Update on Worldwide Monkeypox Outbreak (2022)

I previously reported on the history of the current outbreak of monkeypox among mainly men who have sex with men (MSM) and the need to vaccinate MSM as soon as possible. I also discussed public health messaging around monkeypox and COVID and the need to increase trust in public health in this current time of infectious disease outbreaks. Now that the World Health Organization (WHO) has declared monkeypox a global health emergency of international concern (as of July 23), I wanted to provide you with an update on epidemiology, clinical manifestations, and vaccine strategy.

A very important clinical series was just published on July 21 in The New England Journal of Medicine that gives us a better idea of the most prevalent symptoms.

As a reminder, the first case of monkeypox was reported to the WHO on May 13, 2022. At this point, surveillance has revealed that almost 14,000 cases in the current outbreak have been reported in 78 countries. Most of the initial cases were in Europe, particularly in the UK, where the first European case was reported, but since then transmission has been reported across the world. The countries most affected are Spain, Germany, the United States, England, and France.

In the US, there have been 2891 cases reported as of July 23, 2022, with a high concentration in New York, followed by California. In California, there have been 434 cases reported as of June 23, with approximately one third of those in San Francisco, where I practice.

(Video) Global Monkeypox Outbreak: 75 countries, 16,000 cases and 5 deaths | Latest World News | WION

Most of the cases in this current outbreak are among men (with the worldwide surveillance site from Global Health showing that 99% of cases are in men) and the average age of individuals in this outbreak is 41 years. The major population at risk remains MSM, likely from close skin-to-skin contact and close respiratory contact.

In terms of the main clinical symptoms, an important case series was published in the NEJM this past week which describes the main clinical features of monkeypox in this outbreak. Among 528 cases diagnosed between April 27 and June 24, 2022, at 43 sites in 16 countries, 98% of the persons with infection were gay or bisexual men, 75% were White, and 41% had HIV; the median age was 38 years. Transmission was suspected to have occurred through sexual activity in 95% of the persons with infection.

Skin lesions were noted in 95% of individuals, with the most common anatomical sites being the anogenital area (73%); the trunk, arms, or legs (55%); the face (25%); and the palms and soles (10%). A wide spectrum of skin lesions was seen, including macular (flat), pustular, vesicular (blisters), and crusted lesions, and lesions in multiple phases were present simultaneously. The number of lesions varied widely, with most persons having fewer than 10 lesions and 10% having only a single genital ulcer (which can be confused for another sexually transmitted infection).

Mucosal lesions were reported in 41% of individuals, and among those with anorectal lesions, the involvement was associated pain, proctitis, tenesmus, or diarrhea (or a combination of these symptoms). Oropharyngeal symptoms were reported as the initial symptoms in 5% of the case series, with symptoms that included pharyngitis, odynophagia (pain when swallowing), epiglottitis, and oral or tonsillar lesions. Common systemic features included fever (in 62%), lethargy (41%), myalgia (31%), headache (27%), and lymphadenopathy (56%), symptoms that frequently preceded the rash. Of importance is that the clinical presentation was similar among persons with HIV infection and those without HIV infection.

(Video) Monkeypox outbreak a global health emergency: WHO

Most individuals do not require treatment unless the lesions are very painful or disseminated (in multiple places). The main treatment available for disseminated monkeypox at this time (with multiple lesions) is tecovirimat (an oral antiviral which treats orthopoxviruses), which is available from the Centers for Disease Control and Prevention (CDC) and is getting easier to obtain.

As I've noted previously, a highly effective vaccine called Jynneos has been licensed in the United States to prevent monkeypox and smallpox. On June 1, the CDC updated its recommendations to say that Jynneos is the preferred postexposure prophylaxis for close contact of monkeypox cases (eg, household contacts or healthcare workers) and thereafter, many scientists, including myself, wrote about how we need to give Jynneos as a preventive vaccine to gay and bisexual men. The Jynneos vaccine is highly effective in protecting against monkeypox.

COVID-19 did not have an effective vaccine when it initially spread in the US in early 2020 and required masks, distancing, ventilation, testing, and contact tracing to try to minimize transmission. With monkeypox, we are not at that disadvantage. We have a vaccine and the US is finally procuring more doses. However, our current attempts to test and contact-trace our way out of this epidemic are failing, so we need to vaccinate those at risk (all sexually active MSM in the US).

Moreover, in terms of vaccine strategy, I think we need to be creative about spreading out the doses in this time of limited supplies. The usual dosing strategy for the monkeypox vaccine is one dose followed by a second dose 4 weeks later. I would advocate for the first-dose-first strategy that was used for the COVID vaccine in the UK, Canada, and India at the beginning of the vaccine rollout when supplies were limited. This means that we give one dose now to get as many doses out to MSM as possible followed by the second dose when vaccine supplies increase.

(Video) World Health Organization chief declares monkeypox outbreak a global emergency

I also think we should hold off on vaccinating those who have had smallpox vaccination (which ended around 1970 in the US), since these individuals will likely still have some protection against monkeypox. Then, when vaccine supplies increase, we can extend doses to every MSM who wants to be vaccinated. Later, if we start to see significant rises in monkeypox infections in heterosexuals (which is not occurring now), the vaccine will be offered more widely to all sexually active individuals then.

Finally, I think the focus on the LGBTQ population is very helpful. Just like with HIV and COVID, it is important to define populations most at risk so we can prioritize targeted messaging and resources toward those groups. With HIV, it was counterproductive to say that all groups were at risk, and the same is true for monkeypox. If the infection spreads to all sexually active adults, the vaccine will eventually be offered to all of them (or simultaneously when HPV vaccine is offered to adolescents as a preventive vaccine for a new sexually transmitted infection).

Now that the monkeypox outbreak is officially recognized as a global health emergency, I will be providing you with regular updates. With this new vaccine we can hopefully get on top of this soon.

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(Video) Monkeypox outbreak: New cases show community transmission | International News | English News | WION

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About Dr Monica Gandhi

Monica Gandhi, MD, MPH, is an infectious diseases doctor, professor of medicine, and associate chief in the Division of HIV, Infectious Diseases, and Global Medicine at the University of California, San Francisco (UCSF). She is also director of the UCSF Center for AIDS Research (CFAR) and medical director of the HIV Clinic ("Ward 86") at San Francisco General Hospital. Her research focuses on HIV and women; adherence measurement in HIV treatment and prevention; and, most recently, on how to mitigate the COVID-19 pandemic.

Connect with her on Twitter: @MonicaGandhi9

(Video) WHO declares Monkeypox outbreak a global health emergency | World Latest English News | WION

FAQs

How many deaths has monkeypox caused? ›

Out of more than 57,000 people confirmed to have had monkeypox infections, at least 22 have died, representing a death rate of about 0.04%.

Which countries are affected by monkey pox? ›

View:
LocationCasesDeaths
Central African Republic82
Chile8800
China10
Colombia2,0420
84 more rows
31 Aug 2022

How many monkey pox cases are there in Europe? ›

Europe, which has confirmed more than 22,000 monkeypox cases (more than a third of the global tally), has so far authorized one monkeypox vaccine, a smallpox shot made by Danish firm Bavarian Nordic and marketed in Europe as Imvanex, but the supply is limited worldwide.

How many cases of monkeypox are there? ›

Globally, more than 64,000 infections have been reported since May.

What country has the most monkeypox cases? ›

U.S. leads the world in monkeypox cases, eclipsing nearly 80 countries where the disease occurs.

How do you avoid getting monkeypox? ›

Monkeypox Prevention Steps. Avoid close, skin-to-skin contact with people who have a rash that looks like monkeypox. Do not touch the rash or scabs of a person with monkeypox. Do not kiss, hug, cuddle or have sex with someone with monkeypox.

How many cases of monkeypox are there in the world in 2022? ›

Since the start of the monkeypox outbreak and as of 27 September 2022, 20 083 confirmed cases of monkeypox (MPX) have been reported from 29 EU/EEA countries. In total, 58 cases have been reported from three Western Balkan countries and Turkey.

Is monkeypox a global health emergency? ›

Over the weekend, the World Health Organization (WHO) declared that the monkeypox outbreak spreading globally is a 'public health emergency of international concern' (PHEIC).

What is the treatment for monkeypox? ›

There are no treatments specifically for monkeypox. But because the viruses that cause monkeypox and smallpox are similar, antiviral drugs developed to protect against smallpox may be used to treat monkeypox effectively.

What is the incubation period for monkeypox? ›

The incubation period is 3-17 days. During this time, a person does not have symptoms and may feel fine. The illness typically lasts 2-4 weeks. The severity of illness can depend upon the initial health of the individual and the route of exposure.

Can I get monkeypox vaccine? ›

In the U.S., two vaccines (JYNNEOS and ACAM2000) may be used to prevent the spread of monkeypox. Monkeypox is caused by a virus that is closely related to the virus that causes smallpox. JYNNEOS, a 2-dose vaccine, was developed to protect against both monkeypox and smallpox.

How many monkey pox cases in Florida? ›

According to data from the Florida Department of Health, there are a little more than 1,900 confirmed cases in Florida. Doctors say most of the cases are either in Miami-Dade or Broward counties.

What kills monkey pox? ›

Objects and surfaces can be cleaned with soap and water and common household disinfectants or a bleach product to kill the monkeypox virus.

Is monkeypox in the US 2022? ›

On August 4, 2022, the U.S. Centers for Disease Control and Prevention declared monkeypox a public health emergency in the United States. Wyoming was the last and most recent state in the United States to report at least one monkeypox case.

Which state has the most monkeypox? ›

Washington, D.C., has the highest case rate by population. With 110 cases and a population of less than 690,000, monkeypox has been detected in about 0.016 percent of residents. Next highest is New York state, which leads the overall number of cases with 900 reported cases.

How many cases of monkeypox are in USA? ›

Monkeypox Global Outbreak Stats

Of those cases, 60,220 cases have been identified in 97 countries that have not reported monkeypox cases before. The U.S. has reported the highest number of monkeypox cases, followed by Spain with 6,947, and Brazil with 6,448.

WHO should get monkeypox vaccine? ›

CDC recommends vaccination for people who have been exposed to monkeypox virus and people who may be more likely to get monkeypox. Learn more about who should get vaccinated. There are currently two vaccines (JYNNEOS and ACAM2000) that can be used to prevent monkeypox.

Where has monkeypox spread in the US? ›

2022 U.S. Map & Case Count
LocationCases
New York3,904
North Carolina566
North Dakota6
Ohio275
48 more rows
22 Sept 2022

Do condoms protect against monkeypox? ›

Do condoms prevent you catching or passing on monkeypox? Answer: Use of condoms are always encouraged to prevent Sexually Transmitted Infections. Monkeypox is not a sexually transmitted infection by nature, though it can be passed on by direct contact during sex.

Can dogs get monkeypox? ›

Signs of monkeypox in dogs includes development of a new rash, which to-date have been located on the abdomen and anus. Do not euthanize pets with suspected monkeypox unless directed by a veterinarian.

How can you protect yourself from monkeypox in public? ›

Avoid handling clothes, sheets, blankets or other materials that have been in contact with an infected animal or person. Isolate people who have monkeypox from healthy people. Wash your hands well with soap and water after any contact with an infected person or animal. Avoid animals that may carry the virus.

Where did the 2022 monkeypox outbreak start? ›

An ongoing outbreak of monkeypox, a viral disease, was confirmed in May 2022. The initial cluster of cases was found in the United Kingdom, where the first case was detected in London on 6 May 2022 in a patient with a recent travel history from Nigeria (where the disease is endemic).

What does monkeypox rash look like? ›

What Does a Monkeypox Rash Look Like? Chicago's top doctor said the rashes "can look like a blister, like a pimple and can be very painful." "These sores can look like pimples and may be painful or itchy.

Are monkeypox itchy? ›

Monkeypox symptoms

The rash can initially look like pimples or blisters and may be painful or itchy.

WHO PHEIC monkeypox? ›

Monkeypox was declared a Public Health Emergency of International Concern (PHEIC) by the WHO Director-General Tedros Adhanom Ghebreyesus on July 23, 2022. This is the seventh declaration of a PHEIC since 2005. The PHEIC is governed by the International Health Regulations (IHR).

What does monkeypox emergency mean? ›

Key Takeaways. New York, California, and Illinois have declared monkeypox to be a public health emergency. This often allows health officials to better coordinate their response to the outbreak, frees up resources, waives restrictions, and requires health providers to report relevant data.

Are monkeypox painful? ›

Besides the usual signs, new monkeypox symptoms may include: Painful rash that may start out on your pubic area, genitals, or around your anus. Fewer bumps (one to two bumps)

What happens if you pop a monkeypox blister? ›

Don't lance (pop) or scratch lesions from the rash. This does not speed up recovery and can spread the virus to other parts of the body, increase the chance of spreading the virus to others, and possibly cause the open lesions to become infected by bacteria.

Where does monkeypox rash start? ›

What does the monkeypox rash look like? "During this particular outbreak, we're seeing that the rash may start in the groin, genital region, or around the anus – and sometimes stay in the spot that it started instead of spreading," says Dr. Freeman. People may have only 1 or 2 bumps on their skin.

What does first stage of monkeypox look like? ›

What are the stages of the rash? The rash caused by monkeypox is broken into four stages: macular, papular, vesicular and pustular. According to the CDC, the rash starts out as macules, when the lesions first appear as flat areas of discoloured skin. Then they become papules, progressing to raised bumps.

What does monkeypox feel like? ›

With monkeypox, people usually experience viral symptoms like fever, tiredness, headaches, and general achiness. Some people have these symptoms before developing a rash, while others experience them after the rash appears. Like other viral illnesses (think flu or COVID-19), symptoms vary from person to person.

Does the smallpox vaccine protect against monkeypox? ›

Is there a monkeypox vaccine? The crossover between monkeypox and smallpox means that the prevention plan for them also matches up. According to the CDC, smallpox vaccines are up to 85% effective in preventing monkeypox.

How do you test for monkeypox? ›

To get a specimen to test, the healthcare provider will use a swab to rub vigorously across lesions of your rash. They will take swabs from more than one lesion. This swabbing may be uncomfortable but is necessary to get enough material to detect the monkeypox virus from the specimens.

How long do monkeypox vaccine side effects last? ›

The 'super common' reaction to the monkeypox vaccine

A growing number of social media users have reported a red bump that appears at their Jynneos vaccine injection site, which typically lasts two to three weeks.

Is Smallpox vaccine good for life? ›

Smallpox vaccination provides full immunity for 3 to 5 years and decreasing immunity thereafter. If a person is vaccinated again later, immunity lasts even longer. Historically, the vaccine has been effective in preventing smallpox infection in 95% of those vaccinated.

Can monkeypox spread in a pool? ›

But no additional infections were reported as a result of either case. Myth #3: You can get monkeypox from a swimming pool. Fact: You cannot get monkeypox just by going in a swimming pool. However, if you are in close physical contact with someone who has monkeypox lesions, you could become infected.

How many confirmed cases of monkeypox in Georgia? ›

The latest Department of Public Health numbers show Georgia with 1,240 total confirmed cases. Almost all cases continue to be among men who have sex with men. And Black people are disproportionately affected by the outbreak in Georgia.

Can kids get monkeypox? ›

Is monkeypox a risk for children and adolescents? The risk of children and adolescents getting infected with monkeypox virus is low. Monkeypox can spread to anyone through close, personal, often skin-to-skin contact and not through casual contact (eg, in school, child care settings).

Are monkeypox painful? ›

Monkeypox symptoms

The rash can initially look like pimples or blisters and may be painful or itchy.

What happens if you pop a monkeypox blister? ›

Don't lance (pop) or scratch lesions from the rash. This does not speed up recovery and can spread the virus to other parts of the body, increase the chance of spreading the virus to others, and possibly cause the open lesions to become infected by bacteria.

How many cases of monkeypox are in Texas? ›

Texas, with 1,604 cases, is the state with the fourth-highest total of infections. However, deaths associated with monkeypox are still considered rare. There have only been 15 deaths reported in the world, according to the CDC.

Can dogs get monkeypox? ›

Signs of monkeypox in dogs includes development of a new rash, which to-date have been located on the abdomen and anus. Do not euthanize pets with suspected monkeypox unless directed by a veterinarian.

How do I get rid of monkeypox? ›

There are no treatments specifically for monkeypox. But because the viruses that cause monkeypox and smallpox are similar, antiviral drugs developed to protect against smallpox may be used to treat monkeypox effectively.

What states have cases of monkeypox? ›

2022 U.S. Map & Case Count
LocationCases
New York3,904
North Carolina566
North Dakota6
Ohio275
48 more rows
22 Sept 2022

How quickly does monkeypox spread? ›

The incubation period (interval from infection to onset of symptoms) of monkeypox is usually from 6 to 13 days but can range from 5 to 21 days.

How long do you have to isolate with monkeypox? ›

Current data suggest people can spread monkeypox from the time symptoms start until all symptoms have resolved, including full healing of the rash with formation of a fresh layer of skin. Ideally, people with monkeypox would remain in isolation for the duration of illness, which typically lasts two to four weeks.

What are the stages of monkeypox? ›

The evolution of lesions progresses through four stages—macular, papular, vesicular, to pustular—before scabbing over and desquamation. The incubation period is 3-17 days. During this time, a person does not have symptoms and may feel fine. The illness typically lasts 2-4 weeks.

How many cases of monkeypox are there in the US? ›

As of August 22, monkeypox has spread to all 50 states in the United States, as well as Washington, D.C., and Puerto Rico.
...
2022 monkeypox outbreak in the United States
Index caseBoston, Massachusetts
Arrival dateMay 18, 2022 (4 months, 1 week and 5 days ago)
DateAs of 24 September 2022
Confirmed cases24,846
7 more rows

What states have the largest outbreak of monkeypox? ›

Still, the world's largest monkeypox outbreak belongs to the U.S. The U.S. had reported 22,774 confirmed monkeypox/orthopoxvirus cases as of Wednesday, per the CDC. Highly-populated states are leading the numbers – with 4,300 confirmed cases in California, followed by 3,694 confirmed cases in New York.

Can I get monkeypox vaccine? ›

In the U.S., two vaccines (JYNNEOS and ACAM2000) may be used to prevent the spread of monkeypox. Monkeypox is caused by a virus that is closely related to the virus that causes smallpox. JYNNEOS, a 2-dose vaccine, was developed to protect against both monkeypox and smallpox.

Is monkeypox a leprosy? ›

A widely shared social media post likening the current monkeypox outbreak to biblical-era leprosy outbreaks has some users confused, others amused. The post says but does not provide any evidence that monkeypox, a viral disease, and leprosy, a bacterial infection, are actually the same illness. They are not.

What does the beginning of monkeypox look like? ›

What Does a Monkeypox Rash Look Like? Chicago's top doctor said the rashes "can look like a blister, like a pimple and can be very painful." "These sores can look like pimples and may be painful or itchy.

How do you test for monkeypox? ›

To get a specimen to test, the healthcare provider will use a swab to rub vigorously across lesions of your rash. They will take swabs from more than one lesion. This swabbing may be uncomfortable but is necessary to get enough material to detect the monkeypox virus from the specimens.

How did monkeypox spread to a dog? ›

In what's known as spillback (transmission of pathogens from humans to animals), the dog in France is believed to have been infected with monkeypox through close contact with infected people in the household, including sleeping in the same bed.

Videos

1. New warnings over monkeypox outbreak
(CNBC Television)
2. Monkeypox outbreak meets global health emergency criteria, expert says
(CBC News)
3. Monkeypox Outbreak: How it spreads, who is at risk? | Latest English News | WION
(WION)
4. Monkeypox outbreak: 'Further spread of virus likely,' says WHO | International News | WION
(WION)
5. WHO declares monkeypox a 'global health emergency' | DW News
(DW News)
6. WHO declares highest alert over monkeypox outbreak - BBC News
(BBC News)

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