Cases triple in Europe, urgent action needed to contain spread

The World Health Organization warned on Friday that urgent action is needed to contain the spread of monkeypox in Europe, as cases have tripled in the past two weeks.

According to the WHO, Europe is the center of a global outbreak of the virus, with 90% of confirmed monkeypox cases. New infections have tripled since June 15 with 4,500 confirmed cases in 31 European countries.

Henri Kluge, the head of WHO Europe, called on governments to step up their efforts to prevent monkeypox from settling on the continent, warning that time is of the essence.

“Urgent and concerted action is necessary if we are to turn a corner in the race to reverse the ongoing spread of this disease,” Kluge said.

The World Health Organization refused on Saturday to declare monkeypox a public health emergency of international concern, the highest alert level. However, WHO chief Tedros Adhanom Ghebreyesus said monkeypox is an evolving health threat. Tedros called on governments to step up surveillance and contact tracing and ensure that people at high risk have access to vaccines and antivirals.

Kluge said the WHO will likely soon reconsider whether monkeypox is a global health emergency, given the “rapid evolution and emergency nature of the event”. He said 99% of monkey pox patients in Europe are men between the ages of 21 and 40. The majority of patients who provided demographic information identified as having sex with men, he said.

Monkeypox spreads primarily through close physical contact, with much of the transmission in the current outbreak being through sex. However, a small number of cases have now been reported where the patients did not contract the virus during sexual contact, Kluge said. Relatives of infected people, heterosexual contacts and children have also contracted the virus, he said.

Of the patients for whom information was available about their status, nearly 10% were hospitalized for treatment or isolation and one patient ended up in an intensive care unit, Kluge said. No one in Europe has died from the virus so far, he said.

“There’s just no room for complacency — especially here in the European region with its fast-moving outbreak extending its reach into previously untouched areas by the hour, day and week,” Kluge said.

The stigma of men having sex with men in some countries has made it difficult to get a full picture of the outbreak, Kluge said. Some people with monkeypox symptoms may avoid going to health care providers for a diagnosis because they fear the consequences if someone finds out they’re gay or bisexual, Kluge said. However, it is also crucial to clearly communicate the reality of the current outbreak, he added.

“We know from our lessons in coping with HIV how stigma further fuels outbreaks and epidemics, but our fear of creating stigma to prevent us from acting can be just as damaging,” Kluge said.

Kluge said public health authorities in Europe should quickly step up surveillance of monkeypox and their capacity to diagnose the disease and track samples. Contacts of people who have monkeypox also need to be identified quickly to stop the spread, he said.

Public health authorities also need to educate high-risk communities and the general public about what precautions to take when attending mass rallies this summer, Kluge said. And vaccines should be distributed equitably, focusing on those most at risk, he added.

Monkeypox spreads mainly through close physical contact with a person who is infected or contaminated material such as shared clothing or bedding. The virus can spread through respiratory droplets if an infected person has lesions in the throat or mouth. However, that requires long-term face-to-face contact. Monkeypox is not believed to spread through aerosol particles like Covid-19.

Respiratory droplets fall to the ground quickly, while aerosol particles linger longer in the air, which is one of the reasons Covid is so contagious.

Monkeypox belongs to the same virus family as smallpox, but has milder symptoms. Most people recover within two to four weeks without specific medical treatment.

Monkeypox often begins with flu-like symptoms, such as fever, headache, sore throat, body aches, chills, exhaustion, diarrhea, and swollen lymph nodes. A rash resembling pimples or blisters then appears on the body. People are most contagious when they have a rash.

Kluge said the vast majority of patients in Europe had rashes, and about three-quarters reported flu-like symptoms.

Some patients in the current outbreak have only developed a rash on the genitals or anus before showing flu-like symptoms, according to the U.S. Centers for Disease Control and Prevention. In other cases, patients developed the rash without any flu-like symptoms.

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