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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Recent Outbreaks Update as of July 7, 2022 at 2pm EDT

As of 5pm EDT on July 6, there were 7,243 cumulative confirmed cases of monkeypox in 54 countries, territories, and areas where the virus is not endemic, according to the US CDC.* A majority of the confirmed cases continue to be reported in European countries, with the UK (1,351), Germany (1,304), and Spain (1,256) making up the top 3. Notably, the US moved into the 4th position this week, reporting 604 confirmed cases. No deaths have been reported in non-endemic countries. 

In its first biweekly situation report on monkeypox published July 6, the WHO reported a 77% weekly increase in the number of lab-confirmed monkeypox cases, to more than 6,000 cases, including 3 deaths in Africa, in 59 countries as of July 4. The agency listed the global risk assessment as moderate globally but high in the WHO European region. Nine (9) additional countries reported new cases in the past week, and 10 countries have not reported additional cases in at least 21 days, the maximum incubation period for monkeypox virus. 

Based on data from Global.health,* Our World In Data shows a cumulative total of 7,268 confirmed monkeypox cases and a 7-day average of 302 daily confirmed cases as of July 6. The 7-day rolling average of daily confirmed cases has remained between 286 and 310 for the past week.
*The CDC and Global.health data do not include a majority of the total suspected (1,821) and confirmed (109) cases, including more than 70 deaths, reported through June 28 from African nations to the WHO. 

EMERGENCY COMMITTEE During a July 6 COVID-19 media briefing, WHO Director-General Dr. Tedros Adhanom Ghebreyesus said he plans to reconvene the Emergency Committee during the week of July 18, or sooner if needed, in order to update members on the outbreak’s current epidemiology and evolution, as well as the implementation of countermeasures. 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. 

Dr. Tedros said the WHO is closely following the situation, working with countries and vaccine manufacturers to coordinate the sharing of scarce monkeypox vaccine supplies, as well as with civil society groups and the LGBTQ+ community to spread information and break the stigma surrounding the virus. A majority of cases have been diagnosed among gay, bisexual, or other men who have sex with men (MSM), and Dr. Tedros commended individuals who are sharing their experiences with monkeypox via news and social media platforms. 

CLINICAL PROFILES An observational study published July 1 in The Lancet Infectious Diseases suggests the clinical profiles of cases in the current outbreak differ from those in past outbreaks. The analysis found that among a cohort of 54 monkeypox patients who attended sexual health clinics in London, UK, a higher prevalence of skin lesions in the genital and anal areas and lower prevalence of tiredness and fever were observed than in previously studied monkeypox cases. One-quarter of the patients were diagnosed with a sexually transmitted infection at the same time as monkeypox, suggesting that monkeypox virus transmission is occurring from close skin-to-skin contact, possibly in the context of sexual activity. The authors call for a review of the current “probable case” definition to help better identify potential cases; additional resources for sexual health clinics that are likely to see additional cases; and balanced but targeted health promotion to at-risk groups.

ENVIRONMENTAL SAMPLING Another study, published in Euro Surveillance, details the environmental sampling of 2 monkeypox patients’ hospital rooms and anterooms used by hospital personnel to don and doff their personal protective equipment (PPE). The researchers found high levels of monkeypox DNA contaminate surfaces in direct contact with monkeypox patients, underscoring the importance of reminding healthcare personnel to follow all protective measures to prevent monkeypox transmission. 

EUROPEAN REGION RESPONSE In a joint surveillance bulletin released July 6, the European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe report that 5,949 cases of monkeypox have been identified in 33 European countries and areas as of July 5, with 5,265 of those being laboratory-confirmed. The report also contains epidemiological information, demographics and clinical descriptions of cases, and phylogenetic analysis. 

The ECDC and WHO also this week published a series of examples of risk communication and community engagement (RCCE) strategies for public health authorities addressing monkeypox. The groups also produced a resource toolkit for event organizers, civil society organizations, and public health authorities to help them reach out to event attendees, including at-risk groups, about monkeypox.

US RESPONSE The US CDC announced July 6 that Labcorp will begin using the agency’s orthopoxvirus test—which detects all non-smallpox-related orthopoxviruses, including monkeypox—effectively doubling the current testing capacity provided through the CDC Laboratory Response Network (LRN). The CDC said it expects additional commercial laboratories to join the national effort to expand monkeypox testing capacity throughout the month of July.

The US Department of Health and Human Services (HHS) on July 1 ordered an additional 2.5 million doses of Bavarian Nordic’s 2-dose Jynneos monkeypox vaccine, which will bring the total number of doses to more than 4 million by mid-2023. The vaccine supply will go to the Strategic National Stockpile as part of the Biden-Harris Administration’s monkeypox outbreak response strategy and broader preparedness efforts for possible future monkeypox and smallpox outbreaks. Public health experts have called on the US to share its stocks of monkeypox and smallpox vaccines with the world to prevent a repeat of vaccine inequity experienced during the COVID-19 pandemic.

HHS has made 56,000 vaccine doses available to US states and jurisdictions, and several have organized vaccine clinics, including New York City, where the number of confirmed cases doubled over the past week; Washington, DC; Massachusetts; and Colorado. However, appointments fill quickly and supplies remain limited, leading some experts to question whether one dose of the vaccine might suffice to end the current outbreak.