Monkeypox (MPX) is a zoonotic disease and it is currently the most prevalent Orthopoxvirus infection in humans since the eradication of smallpox and the discontinuation of universal smallpox vaccination. Following its first identification as a human pathogen in the Democratic Republic of Congo in 1970, human cases of MPX are increasingly reported in several African countries.
In endemic areas, MPX virus (MPXV) is probably maintained in nature through circulation among a number of mammals, including squirrels, Gambian pouched rats, striped mice, dormice and primates, with occasional spillover into humans, and is transmitted to humans through a bite or direct contact with the blood, flesh, body fluids or skin/mucous membrane lesions of an infected animal.
MPXV does not spread easily between people. Among humans, MPXV can be transmitted through respiratory droplets during direct and prolonged face-to-face contact. Additionally, the virus can be transmitted by direct contact with the body fluids of an infected person, through contact of mucous membranes or broken skin with lesions, open rashes, or through contaminated objects, such as sheets or clothing.
The incubation period for MPX is usually 6 to 13 days, but can range from 5 to 21 days. The disease typically lasts two to four weeks and usually presents with fever, myalgia, fatigue, and headache. The onset of the rash is considered the beginning of the infectious period; however, it is believed that people with prodromal symptoms can also transmit MPXV.
International emergency
On 14 August 2024, the Director General of the WHO, following the Emergency Committee, pursuant to the provisions of the International Health Regulations (2005) and the epidemiological situation of monkeypox virus (MPXV) infections in Africa declared the ” International public health emergency” (PHEIC – Public Emergency of International Concern).
Following what was already notified by the Ministry of Health with the note of 19 August 2024, containing “Update on mpox disease – Declaration of “International Public Health Emergency (PHEIC – Public Emergency of International Concern)” by the WHO on 14 August 2024“, and taking into account the updates provided by the European Center for Disease Prevention and Control (ECDC) on the epidemiological situation of monkeypox virus (MPXV) infections in Africa, as well as the risk assessment provided, and with specific reference to the latest ECDC indications on organic substances of human origin (SoHO), the following is represented:
- MPXV has been detected in blood, urine, tissue abscesses, and body fluids and could potentially be transmitted via SoHOs. However, to date, no transmission of MPXV via SoHO has been reported, and the likelihood of this occurring is unknown;
- No locally acquired clade I mpox cases have been reported to date in the EU/EEA in the context of the current clade I African outbreak (overall, two MPXV clade Ib cases have been reported outside the epidemic areas in Africa, one in Sweden and one in Thailand);
- available information on the incubation period is based on individuals experiencing symptoms. The possibility of transmission of MPXV by asymptomatic individuals is unknown.
In line with the indications already provided by the Centre with the note of the 24 May 2022, containing “Measures to prevent the transmission of the Monkeypox virus infection through the transfusion of labile blood components”, and without prejudice to the provisions of the Ministerial Decree of 2 November 2015 i regard to the criteria for deferring donors who travel to tropical areas, it is recommended to:
- strengthen the anamnesis on the donor by paying particular attention to close contacts with human cases of MPX (confirmed or suspected), contacts with infected animals or recent travel to areas affected by confirmed indigenous cases of MPX;
- apply the 21 days temporary suspension starting from the last day of exposure, for donors with a history of close contact with confirmed or suspected cases of MPX;
- during the donor’s anamnesis pay attention to the wide range of clinical manifestations of the disease detected in recent epidemics. Evaluations should not overlook mild, nonspecific symptoms;
- Donors with confirmed or suspected MPXV infection should be deferred from donating for at least 14 days after resolution of all symptoms.
Monkeypox multi-country outbreak – ECDC update –26 August 2024
According to a report by the Africa CDC, since the beginning of 2024, 20,000 cases of monkeypox have been reported in 13 African Union countries. There were 3,311 confirmed cases, resulting in 582 deaths. 2,961 cases were reported in the Democratic Republic of Congo. So far, the two countries where community transmission is likely to be occurring are the Democratic Republic of Congo and Burundi. However, available data from several other African countries are not good enough to rule out more widespread transmission than currently reported.
Europe
On August 15, 2024, Sweden reported a person with MPXV clade Ib, with a history of travel to a country in Africa where MPXV is circulating. Cases of Mpox due to MPXV clade II continued to be reported in EU countries since 2022, although the numbers are low.
Other cases
On August 22, Thailand reported a case of MPXV clade Ib in a traveler returning from an African country where the virus is circulating
ECDC risk assessment
Based on the latest ECDC risk assessment, the overall risk to the general EU/EEA population is currently assessed as low. The probability of MPXV clade I infection for close contacts of possible or confirmed imported cases is high, but the severity of disease is expected to be low. However, in this same group, the severity of the disease is considered moderate among those with underlying conditions, particularly among immunocompromised individuals for whom the risk is considered high.
The probability of infection for people with multiple sexual partners who were not previously infected with MPXV clade IIb or vaccinated during the 2022 outbreak is considered moderate. This assessment is based on the difficulty in controlling the spread of infection during the clade II epidemic in 2022/23 in this risk group. Although the severity of the disease is low in most cases, immunocompromised people and those with untreated HIV infection may experience moderate clinical severity. Overall, the risk to these populations is moderate.
Further information can be found at the link.
For other information click also on:
Circolare CNS del 24/05/2022 e Allegato 1
Circolare Ministero della Salute del 25/05/2022
Joint ECDC-WHO Regional Office for Europe Monkeypox Surveillance Bulletin del 20/07/2022
Situation report (WHO) del 06/07/2022
Raccomandazioni WHO del 23/07/2022
Circolare Ministero della Salute del 02/08/2022
Circolare Ministero della Salute del 19/08/2024
Rapid Risk Assessment dell’ECDC del 16/08/2024
ECDC Epidemiological Update 26/08/2024
Circolare CNS del 02/09/2024