Sydney, Jun 27 (The Conversation): The World Health Organisation (WHO) has decided not to declare monkeypox a public health emergency of international concern. This may change in the future. However, WHO Director-General Tedros Adhanom Ghebreyesus said he was 'deeply concerned' about the evolving threat of monkeypox, which he said had reached more than 50 countries. There have been more than 4,100 confirmed cases globally, including at least 13 in Australia.
Also Read: Is Monkeypox a global emergency? World Health Organization's BIG decision, read here
The WHO also acknowledged there were many unknowns about the outbreak. Here are three things we know about monkeypox and three things we want to find out.
The virus causing the current outbreak has several mutations compared with versions of the virus circulating in Africa. However, we don't know if these mutations affect clinical disease and how the virus spreads.
The monkeypox virus has a very large genome, so is more complex to study than smaller RNA viruses, such as influenza and SARS-CoV-2 (the virus that causes COVID).
Experts wonder if the mutations have made it more contagious or changed the clinical pattern to be more like a sexually transmitted infection.
A study from Portugal shows the mutations likely make the virus more transmissible.
Monkeypox has not been described as a sexually transmitted infection in the past. However, the current transmission pattern is unusual. There seems to be a very short incubation period (of 24 hours) following sexual contact in some, but not all, cases.
It is a respiratory virus, so aerosol transmission is possible. But historically most transmission has been from animal to human. When there was transmission between humans, this usually involved close contacts.
The rapid growth of the epidemic in non-endemic countries in 2022, however, has been all due to spread between humans. There may be many more cases than officially reported.
We do not know why the pattern has changed, whether it is sexually transmitted or simply transmitted due to intimate contact in specific and globally connected social networks, or whether the virus has become more contagious.
The virus is found in the skin rash, mouth and semen, but this does not prove it is sexually transmitted.
Will this spread more widely in the community? Does the COVID pandemic increase the risk? Possibly, yes. We must also not drop the ball on surveillance in the wider community or stigmatise the LGBTQI community.
Due to waning immunity from the smallpox vaccine globally and the spread of monkeypox to many countries already, we may see the epidemic spreading more widely.
If it does so and starts infecting large numbers of children, we could see more deaths because children get more severe infection.
So we should monitor globally for clusters of fever and rash, and misdiagnosis as chickenpox, hand foot and mouth disease, herpes simplex or other diseases with a rash.
Another factor is COVID. As people recover from COVID, their immune system is impaired. So people who have had COVID may be more susceptible to other infections. We see the same with measles infection. This weakens the immune system and increases the risk of other infections for two to three years afterwards.
If the epidemic becomes established in countries outside the endemic areas, it may infect animals and create new endemic zones in the world. It is important we do everything possible to stop this epidemic.
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