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Monkeypox: Emergency could last months, with window closing to stop spread, say experts

According to a study, the virus has a mutation that makes transmission easier

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Scientists advising the World Health Organization (WHO) on monkeypox say that the window to stop its spread is closing, as cases are currently doubling every two weeks. In this regard, they raised concerns that it would take several months for the outbreak to peak.

WHO Europe has forecast just over 27,000 monkeypox cases in 88 countries by August 2, up from 17,800 cases in nearly 70 countries at the latest count.

Making predictions beyond that is complex, scientists around the world told Reuters, but there is likely to be sustained transmission for several months and possibly longer.

"We have to get in front of this… It's clear the window of opportunity for doing so is closing," said Anne Rimoin, an epidemiology professor at the University of California, Los Angeles. She is also a member of the WHO expert committee on monkeypox, which met last week to determine whether the outbreak constituted a global health emergency.

A majority of committee members voted against the move but in an unprecedented step, the WHO Director-General Dr Tedros Adhanom Ghebreyesus declared an emergency anyway.

Action stemming from that declaration needs to be urgent, including increased vaccination, testing, isolation for those infected and contact tracing, explained global health experts.

"Transmission is clearly unchecked," said Antoine Flahault, director of the Institute of Global Health at the University of Geneva, who chairs the WHO Europe advisory group.

Jimmy Whitworth, a professor at the London School of Hygiene and Tropical Medicine, said he expected that cases would not plateau for at least the next 4-6 months, or until those at the highest risk of infection were either vaccinated or infected. Sexual health organizations in the UK recently estimated that it could mean around 125,000 people.

Monkeypox has been a globally neglected public health problem in parts of Africa for decades, but in May, cases began to be reported outside countries where it is endemic.

It generally causes mild to moderate symptoms, including fever, fatigue and the hallmark painful skin lesions, which improve in a few weeks. Five people have died in the current outbreak; all of them in Africa.

"I remember clearly... saying that 'I think I'm going to die,' because I can't eat, I can't drink. I can't even swallow my own spit," said Harun Tulunay, 35, a sexual health advocate who was hospitalized with monkeypox in London earlier this month, but has since recovered.

While monkeypox is not currently causing large numbers of deaths globally, an unpleasant virus establishing itself in new populations is still bad news, scientists said.

Flahault's group has modelled three scenarios for the coming months, all of which include "sustained transmission".

Ongoing transmission could also lead to mutations that make the virus more efficient at spreading in humans, scientists said.

On Tuesday, German scientists released a study ahead of a peer review that found mutations (in one of the 47 cases they sequenced) that could help monkeypox spread in people more easily.

"The alarm bell was going off (in Africa) but we kept hitting the snooze button. Now it's time to wake up and do something about it… An infection anywhere is potentially an infection everywhere," Rimoin concluded.

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