Nearly 200 cases of monkeypox in more than 20 countries, WHO says

Microscope image of monkeypox virions
A rare outbreak of monkeypox outside Africa, where the virus is mostly found, has spread to more than 20 countries.
(Associated Press)

The World Health Organization says nearly 200 cases of monkeypox have been reported in more than 20 countries not usually known to have outbreaks of the unusual disease, but described the epidemic as “containable” and proposed creating a stockpile of limited vaccines and drugs for equitable sharing worldwide.

During a public briefing Friday, the United Nations health agency said that there were still many unanswered questions about how the current epidemic arose, but that there was no evidence any genetic changes in the virus were responsible for the outbreak.

“The first sequencing of the virus shows that the strain is not different from the strains we can find in endemic countries, and [this outbreak] is probably due more to a change in human behavior,” said Dr. Sylvie Briand, the WHO’s director of pandemic and epidemic diseases.


Earlier this week, a top advisor to the agency said the outbreak in Europe, U.S., Israel, Australia and beyond was likely linked to sexual activity at two recent raves in Spain and Belgium. That marks a significant departure from the disease’s typical pattern of spread in central and western Africa, where people are mainly infected by animals like wild rodents and primates, and outbreaks don’t spill across borders.

Although the WHO said nearly 200 monkeypox cases have been reported, that seemed a likely undercount. On Friday, Spanish authorities said the number of cases there had risen to 98, including one woman, whose infection is “directly related” to a chain of transmission that had been previously limited to men, according to officials in the Madrid region.

Officials in Britain added 16 more cases to the country’s monkeypox tally, pushing it to 106. And Portugal said its caseload jumped to 74 cases Friday.

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Doctors in Britain, Spain, Portugal, Canada, the U.S. and elsewhere have noted that the majority of infections to date have been in gay and bisexual men, or other men who have sex with men. The disease is no more likely to affect people because of their sexual orientation, and scientists warn that the virus could spread.

Briand said that, based on how past outbreaks of the disease in Africa have evolved, the current situation appeared “containable.”

Still, she said the WHO expected to see more cases reported in the future, noting, “we don’t know if we are just seeing the peak of the iceberg [or] if there are many more cases that are undetected in communities,” she said.


As countries including Britain, Germany, Canada and the U.S. begin evaluating how smallpox vaccines might be used to curb the outbreak, the WHO said its expert group was assessing the evidence and would provide guidance soon.

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Dr. Rosamund Lewis, head of the agency’s smallpox department, said that “there is no need for mass vaccination,” explaining that monkeypox does not spread easily and typically requires skin-to-skin contact for transmission. No vaccines have been specifically developed against monkeypox, but the WHO estimates that smallpox vaccines are about 85% effective.

She said that countries with vaccine supplies could consider them for those at high risk of the disease, like close contacts of patients or health workers, but that monkeypox could mostly be controlled by isolating contacts and continued epidemiological investigations.

Given the limited global supply of smallpox vaccines, the WHO’s emergencies chief, Dr. Mike Ryan, said the agency would be working with its member countries to potentially develop a centrally controlled stockpile, similar to the ones it has helped manage to distribute during outbreaks of yellow fever, meningitis and cholera in countries that can’t afford them.

“We’re talking about providing vaccines for a targeted vaccination campaign, for targeted therapeutics,” Ryan said. “So the volumes don’t necessarily need to be big, but every country may need access to a small amount of vaccine.”

Most monkeypox patients experience only fever, body aches, chills and fatigue. People with more serious illness may develop a rash and lesions on the face and hands that can spread to other parts of the body.