CONTENTS

CHAPTER 1 : INTRODUCTION. 2

CHAPTER 2: TRANSMISSION. 6

CHAPTER 3: RESPONSES. 17

INDEX. 31

0
 CHAPTER ONE INTRODUCTION

What is Monkey pox?

Monkeypox is a viral zoonosis (a virus transmitted to humans from

animals) with symptoms similar to those seen in the past in smallpox
patients, although it is clinically less severe. With the eradication of
smallpox in 1980 and subsequent cessation of smallpox vaccination,
monkeypox has emerged as the most important orthopoxvirus for
public health. Monkeypox primarily occurs in central and west Africa,
often in proximity to tropical rainforests, and has been increasingly
appearing in urban areas. Animal hosts include a range of rodents and
non-human primates.

Monkeypox is a rare disease caused by infection with the monkeypox

virus. Monkeypox virus is part of the same family of viruses as variola
virus, the virus that causes smallpox. Monkeypox symptoms are similar
to smallpox symptoms, but milder, and monkeypox is rarely fatal.
Monkeypox is not related to chickenpox.

1
Monkeypox was discovered in
1958 when two outbreaks of a
pox-like disease occurred in
colonies of monkeys kept for
research. Despite being named
“monkeypox,” the source of the
disease remains unknown.
However, African rodents and
non-human primates (like monkeys) might harbor the virus and infect
people.

The first human case of monkeypox was recorded in 1970. Prior to the
2022 outbreak, monkeypox had been reported in people in several
central and western African countries. Previously, almost all
monkeypox cases in people outside of Africa were linked to
international travel to countries where the disease commonly occurs or
through imported animals. These cases occurred on multiple
continents.

THE PATHOGEN

Monkeypox virus is an enveloped double-stranded DNA virus that

belongs to the Orthopoxvirus genus of the Poxviridae family. There are
two distinct genetic clades of the monkeypox virus: the central African

2
(Congo Basin) clade and the west African clade. The Congo Basin clade
has historically caused more severe disease and was thought to be
more transmissible. The geographical division between the two clades
has so far been in Cameroon, the only country where both virus clades
have been found.

NATURAL HOST OF MONKEYPOX VIRUS

Various animal species have been identified as susceptible to

monkeypox virus. This includes rope squirrels, tree squirrels, Gambian
pouched rats, dormice, non-human primates and other species.
Uncertainty remains on the natural history of monkeypox virus and
further studies are needed to identify the exact reservoir(s) and how
virus circulation is maintained in nature.

OUTBREAKS

Human monkeypox was first identified in humans in 1970 in the

Democratic Republic of the Congo in a 9-month-old boy in a region
where smallpox had been eliminated in 1968. Since then, most cases
have been reported from rural, rainforest regions of the Congo Basin,
particularly in the Democratic Republic of the Congo and human cases
have increasingly been reported from across central and west Africa.

3
Since 1970, human cases of monkeypox have been reported in 11
African countries: Benin, Cameroon, the Central African Republic, the
Democratic Republic of the Congo, Gabon, Cote d’Ivoire, Liberia,
Nigeria, the Republic of the Congo, Sierra Leone and South Sudan. The
true burden of monkeypox is not known. For example, in 1996–97, an
outbreak was reported in the Democratic Republic of the Congo with a
lower case fatality ratio and a higher attack rate than usual. A
concurrent outbreak of chickenpox (caused by the varicella virus, which
is not an orthopoxvirus) and monkeypox was found, which could
explain real or apparent changes in transmission dynamics in this case.
Since 2017, Nigeria has experienced a large outbreak, with over 500
suspected cases and over 200 confirmed cases and a case fatality ratio
of approximately 3%. Cases continue to be reported until today.

Monkeypox is a disease of global public health importance as it not only

affects countries in west and central Africa, but the rest of the world. In
2003, the first monkeypox outbreak outside of Africa was in the United
States of America and was linked to contact with infected pet prairie
dogs. These pets had been housed with Gambian pouched rats and
dormice that had been imported into the country from Ghana. This
outbreak led to over 70 cases of monkeypox in the U.S. Monkeypox has

4
also been reported in travelers from Nigeria to Israel in September
2018, to the United Kingdom in September 2018, December 2019, May
2021 and May 2022, to Singapore in May 2019, and to the United
States of America in July and November 2021. In May 2022, multiple
cases of monkeypox were identified in several non-endemic countries.
Studies are currently underway to further understand the
epidemiology, sources of infection, and transmission patterns

5
 CHAPTER TWO TRANSMISSION

Mode of transmission

Animal-to-human (zoonotic) transmission can occur from direct contact

with the blood, bodily fluids, or cutaneous or mucosal lesions of
infected animals. In Africa, evidence of monkeypox virus infection has
been found in many animals including rope squirrels, tree squirrels,
Gambian pouched rats, dormice, different species of monkeys and
others. The natural reservoir of monkeypox has not yet been identified,
though rodents are the most likely. Eating inadequately cooked meat
and other animal products of infected animals is a possible risk factor.
People living in or near forested areas may have indirect or low-level
exposure to infected animals.

Human-to-human transmission can result from close contact with

respiratory secretions, skin lesions of an infected person or recently
contaminated objects. Transmission via droplet respiratory particles
usually requires prolonged face-to-face contact, which puts health
workers, household members and other close contacts of active cases
at greater risk. However, the longest documented chain of transmission
in a community has risen in recent years from 6 to 9 successive person-
to-person infections. This may reflect declining immunity in all

6
communities due to cessation of smallpox vaccination. Transmission
can also occur via the placenta from mother to fetus (which can lead to
congenital monkeypox) or during close contact during and after birth.
While close physical contact is a well-known risk factor for
transmission, it is unclear at this time if monkeypox can be transmitted
specifically through sexual transmission routes. Studies are needed to
better understand this risk.

SIGNS AND SYMPTOMS

Symptoms of monkeypox can include:

 Fever
 Headache
 Muscle aches and backache
 Swollen lymph nodes
 Chills
 Exhaustion
 Respiratory symptoms (e.g. sore throat, nasal congestion, or
cough)

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  A rash that may be located on or near the genitals (penis,
testicles, labia, and vagina) or anus (butthole) but could also be on
other areas like the hands, feet, chest, face, or mouth.
 The rash will go through several stages, including scabs, before
healing.
 The rash can look like pimples or blisters and may be painful or
itchy.

You may experience all or only a few symptoms

Sometimes, people get a rash first, followed by other symptoms. Others

only experience a rash.

Most people with monkeypox will get a rash.

Some people have developed a rash before (or without) other

symptoms.

Monkeypox symptoms usually start within 3 weeks of exposure to the

virus. If someone has flu-like symptoms, they will usually develop a rash
1-4 days later.

Monkeypox can be spread from the time symptoms start until the rash
has healed, all scabs have fallen off, and a fresh layer of skin has
formed. The illness typically lasts 2-4 weeks.

8
The incubation period (interval from infection to onset of symptoms) of
monkeypox is usually from 6 to 13 days but can range from 5 to 21
days.

PHASES OF ATTACK

A. The invasion period (lasts between 0–5 days) characterized by fever,

intense headache, lymphadenopathy (swelling of the lymph nodes),
back pain, myalgia (muscle aches) and intense asthenia (lack of energy).
Lymphadenopathy is a distinctive feature of monkeypox compared to
other diseases that may initially appear similar (chickenpox, measles,
smallpox)

B. The skin eruption usually begins within 1–3 days of appearance of

fever. The rash tends to be more concentrated on the face and
extremities rather than on the trunk. It affects the face (in 95% of
cases), and palms of the hands and soles of the feet (in 75% of cases).
Also affected are oral mucous membranes (in 70% of cases), genitalia
(30%), and conjunctivae (20%), as well as the cornea. The rash evolves
sequentially from macules (lesions with a flat base) to papules (slightly
raised firm lesions), vesicles (lesions filled with clear fluid), pustules
(lesions filled with yellowish fluid), and crusts which dry up and fall off.
The number of lesions varies from a few to several thousand.

9
Monkeypox is usually a self-limited disease with the symptoms lasting
from 2 to 4 weeks. Severe cases occur more commonly among children
and are related to the extent of virus exposure, patient health status
and nature of complications. Underlying immune deficiencies may lead
to worse outcomes. Although vaccination against smallpox was
protective in the past, today persons younger than 40 to 50 years of
age (depending on the country) may be more susceptible to
monkeypox due to cessation of smallpox vaccination campaigns
globally after eradication of the disease. Complications of monkeypox
can include secondary infections, bronchopneumonia, sepsis,
encephalitis, and infection of the cornea with ensuing loss of vision. The
extent to which asymptomatic infection may occur is unknown.

The case fatality ratio of monkeypox has historically ranged from 0 to

11 % in the general population and has been higher among young
children. In recent times, the case fatality ratio has been around 3–6%.

DIAGNOSIS

The clinical differential diagnosis that must be considered includes

other rash illnesses, such as chickenpox, measles, bacterial skin
infections, scabies, syphilis, and medication-associated allergies.

10
Lymphadenopathy during the prodromal stage of illness can be a
clinical feature to distinguish monkeypox from chickenpox or smallpox.

If monkeypox is suspected, health workers should collect an

appropriate sample and have it transported safely to a laboratory with
appropriate capability. Confirmation of monkeypox depends on the
type and quality of the specimen and the type of laboratory test. Thus,
specimens should be packaged and shipped in accordance with national
and international requirements. Polymerase chain reaction (PCR) is the
preferred laboratory test given its accuracy and sensitivity. For this,
optimal diagnostic samples for monkeypox are from skin lesions – the
roof or fluid from vesicles and pustules, and dry crusts. Where feasible,
biopsy is an option. Lesion samples must be stored in a dry, sterile tube
(no viral transport media) and kept cold. PCR blood tests are usually
inconclusive because of the short duration of viremia relative to the
timing of specimen collection after symptoms begin and should not be
routinely collected from patients.

As orthopoxviruses are serologically cross-reactive, antigen and

antibody detection methods do not provide monkeypox-specific
confirmation. Serology and antigen detection methods are therefore
not recommended for diagnosis or case investigation where resources
are limited. Additionally, recent or remote vaccination with a vaccinia-

11
based vaccine (e.g. anyone vaccinated before smallpox eradication, or
more recently vaccinated due to higher risk such as orthopoxvirus
laboratory personnel) might lead to false positive results.

In order to interpret test results, it is critical that patient information be

provided with the specimens including: a) date of onset of fever, b)
date of onset of rash, c) date of specimen collection, d) current status
of the individual (stage of rash), and e) age.

THERAPEUTICS

Clinical care for monkeypox should be fully optimized to alleviate

symptoms, manage complications and prevent long-term sequelae.
Patients should be offered fluids and food to maintain adequate
nutritional status. Secondary bacterial infections should be treated as
indicated. An antiviral agent known as tecovirimat that was developed
for smallpox was licensed by the European Medicines Agency (EMA) for
monkeypox in 2022 based on data in animal and human studies. It is
not yet widely available.

If used for patient care, tecovirimat should ideally be monitored in a

clinical research context with prospective data collection.

VACCINATION

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Vaccination against smallpox was demonstrated through several
observational studies to be about 85% effective in preventing
monkeypox. Thus, prior smallpox vaccination may result in milder
illness. Evidence of prior vaccination against smallpox can usually be
found as a scar on the upper arm. At the present time, the original
(first-generation) smallpox vaccines are no longer available to the
general public. Some laboratory personnel or health workers may have
received a more recent smallpox vaccine to protect them in the event
of exposure to orthopoxviruses in the workplace. A still newer vaccine
based on a modified attenuated vaccinia virus (Ankara strain) was
approved for the prevention of monkeypox in 2019. This is a two-dose
vaccine for which availability remains limited. Smallpox and monkeypox
vaccines are developed in formulations based on the vaccinia virus due
to cross-protection afforded for the immune response to
orthopoxviruses.

PREVENTION

Raising awareness of risk factors and educating people about the

measures they can take to reduce exposure to the virus is the main
prevention strategy for monkeypox. Scientific studies are now
underway to assess the feasibility and appropriateness of vaccination
for the prevention and control of monkeypox. Some countries have, or

13
are developing, policies to offer vaccine to persons who may be at risk
such as laboratory personnel, rapid response teams and health
workers.

REDUCING THE RISK OF HUMAN-TO-HUMAN TRANSMISSION

Surveillance and rapid identification of new cases is critical for outbreak

containment. During human monkeypox outbreaks, close contact with
infected persons is the most significant risk factor for monkeypox virus
infection. Health workers and household members are at a greater risk
of infection. Health workers caring for patients with suspected or
confirmed monkeypox virus infection, or handling specimens from
them, should implement standard infection control precautions. If
possible, persons previously vaccinated against smallpox should be
selected to care for the patient.

Samples taken from people and animals with suspected monkeypox

virus infection should be handled by trained staff working in suitably
equipped laboratories. Patient specimens must be safely prepared for
transport with triple packaging in accordance with WHO guidance for
transport of infectious substances.

The identification in May 2022 of clusters of monkeypox cases in

several non-endemic countries with no direct travel links to an endemic
area is atypical. Further investigations are underway to determine the

14
likely source of infection and limit further onward spread. As the source
of this outbreak is being investigated, it is important to look at all
possible modes of transmission in order to safeguard public health.

REDUCING THE RISK OF ZOONOTIC TRANSMISSION

Over time, most human infections have resulted from a primary,

animal-to-human transmission. Unprotected contact with wild animals,
especially those that are sick or dead, including their meat, blood and
other parts must be avoided. Additionally, all foods containing animal
meat or parts must be thoroughly cooked before eating.

PREVENTING MONKEYPOX THROUGH RESTRICTIONS ON ANIMAL

TRADE

Some countries have put in place regulations restricting importation of

rodents and non-human primates. Captive animals that are potentially
infected with monkeypox should be isolated from other animals and
placed into immediate quarantine. Any animals that might have come
into contact with an infected animal should be quarantined, handled
with standard precautions and observed for monkeypox symptoms for
30 days.

LGBTQ STIGMATIZATION

15
Several experts have raised concerns about stigmatization of LGBT
people in connection to the monkeypox outbreak.[31]

In June 2022, the public prosecutor of Valencia opened an investigation

of a publication about the monkeypox outbreak by the far-right political
party España 2000, which could constitute hate speech against the
LGBT community.

CHAPTER THREE RESPONSES

World Health Organization

On 20 May, the World Health Organization (WHO) convened an

emergency meeting of independent advisers to discuss the outbreak
and assess the threat level. Initial assessments expressed the
expectation of the outbreak to be contained, and of low impact to the
general population in affected countries. Its European chief, Hans
Kluge, expressed concern that infections could accelerate in Europe as
people gather for parties and festivals over the summer. On 1 June, a
WHO statement acknowledged that undetected transmission had
occurred for some time,and called for urgent action to reduce
transmission. On 14 June, the WHO announced plans to rename the

16
monkeypox virus in order to combat stigma and racism surrounding the
disease. A meeting convened on 23 June determined that the outbreak
did not constitute a public health emergency of international concern
for the time being,but that decision was overturned by a later meeting
on 23 July.

COUNTRIES AND THERE RESPONSES TO MONKEY POX

 Algeria: The Pasteur Institute of Algeria issued a communiqué in

May, in which the Institute described the origins of Monkeypox in
Sub-Saharan Africa, and recommended physical distancing, as well
as the use of masks in crowded or enclosed places, in addition to
avoiding contact with wild animals that may possess the virus.
 Armenia: On 28 July, Health Minister Anahit Avanesian told
reporters that the country had not yet recorded any cases of
Monkeypox, but confirmed that the country had received test kits
from Russia.
 Australia: On 28 July, the Chief Medical Officer of Australia
declared the increasing presence of monkeypox "a communicable
disease incident of national significance". On 4 August, the Health

17
 Minister announced the securing of 450,000 third-generation
monkeypox vaccines.
 Bangladesh: On 22 May, the Directorate General of Health
Services (DGHS) issued warnings at every port in the country to
prevent the spread of monkeypox. The Directorate spokesperson
said that they have asked all air, land and sea ports to be alert.
Suspected cases are instructed to be sent to an infectious disease
hospital and kept in isolation. Bangladesh became the first
country bar shore passes, after the Chittagong Seaport barred
shore passes for all crew unless in the case of an emergency,
while signed-off crew will have to undergo health checks.
 Belgium: The Risk Assessment Group (RAG) and health authorities
declared that those infected with monkeypox must self-isolate for
21 days.
 Brazil: The Brazilian Ministry of Health created groups of
biologists to monitor monkeys and medical groups to monitor
possible cases.On August 8, 2022, during a podcast, the president
of Brazil Jair Bolsonaro made homophobic jokes about the
disease. When questioning the host about whether he would get
a monkeypox vaccine, and the host says yes; Jair Bolsonaro
replied: "I'm sure you want to get the vaccine. You don't fool me"
followed by laughter. The host remains in his serious speech on

18
 the subject, Bolsonaro commented: "Don't you understand?"
clarifying the homophobic tone of the comment.
 Botswana: In June, the Ministry of Health advised the population
of Botswana to go to the nearest hospital in case of any unusual
symptoms. In addition, the ministry advised to avoid close contact
with other people.
 Cambodia: In May, Or Vandine, spokeswoman for the Ministry of
Health, alerted the citizens of Cambodia that Monkeypox could be
lethal due to the lesions caused by this disease, which can lead to
complications in the body's organs. In June 2022, the Cambodian
government ordered screening under the supervision of health
workers of all air, sea and land entry points in the country, in
addition to ordering mandatory quarantine of anyone infected or
in contact with people with the disease.
 Canada: On 21 April, Public Services and Procurement Canada
published a tender request seeking to stockpile doses of smallpox
vaccine to be prepared in the event of a future accidental or
intentional release of the virus. The contract for 500,000 doses
closed on 5 May, and was awarded to Bavarian Nordic. On 24
May, the Public Health Agency of Canada stated that they were in
the process of extracting Imvamune vaccines from their National
Emergency Strategic Stockpile for deployment across the country,

19
 starting with the province of Quebec. On 26 May, Quebec
announced that Imvamune vaccines would be made available to
those who have been in close contact with confirmed or
suspected monkeypox cases. On 7 June, PHAC announced that
travellers returning to Canada may be subject to a mandatory
quarantine period if they become ill with monkeypox, and warned
that quarantined travellers may have restricted access to health
care and delays returning home.
 China: On 2 June, the Chinese CDC issued a notice quoting WHO's
document with a translation of the original "Stigmatising people
because of a disease is never okay. Anyone can get or pass on
monkeypox, regardless of their sexuality."
 Colombia: As of May, the Colombian Ministry of Health was
taking follow-up and control measures. The Director of
Epidemiology and Demography of the Ministry of Health, Claudia
Cuellar, informed the Colombian population about how
monkeypox is spread through people, and she spoke about the
clinical presentation of the virus and international health
regulations.[185] Health authorities in the Department of Norte
de Santander have been on alert, since the department is a
border area where people pass between Colombia and
Venezuela.

20
 Dominican Republic: In May, the Ministry of Public Health of the
Dominican Republic issued a preventive epidemiological alert
after monkeypox was reported in several countries.
 Egypt: On 24 May, the Egyptian Ministry of Health and Population
informed about measures to prevent new Monkeypox infections,
among them, was to wash hands with soap or use an alcohol-
based hand sanitiser, in addition to using personal protective
equipment such as masks. In addition, the Ministry informed that
veterinary quarantine procedures should be taken for animals
that present the disease.
 Fiji: The country's Centre for Disease Control and Border Health
Protection Unit are monitoring the situation. The Ministry of
Health has put in place infection prevention protocols at the
border.Minister for Health Ifereimi Waqainabete said that the
Ministry is on high alert after three suspected cases of
Monkeypox returned negative results.
 Germany: Fabian Leendertz of the Robert Koch Institute
described the outbreak as an epidemic that will not last long: "The
cases can be well isolated via contact tracing and there are also
drugs and effective vaccines that can be used if necessary."
 Guatemala: On 26 May, the Minister of Health of Guatemala,
Francisco Coma, informed that the Ministry declared an

21
 epidemiological alert on the borders of the Central American
country, with the objective of detecting possible cases of
Monkeypox. The minister also mentioned that one of the main
transmissions of Monkeypox is from injuries and body fluids as
well as contact with contaminated clothing.
 India: Union Health Minister Mansukh Mandaviya directed the
National Centre for Disease Control and the ICMR to keep a close
watch and monitor the situation. The Union Health Ministry has
also directed airport and port health officers to be vigilant,
according to official sources. They have been instructed to isolate
and send samples to the National Institute of Virology of any sick
passenger with a travel history to infected countries.
 Indonesia: When cases of monkeypox were reported in Australia
in May 2022, they triggered the alert of health authorities in
Indonesia. Mohammad Syahril, ministry spokesperson, urged
medical personnel and the country's population to be alert and
aware of the symptoms of the disease.
 Ireland: The Health Service Executive (HSE) has set up a
multidisciplinary incident management team to prepare for the
possible arrival of monkeypox, and infectious diseases experts are
on alert for patients with symptoms of the virus. On 26 July, the

22
 Government of Ireland confirmed the issuing of a vaccination for
specific groups and to increase awareness.
 Japan: The Japanese health ministry has confirmed its first case of
monkeypox on 25 July 2022. It was detected from a male in his
30s residing in the Tokyo area.
 Kosovo: On 23 May, the Ministry of Health and the National
Public Health Institute, have drafted a document of
recommendations and measures to help prevent the spread of
the disease. In a press statement, healthcare authorities have
declared that the situation is being closely monitored.
 Luxembourg: On 21 May, the Ministry of Health said that they are
monitoring the situation with Europe.[201] The National
Infectious Diseases Department of the HLC and refrain from close
contact activities until the infection has resolved.
 Malaysia: On 27 May, the Malaysian Ministry of Health
reactivated the MySejahtera app to provide information and
surveillance on monkeypox.
 Mexico: In May, Mexican health authorities have posted notices
in clinics and hospitals for the purpose of identifying suspected
cases in the country. In addition, the Ministry of Health has issued
an epidemiological alert on 26 May 2022.

23
 Morocco: In May, several regional directors of the Moroccan
Ministry of Health are coordinating a surveillance system for
Monkeypox with the Directorate of Epidemiology and Disease
Control in order to prevent cases of Monkeypox from European
countries from spreading to Morocco, according to the Al Akhbar
[ar] newspaper. Due to the "Marhaba 2022" operation, an
operation that aims to facilitate the travel of Moroccans living
abroad by sea when they travel during the summer period,
sanitary measures have already been put in place.
 Netherlands: The Netherlands started vaccinating people
considered 'at risk' for monkeypox infection at the end of July
2022. This includes people on pre-exposure prophylaxis for HIV
prevention.
 Nigeria: The director general of the NCDC, Ifedayo Adetifa,
advised the Nigerian population to avoid eating bush meat to
prevent new Monkeypox infections, in addition to storing food
properly to avoid being contaminated by rodents, as Monkeypox
is a viral zoonosis.
 Philippines: Former health secretary Francisco Duque III said that
the Philippines was intensifying its border control measures amid
the threat of the monkeypox virus. The health department stated

24
 it is exploring potential sources of monkeypox vaccines and
antivirals.
 Saudi Arabia: On 21 May, the Saudi Ministry of Health stated that
they are ready to monitor and investigate cases of monkeypox, if
any occurs. They added that it also has an integrated preventive
plan to deal with such cases if they appear, including identifying
suspected and confirmed cases.
 Senegal: Badara Ly of the Ministry of Health and Social Action,
spoke about the creation of a contingency plan in Senegal during
an online conference with the WHO in May, in addition the doctor
alerted the health system and advised the creation of fact sheets
on prevention methods and reinforcement of screening in border
areas.
 South Africa: On 26 May, the National Institute for Communicable
Diseases (NICD) gave a communiqué on how the virus is
transmitted, and the institute stated that the 2022 outbreak is the
largest outbreak of Monkeypox outside of endemic regions. In
addition, the NICD affirmed that the virus mainly spreads in
tropical forest areas in West and Central Africa.
 Taiwan: On 30 May, the Taiwan Centers for Disease Control
officially listed monkeypox as a notifiable infectious disease, and
on 23 June, monkeypox was officially upgraded to a second-class

25
 notifiable infectious disease, which means that confirmed cases
must be notified within 24 hours, and if necessary, isolation
treatment may be implemented in designated isolation treatment
institutions.
 Thailand: On 24 May, the Department of Disease Control (DDC)
started screening all overseas passengers from Central African
countries and other outbreak countries at international airports.
On 26 May 2022, the DDC set up an emergency operations center
to monitor the outbreak situation and plan for a possible outbreak
in the kingdom.Anutin Charnvirakul, Minister of Public Health,
said that the government is seeking a smallpox vaccine from the
WHO to bolster the public's immunity in case of a viral outbreak.
 United Kingdom: On 22 May, Education Secretary Nadhim Zahawi
said "we're taking it very, very seriously" and that the UK
government had already started purchasing smallpox
vaccines.The Terrence Higgins Trust and British Association for
Sexual Health and HIV (BASHH) expressed concern about the
impact on sexual health services in the United Kingdom.
 United States: On 22 May, President Joe Biden commented "they
haven't told me the level of exposure yet but it is something that
everybody should be concerned about". National security advisor
Jake Sullivan told reporters the US has a vaccine that is relevant to

26
 treating monkeypox. On 25 May, the CDC issued an alert for gay
and bisexual men to be especially vigilant. In addition, the CDC
placed its monkeypox travel alert at "Level 2", following reports of
cases in Australia and several countries in Europe. Beginning 18
July 2022, Sonic Healthcare USA started testing for monkeypox
using CDC's orthopoxvirus test, which includes monkeypox virus
at Sonic Reference Laboratory in Austin, Texas.
 Vietnam: On 24 May, Vietnam's Ministry of Health asked border
localities to increase surveillance to detect possible cases of
monkeypox.

Dependent territories

Gibraltar: On 31 May, a Strategic Coordination Group met to discuss

Gibraltar's state of preparedness in the eventuality that a case of
Monkeypox was confirmed in the territory amid the rapid rise of cases
in the United Kingdom and Spain.

HOW MONKEYPOX RELATES TO SMALLPOX

The clinical presentation of monkeypox resembles that of smallpox, a

related orthopoxvirus infection which has been eradicated. Smallpox
was more easily transmitted and more often fatal as about 30% of

27
patients died. The last case of naturally acquired smallpox occurred in
1977, and in 1980 smallpox was declared to have been eradicated
worldwide after a global campaign of vaccination and containment. It
has been 40 or more years since all countries ceased routine smallpox
vaccination with vaccinia-based vaccines. As vaccination also protected
against monkeypox in west and central Africa, unvaccinated
populations are now also more susceptible to monkeypox virus
infection.

Whereas smallpox no longer occurs naturally, the global health sector

remains vigilant in the event it could reappear through natural
mechanisms, laboratory accident or deliberate release. To ensure
global preparedness in the event of reemergence of smallpox, newer
vaccines, diagnostics and antiviral agents are being developed. These
may also now prove useful for prevention and control of monkeypox.

28
 INDEX

REFERENCE

Wikipedia search

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2. "Monkeypox spreads in West, baffling African scientists". ABC
News. Archived from the original on 20 May 2022. Retrieved 20
May 2022.
3. Mandavilli, Apoorva (18 May 2022). "A Massachusetts Man Is
Infected With Monkeypox". The New York Times. ISSN 0362-4331.
Archived from the original on 20 May 2022. Retrieved 20 May
2022.
4. "Outbreak Brief #4: Monkeypox in Africa Union Member States"
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