The World Health Organization on Saturday called monkeypox a “public health emergency of international concern,” noting there are more than 18,000 cases across 75 countries outside of Africa.

The United States is second only to Spain in the number of reported cases during this global outbreak, though France, Germany and the United Kingdom aren’t far behind, according to the World Health Organization. The illness was already endemic in western and central African nations.

The New York Times notes that “public health emergency of international concern” is a designation now used only to describe COVID-19 and polio. It’s the international public health organization’s highest declaration for a contagious illness.

The Biden administration is deciding whether it should declare the U.S. monkeypox outbreak a public health emergency, The Washington Post said this week. The administration does plan to name a monkeypox coordinator to help coordinate federal efforts to tame the outbreak.

The United States as of July 25 has 3,484 confirmed cases, nearly 1,000 of them in New York, though California, Florida, Georgia, Illinois and Texas have at least 220 cases each, according to the Centers for Disease Control and Prevention monkeypox map. Just Alaska, Maine, Montana and Wyoming do not have any confirmed monkeypox cases.

And the virus is changing rapidly, which could boost its spread. Early findings from studying samples taken from patients suggest 47 mutations in the last three or four years — a time in which fewer than 10 would have been expected, according to the study authors at the University of Edinburgh.

Declaring the threat

Dr. Tedros Adhanom Ghebreyesus, the World Health Organization’s director-general, made the health crisis declaration after a panel of advisers couldn’t agree on whether the designation is warranted, the Times reported. Some still deemed monkeypox a “growing threat,” a lower but still international-crisis level assessment — though case numbers are five times higher than they were a month ago.

“The good news is the version of monkeypox spreading across the globe — the West African type — isn’t particularly deadly. According to the CDC, more than 99% of patients can expect to survive,” NPR’s guide to monkeypox said.

Public health officials agree that in this outbreak most cases are very painful, but less likely to be life-threatening as they present with fever, headache, swollen glands, rash and pus-filled lesions that sometimes scar. Typically, cases resolve on their own in a couple of weeks. But monkeypox is highly contagious and can be spread through close contact not only with infected people and animals, but through contact with contaminated linens, clothing and surfaces.

Given its rate of spread and the pace of mutation, some worry that it could become entrenched in the United States and other high-case-count countries.

Cases have now been reported in two U.S. children, likely household members of someone who has been infected. “Federal health authorities said there was no evidence yet of sustained transmission among broader population groups,” The Washington Post article said, noting transmission has so far been largely within the gay and bisexual community.

According to NPR, “Monkeypox isn’t considered a sexually transmitted disease, but the CDC says researchers are still trying to sort out whether the virus can be found in semen, vaginal fluids and feces. Sexually active individuals should be open about their potential exposure to the virus, and ask your partner or partners to do the same.”

Finding cases in children can herald wider community spread, experts said. One worry is that the virus can spread to animals, which would make it much more likely to become endemic, as happened in west and central Africa. As NPR reported, before this outbreak, most of the cases outside Africa were tied to either international travel or imported animals.

A New York Times article noted that “The longer the outbreak goes on, the greater the chances are of the virus moving from infected people to animal populations, where it could persist and sporadically trigger new infections in people. This is one way that a disease can become endemic in a region.”

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The terrible toll from COVID-19 and the rapid spread of monkeypox should tell governments they need to beef up their preparation for and response to new pandemics, Tom Inglesby, director of the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health, told The New York Times.

“As much as the world is tired of infectious disease crises, they are part of a new normal that is going to demand a lot of ongoing attention and resources,” he said. “We need global vaccine and therapeutics production and stockpiling approaches that don’t yet exist.”

Testing and vaccines

As CNN reported, Dr. Ashish Jha, the White House COVID-19 response coordinator, told reporters during Monday’s White House press briefing that as testing is more readily available, case counts are likely to rise.

“Jha said the U.S. has ramped up testing access since early cases of monkeypox emerged — going from a capacity for 6,000 tests per week to 80,000 tests per week. And he told CNN during the White House press briefing that he does not believe lower monkeypox testing capacity early on was a major limitation, but that one of the challenges was making it easier for providers to order a test,” CNN reported.

“While some health officials say an emergency declaration is necessary to give the government authority to cut through red tape and collect data about the virus’s spread, others argued that the move is mostly symbolic and will not address vaccine shortages, treatment barriers or other challenges that have hindered the U.S. response,” according to three people who spoke to The Washington Post on the condition of anonymity because they were not authorized to comment.

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Two smallpox vaccines considered about 85% effective against monkeypox are being used. In this outbreak, it’s too soon to tell how effective they will prove to be.

The older of the two vaccines, ACAM2000, is a live virus that has more side effects. The Jynneos vaccine is quite new and has fewer side effects. It contains inactivated virus.

The government had provided more than 300,000 vaccine doses to states and territories by the end of last week. Jha told CNN the White House planned “to make it easier for medical providers to access doses of the antiviral medication, TPOXX, that are currently in the national stockpile.”

The stockpile has 1.3 million doses, Jha said.

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