On 9 February 2023, the International Health Regulations Committee met to assess the public health risk posed by mpox (monkeypox) globally. In their report they concluded that in their assessment, mpox continues to constitute a Public Health Emergency
of International Concern, a decision which Dr Tedros Adhanom Ghebreyesus, Director-General of WHO endorses.
Although there has been a decline in cases globally, and a sharp decline in the WHO European Region in particular, the threat from
the disease has not gone away. There is still a high risk of mpox being imported from one country to another, both within the European Region and from other regions where infection continues to circulate.
Achieving and sustaining elimination
of infection in our region has to be the next priority.
The experience of the United Kingdom
In the first few weeks of the mpox outbreak in the middle of 2022, the United Kingdom reported some of the highest case numbers in the European Region. More recently the number of new cases has fallen dramatically. From identifying 350 cases a week in
July, this fell to zero new cases identified in the 2 weeks prior to 19 December – as Professor Susan Hopkins, Chief Medical Advisor at the UK Health Security Agency (UKHSA) told us:
“Mpox cases have significantly declined
across all 4 nations of the UK (England, Scotland, Wales, Northern Ireland), thanks to the rapid rollout of vaccines by the National Health Service and sexual health services, improved access to diagnostic testing and widespread awareness of the symptoms”.
The next step in the United Kingdom’s mpox response: elimination
Building on this encouraging picture, the UKHSA has now developed an elimination strategy, in collaboration with the United Kingdom’s 4 public health agencies, which it is putting into action over the next 6–12 months.
“Through
our strategy we hope to maintain the low number of identified cases and move towards our ultimate goal of eliminating transmission of the disease in the UK, through actions such as vaccinations, rapid and accurate case-finding, robust contact-tracing
and global collaboration with international organizations, including WHO,” said Professor Hopkins.
Within the comprehensive strategy are 8 key actions that provide a roadmap for achieving the goal of elimination. These are:
- continuing communications and engagement with those who face the highest risk of exposure to mpox;
- offering vaccines to those at highest risk during outbreaks and developing the evidence base for a longer-term vaccination programme;
- ensuring rapid and accurate case-finding;
- establishing robust contact-tracing;
- continuing population-level surveillance;
- continuing global collaboration with international organizations including WHO, to share knowledge and support the global response;
- implementing infection prevention and control arrangements to prevent transmission in health-care settings;
- focusing research and evaluation on areas that will direct and improve outbreak response including diagnostics and viral characteristics, epidemiological changes over time, the presence and nature of new symptoms and/or asymptomatic infection and the protective effects of past smallpox vaccination.
No room for complacency
While the United Kingdom is providing a good example to other Member States of how elimination could be achieved, Professor Hopkins is clear that authorities implementing a strategy is not in itself enough to end the mpox outbreak; individuals need to
be part of the solution too, and she has been pleased to see how those at highest risk from mpox in the United Kingdom took action to protect themselves and prevent further transmission:
“Maintaining awareness is crucial. It is vital
that people remain alert to the risk mpox poses and seek advice if they have symptoms, to protect themselves and others”.
WHO’s recommendations to Member States
Over the last few months, WHO/Europe has published a series of policy briefs to guide Member States in their mpox response. Within the policy brief “Considerations for the control and elimination of monkeypox in the WHO European Region” a number of objectives have been outlined to help Member States meet the overall aim of first controlling the mpox outbreak and ultimately achieving and sustaining elimination in all Member States of the Region. These objectives are to:
- establish strong case-based national mpox surveillance in priority groups (in particular in men who have sex with men) and the wider general population, and report all cases to national and regional surveillance systems to monitor transmission levels;
- establish safe and high-quality orthopoxvirus diagnostics, including virus characterization;
- formulate, implement and monitor appropriate evidence-based mpox control and prevention policies with the involvement of the affected population, including:
a) behavioural interventions to reduce risk of infection
b) case detection, management and isolation
c) contact tracing and management
d) pre- and post-exposure vaccination; - ensure the availability of safe and effective mpox vaccines and antivirals for priority groups;
- ensure high vaccination uptake in the highest-risk population groups;
- optimally manage cases, including those with severe disease;
- implement infection prevention and control systems to minimize the risk of onward transmission in health-care settings;
- prevent the establishment of a new mpox animal reservoir in the WHO European Region.