Outbreak Alerts
Editor: Alyson Browett, MPH

Contributors: Christina Potter, MSPH, Eric Toner, MD, Rachel Vahey, MHS, and Lane Warmbrod, MS, MPH
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UPCOMING WEBINAR The country’s response to the COVID-19 pandemic led to new public-private partnerships (PPPs) that drove the development of new medical countermeasures and bolstered domestic manufacturing capacity for medical products. It is critical to sustain PPPs and build a domestic bioindustrial base beyond the current pandemic. Join us for a webinar, Strengthening Private Public Partnerships in Pandemic Preparedness for National Security and Economic Competitiveness, on Wednesday, July 20, at 12pm ET. Register here: https://jh.zoom.us/webinar/register/WN_fiapVqnbToKHkgwPcaDtIA
Recent Outbreaks Update as of July 12, 2022 at 2pm EDT

As of 5pm EDT on July 12, there were 10,611 cumulative confirmed cases of monkeypox in 65 countries, territories, and areas, according to the US CDC.* A majority of the confirmed cases continue to be reported in European countries, with Spain (2,447), the UK (1,735), and Germany (1,636) making up the top 3. The US remains in 4th position this week, reporting 928 confirmed cases. No deaths have been reported in countries not historically reporting monkeypox, while 3 deaths from confirmed or suspected cases have been reported in other countries. 

Based on data from Global.health,** Our World In Data shows a cumulative total of 10,527 confirmed monkeypox cases and a 7-day average of 484 daily confirmed cases as of July 12. The 7-day rolling average of daily confirmed cases has increased about 35% from 1 week ago.
*The CDC updated its global monkeypox map to include countries historically reporting monkeypox cases and delineate between those and countries not historically reporting monkeypox cases. The CDC map only includes cases confirmed as monkeypox virus or orthopoxvirus through laboratory testing.
**Global.health data only include countries that have not historically reported monkeypox cases. 

GLOBAL SITUATION The WHO this week confirmed that the Emergency Committee will reconvene next week to discuss the ongoing monkeypox outbreaks, although it was not specified which day or days the meetings will take place. Following 2 days of deliberation in June, the Emergency Committee stopped short of declaring a Public Health Emergency of International Concern (PHEIC). The PHEIC designation is the WHO’s highest level of alert, showing an event constitutes an extraordinary public health risk to other countries through international spread and requires a coordinated international response. 

With the virus now spreading in dozens of countries, efforts to control its spread and stop it from establishing itself in the human population become more challenging. Some experts say the warning signs of a potential global outbreak have been present for decades but were largely ignored until the virus began circulating in higher-income countries. Others caution that the true scale of the current monkeypox outbreak is not yet fully understood, as global testing capacity, surveillance, and contact tracing continue to ramp up.

EUROPEAN REGION SITUATION The European Centre for Disease Prevention and Control (ECDC) on July 8 published its first risk assessment update on the multi-country monkeypox outbreak, saying that the likelihood of further monkeypox spread within networks of people with multiple sexual partners in Europe is considered high and the likelihood of spread among the broader population is very low. The report notes that prioritizing pre-exposure vaccination of high-risk groups, including men who have sex with men (MSM) and healthcare workers, should be considered in developing prevention strategies. Two studies published in Eurosurveillance—one examining local viral transmission in Madrid, Spain, and the other in Berlin, Germany—call for increased efforts to work with at-risk groups to reduce stigma, target information, and provide recommendations. 

The UK Health Security Agency (UKHSA) on July 12 released an epidemiological update on the monkeypox outbreak in England, noting that, for cases with available data, 75% are in London, 99% are among males, and the median age is 36 years. Notably, in a technical briefing released last week, the agency said incidence continues to grow, with modeling implying positive growth between 3.8% to 6.7% per day, corresponding to a doubling time of 15 days (90% CI: 10 days, 18 days). On July 10, the UK Advisory Committee on Dangerous Pathogens (ACDP) recommended that the West African clade of monkeypox currently responsible for community transmission within the UK no longer be classified as a high consequence infectious disease (HCID) but that future importations of the West African clade or Congo Basin clade should be designated as HCIDs.

US RESPONSE US health authorities are applying lessons learned during the COVID-19 pandemic to the monkeypox outbreak, but efforts to close gaps in testing, vaccination, and surveillance continue to falter. Some experts blame systemic challenges within the nation’s public health response structure, including a lack of funding and authority, that have existed for decades. 

Monkeypox vaccine remains in short supply, with appointment slots filling as soon as they are released in New York City and other metropolitan areas that have received supplies of the 2-dose Jynneos vaccine from the federal government. The US CDC and its Laboratory Response Network (LRN) continue to expand monkeypox testing capacity, with a goal of supporting 5 commercial laboratories to establish testing capacity of 10,000 tests per week per lab. Within the past week, Labcorp, Mayo Clinic Labs, and Quest Diagnostics have launched monkeypox tests to increase access and availability.