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Monkeypox has been upgraded to a “health emergency of international concern”, which is the same level as the new crown. What does it mean?

On the afternoon of July 23, local time in Geneva, Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (hereinafter referred to as WHO), announced at a press conference that the monkeypox epidemic was listed as a “public health emergency of international concern”. This is the highest level of alert issued by the WHO for a global public health emergency, which also means that the monkeypox epidemic and the new crown epidemic have become the same alert level. The designation means the WHO now believes the outbreak poses a serious enough threat to global health and could escalate into a pandemic requiring a coordinated international response to prevent further spread of the virus.

However, listing the monkeypox outbreak as a “public health emergency of international concern” has not been as smooth as the new crown epidemic. According to the “International Health Regulations (2005)”, the determination of “public health emergencies of international concern” mainly depends on four aspects: serious, sudden, unexpected and whether the risk of international transmission is not Very high (significant risk for international spread). After discussions among experts of the WHO committee, there are still differences in the research and judgment of the monkeypox epidemic in these major aspects, and no consistent results have been reached. But Tedros Adhanom Ghebreyesus, as WHO Director-General, has the final discretion. After careful consideration of all the experts, he decided to announce the decision after much deliberation. This is also the first time WHO has made such a statement without consensus from a panel of experts since the establishment of the Public Health Emergencies of International Concern system in 2005.

On June 27, 2022 local time, Seoul, South Korea, National Central Medical Center, medical staff are vaccinated against monkeypox.

According to the data of the US National Centers for Disease Control and Prevention (CDC) on July 25, the monkeypox epidemic has spread to 75 countries and regions, with a total of 18,000 confirmed cases, of which only 243 cases appeared in African countries with historical cases. Most cases have been found in countries and territories with no historical records of monkeypox. According to NBC, the confirmed cases of monkeypox in Europe account for more than 80% of the global cases, making it the epicenter of the global monkeypox epidemic. Tedros also said at a press conference that the global risk of monkeypox is moderate, but the threat in Europe is high.

Since the UK reported the first case of monkeypox in Europe in May this year, the number of new monkeypox cases in Europe has been increasing every day, and since the end of June, the growth rate of monkeypox cases in Europe has reached a new high. According to the European Centre for Disease Prevention and Control, in early July, the number of new daily confirmed cases in Europe had doubled compared to late June.

Viruses that are not fully understood

According to Jin Dongyan, a virologist at the University of Hong Kong, the monkeypox epidemic was finally classified as a ” public health emergency of international concern”, mainly due to two factors: first, the number of confirmed cases in the world has indeed reached a certain scale; second However, the mode and characteristics of the current circulating monkeypox virus are still unclear in the world. This is an important reason for raising monkeypox to the highest level of warning.

Compared to the 2018 West African monkeypox virus, at least two mutant strains of the virus are now circulating in the United States, according to an earlier NBC report. And we now know very little about these mutated strains. But what is certain is that the current monkeypox strains have changed in both clinical manifestations and transmission methods in patients. In the past, it was widely believed that the typical symptoms of monkeypox were blisters on the patient’s face, extremities and trunk. Now, many cases found in Europe and the United States do not have such symptoms. Many of them only have a small amount of herpes near the genitals or anus, so many people can’t judge whether they have monkeypox at first.

An electron microscope image shows the monkeypox virus in Madrid, Spain, on May 26, 2022.

On the other hand, the current monkeypox virus seems to have changed in the way of infection compared with before. Jin Dongyan told this magazine that in the past, monkeypox was mainly transmitted by physical contact and aerosol. It required close contact with the respiratory secretions and skin lesions of the infected person, and long-term face-to-face transmission of respiratory droplets. Based on existing cases, it seems likely that monkeypox can also be transmitted through sexual activity.

The team studied 528 confirmed cases of infection at 43 sites in 16 countries between April 27 and June 24, 2022, according to the New England Medicine study. It was found that 98% of those infected were gay or bisexual men, and 41% of them had the human immunodeficiency virus (HIV).

Electron microscope images provided by the U.S. Centers for Disease Control and Prevention show mature monkeypox virus (left) and immature virions (right) from human skin samples associated with the 2003 prairie dog outbreak.

Jin Dongyan told the publication: “We have never observed in the past that monkeypox can also be transmitted through sexual behavior. Pox can be transmitted through semen. Further research is needed to obtain conclusive evidence to find out whether the new mode of transmission is just special close contact transmission. But behind this phenomenon shows that the current circulating monkeypox virus has appeared in the mode of transmission It has new characteristics, and we know very little about it. In addition, this round of epidemic has infected 18,000 people, and the source of infection and transmission chain of many of them are still unclear. We do not yet fully understand the key information, and further research and judgment are required.”

Could monkeypox be the next global pandemic virus?

On July 25 , local time , the Japanese Ministry of Health, Labour and Welfare announced that the first confirmed case of monkeypox in Japan was found in Tokyo. On the same day, the Japanese Ministry of Foreign Affairs issued a global level-1 travel warning for the monkeypox outbreak. More and more countries have been affected by the monkeypox epidemic, especially in Asia, including Taiwan, where monkeypox cases have been found one after another recently. Many people worry about whether monkeypox will become a global pandemic like the new coronavirus. Virus. Jin Dongyan said that at present, the probability of a global pandemic of monkeypox is extremely small.

“The most important thing to judge whether the virus is going to be a large outbreak is its transmissibility, and we are now seeing that monkeypox spreads a little more in the gay men’s group, and it does not spread widely in other groups. Also, we don’t see a single person spreading multiple super-spreaders. Analogous to the spread of the new coronavirus, the new coronavirus delta strain has an R0 value of about 6 , which can double the number of infections in 1.5 days at the peak of the epidemic . Now The infectivity of the monkeypox virus is still incomparable with the new coronavirus and smallpox. ” Jin Dongyan said. On the other hand, the fatality rate of monkeypox is also very low. At present, there are only 5 deaths in this monkeypox epidemic , and all of them occurred in Africa. In fact, monkeypox is inherently a self-limiting virus, and patients usually within 2-3 weeks.

A Haaglanden GGD employee prepares supplies for the monkeypox vaccine at the local vaccination center in Reiswijk, the Netherlands, on July 25, 2022. Haglanden and Amsterdam GGD have begun vaccinating monkeypox for specific risk groups.

After the WHO classified monkeypox as a “health emergency of international concern”, the General Administration of Customs of my country issued the “Announcement on Preventing the Introduction of Monkeypox into my country” on July 24. Prior to this, the National Health and Health Commission issued the “Monkeypox Prevention and Control Technical Guidelines (2022 Edition)” in early July, clarifying that during the quarantine period for existing inbound personnel, while investigating the infection of the new coronavirus, all localities should take the initiative to conduct inspections on inbound personnel. Monkeypox virus screening. In Jin Dongyan’s view, the harm of monkeypox to China is very limited, and even if it is introduced into China, we have the ability to quickly produce a vaccine to deal with it.

Jin Dongyan told this magazine: “We can make a strategic reserve at any time. We can re-use China’s unique vaccinia virus Tiantan strain, and Sinopharm Zhongsheng will make a certain technical reserve and produce some vaccines in an appropriate amount in case of emergency, or provide To other countries. There are three different viruses in the Poxviridae family: vaccinia, smallpox and monkeypox, but the vaccinia virus is specially used as a vaccine, and it has good protection against smallpox, which has been proved by history. The protection against smallpox is also very good. At present, the vaccines that are being implemented in the world are also vaccinia virus. And against monkeypox virus, the vaccinia virus that we used to defeat smallpox in the past is still effective .”

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