Outbreak Alerts
Editor: Alyson Browett, MPH

Contributors: Christina Potter, MSPH, Eric Toner, MD, Rachel Vahey, MHS, and Lane Warmbrod, MS, MPH
The Johns Hopkins Center for Health Security is analyzing and providing updates, as needed, on the monkeypox outbreaks occurring in several non-endemic nations worldwide. If you would like to receive these updates, please sign up here.
Recent Outbreaks Update as of June 15, 2022 at 12pm EDT

As of 5pm EDT on June 14, there were 1,879 cumulative confirmed cases of monkeypox in 35 countries outside the endemic regions of West and Central Africa, according to the US CDC. As of 12pm EDT today, the Global.health database reports 1,806 confirmed cases and an additional 99 suspected cases. No deaths have been reported in the outbreaks in non-endemic countries. The Global.health team also recently published an article in Lancet Infectious Diseases describing their data collection and other efforts during this outbreak. 

The World Health Organization (WHO) announced yesterday that its Emergency Committee will convene under the International Health Regulations (IHRs) to advise whether the ongoing monkeypox epidemic constitutes a Public Health Emergency of International Concern (PHEIC). The latest WHO risk assessments have designated the risk of further spread in Europe as high, while the risk of spread among the rest of the world is moderate. 

To further reduce stigmatization, many in the scientific community are calling for a change in monkeypox virus nomenclature. For example, a recent position paper authored by an international group of experts suggests changing “West African,” “Central African,” and “Congo Basin” clades to a numerical system, as naming diseases and disease groups after geographic locations can fuel discrimination or stigmatization of those locations and associated peoples or goods. Experts have already commented on the troubling association between monkeypox and Africa, particularly as news media outlets have often depicted the current monkeypox outbreaks in non-endemic countries alongside photos of Africa and Africans, practices that are misleading and racially insensitive.

Eurosurveillance, the journal of the European Centre for Disease Prevention and Control (ECDC), recently published a letter to the editor from health officials in Italy, which suggests that there may have been multiple independent introductions of monkeypox to Italy, citing cases with travel history to the Canary Islands and a traveler returning from Ghana. The UK Health Security Agency (UKHSA) released its first technical briefing on the outbreak last Friday to share data and preliminary analyses useful to public health investigators and academic researchers. The UKHSA’s high-level findings include existing evidence gaps, case characteristics, preliminary assessments of genetic mutations of concern, an estimate of the serial interval (9.8 days; 95% CI: 5.9-21.4), and difficulties related to contact tracing and sharing genomic data. Additional studies are also strengthening the evidence base for sexual transmission, including documentation that the virus is capable of infection and replication in semen.

The WHO released new interim guidance for clinical management and infection prevention and control for monkeypox as well as new interim guidance on vaccines and immunization. Notably, the vaccination guidance includes information on both pre- and post-exposure prophylaxis (PrEP and PEP, respectively) but discourages mass vaccination at this time. The US Centers for Disease Control and Prevention (CDC) also disseminated new case definitions for monkeypox to encourage broader clinical awareness and testing. 

Experts continue to disagree regarding how best to characterize the risk of respiratory transmission for the general public. US CDC representatives recently emphasized that monkeypox generally does not linger in the air over long or short distances, although it does recommend that clinicians take precautions against respiratory transmission. While experts agree that respiratory transmission is likely not a major driver of these outbreaks, some have found the CDC’s guidance on this issue confusing. It has been noted that this particular route of transmission has not been well studied in monkeypox, but at least one instance of respiratory transmission has been documented in a prior outbreak. The WHO's most recent situation update does note the risk of respiratory transmission at close distances, in addition to more traditional modes of transmission.