The World Health Organization’s declaration of the monkeypox outbreak as a public health emergency is premature because the disease poses low severity with a rare threat of increased spread worldwide, said Raman R Gangakhedkar, former head scientist of epidemiology and communicable diseases at the Indian Council of Medical Research.
“This is a self-limiting disease. If people get infected, they may get lesions but chances of fatality are extremely rare. From my viewpoint, declaring monkeypox a public health emergency is a premature move. I don’t think the conditions are strong enough for declaring this disease a public health emergency,” Gangakhedkar told Moneycontrol on July 25.
Though the International Health Regulations Emergency Committee of WHO didn’t reach a consensus on whether the monkeypox outbreak represented a public health emergency of international concern, Director General Tedros Adhanom Ghebreyesus decided that an outbreak in more than 70 countries now qualified as a global emergency.
Gangakhedkar said declaration of a disease as an emergency can’t be done just on the basis of detection in different parts of the world. It requires an overall assessment of transmission and mortality threat. The disease’s symptoms are similar to smallpox but less severe.
“Monkeypox has now been detected in Europe and the US and several other countries, but if you see other conditions like mortality, the spread potential and the infected pool of the population, all these remain very, very low,” he added.
Avoid bias
According to WHO, monkeypox is transmitted to humans through close contact with an infected person or animal, or with material contaminated with the virus. It is usually a self-limited disease with symptoms lasting from 2 to 4 weeks. In recent times, the case fatality ratio has been around 3-6 percent.
Asked about the majority of infections in the current outbreak in men who have sex with men, especially those who have multiple partners, Gangakhedkar, who was a key figure working on HIV prevention and control strategies in India, said associating monkeypox with any particular sexuality or gender identity would be incorrect.
“We must be careful about linking monkeypox with a particular sexuality because then it may lead to stigmatisation. This disease can’t be termed as a disease for any particular sexuality or a gender identity, as further studies are needed. Also, how this disease transmits in a couple setting is still unknown,” he said. “Any form of association of monkeypox to a sexuality will increase the chances of people not coming forward fearing disclosure of their sexual identity.”
Commenting on the challenges of tracing the disease in India, the top epidemiologist said the monkeypox incubation period makes it hard. The incubation period – the interval from infection to the onset of symptoms – of monkeypox is usually from 6 to 13 days but can range from 5 to 21 days, according to WHO.
“The blisters which you see in the monkeypox images of a patient actually appear very late and that is why it’s a challenge to detect cases early. A patient can continue to transmit the infection unless the symptoms aggravate,” Gangakhedkar said.
The former ICMR head of epidemiology said the elderly are likely to be less prone to monkeypox because they will be protected if they’ve taken the smallpox vaccine.
Gangakhedkar also said gene analysis has shown that the monkeypox virus has mutated since the previous outbreak, but their implications for disease severity or transmissibility are still unclear and need more study.
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