On 23 July 2022, the World Health Organization (WHO) declared the outbreak of monkeypox to be a Public Health Emergency of International Concern (PHEIC), with more than 16,000 reported cases of monkeypox in 75 countries and territories.
Today, Israel is facing the same threat as the rest of the world with the sudden outbreak of the monkeypox plague. It’s to be hoped and expected that the outstanding performance of the health ministry and health funds in controlling the corona pandemic can serve as a stepping stone toward creating a plan for dealing with this new virus.
What is monkeypox?
Monkeypox is an infectious viral disease that is caused by the zoonotic monkeypox virus, which can infect humans and some animals. Zoonotic viruses can cause inter-species infections as well as people-to-people spreading. The smallpox virus is also a member of this genus, known as the variola virus.
When a person is infected, they will show symptoms that include fever, swollen lymph nodes, and a rash that breaks out into blisters which then crust over. The symptoms can resemble chickenpox, measles and smallpox, but the definitive sign is the presence of swollen glands, appearing before the onset of the rash behind the ear, below the jaw, in the neck or the groin.
Cases may have serious outcomes, particularly for children, pregnant women or people with suppressed immune systems. Complications arising from infection can include secondary infections such as pneumonia, sepsis, encephalitis, and severe eye infection causing loss of vision. Infection during pregnancy can result in stillbirth or birth defects. The time from exposure to onset of symptoms ranges from five to three weeks, and the symptoms can last for two to four weeks. The classic manifestation of an infection is fever and muscle pains, followed by swollen glands and lesions.
It can spread from infected animals through bites or scratches. Person-to-person transmission can occur through inhalation of tiny water droplets (similar to covid-19 and flu transmission) and exposure to contaminated surfaces or infected body fluids (similar to HIV).
Doctors can confirm the diagnosis by detecting the DNA of the virus in a lesion. People who have been infected are themselves infectious to others from the onset of symptoms until all the scabs on the skin lesions have fallen off.
When did the monkeypox pandemic start?
The first reported case was in London in May 2022 when an individual who had recently traveled to Nigeria, where the disease is endemic, showed up with the typical symptoms. It was the first time monkeypox had spread widely outside Central and West Africa for many years. From mid-May, cases were reported from an increasing number of countries in Europe, North and South America, Asia, Africa, and Oceania.
On 23 July, the World Health Organization (WHO) declared the outbreak to be a global health emergency. As of July 30th, there were a total of 22,763 confirmed cases.
What are the treatments for monkeypox?
There is no known cure for monkeypox once a person is infected. Prevention of the spread through vaccination with the smallpox vaccine is around 85% effective for close contacts and reduces the severity of symptoms. However, routine smallpox vaccination was suspended in the US in 1972 when the WHO declared that smallpox had been eliminated. This means that only the adult population now carries any degree of immunity through vaccination.
The FDA approved a new combined smallpox and monkeypox vaccine based on a modified vaccinia Ankara, but it has minimal availability. Only people at a higher degree of immediate risk (for example a person who has been in close contact with someone who already has monkeypox) would be considered for vaccination right now. Mass immunization is not available at this time.
The same steps that were effective in reducing infections with COVID-19 should be taken. Avoid close contact with people who are infected or have been exposed through travel in countries where monkeypox is endemic (mostly the West African and Central African countries). Regular hand washing, wearing masks and self-isolation for infected people can also reduce the risk of cross-infection.
Antiviral drugs like cidofovir, tecovirimat, vaccinia immune globulin, and the smallpox vaccine may be used during this outbreak.
How can Israel again lead the way in the fight against the virus?
There is worldwide recognition that Israel was the leading country fighting the Corona virus pandemic through every phase. The milestones of Israel’s battle include being the first to introduce free vaccination for the adult population in January 2021, with 55% of the population being one-dose vaccinated by mid-March. It was also the first to bring in double-dose vaccination by early February. By the end of June, 56% of the total population had received two jabs. By comparison, by mid-March only 24% of the US population had received one dose, and by the end of June, the double dose level was less than 50%. Currently, Israel has the highest quadruple dosing level, and uses antiviral drugs extensively when treating infected patients.
Until vaccinations can be made available to the general public in the same way that COVID-19 vaccines were at the very beginning of the pandemic, there needs to be a widespread campaign of publicity so that people are aware of the potential dangers, and can adjust their socializing patterns to reduce unnecessary contract. Social distancing and mask-wearing may be the best ways to limit the spread of monkeypox until vaccines have become available.
One possible route could be for the government in Israel to initiate a smallpox vaccination program on the same scale as it did for the COVID-19 vaccine. This makes Israel a strong leader because it has the experience and the correct infrastructure to roll out such a program and to reach almost total immunization within a few weeks.