Voices: I specialize in infectious diseases.  Here's the truth about smallpox

Voices: I specialize in infectious diseases. Here’s the truth about smallpox



Monkeypox is the latest global public health threat to make headlines – the latest centering on the rising number of cases in the US. Most people who contract the monkeypox virus experience flu-like symptoms and a blistering rash that lasts two to four weeks, but a small percentage of infected people develop sepsis or other serious illnesses and life-threatening complications.

It is not uncommon for there to be small outbreaks of smallpox in Central and West Africa, but in recent months, dozens of countries in other regions of the world have reported thousands of smallpox cases.

As an infectious disease epidemiologist, I have received many questions from colleagues and friends about whether a monkeypox pandemic will be the next big disruption in our lives. A disease is considered a pandemic when two distinct conditions are met: cases are occurring globally and the number of diagnosed cases is large enough to qualify as an epidemic. An epidemic is characterized by new cases of a disease occurring at a higher than typical rate in at least several communities.

While the smallpox situation is certainly newsworthy, as of mid-July 2022 it has clearly not met both requirements for pandemic status. More importantly, current evidence suggests that chickenpox is very unlikely to become a global health catastrophe, even if the virus spreads and becomes a pandemic.

As of mid-July 2022, monkeypox cases associated with the current outbreak were mostly occurring in Europe and the Americas, and few cases were being reported in Africa and Asia.

Is smallpox global?

Both the 2009 H1N1 flu virus and the SARS-CoV-2 coronavirus that emerged in 2019 quickly spread to all regions of the world. Global health experts fully agreed that these were pandemic events. In contrast, the Ebola Virus epidemic in West Africa from 2014 to 2016 was mostly contained only in that region of the world and never spread globally.

The current distribution of smallpox cases is somewhere between these two scenarios. As of mid-July 2022, about 9,200 total cases of monkeypox had been reported by 63 countries. For reasons that are not yet fully understood, almost all of these cases occurred in Europe and the Americas, and only a few cases were reported from Africa, Asia and the Middle East countries.

Is this distribution global enough to meet the definition of a pandemic? It might be.

Is monkeypox an epidemic?

The next condition for reaching the pandemic threshold is whether the places where smallpox is present are experiencing epidemics.

Europe and the Americas typically have zero smallpox cases per year, so the current case count in these regions is much higher than usual. But it’s also important to look at how much community transmission is happening. If hundreds of people get sick after attending a single event – ​​such as a concert or festival – this would normally be classified as an outbreak. The situation would only become an epidemic if infections began to occur among many people who were not close contacts of the event’s participants. Once widespread and sustained community transmission begins to occur, it is much more difficult to control a virus.

Most people diagnosed with smallpox in May and June 2022 were men in their 20s and 50s who identify as members of the group. LGBT+ community. As of July 2022, cases were still not occurring at significant levels across multiple age groups and sociodemographics.

Is the current pattern of spread sufficient to classify monkeypox as an epidemic rather than an outbreak? Perhaps, but only in some of the countries that have reported smallpox cases this year.

Since the answers to whether smallpox is global and an epidemic are “maybe” rather than “yes”, this suggests that smallpox is not a pandemic – at least not yet. But it could become one soon.

How worried should you be about smallpox?

Pathogens such as monkeypox are often spread by touch and other types of close contact with an infected person. Epidemiologists are far less concerned about pathogens with “person-to-person” transmission than they are about respiratory viruses like influenza and coronaviruses, which can easily spread through the air.

Over the course of just a few months, Covid-19 has gone from being a local concern in Wuhan, China, to the worst pandemic in a century. That’s not going to happen with monkeypox.

Because? First, the monkeypox virus is much less contagious than the circulating strains of coronavirus. Second, monkeypox is less deadly than Covid-19. The case fatality rate during the current international outbreak is less than one death per 1,000 adult cases, which is lower than the percentage of unvaccinated people who die after receiving Covid-19. And third, existing vaccines will be able to help slow the spread of smallpox in high-risk populations if problems with limited supplies can be resolved.

The World Health Organization follows a set of rules called the International Health Regulations that guide global public health responses to emerging threats. Under these regulations, WHO has the authority to declare a “public health emergency of international concern” – commonly abbreviated to the acronym CHOICE – when an infectious disease is spreading internationally and may “potentially require a coordinated international response”. The aim is to detect and respond to potential global health crises and prevent them from becoming pandemics.

An expert panel convened by the World Health Organization on June 23 determined that smallpox was an “outbreak in several countries” but did not meet the criteria to be a public health emergency of international concern. The panel will meet again on July 21 to review the distribution and frequency of new case reports. If the rate of new cases continues to increase and there is evidence of transmission in more diverse populations, monkeypox could be declared a public health emergency.

But even if smallpox is declared a public health emergency of international concern, it will not become a devastating pandemic like COVID-19.

Kathryn H. Jacobsen is the William E. Cooper Distinguished University Chair and Professor of Health Studies at University of Richmond, Virginia

This article is republished from The conversation under a Creative Commons license. read the original article.

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