Re-emergence of human monkeypox highlights capacity gaps, global health security goals

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About six months ago, the World Health Organization and the U.S. Centers for Disease Control and Prevention brought together researchers, ministries of health staff, global health program and policy leaders, and experts in pox viruses to discuss re-emergence of a disease that has been reported in more countries during the last decade than in the four decades that had followed its discovery in humans.

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Monkeypox, a virus with an 11-percent fatality rate among people infected by it, was first noted in humans in 1970, in what is now the Democratic Republic of Congo, during efforts to eliminate smallpox. With symptoms similar to those of smallpox, monkeypox has the critical difference of being maintained and transmitted by animals, including ones that are hunted and consumed as bushmeat. And while smallpox was eliminated in 1980, human monkeypox continued to be transmitted, now without the widespread protection that had been offered by large-scale access to smallpox vaccinations, which also provides immunization against the more recently discovered pox virus.

As a result, a summary released today in the CDC’s Morbidity and Mortality Weekly Report says, the virus has resurged in West and Central African countries that had not seen a case in years, and where capacities to recognize and respond quickly to cases have diminished. Nigeria, the most populous country in Africa, is home to the largest documented outbreak, with 80 confirmed cases, the summary notes. “The emergence of cases,” the authors add, “is a concern for global health security.”

While a 2003 outbreak of human monkeypox in the U.S., brought in with a shipment of small animals from Ghana, was contained in little more than a month, the CDC summary notes that many of the countries where the virus is endemic are hobbled by the same gaps in training, equipment, and staffing that slowed initial local responses to the outbreak of Ebola in West Africa in 2014. The report notes that disease surveillance capacities in West Africa have generally improved as a result of evaluations and responses supported by the Global Health Security Agenda, a multi-country initiative launched by the CDC in 2014, now facing elimination of U.S.-led programs in 39 of 49 countries. But the authors write, the resources needed to detect, prevent, and respond to diseases that can flourish in remote rain forest regions, and then spread rapidly as populations migrate, including human monkeypox, require long-term investments in technology and training. Those investments offer the bonus, the authors add, of improving abilities to identify and contain future outbreaks, as yet unrecognized.

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