Staff Writer

#TrinidadandTobago, July 17, 2023 – It is an unfortunate reality for Trinidad and Tobago as they have now recorded the first case of the Monkeypox Virus.

The infected individual according to the Ministry of Health, is a middle aged male with travel related history.

He was tested on Tuesday July 11th, and the sample sent to the Caribbean Public Health Agency’s (CARPHA) laboratory through the Trinidad Public Health Lab.

Taking action, the Ministry said the County Medical Officer of Health (CMOH) has started the local public health response, which includes contact tracing.

Trinidad and Tobago now joins the global community that has had MonkeyPox cases as expressed by the World Health Organisation’s update as of July 4th, 2023, that 88,144 Mpox cases have been detected globally amongst 112 countries. Also, there have been a total of 149 deaths.

The Ministry reminded the public that the virus is spreading worldwide as we speak, and that it is important to maintain good hygiene practices such as hand washing or sanitising where appropriate.

The vaccine is currently available in Trinidad and Tobago but will, at this time, be used for positive cases only.

The Ministry expressed that it will continue to provide updates to the public as necessary.

Staff Writer

November 30, 2022 – Mpox is what the Monkeypox disease will be called going forward according to the World Health Organization which decided on a rename citing incidents of racism. The announcement was made on Monday November 28th; three months after the WHO had announced their intent to seek the change.

“When the outbreak of monkeypox expanded earlier this year, racist and stigmatizing language online, in other settings and in some communities was observed and reported to WHO.”

The organization explained. The names of the two clades were changed earlier this year as well. The two clades of Mpox had been named after the areas in which they were found, in the Congo Basin and West Africa.

“Consensus was reached to now refer to the former Congo Basin (Central African) clade as Clade one (I) and the former West African clade as Clade two (II),” the WHO said in August.

The changes come as the globe experiences its largest outbreak in history with thousands of cases across the globe in areas where the virus had never historically presented.

Mpox disease, formerly known as monkeypox disease, was named by scientists in 1970 after the virus which causes it which was first discovered in monkeys in 1958. While the disease has been renamed, the virus that causes it is still called monkeypox virus.

A virus and the disease it causes are separate entities, for example the Spanish Flu disease, is caused by an offshoot of the H1N1 virus and COVID-19 is caused by the SARS-Cov-2 virus While neither of these diseases are named after their viruses Monkeypox was.

It is now up to the International Committee on the Taxonomy of Viruses (ICTV) to rename the virus.

Both Mpox and Monkeypox will be used simultaneously to refer to the disease for the next twelve months until monkeypox is totally phased out.

Editor

November 29, 2022 – It’s a 52-year-old name which has run its course and in a year will be completely phased out, making way for its new, more politically correct and patient sensitive title: MPox.  The World Health Organization briefed the world of the shift in a media statement on Monday November 29; the renaming process described as “accelerated.”

“When the outbreak of monkeypox expanded earlier this year, racist and stigmatizing language online, in other settings and in some communities was observed and reported to WHO.  In several meetings, public and private, a number of individuals and countries raised concerns and asked WHO to propose a way forward to change the name.”

The World Health Organization has as part of its global health remit, to name or rename illnesses in consultation with its member states; some 45 countries weighed in on this particular change which factored in stigmatization and versatility.

“Various advisory bodies were heard during the consultation process, including experts from the medical and scientific and classification and statistics advisory committees which constituted of representatives from government authorities of 45 different countries.

The issue of the use of the new name in different languages was extensively discussed.  The preferred term mpox can be used in other languages.  If additional naming issues arise, these will be addressed via the same mechanism. Translations are usually discussed in formal collaboration with relevant government authorities and the related scientific societies.”

Although monkeyPox symptoms disappear on their own in a matter of weeks, for some the symptoms have led to medical complications and death.  Immuno-compromised children are listed as particularly vulnerable, so are newborn babies.

“Complications from monkeypox include secondary skin infections, pneumonia, confusion, and eye problems. More recent complications include proctitis (sores and swelling inside the rectum that cause pain) and pain or difficulty when urinating.  In the past, between 1% to 10% of people with monkeypox have died.  It is important to note that death rates in different settings may differ due to a number of factors, such as access to health care.  These figures may be an overestimate because surveillance for monkeypox has generally been limited in the past,” informed the CDCs website.

Dr Tedros Adhanom Ghebreyesus, Direcgtor-General, WHO in considering the advice from health experts specifically recommends:  “Adoption of the new synonym mpox in English for the disease; Mpox will become a preferred term, replacing monkeypox, after a transition period of one year.  This serves to mitigate the concerns raised by experts about confusion caused by a name change in the midst of a global outbreak.  It also gives time to complete the ICD update process and to update WHO publications;  The synonym mpox will be included in the ICD-10 online in the coming days.  It will be a part of the official 2023 release of ICD-11, which is the current global standard for health data, clinical documentation and statistical aggregation. The term “monkeypox” will remain a searchable term in ICD, to match historic information.”

As of November 28, there had been 81,188 cases of mpox recorded worldwide according to the US Centers for Disease Control (CDC).  Most alarming; over 80,000 of the cases have been recorded in locations not historically known to have monkeypox.  Some 110 countries have now recorded mpox, a staggering 103 of them are newly added to the list of nations where the disease has been detected.

The biggest explosion of cases is recorded in the United States; 29,288 people were confirmed with the disease and 14 people have died as a result of it.

Regionally, Cuba, Dominican Republic, Jamaica, The Bahamas, Aruba, Curacao, Barbados, Martinique, Guadeloupe, Bermuda and Guyana have confirmed mpox on their shores.

In the coming days, the new mpox name will be added to the International Classification of Diseases or ICD and will be used in communication from health bodies.  While the label: MonkeyPox will become a relic, it will continue to be used for at least another year.

“WHO will adopt the term mpox in its communications, and encourages others to follow these recommendations, to minimize any ongoing negative impact of the current name and from adoption of the new name,” it said in the statement posted at its website.

Maurizio de Angelis/Science photo library
Monkeypox virus, illustration. Monkeypox virus particles are composed of a DNA (deoxyribonucleic acid) genome surrounded by a protein coat and lipid envelope.

Staff Writer

#USA, August 25, 2022 – Monkeypox DNA can linger on many household surfaces and items not just bedding according to the CDC,  but possible risk of transmission from these surfaces appears low.

A new study to assess the degree of household contamination carried out in the home of two monkeypox positive roommates found virus DNA on 70 percent of the high contact surfaces in the shared area.

The two were still symptomatic when the home was swabbed, and 21 of the 30 high contact items swabbed were found to have virus DNA present after 20 days of isolation despite regular cleaning.

These high contact areas included blankets, cloth furniture, coffee machines, handles and switches.  Scientists say the regular cleaning might have inactivated the virus and limited the level of contamination within the household.

While the DNA was present, the live virus was not indicating that transmission was unlikely to take place. Whether this was because of the virus’ lifespan or cleaning solutions remains unclear.  The CDC says more information is needed to truly assess the potential for indirect transmission of monkeypox.

Until the agency figures out the truth, people living in or visiting the home of someone with monkeypox should “wear a well-fitting mask, avoiding touching possibly contaminated surfaces, maintaining appropriate hand hygiene, avoid sharing eating utensils, clothing, bedding, or towels, and following home disinfection recommendations.”

There are over 41 thousand cases in the latest outbreak across 94 countries with the US suffering the most, recording more than 14 thousand cases.

Staff Writer

#USA, August 25, 2022 – The US Center for Disease Control is re-organizing after its director Rochelle Walensky admitted that “performance did not meet expectations.”

The director admitted the shortfall not to the public, but in a private staff memo that the Washington Post obtained.

Critics say the agency did not move fast enough at the beginning of the outbreak. A call that has been echoed with the monkeypox pandemic even as the country watched millions of doses expire and are now struggling to provide more.

“For 75 years, the CDC and public health have been preparing for COVID-19, and in our big moment, our performance did not reliably meet expectations—My goal is a new, public health action-oriented culture at CDC that emphasizes accountability, collaboration, communication, and timeliness,” Walensky said in the memo which was reportedly based on an internal review which criticized the agency’s lag in getting information to the public.

There have been consistent changes in the CDC’s strategy for fighting Covid since the pandemic was declared. The agency moved from extremely tight protocols, including lockdowns and quarantining, to their current much looser system as vaccines were distributed throughout the country.

Issues with data collection development of tests and vaccine rollout all affected the nation’s ability to fight the disease.

The initiative to rework the agency will be headed by an executive team that will report directly to Walensky.

Staff Writer

July 25, 2022 – An altered version of the smallpox vaccine which is effective against Monkeypox is being offered in countries around the world to protect the most vulnerable as cases rise and the World Health Organization declares the event a Public Health Emergency of International Concern.

The vaccine is called Imvanex in the UK and Europe, Jynneos in the US and Imvamune in Canada but the vaccine is the same in every case and is made by the same company.  The vaccine is effective before and even after contact with an infected person.  But for persons who may already be infected, it works best within four days of contact with an infected individual.

Unfortunately because Monkeypox has never broken out on this scale, demand is outstripping supply across the globe.  The UK at present is only offering one dose to the most vulnerable populations.  These include healthcare workers who are caring for and who are due to start caring for a patient with confirmed Monkeypox.

Gay, bisexual and other men who have sex with men (GBMSM) is at the highest risk of exposure and  people who have already had close contact with a patient with confirmed Monkeypox.

In terms of supply for the Turks and Caicos there has been no mention yet of providing overseas territories with the vaccine.

In fact the UK is firm on their stance that those at most risk will be considered first with every new batch that becomes available.  Not even healthcare workers “who work in non-specialist wards or clinics, even those in frontline services and Accident and Emergency” will get a vaccine if they do not meet the criteria.

The Caribbean Public Health Agency CARPHA has also not made any mention of procuring the vaccine as yet.  In the agency’s latest communication on July 18th it warned countries to be vigilant and Dr. Joy St. John, Executive Director said, “Personnel are prepared to respond in country to assist in the investigation and control of an outbreak, should the need arise.”

The Pan American Health Organization (PAHO) said vaccination should be done on a case by case basis but stressed, “Mass vaccination is not required nor recommended for Monkeypox at this time.”

Anyone can get Monkeypox through prolonged close contact with a positive individual, touching rashes or materials that have been in contact with an infected individual’s open lesions.

Staff Writer

July 15, 2022 – Monkeypox cases have increased high double percentage points over the past ten days with 2614 new cases and 2 new deaths recorded.

Nine new countries have reported cases including four Caribbean countries namely St Lucia, Dominican Republic, Jamaica, The Bahamas and now Turks and Caicos Islands have logged suspected and confirmed cases and the  World Health Organization says for the first time local transmission of Monkeypox has been reported in newly-affected countries without epidemiological links to countries that have previously reported Monkeypox in West or Central Africa.

This is concerning news as it means tracing the outbreak becomes more difficult.

The massive spike has forced the WHO to start biweekly reports to keep the world up to date.  The majority of the 6,027 recorded cases so far remain in Europe with 4,920 but the amount of cases in the Americas is rising with 902 cases so far.  The African region has the third least amount of cases with 173 but the three recorded deaths so far have happened in that region.

Closer to home The Bahamas confirmed their single case on June 24th and Jamaica confirmed their single case on July 6th, both positives were recorded from men who had recently been in London.  Both countries say they are establishing contact tracing and quarantine protocols.

Most of the infected parties so far are male but the disease can infect anyone who has close contact with a symptomatic person or the fluid from their rashes.  Additionally citizens and doctors are now being warned to be aware that Monkeypox may not appear as it once did.

Describing the symptoms in this outbreak as ‘atypical’ the WHO said,

“Many cases in newly-affected areas are not presenting with the classically described clinical picture for Monkeypox (fever, swollen lymph nodes, followed by centrifugal rash).  Among the cases who reported at least one symptom, 81% presented with systemic rash (widespread rash on the body), 50% presented with fever and 41% presented with genital rash.”

Less symptoms and a less obvious rash are becoming more common in many cases and people are advised to be on the alert for this.

Advice from the WHO is to keep infected persons isolated, be on the lookout for any rashes and get tested immediately if you spot one in any area of your body.  Refrain from sustained contact with people with symptoms of Monkeypox as that is how the disease spreads.

Wear personal protective equipment like gloves when handling, sheets, clothing etc. that have been exposed to open sores from positive Monkeypox cases and continue to observe social distancing protocols. .

Staff Writer

June 27, 2022 – The World Health Organization says while Monkeypox is not a Public Health Emergency of International Concern (the highest alert the body can give) they are concerned about the rapid spread and data gaps in the current outbreak.

“I am deeply concerned by the spread of Monkeypox, which has now been identified in more than 50 countries, across five WHO regions, with 3,000 cases since the early May,” said Director General Dr Tedros Ghebreyesus.

There had been fears that the WHO would declare the outbreak an emergency of international concern going into a June 23 meeting. He maintained that the world had neglected Monkeypox research despite the fact that it had been circulating in Africa for many years. He stressed that this approach to neglected diseases must change as the world is an interconnected population. This inter connectivity could prove disastrous for vulnerable people.

“What makes the current outbreak especially concerning is the rapid, continuing spread into new countries and regions and the risk of further, sustained transmission into vulnerable populations including people that are immunocompromised, pregnant women and children,” he said.

In order to combat this he called for the communication and collaboration between member states and a collective response.

So far the disease has been exhibiting different symptoms than usual including rashes localized to the genitals instead of the entire body like usual. This prompted the US Centers for Disease Control to change the requirements advising doctors to test anyone who appeared with a rash seeming like Monkeypox.

Ghebreyesus revealed Monkeypox was an evolving health threat that the WHO was following extremely closely and maintained that countries should use surveillance, contact tracing, isolation, and ensuring health tools were available to at risk populations as ways to control the spread.

Although no cases have been reported in the Caribbean, it is important that persons are aware of the situation as it continues to evolve.

Monkeypox is a viral illness and is found in a number of countries in Central and West Africa.  The more recent news of spread to countries without known endemic disease is unusual.  Cases may occur in persons who have travelled from Nigeria or who have been in contact with persons with the confirmed illness.  Cases which have been reported since May 14 2022, have largely had no history of travel.

The UK Health Security Agency (UKHSA) has announced that the total number of monkeypox cases confirmed in England since 6 May is 20.  The UKHSA initially identified one case of monkeypox on 7^th May 2022 in an individual with a history of recent travel to Nigeria.  Subsequently, additional infections have been identified, some of which have been linked and others which have been unrelated.  This spread as well as the occurrence of cases in Europe and other countries has suggested the possibility of community spread.   Active investigations are ongoing in countries which have identified cases including contact tracing, testing isolation etc. in order to prevent further spread.

The World Health Organization (WHO), held an emergency meeting on Friday 20^th May 2022 to discuss the monkeypox outbreak.  WHO is working with affected countries in order to expand disease surveillance to find and support people who may be affected, and to provide guidance on how to manage the disease.

It is expected that more cases will be identified through surveillance with the possibility of additional countries being affected.

TCI residents returning from, or going to, countries where cases have been identified, are urged to be aware of the signs of infection and to seek medical help if they think they may be at risk.

 How the virus spreads

Monkeypox does not spread easily between people.  The virus spreads through close contact with an infected animal (rodents are believed to be the primary animal reservoir for transmission to humans), humans, or materials contaminated with the virus.  Human-to-human transmission occurs through large respiratory droplets and by direct contact with body fluids or lesion material.  Respiratory droplets generally cannot travel more than a few feet, so prolonged face-to-face contact is required.

The virus enters the body through broken skin (even if not visible), the respiratory tract, or the mucous membranes (eyes, nose, or mouth).

Person-to-person spread is uncommon, but may occur through:

• contact with clothing or linens (such as bedding or towels) used by an infected person
• direct contact with monkeypox skin lesions or scabs
• coughing or sneezing of an individual with a monkeypox rash

Animal-to-human transmission may occur through a bite or scratch, preparation of wild game (in areas where the virus is present in animals such as Central and West Africa), and direct or indirect contact with body fluids or lesion material.

Individuals, particularly those who are gay, bisexual or MSM, are urged to be alert to any unusual rashes or lesions on any part of their body, especially their genitalia, and to contact a health services if they have concerns.

Monkeypox has not previously been described as a sexually transmitted infection, though it can be passed on by direct contact during sex. It can also be passed on through other close contact with a person who has monkeypox or contact with clothing or linens used by a person who has monkeypox.

 Symptoms

The incubation period is the duration/time between contact with the infected person and the time that the first symptoms appear. The incubation period for monkeypox is between 5 and 21 days.

Initial symptoms of monkeypox include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion.

Within 1 to 2 days a rash can develop, often beginning on the face, then spreading to other parts of the body including the genitals.

The rash changes and goes through different stages – it can look like chickenpox or syphilis, before finally forming a scab which later falls off.

The illness tends to be mild and self-limiting within 2-4 weeks, however it can in some cases be severe particularly in persons with weakened immune systems and children. In some cases, affected persons may die.

 Treatment

Treatment for monkeypox is mainly supportive. The illness is usually mild and most of those infected will recover within a few weeks without treatment.

There is no specific vaccine for monkeypox, however, vaccines used against smallpox can be used for both pre and post exposure and is up to 85% effective in preventing monkeypox. People vaccinated against smallpox in childhood may experience a milder disease.

Anyone with unusual rashes or lesions on any part of their body, especially their genitalia, is advised to visit their health care provider, particularly anyone who; 1) traveled to countries where monkeypox cases have been reported 2) reports contact with a person who has a similar rash or received a diagnosis of confirmed or suspected monkeypox, or 3) is a man who has had close or intimate in-person contact with other men in the past month.

As the virus does not usually spread easily between people and the risk to the general public is expected to be low, however the public is advised to monitor the situation as it develops and obtain information from credible sources. The MOH should be notified of any suspected cases.

The Ministry of Health will continue to monitor developments and provide updates accordingly.

Staff Writer

#UnitedKingdom, May 19, 2022 – Urgent investigations are now underway to determine whether or not Monkeypox is possibly already in the community spread phase in the UK.

The UK Health Security Agency (UKHSA) reported the first case on May 7th from a patient who recently traveled to Nigeria and a second on May 14th but now four new cases have popped up in and around London with no known connection to either of these cases and no link to a country where the virus is endemic.

This is a cause for concern, UKHSA says.   Dr. Susan Hopkins UKHSA’s Chief Medical Advisor said, “This is rare and unusual. UKHSA is rapidly investigating the source of these infections because the evidence suggests that there may be transmission of the monkeypox virus in the community, spread by close contact.”

The four patients are all men and all have the West African clade of the virus which is the milder version.  It doesn’t spread easily between people and the risk of outbreak is low. At least two of the cases have common contacts and all of the cases are men who identify as gay or bisexual.  It is important to note that the virus is not partial to any one sexual group or gender.

The virus is spread by close contact however and UKHSA is urging these vulnerable groups to be aware of any monkeypox symptoms they may experience.

These may include,  “fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion.   A rash can develop, often beginning on the face, then spreading to other parts of the body including the genitals.  The rash changes and goes through different stages, and can look like chickenpox or syphilis, before finally forming a scab, which later falls off.”

Even though monkeypox has occurred in primates there is no concrete evidence of which animal naturally carries the virus. Previously cases of Monkeypox have occurred in the US and UK because of international travel or imported exotic animals.