Until recently, monkeypox or monkeypox it was a viral disease that only occurred in rural areas of Central and West Africa, about which we western countries knew little. The situation changed completely on May 14, when the United Kingdom’s National Health Security Agency reported two cases with no history of recent travel or contact with an imported case. Since then it has become an infection that everyone talks about.
A month after these first cases appeared, as of June 20, the confirmed cases in Spain already totaled 500, and there were more than 1,800 throughout Europe, to which we must add more than 300 in the rest of the world.
Most of them have mild symptoms that do not require admission and none have died. Almost all are young men with a median age of 36 years with a history of sex considered risky.
Moderate risk at the moment
The WHO currently considers the public health risk of this outbreak to be moderate. After all, it is the first time that many cases of this infection have been reported simultaneously in endemic and non-endemic countries from very different geographical areas (28 countries).
But, although the current risk to human health and the general population is low, the risk to public health could become high if this virus becomes established in non-endemic countries.
Likewise, it can pose a risk for health personnel, in case they do not use the appropriate infection prevention and control measures or do not have adequate personal protection equipment, as well as for other vulnerable population groups such as children or people with immunosuppression. .
Ensuring early detection and diagnosis
This outbreak has been a new challenge to address worldwide. In Spain, the Ministry of Health has worked to guarantee the early detection and diagnosis of monkeypox cases.
First, an alert was opened at the national level and a risk assessment was carried out. A procedure was also approved for the early detection and case management in response to the monkeypox alert. Next, the availability and usefulness of vaccines were reviewed and vaccination recommendations for the current situation.
Vaccines come back to the scene against an unexpected infection. But in this outbreak, is the vaccine the solution?
Those over 50 are protected
On the one hand, it has been shown that prior vaccination against smallpox can confer protection against monkeypox. In Spain, vaccination against smallpox was administered between 1903 and 1979. But from 1972, the year in which smallpox was eliminated in Spain, vaccination coverage declined. That is why it is considered that the population over 50 years of age can be protected, at least in the face of serious illness.
On the other hand, in the European Union there is no authorized vaccine against monkeypox. The vaccine IMVANEX (from Bavarian Nordic), authorized in 2013 by the European Commission, is indicated for active immunization against smallpox in adults (≥18 years). However, in 2019 this same vaccine was licensed in the United States (with the trade name JYNNEOS) for the prevention of smallpox and monkeypox.
In addition, we have the experience of using the smallpox vaccines ACAM2000 and IMVANEX in previous outbreaks in USA Y United Kingdom, showing that early postexposure vaccination with smallpox vaccine can prevent monkeypox virus infection. And if not, at least reduce gravity of the symptom.
Vaccinate identified close contacts within 4 days
Considering the current scenario of limited vaccine availability, it is recommended to offer vaccination to identified close contacts within 4 days of contact with a confirmed case. The Ministry of Health will monitor the evolution of the outbreak and more vaccines will be available soon, but the extension of vaccination to the general population seems unlikely, even if sufficient doses are available.
These recommendations are in line with those of the ECDC and the WHO. It is a good time to remember that we always work at an international level, sharing available information and debating between countries to achieve a joint and harmonized response.
Maria Aurora Limia SanchezHead of the Vaccination Programs Area in the General Directorate of Public Health, Ministry of Health (Spain) Y Laura Sanchez-Cambronero CejudoHead of Section of the Vaccination Programs Area, Ministry of Health (Spain)