Monkeypox cases have tripled across Europe in the past two weeks, latest data has revealed. Dr Hans Henri P Kluge, the World Health Organisation's (WHO) regional director for Europe, has intensified calls for governments to "scale up efforts" in the coming weeks and months to prevent the rare infection from establishing itself across a "growing geographical area".
He stressed that "urgent and coordinated action" was needed for Europe to turn a corner in the race to reverse the ongoing spread of this disease. Public Health Wales, in its latest update on June 27, confirmed there are nine cases of monkeypox in Wales which are being "managed appropriately".
As of June 26, there were 1,076 laboratory-confirmed cases in the UK. Of these, 27 were in Scotland, five were in Northern Ireland, nine were in Wales and 1,035 were in England. Monkeypox was added to the list of notifiable diseases by the UK Health Security Agency (UKHSA) this week. These are infectious diseases, such as measles, scarlet fever, and whooping cough, which have to be reported to local authorities or local health protection teams.
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Dr Kluge said: "The WHO European Region represents almost 90% of all laboratory-confirmed and globally reported cases since mid-May, and since my last statement on June 15 six new countries and areas - taking the total to 31 - have reported monkeypox cases, with new cases tripling over the same period to over 4,500 laboratory confirmed cases across the region.
"There is simply no room for complacency – especially right here in the European Region with its fast-moving outbreak that with every hour, day and week is extending its reach into previously unaffected areas."
The WHO Regional Office for Europe (WHO/Europe) and the European Centre for Disease Control and Prevention (ECDC) are issuing weekly joint monkeypox surveillance bulletins to summarise the rapidly-evolving situation. It found that most cases reported so far have been among people between 21 and 40 years old, and 99% have been men.
"The majority of those for whom we have information are men who have sex with men," said Dr Kluge. "However, small numbers of cases have also now been reported among household members, heterosexual contacts, and non-sexual contacts as well as among children.
"Where information is available, close to 10% of patients were reported to have been hospitalised either for treatment or for isolation purposes, and one patient has been admitted to an ICU. Fortunately, no people are reported to have died so far. The vast majority of cases have presented with a rash and about three-quarters have reported systemic symptoms such as fever, fatigue, muscle pain, vomiting, diarrhoea, chills, sore throat or headache."
He added: "We need to continue to examine this information carefully over the next few weeks and months to better understand exposure risks, clinical presentations in different population groups, and - most importantly – to rapidly identify any changes in the trajectory of the outbreak that would affect our public health risk assessment."
Dr Kluge said the stigmatisation of men who have sex with men in several countries is compounding the challenge. He added: "Many may simply choose not to present to health authorities, fearful of possible consequences. We know from our lessons in dealing with HIV how stigma further fuels outbreaks and epidemics, but allowing our fear of creating stigma to prevent us from acting may be just as damaging."
He called on countries to quickly scale up surveillance of monkeypox, including sequencing, and obtain the capacity to diagnose and respond to the disease. "Cases need to be found and investigated by a laboratory, and contacts identified promptly, so that the risk of onward spread can be reduced," he said. "WHO/Europe is working to support countries by delivering monkeypox virus tests and associated diagnostic training to 17 member states. We have already delivered almost 3,000 tests to seven member states and shipments to others are in process.
"As with any challenge, political leadership is required to support the public health response. Transparency goes hand in hand with public trust to ensure that gaps in responding to monkeypox can be swiftly addressed, and that countries partner with WHO and with each other for the collective good."
A strategy published by the UKHSA has recommended that some gay and bisexual men at higher risk of exposure to monkeypox should be offered vaccines to help control the recent outbreak of the virus. Although anyone can contract monkeypox, data from the latest outbreak shows higher levels of transmission within – but not exclusive to – the sexual networks of gay, bisexual and other men who have sex with men.
The virus is not currently defined as a sexually transmitted infection, but it can be passed on by close and intimate contact that occurs during sex.
Dr Sophia Makki, incident director at UKHSA said: “The monkeypox outbreak in the UK continues to grow, with over a thousand cases now confirmed nationwide. We expect cases to continue to rise further in the coming days and weeks. If you are attending large events over the summer or having sex with new partners, be alert to any monkeypox symptoms so you can get tested rapidly and help avoid passing the infection on.
"Currently the majority of cases have been in men who are gay, bisexual or have sex with men. However, anyone who has had close contact with an individual with symptoms is also at increased risk. If you are concerned that you may have monkeypox, don’t go to events, meet with friends or have sexual contact. Instead, stay at home and contact 111 or your local sexual health service for advice. We are grateful to all the people who have come forward so far for testing and to assist us with our contact tracing."
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