The World Health Organization (WHO) has declared the monkeypox outbreak a ‘health emergency of international concern’, the highest alert level worldwide. According to professor Laurens Liesenborghs of the Institute of Tropical Medicine, there is no reason to panic, ‘but the virus is not under control’.
The WHO responds to virus reports from 75 – mainly European and North American – countries, while the virus normally appears mainly in African countries. Symptoms include headache and muscle aches, fever, and blistered rash on the skin.
Laurens Liesenborghs, professor of Emerging Infectious Diseases, thinks the state of emergency is justified, ‘although the WHO was again a bit late and cautious with its response’.
Isn’t it only about 16,000 infections worldwide?
Laurens Liesenborghs: The infections are increasing sharply and exponentially. The monkey pox is not sufficiently under control. In the Tropical Institute we notice this with seven to ten confirmed cases per day. Urgent action is therefore required.
Why does the WHO only sound the alarm when the virus is circulating in Europe and North America, when it has been circulating in Africa since 1958?
Liesenborghs: The disease was somewhat neglected as long as it remained within the borders of Africa. Now that she shows up in the West, it’s suddenly all hands on deck. But we also see differences between Africa and the West. In Africa, the disease is a zoonosis, it is transmitted from animals to humans and you regularly have large outbreaks. Human-to-human transmission is limited. The disease has changed in the West because infections here happen from person to person and that gives the uncontrolled increase of the virus. So that is worrying. But it is rather doubly and sour that the disease has been ignored for years as long as it only occurred in Africa.
Could the disease have been eradicated already?
Liesenborghs: Eradication is very difficult because of that huge virus reservoir in animals. Common smallpox was eradicated because it only spread from person to person and not through animals. There are vaccines that would protect vulnerable populations in Africa, but that costs a huge amount of money and until recently there was no question of vaccinating those at-risk populations.
Is there a specific monkeypox vaccine or is it being developed?
Liesenborghs: No, we use the third generation vaccines developed for common smallpox. The monkeypox virus is very similar to that smallpox virus and we count on cross-protection. We know from animal experiments and epidemiological data that smallpox vaccines can work, but to what extent we do not yet know exactly. In Africa we did see that after the cessation of vaccination campaigns for classical smallpox, monkeypox started to increase year after year.
Is the monkeypox virus deadly? Only five deaths have been reported worldwide.
Liesenborghs: No patients have died of monkey pox here yet. There is also no treatment with antiviral drugs yet, because they are still in the testing phase. Most patients recover spontaneously after about three weeks, although some hygiene measures or antibiotics are sometimes necessary. Occasionally, a patient ends up in the hospital for pain relief, but the vast majority have mild symptoms. In Africa we see that sometimes scars remain or the eye is affected, which can lead to blindness. We don’t see that kind of impact here. So the image is not black and white. There is no threat of another pandemic, but neither can you pretend that nothing is happening. For the Tropical Institute it is all hands on deck because we are now receiving a lot of patients. However, there is no reason to panic. If monkey pox were as contagious as covid, we would already be in lockdown. It simply has to be tackled and the WHO is now sending the right signal for that. There is a small chance that the virus will also spread through the air or via contaminated surfaces, but that is mainly a theoretical risk. To really become infected, intense skin contact or sexual contact is needed. All our patients are gay men who got the virus through sexual contact.
Gay men are the main risk group?
Liesenborghs: Awareness about the risk is increasing because of the media coverage, but it is painful that there is again a stigma for that group of people. In the West, the virus may have initially been spread through a small segment of the gay population who sometimes had many different sexual contacts. That was probably the catalyst. In Africa we see entire families, including women and children, who are infected with the virus. The virus does not discriminate. To dismiss monkeypox as a gay disease is simply incorrect, because it absolutely isn’t. Anyone can be infected.