Monkeypox: The Newest Public Health Emergency of International Concern

Not again!  Monkeypox has now been declared our latest Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO).  This is a formal declaration of "an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response."[1]

Monkeypox clearly fits this mold.  It has spread across six WHO regions constituting a global outbreak encompassing more than 17,000 non-travel cases in over 70 nations.  The United States is home to the most identified cases, now at 4,639.  Consequently, we need to have dedicated and coordinated stance to bring this under control. 

The good news is that monkeypox (so far) has low secondary attack rates within households (~8%) and—for the most part—requires close and intimate physical contact.  Moreover, hospitalizations have occurred at a low rate and no deaths have been reported at this time.  

The bad news: monkeypox DNA has been noted in a high percentage of seminal fluid specimens assessed, suggesting possible sexual transmission.  In addition, cases are emerging with milder symptoms and/or less typical skin lesions which impede detection and facilitate further community spread.

Whereas a vast majority of cases have occurred in gay, bisexual, trans, and other men who have sex with men (MSM), it is essential to identify cases within and outside of MSM populations.  For example, two children have now been diagnosed within the U.S.  In addition, approaching potential patients in a non-stigmatizing manner is essential in case finding.  Sometimes reviewing a first-person account of monkeypox can be eye-opening, and I direct readers to this short narrative in the New Yorker.[2]

One may ask whether the recognition of newly emerging threats is the new normal?  Keep in mind that since 2009, the WHO has declared seven PHEICs, thus averaging one every two years:

• Influenza A(H1N1)
• Polio
• Ebola (Western Africa)
• Zika
• Ebola (Kivu)
• COVID-19
• Monkeypox

Our immense human population, habitat destruction, global connectivity, changing climate, and breakdowns of the public health infrastructure, here and abroad, all contribute to a volatile mixture in which new pathogens can emerge, old pathogens can re-emerge, and PHEICs can thrive.