Monkeypox declared global health emergency as WHO pushes containment

Jolyon Attwooll

25/07/2022 4:52:06 PM

GPs’ role ‘key’ as Australian health authorities reinforce efforts to keep a lid on the country’s case numbers.

Monkeypox test
The number of non-endemic cases has gone up sharply in the past months. (Image: AAP Photos)

Clinicians and sexual health workers hope the emergency declaration by the World Health Organization (WHO) will help efforts to contain the virus in Australia.
The WHO announced its decision to declare a public health emergency of international concern on 23 July, after case numbers increased to more than 16,000 and across at least 75 countries and territories.
The organisation said it wants its declaration to raise awareness and increase the chances of halting human-to-human transmission.
Associate Professor Michael Burke, a GP in Western Sydney who was one of the founding members of RACGP Specific Interests Sexual Health Medicine, says it remains ‘early days’ for the virus in Australia.
‘We expect that like the UK, the numbers will increase in Australia, given … many international travel links with many locations throughout the world,’ he told newsGP.
There were no cases of monkeypox ever recorded in Australia until May, when the virus was detected by GPs among patients in Victoria and NSW who had returned from overseas. 
At the time of the WHO declaration, there had been 44 cases recorded overall in Australia. Most of those have been among gay, bisexual and men who have sex with men, and the majority among returned travellers.
There have, however, been a handful of cases where local transmission is suspected. The majority of patients have been in NSW and Victoria, but individual cases have also been found in the ACT, the Northern Territory, Queensland and South Australia.
In May Professor Michael Kidd said he believes it should be possible to contain the disease in Australia, urging GPs ‘to keep their wits about them’.
The number of cases recorded so far and the rate of the disease’s spread in Australia has been low in comparison to several other countries where the virus has been detected. There have been more than 3000 cases recorded in Spain and more than 2000 in Germany and the UK.
GPs will continue to play an important part in supporting efforts to stop the virus’ spread, according to Associate Professor Burke.
‘General practitioners have a very key role to play, they need to be aware of the symptomatology then do the appropriate testing and ensure that people do the necessary isolation,’ he said.
Last week, Heath Paynter of the Australian Federation of AIDS Organisations, said that the country has ‘a golden opportunity’ to put measures in place to prevent cases from escalating.
In a webinar for clinicians about monkeypox, Mr Paynter said securing the supply of a third-generation vaccine that could be scaled up to cover those most at risk is fundamental to containment efforts, as is targeted communication.
Currently, one vaccine has been approved by Australian Technical Advisory Group on Immunisation (ATAGI) for use among at-risk groups: ACAM2000, a live-attenuated smallpox vaccine.
ATAGI advises the vaccine is ‘also effective against monkeypox’ and can be used either for post-exposure prophylaxis or pre-exposure prophylaxis ‘in individuals with high risk of exposure to and/or severe outcomes from monkeypox virus’.
ACAM2000 may also be considered for healthcare workers ‘likely to see patients with monkeypox’, including those in primary care, sexual health clinics and hospitals, as well as clinicians administering monkeypox vaccinations, provided they have not previously received a smallpox vaccine.
However, the vaccine is not recommended for use in severely immunocompromised people, including those with HIV.
Deputy Chief Medical Officer Professor Michael Kidd has said Australia is ‘working very hard’ to secure supplies of another vaccine, MVA-BN, saying there are ‘global supply constraints’.
That vaccine has not yet been approved for emergency use by the Therapeutic Goods Administration.
Professor Kidd has also warned about the dangers of stigma and urged GPs to seek help if they believe a patient has the virus.

‘If you do have a patient who you suspect [monkeypox], please reach out, before you take any specimens, to your local public health authority,’ he said.
Associate Professor Burke says expanding vaccine options offers ‘a very plausible avenue of response’.
‘We know that the smallpox vaccine is effective at a rate of about 85% in preventing monkeypox,’ he said.
‘And whereas many of the older people in our community have been vaccinated against smallpox, that hasn’t been done in Australia for many decades.
‘I think we just need to watch the situation and look at the possibilities and be guided by the research as it comes through.’
There has been a low mortality rate so far globally, with five deaths recorded.
The Department of Health (DoH) currently advises that most people do not require antiviral treatment.
‘Because most infections are mild in the current outbreak, most patients will not require antiviral treatment,’ its treatment guidelines read.
‘Monkeypox is usually a self-limiting illness and most people recover within a few weeks. However, severe illness can also occur, particularly in immunocompromised people.’
The WHO has declared a public health emergency on six previous occasions in the past 15 years, according to the ABC.
It was not a unanimous decision to declare a public health emergency for monkeypox, with Reuters reporting nine members of WHO’s emergency committee were opposed to the declaration while six were in favour.
However, WHO director-general Tedros Adhanom Ghebreyesus cast a deciding vote with the view the declaration would help keep ‘a heightened level of awareness and alert, which would increase the probability of stopping human-to-human transmission of monkeypox virus’.
The WHO is also hoping that the declaration will boost political commitment to the response, as well as international coordination to secure wider access to vaccines and antivirals.
Read the monkeypox treatment guidelines on the Department of Health website, which also has a full list of resources to help clinicians respond to the virus.

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