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Cases of monkeypox in the American continent now amount to 1,325 in 14 countries and territories, according to the latest epidemiological update from the Pan American Health Organization (PAHO), published this Sunday, which contains data up to July 8.

81% of infections were reported in the United States (53%) and Canada (28%), where there has been a relative increase of 77% and 31% in the last seven days, respectively. During the exact period, Brazil and Peru reported an increase of 198% and 500%, respectively.

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Of the 472 cases for which information on gender and age is available, 75% correspond to men between 18 and 44 years of age. Of the 168 cases with available information on sexual orientation, 94% identified themselves as men who have sex with men and of these, 24% are HIV positive. Of 52 cases with available information on the probable place of exposure, 35% reported social events with sexual contact. 

Of the 145 cases with available information, 92 are health workers. These cases are being investigated to determine if the infection was caused by occupational exposure.

Strengthen surveillance

The Pan American Health Organization suggests that member states continue to strengthen surveillance, diagnosis, investigation and contact tracing, clinical management, infection prevention and control, and risk communication activities.

PAHO explains that “after a long period of social distancing and restrictions imposed by the COVID-19 pandemic “, attendance at mass events has increased considerably and with it, the interaction between people (including sexual contact).

“Considering the period of school recess and vacations in several countries of the region, the possibility of attending events with a high agglomeration of people increases and with it the probability of greater exposure to monkeypox infection,” they maintain in the report.

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To reduce the risk of transmission of monkeypox associated with events, PAHO recommends that health authorities identify the events with the highest risk “based on the predominant modes of transmission and the probable profile of the attendees”; 

include monkeypox among the diseases routinely monitored and reported; to adopt measures to rapidly isolate cases and provide adequate clinical treatment; to keep the general population and event organizers informed about the evolution of the outbreak,

” Meetings should be used as opportunities to disseminate information and conduct risk communication and community engagement activities,” they add. 

In addition, the medical personnel in charge of the event must receive training on how to identify and treat people with compatible symptoms and on the protective equipment they should wear. 

For the general population, PAHO reminds us that people who have symptoms “should refrain from having close contact with any other person, avoid attending meetings and follow the advice of health authorities.”  

Overall situation 

From January 1 to July 7, 2022, 7,892 confirmed cases, including three deaths, were reported in 63 states across five World Health Organization (WHO) regions.

The three deaths were recorded in Nigeria (1) and the Central African Republic (2). 

82% of the confirmed cases (6,496 34 countries) were registered in Europe; 15% (1184 cases in 14 countries) in the Americas, 2% (173 cases in 8 countries) in Africa, <1% (24 cases in 4 countries) in the Western Pacific region, and <1% (15 cases in 3 countries ) in the Eastern Mediterranean region. 

During the last seven days, the cases reported globally have increased by 41.6%. The largest increase of 82% occurred in Africa, followed by the Western Pacific (60%), the Americas (57%) and Europe (38%).

 78% of confirmed cases globally correspond to men between 18 and 44 years of age ( seven cases have been registered in those under 18 years of age in African and European countries). 98% of the cases were identified as men who have sex with men, and of these, 41% are HIV positive. 47% of the cases indicated that they had previous exposure to the disease during social events with sexual contact. 

Of the 1,110 cases with available information, 113 are health workers.

Symptoms

Monkeypox lesions usually appear on the palms of the hands.

The WHO explains that “most cases do not present the classic clinical picture described for monkeypox (fever, swollen lymph nodes, followed by a rash)”. The cases of the current outbreak present the following clinical characteristics:

  • Few or even a single injury
  • Absence of skin lesions in some cases, with anal pain and rectal bleeding
  • Lesions in the genital or perineal/perianal area that do not spread to other areas of the body
  • Lesions appearing at different stages of development (asynchronous)
  • The appearance of lesions before the appearance of fever, malaise and other systemic symptoms (absence of prodromal period). 

Of the 1,563 confirmed cases for which hospitalization data is available, only 9% required hospitalization for isolation or treatment. Two patients required admission to an intensive care unit (ICU). 

The WHO insists that “the true magnitude of the outbreak is likely to be underestimated in countries that did not previously record monkeypox cases due to late clinical diagnosis and lack of access to laboratory tests.” 

Based on historical data, case fatality is highest in children, young adults, and immunocompromised people, including people living with uncontrolled HIV infection, who are at higher risk of developing severe disease. 

The WHO Emergency Committee will meet again 

The director of the World Health Organization (WHO ) announced that he would reconvene the Emergency Committee to assess whether monkeypox is an international emergency.

Dr Tedros Adhanom Gebreyesus said he remains concerned about the magnitude and spread of the virus. “Testing remains a challenge, and it is very likely that there will be a significant number of cases that go undetected,” he explained.

At its previous meeting, held on June 25, the Committee decided that the outbreak, which has also increased cases in African countries where the disease is endemic and in others where it had not previously been detected, was not yet a health emergency.

Dr Tedros announced that the Committee would meet the week of July 18 or sooner if necessary.

 

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