that the man was being treated at the National Center for Infectious Diseases, 13 close contacts had been identified and the search was ongoing.
The South Korean citizen who reported to the Korean CDC had just returned from Germany, where cases have been on trend recently. On his return flight he was symptomatic with headache, fever, sore throat, fatigue and skin lesions. Another case is also being investigated.
On Thursday, South African Health Minister Joe Phaahla reported that they had confirmed a case of smallpox in a 30-year-old man from Johannesburg with no travel history, meaning it was acquired in the community and the scope of infections are still unknown. The Minister of Health assured the press that the tracking of contacts was underway.
With more than 900 cases, Britain leads the rest of the countries in the large number of cases. According to the UK Health Safety Agency, cases shot up more than 40 per cent in less than a week. Europe remains the epicenter of the smallpox outbreak, with Germany surpassing Spain and Portugal. However, in North America, Canada has seen 267 cases and the United States 173.
Figure 2: Accumulated cases of monkeypox in Europe from June 24, 2022. Source: @antonio_caramia
Professor Yaneer Bar-Yam, Ph.D., president of the New England Complex System Institute and co-founder of WHN, emphatically stated, “There is no justification for waiting for the monkeypox pandemic to grow further. The best time to act is now.If we take immediate action, we can control the outbreak with minimal effort and prevent the consequences from getting worse.The necessary actions now only require clear public communication about symptoms, widely available tests and follow-up with very few contacts quarantine. Any delay only makes the effort more difficult and the consequences more serious. “
Dr Eric Feigl-Ding, PhD, epidemiologist and health economist and co-founder of WHN, added: “The WHO urgently needs to declare its own public health emergency of international interest (PHEIC): the lessons of no declare A PHEIC immediately in early January 2020 must be remembered as a history lesson of what it can mean for the world to act late in the face of an epidemic. “
WHO Director-General Dr Tedros Adhanom Ghebreyesus has previously acknowledged that the disease is more widespread than official figures suggest. At Thursday’s emergency committee meeting, he reaffirmed that “person-to-person transmission is ongoing and probably underestimated.” His statement implies that public health officials do not have a clear understanding of where these cases arise and how far they are.
Public health officials have focused on tracking cases between men who have sex with men. The UK Health Safety Agency noted that the monkeypox virus appears to be a threat “to the sexual networks of gay, bisexual and other men who have sex with men”.
David Heymann, a professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine present at the WHO emergency conference, told the Washington Post: “We are beginning to understand how widespread it really is. We know that it is widespread in certain populations and we need to know if it is also spreading to other populations. ” There is growing evidence that there are multiple routes of transmission that also include air routes, although it does not spread easily between people and requires close contact.
Figure 3: cases of smallpox of the monkey by date and country from June 24, 2022. Source @antonio_caramia.
Genetic sequencing data locates the origin of the outbreak a few years back. Trevor Bedford, an evolutionary biologist at Seattle’s Fred Hutchinson Cancer Research Center, told the New York Times that “genomic patterns would suggest this happened around 2018,” when the virus potentially improved to spread from person to person.
Anthropologist and adjunct professor Sagan Friant of Pennsylvania State University, who has been studying the zoonotic interactions of monkeypox in Nigeria, said in May during an interview with WPSU Public Media for Central Pennsylvania: “Many of the export cases we have seen in the past have had one or a few or zero subsequent cases due to human-to-human contact.But now how are we seeing these multiple cases [in] various parts of the world, you are seeing a sustained person-to-person transmission that is very unexpected and something we are watching. “
He also explained that the zoonotic interaction between humans and animals goes both ways. Pouring virus from human monkeypox into animals such as rodents in countries outside previously non-endemic regions would mean the virus could find a permanent niche around the world, repeatedly threatening new outbreaks.
Genomic analysis of recent cases has surprised virologists. Monkeypox is a large double-stranded DNA virus with highly efficient error correction mechanisms during replication. It acquires approximately one or two mutations per year compared to the 20 to 30 mutations in RNA viruses. However, the current monkeypox virus has gained nearly 50 mutations compared to the 2018 version, meaning it should have taken the monkeypox virus several decades to acquire these many changes in its DNA.
Scientists are focusing on a family of enzymes called APOBEC3 based on their analysis of recent cases and the specific type of mutations associated with that enzyme. Enzymes are part of the antiviral defense systems possessed by animals, including humans, that induce mutations in the virus when they find it.
Richard Neher, a computer evolutionary biologist at the University of Basel, speaking to STAT News, explained that “the idea behind this sabotage scheme is that if you trigger enough mutations, some of them will certainly be harmful. The virus will not be able to “Replicate and what’s left is just a piece of dead DNA. It would be like rearranging the letters on your enemy’s typewriter so they can’t get a clear message across.” However, the process is not infallible, and mutations that lead to an advantage can be passed on to the next generation.
Dr. Bedford said that while mice carry only one version of the APOBEC3 enzyme, humans have seven. The implication is that the rapid accumulation of mutations may be a product of the monkeypox virus that has been spread through humans rather than rodents in humans. Neher admitted, “We don’t understand well enough how this virus interacts with the host [people]or what these individual mutations could do “.
As urbanization, deforestation, and climate change have radically altered the natural habitats of animals and the pathogens that have colonized them, the jump to human hosts becomes increasingly inevitable unless efforts are made immediately to study and address this. convincing question. The virologist Dr. Michael Malim of King’s College London, who discovered APOBEC3 in 2002, told the Times: “These overflows of other species, and what that means and what the trajectory is, is very unpredictable. And more and more is happening.”