At the start of an emergency meeting of the World Health Organization (WHO) on Thursday, to decide whether the current global epidemic of smallpox virus should be declared a public health emergency of international concern (PHEIC), the World Health Network ), independent international cooperation of scientists and concerned citizens, stated on Wednesday, June 22, 2022, that the monkeypox epidemic meets the definition of a pandemic.
The statement said: “The World Health Network (WHN) today announced that it is declaring the current monkeypox epidemic a pandemic, given that there are currently 3,417 confirmed cases of monkeypox reported in 58 countries, and the outbreak is rapidly grows on many continents.
They explained that without concerted global action, the outbreak would continue and move to vulnerable populations such as children, expectant mothers and the immunocompromised. They warned that all people aged 40 and under who had never been immunized against smallpox before remained extremely vulnerable to monkeypox and that spilling on animals such as rodents and pets could potentially make the pathogen endemic in a wide geographical region. with significant long-term consequences.
The WHN statement reads: “Even with mortality much lower than smallpox, unless action is taken to stop the continued spread – actions that can be put into practice – millions of people will die and many more will go blind and they will become disabled. So far, only one death in Brazil has been attributed to monkeypox.
As of June 24, there were 4,118 confirmed or suspected cases involving at least 65 countries and territories. Yesterday, another 461 cases were added to the growing number. The seven-day creeping average of new infections has risen to 280 a day and is rising. Taiwan, Singapore and South Korea are the last countries in Asia to have confirmed cases. Other non-endemic countries that have recently reported cases of monkeypox include South Africa, Croatia, Bulgaria, Colombia and Gibraltar.
Figure 1: Mean and cumulative cases of monkeypox infections for seven days. A @antonio_caramia source gave permission to WSWS to use these numbers. Please follow the hyperlink to the website.
The case in Singapore involves a British Airways flight attendant who visited several restaurants during a stay in mid-June. On June 20, he developed flu-like symptoms and pathognomonic skin rashes, prompting him to seek medical attention. The Ministry of Health of Singapore told the press that the man is being treated at the National Center for Infectious Diseases, 13 close contacts have been identified and the search continues.
The South Korean citizen, who reported to the Korean CDC, has just returned from Germany, where cases have been on the rise recently. He had symptoms of the return flight with headache, fever, sore throat, fatigue and skin lesions. Another case is being investigated.
On Thursday, South African Health Minister Joe Faala said they had confirmed a case of monkeypox in a 30-year-old man from Johannesburg with no travel history, meaning he had been acquired in the community and the extent of the infection remained unknown. The Minister of Health assured the press that a follow-up of contacts is underway.
With more than 900 cases, the UK is leading in all other countries in the number of cases. According to the UK Health Security Agency, cases have increased by more than 40 percent in less than a week. Europe remains the epicenter of the monkeypox epidemic, with Germany ahead of Spain and Portugal. However, in North America, Canada saw 267 cases and the United States 173.
Figure 2: Cumulative cases of monkeypox in Europe as of June 24, 2022 Source: @antonio_caramia
Professor Janier Bar-Yam, PhD, president of the New England Integrated System Institute and co-founder of the WHN, said emphatically: “There is no excuse to wait for the monkeypox pandemic to grow. The best time to act is now. By taking immediate action, we can control the outbreak with the least amount of effort and prevent the consequences from getting worse. The necessary action now requires only clear public communication on symptoms, widely available tests and contact tracking with very little quarantine. Any delay only makes the effort harder and the consequences more severe. ”
Dr Eric Feigel-Ding, PhD, epidemiologist and health economist and co-founder of WHN, added: “WHO urgently needs to declare its own public health emergency of international concern (PHEIC) – the lessons of non-declaration January 2020 should be remembered as a history lesson about what action late during an epidemic could mean to the world.
WHO Director-General Dr. Tedros Adanom Gebrejesus has previously acknowledged that the disease is more prevalent than official figures suggest. At a meeting of the emergency committee on Thursday, he confirmed this fact, saying: “The person-to-person transmission continues and is probably underestimated.” His statement suggests that public health officials do not have a clear understanding of where these cases occur and how widespread they are.
Public health officials are focused on tracking cases among men who have sex with men. The UK Health Security Agency noted that the monkeypox virus appears to be a threat “in the sexual networks of gays, bisexuals and other men who have sex with men”.
David Hayman, a professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine, attending 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 spread to other populations. ” contact.
Figure 3: Cases of monkeypox by date and country as of June 24, 2022. Source @antonio_caramia.
Genetic sequencing data traces the origins of the outbreak back several years. Trevor Bedford, an evolutionary biologist at the Fred Hutchinson Cancer Research Center in Seattle, told the New York Times that “genomic models suggest this happened around 2018,” when the virus has potentially improved in spread. from person to person.
Anthropologist and assistant professor Sagan Fryant of Pennsylvania State University, who studies the zoonotic interactions of monkeypox in Nigeria, said in an interview with WPSU public media in Central Pennsylvania in May: “Many of the export cases we’ve seen in the past have had one or more or zero subsequent cases due to contact between a person. But now that we see these many cases [in] many parts of the globe you see a prolonged transmission from person to person, which is very unexpected and something we are watching.
She also explained that the zoonotic interaction between humans and animals goes in both directions. The spread of the monkeypox virus from humans back to animals as rodents in countries outside previously non-endemic regions would mean that 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 very effective mechanisms for error correction during replication. It acquires approximately one or two mutations per year compared to 20 to 30 mutations for RNA viruses. However, the current monkeypox virus has received almost 50 mutations compared to the 2018 version, which means that it would take several decades for it to acquire these many DNA changes.
The researchers focused 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 that animals, including humans, have that cause mutations in the virus when they come in contact with it.
Speaking to STAT News, Richard Necher, a computational evolutionary biologist at the University of Basel, explained that “the idea behind such a 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 will remain is just a dead piece of DNA. It would be like rearranging the letters on your enemy’s typewriter so that they can’t get a clear message. “However, the process is uncertain and the mutations that carry the 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 bottom line is that the rapid accumulation of mutations may be a product of the monkeypox virus, which has spread to humans, not rodents. Neher admitted: “We do not have a good enough understanding of 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 the animals and the pathogens that colonized them, a leap in human hosts becomes increasingly inevitable unless immediate efforts are made to investigate and address this insurmountable issue. Virologist Dr Michael Malim of King’s College London, who opened APOBEC3 in 2002, told the Times: “These transfusions of other types and what they mean and what the trajectory is – it’s very unpredictable. And it’s happening more and more. “
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