monkeypox
Monkeypox: Govt orders screening passengers at all airports, land ports
The government has instructed the authorities concerned to strengthen surveillance and screening of people coming to Bangladesh from countries with confirmed Monekypox cases through the land ports and airports.
The Directorate General of Health Services (DGHS) issued a notice in this regard on Sunday.
Also read: Monkeypox usually self-limiting but may be severe in some individuals: WHO
According to the notice, Monkeypox is not a new disease. It was found among people in West and Middle African countries in the past. Recently it has been detected among people living in European and American countries with no history of travelling in the African countries.
People who contracted the virus or came close to the infected people should be listed as suspected patients of Monkeypox, it said.
The suspected patients or patients having symptoms should be taken to government hospitals or Infectious Diseases Hospital and kept in isolation and it should be reported to the Institute of Epidemiology, Disease Control and Research (IEDCR).
Monkeypox usually self-limiting but may be severe in some individuals: WHO
Monkeypox is usually self-limiting but may be severe in some individuals, such as children, pregnant women or persons with immune suppression due to other health conditions, says the World Health Organization (WHO) on Sunday.
Eating inadequately cooked meat and other animal products of infected animals is a possible risk factor, according to the WHO which is dedicated to the well-being of all people and guided by science.
Monkeypox virus is transmitted from one person to another by close contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding. The incubation period of monkeypox is usually from 6 to 13 days but can range from 5 to 21 days.
Also read: Israel confirms 1st monkeypox case
As of now, 92 laboratory confirmed cases, and 28 suspected cases of monkeypox with investigations ongoing, have been reported to the WHO from 12 Member States that are not endemic for monkeypox virus.
Monkeypox endemic countries are Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Ghana (identified in animals only), Ivory Coast, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan.
Since 13 May 2022, cases of monkeypox have been reported to WHO from 12 Member States that are not endemic for monkeypox virus, across three WHO regions.
Epidemiological investigations are ongoing, however, reported cases thus far have no established travel links to endemic areas.
The situation is evolving and WHO expects there will be more cases of monkeypox identified as surveillance expands in non-endemic countries.
Reported cases thus far have no established travel links to an endemic area, said the WHO on Sunday.
Based on currently available information, cases have mainly but not exclusively been identified amongst men who have sex with men (MSM) seeking care in primary care and sexual health clinics.
To date, all cases whose samples were confirmed by PCR have been identified as being infected with the West African clade.
Also read: African scientists baffled by monkeypox cases in Europe, US
Genome sequence from a swab sample from a confirmed case in Portugal, indicated a close match of the monkeypox virus causing the current outbreak, to exported cases from Nigeria to the United Kingdom, Israel and Singapore in 2018 and 2019.
The identification of confirmed and suspected cases of monkeypox with no direct travel links to an endemic area represents a highly unusual event.
Surveillance to date in non-endemic areas has been limited, but is now expanding.
WHO expects that more cases in non-endemic areas are likely to be reported. Available information suggests that human-to-human transmission is occurring among people in close physical contact with cases who are symptomatic.
In addition to this new outbreak, WHO continues to receive updates on the status of ongoing reports of monkeypox cases through established surveillance mechanisms (Integrated Disease Surveillance and Response) for cases in endemic countries [1], as summarized in table 2.
Epidemiology of the Disease
Monkeypox is a viral zoonosis (a virus transmitted to humans from animals) with symptoms very similar to those seen in the past in smallpox patients, although it is clinically less severe.
It is caused by the monkeypox virus which belongs to the orthopoxvirus genus of the Poxviridae family.
There are two clades of monkeypox virus: the West African clade and the Congo Basin (Central African) clade.
The name monkeypox originates from the initial discovery of the virus in monkeys in a Danish laboratory in 1958. The first human case was identified in a child in the Democratic Republic of the Congo in 1970.
Various animal species have been identified as susceptible to the monkeypox virus. Uncertainty remains on the natural history of the monkeypox virus and further studies are needed to identify the exact reservoir(s) and how virus circulation is maintained in nature.
Human infections with the West African clade appear to cause less severe disease compared to the Congo Basin clade, with a case fatality rate of 3.6% compared to 10.6% for the Congo Basin clade.
Suspected Case Symptoms
A person of any age presenting in a monkeypox non-endemic country with an unexplained acute rash; and one or more of the following signs or symptoms, since 15 March 2022 – headache, acute onset of fever (>38.5oC), lymphadenopathy (swollen lymph nodes), myalgia (muscle and body aches), back pain and asthenia (profound weakness).
WHO Risk Assessment
Endemic monkeypox disease is normally geographically limited to West and Central Africa.
The identification of confirmed and suspected cases of monkeypox without any travel history to an endemic area in multiple countries is atypical, hence, there is an urgent need to raise awareness about monkeypox and undertake comprehensive case finding and isolation (provided with supportive care), contact tracing and supportive care to limit further onward transmission.
Cross-protective immunity from smallpox vaccination will be limited to older persons, since populations worldwide under the age of 40 or 50 years no longer benefit from the protection afforded by prior smallpox vaccination programmes.
There is little immunity to monkeypox among younger people living in non-endemic countries since the virus has not been present there.
WHO Advice
Identification of additional cases and further onward spread in the countries currently reporting cases and other Member States is likely.
Any patient with suspected monkeypox should be investigated and if confirmed, isolated until their lesions have crusted, the scab has fallen off and a fresh layer of skin has formed underneath.
Countries should be on the alert for signals related to patients presenting with an atypical rash that progresses in sequential stages – macules, papules, vesicles, pustules, scabs, at the same stage of development over all affected areas of the body – that may be associated with fever, enlarged lymph nodes, back pain, and muscle aches.
In non-endemic countries, one case is considered an outbreak. Because of the public health risks associated with a single case of monkeypox, clinicians should report suspected cases immediately to national or local public health authorities regardless of whether they are also exploring other potential diagnoses.
Israel confirms 1st monkeypox case
The Israeli Ministry of Health on Saturday confirmed the country's first monkeypox case after the viral disease has recently been detected across North America and Europe.
A man in his 30s returning from western Europe, who visited Ichilov Hospital in Tel Aviv with suspicious lesions of the virus and identified by the ministry as Israel's first suspected case of monkeypox was proved to have contracted the disease, according to a ministry statement.
A clinical sample was tested at the Israel Institute for Biological Research, where the suspicion of monkeypox was verified, according to the statement.
Also read: What is monkeypox and where is it spreading?
The man, who was exposed to a monkeypox patient in western Europe, has been hospitalized in quarantine to complete medical examination and supervision.
According to the ministry, the man is in good medical condition. The ministry also called on those who had returned from abroad and developed a fever and a blistering rash to see a doctor.
Recently, cases of monkeypox have been reported in the United States, Canada, Australia and several western European countries.
Monkeypox is common in wild animals like rodents and primates, but humans can also get infected with the virus.
Symptoms include skin rashes, fever, headache, muscle ache, backache, swollen lymph nodes, chills and exhaustion.
Also read: African scientists baffled by monkeypox cases in Europe, US
The rash eventually forms a scab, which later falls off, indicating that the person is no longer infectious.
African scientists baffled by monkeypox cases in Europe, US
Scientists who have monitored numerous outbreaks of monkeypox in Africa say they are baffled by the disease’s recent spread in Europe and North America.
Cases of the smallpox-related disease have previously been seen only among people with links to central and West Africa. But in the past week, Britain, Spain, Portugal, Italy, U.S., Sweden and Canada all reported infections, mostly in young men who hadn’t previously traveled to Africa.
There are about 80 confirmed cases worldwide and 50 more suspected ones, the World Health Organization said. France, Germany, Belgium and Australia reported their first cases Friday.
“I’m stunned by this. Every day I wake up and there are more countries infected,” said Oyewale Tomori, a virologist who formerly headed the Nigerian Academy of Science and who sits on several WHO advisory boards.
“This is not the kind of spread we’ve seen in West Africa, so there may be something new happening in the West,” he said.
To date, no one has died in the outbreak. Monkeypox typically causes fever, chills, rash and lesions on the face or genitals. WHO estimates the disease is fatal for up to one in 10 people, but smallpox vaccines are protective and some antiviral drugs are being developed.
British health officials are exploring whether the disease is being sexually transmitted. Health officials have asked doctors and nurses to be on alert for potential cases, but said the risk to the general population is low. The European Center for Disease Control and Prevention recommended all suspected cases be isolated and that high-risk contacts be offered smallpox vaccine.
Nigeria reports about 3,000 monkeypox cases a year, WHO said. Outbreaks are usually in rural areas, when people have close contact with infected rats and squirrels, Tomori said. He said many cases are likely missed.
Dr. Ifedayo Adetifa, head of the country’s Center for Disease Control, said none of the Nigerian contacts of the British patients have developed symptoms and that investigations were ongoing.
WHO’s Europe director, Dr. Hans Kluge, described the outbreak as “atypical,” saying the disease’s appearance in so many countries across the continent suggested that “transmission has been ongoing for some time.” He said most of the European cases are mild.
On Friday, Britain’s Health Security Agency reported 11 new monkeypox cases, saying “a notable proportion” of the infections in the U.K. and Europe have been in young men with no history of travel to Africa and who were gay, bisexual or had sex with men.
Authorities in Spain and Portugal also said their cases were in young men who mostly had sex with other men and said those cases were picked up when the men turned up with lesions at sexual health clinics.
Experts have stressed they do not know if the disease is being spread through sex or other close contact related to sex.
Nigeria hasn’t seen sexual transmission, Tomori said, but he noted that viruses that hadn’t initially been known to transmit via sex, like Ebola, were later proven to do so after bigger epidemics showed different patterns of spread.
Also Read: US case of monkeypox reported in Massachusetts man
The same could be true of monkeypox, Tomori said.
In Germany, Health Minister Karl Lauterbach said the government was confident the outbreak could be contained. He said the virus was being sequenced to see if there were any genetic changes that might have made it more infectious.
Rolf Gustafson, an infectious diseases professor, told Swedish broadcaster SVT that it was “very difficult” to imagine the situation might worsen.
“We will certainly find some further cases in Sweden, but I do not think there will be an epidemic in any way,” Gustafson said. “There is nothing to suggest that at present.”
Scientists said that while it’s possible the outbreak’s first patient caught the disease while in Africa, what’s happening now is exceptional.
“We’ve never seen anything like what’s happening in Europe,” said Christian Happi, director of the African Centre of Excellence for Genomics of Infectious Diseases. “We haven’t seen anything to say that the transmission patterns of monkeypox have been changing in Africa. So if something different is happening in Europe, then Europe needs to investigate that.”
Also read: North Korea’s suspected COVID-19 caseload nears 2 million
Happi also pointed out that the suspension of smallpox vaccination campaigns after the disease was eradicated in 1980 might inadvertently be helping monkeypox spread. Smallpox vaccines also protect against monkeypox, but mass immunization was stopped decades ago.
“Aside from people in west and Central Africa who may have some immunity to monkeypox from past exposure, not having any smallpox vaccination means nobody has any kind of immunity to monkeypox,” Happi said.
Shabir Mahdi, a professor of vaccinology at the University of Witwatersrand in Johannesburg, said a detailed investigation of the outbreak in Europe, including determining who the first patients were, was now critical.
“We need to really understand how this first started and why the virus is now gaining traction,” he said. “In Africa, there have been very controlled and infrequent outbreaks of monkeypox. If that’s now changing, we really need to understand why.”
What is monkeypox and where is it spreading?
European and American health authorities have identified a number of monkeypox cases in recent days, mostly in young men. It’s a surprising outbreak of a disease that rarely appears outside Africa.
Health officials around the world are keeping watch for more cases because, for the first time, the disease appears to be spreading among people who didn’t travel to Africa. They stress, however, that the risk to the general population is low.
WHAT IS MONKEYPOX?
Monkeypox is a virus that originates in wild animals like rodents and primates, and occasionally jumps to people. Most human cases have been in central and west Africa, where the disease is endemic.
The illness was first identified by scientists in 1958 when there were two outbreaks of a “pox-like” disease in research monkeys — thus the name monkeypox. The first known human infection was in 1970, in a 9-year-old boy in a remote part of Congo.
Monkeypox belongs to the same virus family as smallpox but causes milder symptoms.
Most patients only experience fever, body aches, chills and fatigue. People with more serious illness may develop a rash and lesions on the face and hands that can spread to other parts of the body.
The incubation period is from about five days to three weeks. Most people recover within about two to four weeks without needing to be hospitalized.
Monkeypox can be fatal for up to one in 10 people and is thought to be more severe in children.
People exposed to the virus are often given one of several smallpox vaccines, which have been shown to be effective against monkeypox. Anti-viral drugs are also being developed.
On Thursday, the European Centre for Disease Prevention and Control recommended all suspected cases be isolated and that high-risk contacts be offered the smallpox vaccine.
The World Health Organization estimates there are thousands of monkeypox infections in about a dozen African countries every year. Most are in Congo, which reports about 6,000 cases annually, and Nigeria, with about 3,000 cases a year.
Also Read: US case of monkeypox reported in Massachusetts man
Patchy health monitoring systems mean many infected people are likely missed, experts say.
Isolated cases of monkeypox are occasionally spotted outside Africa, including in the U.S. and Britain. The cases are typically associated with travel to Africa or contact with animals from areas where the disease is more common.
In 2003, 47 people in six U.S. states had confirmed or probable cases. They caught the virus from pet prairie dogs that been housed near imported small mammals from Ghana.
It’s the first time monkeypox appears to be spreading among people who didn’t travel to Africa. Most of the cases involve men who have had sex with men.
In Europe, infections have been reported in Britain, Italy, Portugal, Spain and Sweden.
Britain’s Health Security Agency said its cases are not all connected, suggesting that there are multiple chains of transmission happening. The infections in Portugal were picked up at a sexual health clinic, where the men sought help for lesions on their genitals.
On Wednesday, U.S. officials reported a case of monkeypox in a man who had recently traveled to Canada. The Public Health Agency of Canada also confirmed two cases related to that positive test. Health officials in Quebec earlier said they suspected 17 cases in the Montreal area.
It’s possible, but it’s unclear at the moment.
Monkeypox has not previously been documented to have spread through sex, but it can be transmitted through close contact with infected people, their body fluids and their clothing or bedsheets.
Michael Skinner, a virologist at Imperial College London, said it’s still too early to determine how the men in the U.K. were infected.
“By nature, sexual activity involves intimate contact, which one would expect to increase the likelihood of transmission, whatever a person’s sexual orientation and irrespective of the mode of transmission,” Skinner said.
Francois Balloux of University College London said monkeypox said sex qualifies as the kind of close contact needed to transmit the disease.
The U.K. cases “do not necessarily imply any recent change in the virus’ route of transmission,” Balloux said.
US case of monkeypox reported in Massachusetts man
Massachusetts on Wednesday reported a rare case of monkeypox in a man who recently traveled to Canada, and health officials are looking into whether it is connected to small outbreaks in Europe.
Monkeypox is typically limited to Africa, and rare cases in the U.S. and elsewhere are usually linked to travel there. A small number of confirmed or suspected cases have been reported this month in the United Kingdom, Portugal and Spain.
Also read: North Korea’s suspected COVID-19 caseload nears 2 million
U.S. health officials said they are in contact with officials in the U.K. and Canada as part of the investigation. But "at this point in time, we don’t have any information that links the Massachusetts case to cases in the UK,” said Jennifer McQuiston of the U.S. Centers for Disease Control and Prevention.
Though it's the only U.S. case the CDC is aware of, “I do think we are preparing for the possibility of more cases,” she said.
The U.S. case poses no risk to the public, and the Massachusetts resident is hospitalized but in good condition, officials said.
The man traveled to Canada at the end of April to meet friends and returned in early May, McQuiston said. A CDC statement said he used private transportation.
The case is the first in the U.S. this year. Last year, Texas and Maryland each reported a case in people who traveled to Nigeria.
Monkeypox typically begins with a flu-like illness and swelling of the lymph nodes, followed by a rash on the face and body. In Africa, people have been infected through bites from rodents or small animals, and it does not usually spread easily among people.
Also read:India records 2,841 new COVID-19 cases, 9 more deaths
However, investigators in Europe say most of the cases have been in gay or bisexual men, and officials are looking into the possibility that some infections were spread through close contact during sex.
Monkeypox comes from the same family of viruses as smallpox. Most people recover from monkeypox within weeks, but the disease is fatal for up to 1 in 10 people, according to the World Health Organization.