H5N1

ECDC: Monkeypox multi-country outbreak

Via ECDC, an August 8 situation update: Monkeypox multi-country outbreak. Excerpt:

Since the start of the monkeypox outbreak and as of 8 August 2022, 13 912 confirmed cases of monkeypox (MPX) have been reported from 29 EU/EEA countries: Spain (4 942), Germany (2 887), France (2 423), Netherlands (959), Portugal (710), Italy (545), Belgium (482), Austria (173), Denmark (123), Sweden (114), Ireland (97), Poland (76), Norway (65), Hungary (48), Greece (39), Slovenia (38), Luxembourg (34), Malta (30), Czechia (28), Romania (28), Finland (20), Croatia (12), Iceland (11), Estonia (9), Slovakia (8), Bulgaria (4), Latvia (3), Lithuania (3) and Cyprus (1).  

Two deaths have been reported from Spain.  

Since the start of the monkeypox outbreak and as of 8 August 2022, the following Western Balkan countries have reported confirmed cases of monkeypox: Serbia (23), Bosnia and Herzegovina (1) and Montenegro (1). In addition, five cases have been reported from Turkey.  

Since the start of the outbreak, ECDC provides updates for EU/EEA countries, the Western Balkans and Turkey twice a week (Tuesdays and Fridays), with the number of MPX cases reported to The European Surveillance System (TESSy) or collected through ECDC’s epidemic intelligence from official public sources.

Joint ECDC-WHO Regional Office for Europe Monkeypox Surveillance Bulletin

Via ECDC: Joint ECDC-WHO Regional Office for Europe Monkeypox Surveillance Bulletin. The summary:

A total of 15926 cases of monkeypox have been identified through IHR mechanisms and official public resources up to 2 August 2022, 14:00, from 38 countries and areas throughout the European region. Case-based data were reported for 15624 cases from 32 countries and areas to ECDC and the WHO Regional Office for Europe through The European Surveillance System (TESSy), up to 2 August 2022, 10:00. 

Of the 15624 cases reported in TESSy, 15524 were laboratory confirmed. Furthermore, where sequencing was available, 203 were confirmed to be of the West African clade. 

The earliest date of symptom onset was reported as 11 March 2022. The majority of cases were between 31 and 40 years-old (6349/15595 - 41%) and male (15439/15572 - 99.1%). Among cases with known HIV status, 36% (2690/7487) were HIV-positive. The majority of cases presented with a rash (9126/9626 - 94.8%) and systemic symptoms such as fever, fatigue, muscle pain, chills, or headache (6300/9626 - 65%). 

399 cases were hospitalised (5.6%), of which 150 cases required clinical care. Three cases were admitted to ICU, among whom one was admitted to ICU for reasons unrelated to monkeypox infection. The two other cases admitted to ICU were reported to have died of monkeypox. 

Some (41) cases were reported to be health workers, however no occupational exposure has been reported.

Monkeypox: Brazil confirms first death

Via Folha de São Paulo: Monkeypox: Brazil confirms first death. Excerpt from the Google translation, lightly edited:

The Ministry of Health confirmed the first death of monkeypox in Brazil. The patient was a 41-year-old man from Minas Gerais.  

According to authorities in the ministry, heard by Folha, the victim had comorbidities and was immunosuppressed.  

The ministry informed, in a note, that the man was hospitalized in a public hospital in Belo Horizonte (MG), and was later directed to the CTI (Intensive Care Center).  

"The Ministry of Health confirms a death related to monkeypox, known as monkeypox, in Brazil. It is a 41-year-old male patient with low immunity and comorbidities, including cancer (lymphoma), which led to worsening of the condition. He was hospitalized in a public hospital in Belo Horizonte, being later directed to the CTI. The cause of death was septic shock, aggravated by monkeypox", said the folder, in a note.  

In a statement, the Minas Gerais Health Department confirmed that the patient was being followed up for "other serious clinical conditions".  

Health Ministry officials initially reported that the person was from Uberlândia, but the Minas Gerais Health Department said the patient lived in Belo Horizonte. Uberlândia City Hall also said that the victim was not from the city.  

Until this Thursday (28), Brazil had already registered 1,066 confirmed diagnoses of the disease, according to the Ministry of Health. The federal government has announced the creation of an emergency monkeypox committee and treats monkeypox as an outbreak.  

On Saturday (23), the WHO (World Health Organization) classified the spread of the disease as a public emergency of global concern. The entity considers the situation in Brazil for the disease as alarming.

Multi-country monkeypox outbreak: Situation update

WHO has published a DON: Multi-country monkeypox outbreak: situation update. Excerpt:

This current Disease Outbreak News on the multi-country monkeypox outbreak is an update to the previously published Disease Outbreak News of 10 June, with updated data, some further details on surveillance and reporting, One Health, gatherings, Risk communication and community engagement and International travel and points of entry.  

In this edition, we are removing the distinction between endemic and non-endemic countries, reporting on countries together where possible, to reflect the unified response that is needed.  

Outbreak at a glance  

Since 1 January 2022, cases of monkeypox have been reported to WHO from 42 Member States across five WHO regions (the Regions of the Americas, Africa, Europe, Eastern Mediterranean, and Western Pacific). As of 15 June, a total of 2103 laboratory confirmed cases and one probable case, including one death, have been reported to WHO. The outbreak of monkeypox continues to primarily affect men who have sex with men who have reported recent sex with new or multiple partners.  

While epidemiological investigations are ongoing, most reported cases in the recent outbreak have presented through sexual health or other health services in primary or secondary health care facilities, with a history of travel primarily to countries in Europe, and North America or other countries rather than to countries where the virus was not historically known to be present, and increasingly, recent travel locally or no travel at all.  

Confirmation of one case of monkeypox, in a country, is considered an outbreak. The unexpected appearance of monkeypox in several regions in the initial absence of epidemiological links to areas that have historically reported monkeypox, suggests that there may have been undetected transmission for some time.  

WHO assesses the risk at the global level as moderate considering this is the first time that many monkeypox cases and clusters are reported concurrently in many countries in widely disparate WHO geographical areas, balanced against the fact that mortality has remained low in the current outbreak.  

Description of the outbreak  

Between 1 January to 15 June 2022, a cumulative total of 2103 laboratory confirmed cases, one probable case, and one death have been reported to WHO from 42 countries in five WHO Regions. The majority of cases (98%) have been reported since May 2022 (Figure 1).  

Figure 1: Confirmed cases of monkeypox by WHO region from January 2022 to 15 June 2022, data as of 15 June 2022 17:00 CEST 

Note: the data for the current epi week are incomplete and should be interpreted cautiously.

Multi-country monkeypox outbreak: situation update

WHO has published Multi-country monkeypox outbreak: situation update. Excerpt:

Outbreak at a glance  

Since 13 May 2022, and as of 2 June 2022, 780 laboratory confirmed cases of monkeypox have been reported to or identified by WHO from 27 Member States across four WHO regions that are not endemic for monkeypox virus. Epidemiological investigations are ongoing. Most reported cases so far have been presented through sexual health or other health services in primary or secondary health care facilities and have involved mainly, but not exclusively, men who have sex with men (MSM).  

While the West African clade of the virus has been identified from samples of cases so far, most confirmed cases with travel history reported travel to countries in Europe and North America, rather than West or Central Africa where the monkeypox virus is endemic.  The confirmation of monkeypox in persons who have not travelled to an endemic area is atypical, and even one case of monkeypox in a non-endemic country is considered an outbreak.  

While most cases are not associated with travel from endemic areas, Member States are also reporting small numbers of cases in travelers from Nigeria, as has been observed before.  

The sudden and unexpected appearance of monkeypox simultaneously in several non-endemic countries suggests that there might have been undetected transmission for some unknown duration of time followed by recent amplifier events.  

WHO assesses the risk at the global level as moderate considering this is the first time that many monkeypox cases and clusters are reported concurrently in non-endemic and endemic countries in widely disparate WHO geographical areas.  

WHO continues to receive updates on the situation in endemic countries.  

Description of the outbreak  

As of 2 June 2022, 780 laboratory confirmed cases have been notified to WHO under the International Health Regulations (IHR) or identified by WHO from official public sources in 27 non-endemic countries in four WHO Regions. This represents an increase of 523 laboratory confirmed cases (+203%) since the Disease Outbreak News of 29 May, when a total of 257 cases were reported.  

As of 2 June 2022, there have been no deaths associated within the current monkeypox outbreak in non-endemic countries, however, cases and deaths continue to be reported from endemic countries (see Table 2).  

While investigations are ongoing, preliminary data from polymerase chain reaction (PCR) assays indicate that the monkeypox virus strains detected in Europe and other non-endemic areas belong to the West African clade.  

Figure 1 and Table 1 show the geographical distribution of monkeypox cases reported to or identified by WHO between 13 May to 2 June 2022 in non-endemic countries. The majority of cases (n=688; 88%), were reported from the WHO European Region (20 Countries). Confirmed cases have also been reported from the Region of the Americas (n=80; 10%), Eastern Mediterranean Region (n=9; 1%) and Western Pacific Region (n=3; <1%).  

The case count fluctuates as more information becomes available daily and data is verified by WHO in accordance with the provisions of the IHR.

ECDC risk assessment: Monkeypox multi-country outbreak

ECDC has published Risk assessment: Monkeypox multi-country outbreak. Click or tap through to download the full report. The executive summary, with my bolding:

Key messages  

Monkeypox (MPX) does not spread easily between people. Human-to-human transmission occurs through close contact with infectious material from skin lesions of an infected person, through respiratory droplets in prolonged face-to-face contact, and through fomites. The predominance, in the current outbreak, of diagnosed human MPX cases among men having sex with men (MSM), and the nature of the presenting lesions in some cases, suggest transmission occurred during sexual intercourse.  

Based on ECDC’s epidemiological assessment, the likelihood of MPX spreading in persons having multiple sexual partners in the EU/EEA is considered high. Although most cases in current outbreaks have presented with mild disease symptoms, monkeypox virus (MPXV) may cause severe disease in certain population groups (young children, pregnant women, immunosuppressed persons). However, the likelihood of cases with severe morbidity cannot be accurately estimated yet. The overall risk is assessed as moderate for persons having multiple sexual partners (including some groups of MSM) and low for the broader population.  

Treatment is mainly symptomatic and supportive, including prevention and treatment of secondary bacterial infections. Smallpox vaccine can be considered for post-exposure prophylaxis of close contacts at increased risk for severe disease, however careful benefit/risk assessment should be performed for the exposed individual. Important information on the use of currently available smallpox vaccines is missing for groups at increased risk for severe disease. In addition, antivirals are potential treatment options for severe cases.  

EU/EEA countries should focus on prompt identification, management, contact tracing and reporting of new MPX cases. Countries should update their contact tracing mechanisms, their diagnostic capacity for orthopoxviruses and review the availability of smallpox vaccines, antivirals and personal protective equipment (PPE) for health professionals.  

An interim case definition is proposed for case reporting. Guidance for the management of MPX cases and close contacts is also included. Cases should remain isolated until their rash heals completely, avoiding contact with immunosuppressed persons and pets. Abstaining from sexual activity and close physical contact is also advised until the rash heals. Most cases can remain at home with supportive care.  

Close contacts of MPX cases should self-monitor for the development of symptoms up to 21 days from the last exposure to a case.  

Healthcare workers should wear appropriate PPE (gloves, water-resistant gown, FFP2 respirator) when screening suspected cases or caring for a MPX case. Laboratory personnel should also take precautions to avoid occupational exposure.  

Close contacts of a MPX case should be deferred from blood, organ or bone marrow donations for a minimum of 21 days from the last day of exposure.  

Proactive risk communication and multiple community engagement activities should be carried out to increase awareness, provide updates and guidance to those at increased risk and the wider public. Risk communication messages should stress that MPXV is spread through close contact between people, especially in the same household, potentially including the sexual route. A balance should be kept between informing those most at risk but also communicating that the virus does not spread easily between people the risk to the broader population is low.  

There is a potential risk of human-to-animal transmission in Europe, therefore close intersectoral collaboration between human and veterinary public health authorities working from a ‘One Health’ perspective is needed to manage exposed pets and prevent the disease from being transmitted in wildlife. EFSA is not aware to date of any reports on infections in animals (pets or wild animals) in the EU.  

Several unknowns still exist regarding this outbreak and ECDC will continue to monitor developments closely and update the risk assessment as new data and information become available.

WHO: Multi-country monkeypox outbreak in non-endemic countries

WHO has published Multi-country monkeypox outbreak in non-endemic countries. Click or tap through for the full report including tables, a map, and many links. Excerpt:

Outbreak at glance                   

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. 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.  

The objective of this Disease Outbreak News is to raise awareness, inform readiness and response efforts, and provide technical guidance for immediate recommended actions.  

The situation is evolving and WHO expects there will be more cases of monkeypox identified as surveillance expands in non-endemic countries. Immediate actions focus on informing those who may be most at risk for monkeypox infection with accurate information, in order to stop further spread. Current available evidence suggests that those who are most at risk are those who have had close physical contact with someone with monkeypox, while they are symptomatic. WHO is also working to provide guidance to protect frontline health care providers and other health workers who may be at risk such as cleaners. WHO will be providing more technical recommendations in the coming days.   

Description of the outbreak  

As of 21 May, 13:00, 92 laboratory confirmed cases, and 28 suspected cases of monkeypox with investigations ongoing, have been reported to WHO from 12 Member States that are not endemic for monkeypox virus, across three WHO regions (Table 1, Figure 1). No associated deaths have been reported to date. 

Reported cases thus far have no established travel links to an endemic area. 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. 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 will be reported. Available information suggests that human-to-human transmission is occurring among people in close physical contact with cases who are symptomatic.

UK: Person diagnosed with monkeypox in England after visiting Nigeria

Via The Guardian: Person diagnosed with monkeypox in England after visiting Nigeria. Excerpt:

A person is being treated for monkeypox in England, a rare viral infection similar to the eradicated disease smallpox, public health authorities have confirmed.  

Public Health England (PHE) says monkeypox is not very transmissible and the patient is not thought to pose a risk to other people. He or she – their identity has not been revealed – is thought to have contracted it during a visit to Nigeria. 

PHE is getting in touch with people who may have been in contact with the patient as a precautionary measure, including those who travelled to the UK on the same flight. It says they will be given appropriate advice and be monitored if necessary.  

“Monkeypox does not spread easily between people and the overall risk to the general public is very low. We are following up with those who have had close contact with the patient to offer advice and to monitor them as necessary,” said Dr Meera Chand, consultant microbiologist at PHE.

“PHE and the NHS have well established and robust infection control procedures for dealing with cases of imported infectious disease and these will be strictly followed to minimise the risk of transmission,” she said.  

The individual was in south-west England when they fell ill and was transferred to the high consequence infectious disease centre at Guy’s and St Thomas’ NHS Foundation Trust in London. 

There were three cases of monkeypox in the UK in September last year. The first was a resident of Nigeria who was staying at a naval base in Cornwall. There was no link to the second case, it was said at the time, even though that person had also spent time in Nigeria. The third was a healthcare worker involved in the care of one of the patients at Blackpool Victoria hospital before the infection was identified. 

Last year PHE said there had been a sustained outbreak of monkeypox in Nigeria in September 2017 and that it was expected the virus would continue to circulate there.

ECDC: CDTR, May 17

ECDC has published Communicable disease threats report, 12-18 May 2019, week 20. The summary: 

The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period from 12-18 May 2019 and includes updates on poliomyelitis, chikungunya virus disease and dengue, measles, monkeypox, dengue, Ebola virus disease, influenza, Rift Valley fever, Crimean-Congo haemmorhagic fever and Legionnaires' disease.

WHO AFRO outbreaks and other emergencies, week 40: 29 September - 5 October 2018

Via ReliefWeb, a WHO AFRO report: WHO AFRO Outbreaks and Other Emergencies, Week 40: 29 September - 5 October 2018 (Data as reported by 17:00; 5 October 2018). Excerpt:

This Weekly Bulletin focuses on selected acute public health emergencies occurring in the WHO African Region. The WHO Health Emergencies Programme is currently monitoring 58 events in the region. This week’s edition covers key new and ongoing events, including:  

• Hepatitis E in Central African Republic 

• Monkeypox in Central African Republic 

• Dengue fever in Senegal 

• Ebola virus disease in the Democratic Republic of the Congo 

• Humanitarian crisis in Cameroon 

For each of these events, a brief description, followed by public health measures implemented and an interpretation of the situation is provided. 

A table is provided at the end of the bulletin with information on all new and ongoing public health events currently being monitored in the region, as well as events that have recently been closed. 

Major issues and challenges include: 

• The Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo has reached a critical juncture, marked by a precarious security situation, persistence of pockets of community resistance/mistrust and expanding geographical spread of the disease. During the reporting week, there was an incident involving a response team performing burial activity in Butembo. This came barely days following a widespread community strike (“ville morte”) in Beni and several towns, and an earlier armed attack in Beni. These incidents severely disrupted most outbreak control interventions. 

Meanwhile, EVD cases have been confirmed in new areas with worse insecurity and in close proximity to the border with Uganda. All these factors come together to elevate the risk of further propagation of the outbreak. Meanwhile, most communities support the response. The Ministry of Health, WHO and partners continue to work closely with communities and are able to provide vaccines to contacts and treatment to those who are sick. 

• During the reporting week, the Ministry of Health and Population in the Central African Republic has declared two simultaneous outbreaks of hepatitis E and monkeypox in the country. These outbreaks are occurring against the backdrop of a deteriorating security situation and resulting precarious living conditions in the community. 

Of particular concern is the outbreak of hepatitis E, which has a higher potential to gain a foothold in such situation. The risk factors for transmission of water-borne disease are prevalent in the communities. There is a need to aggressively tackle these outbreaks at this early stage to avoid them gaining a foothold.