Monkeypox: WHO asks countries to notify new cases, issues testing guidance

As cases of Monkeypox are emerging from different regions in the world, the World Health Organisation (WHO) has asked all the countries to immediately notify it of positive laboratory results including those awaiting confirmation. 

Under its interim guidance on laboratory testing for the Monkeypox virus the apex public health agency said that any individual that meets the suspected case definition for Monkeypox should be offered testing. 

Monkeypoxvirus (MPXV) is a double-stranded DNA virus, a member of the orthopoxvirus genus within the Poxviridae family. Poxviruses cause disease in humans and many other animals. Infection typically results in the formation of lesions, skin nodules or disseminated rash. Other orthopoxvirus (OPXV) species pathogenic to humans include cowpox virus, and variola virus that causes smallpox, which has been eradicated.  

According to WHO, the laboratory confirmation of specimens from a suspected case is done using nucleic acid amplification testing (NAAT), such as real time or conventional polymerase chain reaction (PCR). NAAT can be generic to orthopoxvirus (OPXV) or specific to Monkeypoxvirus (MPXV, preferable), it said. 

“Member States are requested to immediately notify WHO under the International Health Regulations (IHR) 2005 of positive laboratory results, including a generic OPXV laboratory test that awaits confirmation,” the WHO said in the guidance. 

“The recommended specimen type for diagnostic confirmation of Monkeypox in suspected cases is skin lesion material, including swabs of lesion exudate, roofs from more than one lesion, or lesion crusts. All manipulations in laboratory settings of specimens originating from suspected, probable or confirmed cases of Monkeypox should be conducted according to a risk-based approach,” the WHO said. 

In addition to NAAT, the WHO said, sequencing is useful to determine virus clade and to understand epidemiology. “Member States are strongly encouraged to share MPXV genetic sequence data in available and publicly accessible databases,” said the WHO. 

WHO said that it is working with its partners to better understand the extent and cause of an outbreak of Monkeypox. The WHO said that the virus is endemic in some animal populations in a number of countries, leading to occasional outbreaks among local people and travelers. The recent outbreaks reported across 11 countries so far are atypical, as they are occurring in non-endemic countries. 

There are about 100 confirmed cases. More cases are likely to be reported as surveillance expands, the WHO had said on Friday. WHO is working with the affected countries and others to expand disease surveillance to find and support people who may be affected, and to provide guidance on how to manage the disease. The WHO said that Monkeypox spreads differently from COVID-19.  

“As Monkeypox spreads through close contact, the response should focus on the people affected and their close contacts. People who closely interact with someone who is infectious are at greater risk for infection: this includes health workers, household members and sexual partners. Stigmatizing groups of people because of a disease is never acceptable. It can be a barrier to ending an outbreak as it may prevent people from seeking care, and lead to undetected spread,” the WHO said. 

Monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, hence the name ‘Monkeypox.’  

According to the Centre for Disease Control and Prevention, in humans, the symptoms of Monkeypox are similar to but milder than the symptoms of smallpox. Monkeypox begins with fever, headache, muscle aches, and exhaustion. 

The main difference between symptoms of smallpox and Monkeypox is that Monkeypox causes lymph nodes to swell (lymphadenopathy) while smallpox does not. The incubation period (time from infection to symptoms) for Monkeypox is usually 7−14 days but can range from 5−21 days.  

The CDC said that the transmission of Monkeypox virus occurs when a person comes into contact with the virus from an animal, human, or materials contaminated with the virus. Human-to-human transmission is thought to occur primarily through large respiratory droplets. 

Respiratory droplets generally cannot travel more than a few feet, so prolonged face-to-face contact is required. Other human-to-human methods of transmission include direct contact with body fluids or lesion material, and indirect contact with lesion material, such as through contaminated clothing or linens.   

While there is currently no proven, safe treatment for Monkeypox virus infection, JYNNEOS (also known as Imvamune or Imvanex) is an attenuated live virus vaccine which has been approved by the US Food and Drug Administration for the prevention of Monkeypox. The vaccine is used all over the world. 

The Czech Republic, Austria and Slovenia are the latest countries to have registered their first cases of Monkeypox. At least 20 countries have reported outbreaks of the viral disease, where Monkeypox is not endemic. Majority of 100 confirmed or suspected infections have been reported from Europe. The US and UK have also reported Monkeypox cases. 

Also read: 92 Monkeypox cases reported so far; here’s what you need to know  

Also read: Monkeypox: Moderna tests potential vaccines in pre-clinical trials