The World Health
Organisation (WHO) has decided not to declare monkeypox a public health
emergency of international concern. This may change in the future.
However, WHO Director-General Tedros Adhanom Ghebreyesus
said he was "deeply concerned" about the evolving threat of
monkeypox, which he said had reached more than 50 countries.
There have been more than 4,100 confirmed cases globally,
including at least 13 in Australia.
The WHO also acknowledged there were many unknowns about the
outbreak.
Here are three things we know about monkeypox and three
things we want to find out.
1. Monkeypox is caused by a virus
Monkeypox is a large DNA virus belonging to the
orthopoxvirus family. Unlike the related smallpox virus, variola, which only
affected humans, monkeypox virus is found in rodents and other animals in parts
of Africa.
We know of two clades (virus groupings), and it is the less
severe of the two currently circulating outside Africa.
Orthopoxviruses are stable viruses that do not mutate much.
Multiple mutations, however, have been described in the virus causing the
current outbreak.
In the United States, at least two separate strains have
been circulating, suggesting multiple introductions into the country.
2. You can be infected for more than a week and not know
It takes an average 8.5 days from infection to showing
symptoms, such as enlarged lymph nodes, fever and a rash, which usually looks
like fluid-filled blisters that erupt. People are infectious while they have
the rash, and are usually infectious for about two weeks.
Children are most severely affected and have a higher risk
of dying from the disease. Historically, in the endemic countries of Africa,
almost all deaths have been in children.
The European epidemic is mostly in adult males, so this,
together with better access to care, may explain the low rate of deaths in
these countries.
3. We have vaccines and treatments
Vaccines work. Past vaccination against smallpox provides
85% protection against monkeypox. Smallpox was declared eradicated in 1980, so
most mass vaccination programs ceased in the 1970s.
Australia never had mass smallpox vaccination. However, an
estimated 10% of Australians have been vaccinated in the past, mostly migrants.
Vaccines protect for many years but immunity wanes. So
declining population-level protection is likely responsible for the resurgence
of monkeypox seen since 2017 in Nigeria, one of seven endemic hot spots in
Africa.
Mass vaccination is not recommended. But vaccines can be
given to contacts of confirmed cases (known as post-exposure prophylaxis) and
people at high risk of contracting the virus, such as some lab or health
workers (pre-exposure prophylaxis).
There are also treatments, such as vaccinia immune globulin
and antivirals. These were developed against smallpox.
1. How much do these new mutations matter?
The virus causing the current outbreak has several mutations
compared with versions of the virus circulating in Africa. However, we don't
know if these mutations affect clinical disease and how the virus spreads.
The monkeypox virus has a very large genome, so is more
complex to study than smaller RNA viruses, such as influenza and SARS-CoV-2
(the virus that causes Covid).
Experts wonder if the mutations have made it more contagious
or changed the clinical pattern to be more like a sexually transmitted infection.
A study from Portugal shows the mutations likely make the virus more
transmissible.
2. How is it spread? Is that changing?
Monkeypox has not been described as a sexually transmitted
infection in the past. However, the current transmission pattern is unusual.
There seems to be a very short incubation period (of 24 hours) following sexual
contact in some, but not all, cases.
It is a respiratory virus, so aerosol transmission is
possible. But historically most transmission has been from animal to human.
When there was transmission between humans, this usually involved close
contacts.
The rapid growth of the epidemic in non-endemic countries in
2022, however, has been all due to spread between humans. There may be many
more cases than officially reported.
We do not know why the pattern has changed, whether it is
sexually transmitted or simply transmitted due to intimate contact in specific
and globally connected social networks, or whether the virus has become more
contagious.
The virus is found in the skin rash, mouth and semen, but
this does not prove it is sexually transmitted.
3. How far will it spread? Does Covid make a difference?
Will this spread more widely in the community? Does the
Covid pandemic increase the risk? Possibly, yes.
We must also not drop the ball on surveillance in the wider
community or stigmatise the LGBTQI community.
Due to waning immunity from the smallpox vaccine globally
and the spread of monkeypox to many countries already, we may see the epidemic
spreading more widely.
If it does so and starts infecting large numbers of
children, we could see more deaths because children get more severe infection.
So we should monitor globally for clusters of fever and
rash, and misdiagnosis as chickenpox, hand foot and mouth disease, herpes
simplex or other diseases with a rash.
Another factor is Covid. As people recover from Covid, their
immune system is impaired. So people who have had Covid may be more susceptible
to other infections.
We see the same with measles infection. This weakens the
immune system and increases the risk of other infections for two to three years
afterwards.
If the epidemic becomes established in countries outside the
endemic areas, it may infect animals and create new endemic zones in the world.
It is important we do everything possible to stop this
epidemic.
- Reuters
Comment
The newly elected Regional Director for South-East Asia of World Health Organization (WHO) Saima Wazed, a global mental health expert, will take office for the next five years today.
The member states voted to nominate Wazed to the post during a meeting at the 76th session of the WHO Regional Committee for the South-East Asia Region on January 1, 2024.
Later, her nomination was approved during the 154 session of the WHO Executive Board held on January 22-27 in Geneva, Switzerland, according to WHO sources.
Ms. Saima Wazed will replace Dr. Poonam Khetrapal Singh, the outgoing RD of South-East Asia Region of WHO.
Bangladesh, Bhutan, the Democratic People's Republic of Korea (DPRK), India, Indonesia, Maldives, Nepal, Sri Lanka, Thailand and Timor-Leste took part in the voting in New Delhi.
Wazed, a renowned autism expert, had secured eight votes. The other candidate, Dr Shambhu Prasad Acharya, nominated by Nepal, received two votes.
Saima Wazed is the first from Bangladesh and the second woman Regional Director of WHO South-East Asia Region.
She is the daughter of Prime Minister Sheikh Hasina and is globally famed for her role as a mental health expert-particularly autism. She is an advisor to the WHO's director-general for mental health.
With that, Saima Wazed will be the first Bangladeshi to hold the post created in 1948 as part of WHO's regional divisions.
She spearheaded the campaign for autism awareness in Bangladesh at a time when parents would hide their children with this neurodevelopmental disorder due to the social stigma attached to the developmental disability.
Ms Saima Wazed has a Bachelor degree from Barry University in Florida, USA, and holds a master's degree in clinical psychology. She is a candidate for a doctorate in Organizational Leadership from the same university.
Since 2019, she has been an Advisor to the WHO Director-General on Mental Health and Autism and has been a member of WHO's Expert Advisory Panel on Mental Health since 2014.
Ms Wazed was designated Goodwill Ambassador for Autism in WHO South-East Asia in 2017. She co-authored WHO South-East Asia Regional Strategy on Autism Spectrum Disorder the same year.
She is an Associate Fellow at the Global Health Program Chatham House, UK, Chairperson of the National Advisory Committee on Autism and NDDs, Dhaka Bangladesh, and Chairperson of the Shuchona Foundation, Dhaka, Bangladesh.
Ms Wazed was conferred 'Excellence in Public Health' award by WHO South-East Asia Regional Office in 2014, and Ibrahim Memorial Gold Medal in 2016 by the Dr Ibrahim Memorial Council, Bangladesh, for her work on autism and neurodevelopment disorders.
In 2017, Ms Wazed received International Champion Award from US organization Shema Kolainu for her work on autism in South-East Asia. In 2019, she was conferred Innovative Women Leaders in Global Mental Health award by the Global Mental Health Programs, Columbia University, USA.
-BSS
South-East Asia WHO Saima Wazed
Comment
Over the past few decades, the countries of WHO’s South East
Asia region have made major strides in both clinical medicine and public
health. They have benefitted from government commitment and the strong human
resource capacity of healthcare and health-related personnel, many of whom have
led a successful fight against TB, leprosy, polio, malaria, and other
communicable diseases as well as maternal, newborn and child health that have
long plagued the region. They have done this against a backdrop of massive
rural-to-urban migration, the emergence of cities whose health and social
services have been pushed to the limit, and epidemiological transition and the
emergence of new lifestyles and associated health challenges.
So today, as the SEARO Region prepares for a new Regional
Director, the demographic transition, impact on health of climate change,
preparedness for future pandemic and most importantly it’s vast range of
non-communicable diseases, that are now challenging governments and their
ministries of health. Foremost among non-communicable diseases are a series of
mental health problems associated with stigma, discrimination, marginalization
and misunderstanding that in the past have been poorly addressed, and which now
call for urgent attention. Throughout the world more work days are being lost
as a result of a pandemic of mental health problems that are undermining family
health and stability, eroding many of the gains that have been achieved in
education and literacy, and placing demands on healthcare systems that have
traditionally focused on communicable diseases and not kept pace with this new
world of mental health challenge. Young people in the SEARO region are being
threatened as never before, along with alarming suicide rates. All these were
recognized at the last SEARO Regional Committee in Bhutan in 2022 WHO, when the
member states of WHO adopted the Paro Declaration calling for new vision and
commitment to mental health care and the development of services that focus on
community participation and primary care that is not only delivered by doctors
and nurses, but also by psychiatric social workers, and many other paramedical
personnel who can be trained to take on this new and fast-growing problem. The
Ministers of Health who came together to address this new challenge agreed that
“…there can be no health without mental health” and they called for major
investments to be made by governments and external partners in preventing and
mitigating mental health problems in ways that reduce treatment costs and
increase human productivity, employment and quality of life.
If the SEARO region and its Member States are to move
forward and take up this dramatic emerging problem, it must do so with vision
and a deep understanding of the world of mental health, psychosocial wellbeing,
and the role of community and society in promoting and protecting mental
health. This will not be simple or easy, but if it is not taken up just as the
regions’ Ministers of Health asked for in their Paro Declaration, countries
will find themselves faced with one of the most complex public health problem
the region has ever seen, and health and socioeconomic development risks being
stunted.
Whoever is selected to take SEARO and its Member States into the new future, must have a clear understanding of the challenge of mental health and a body of experience in the area of mental health prevention and management as well as negotiating power to bring wide range of experts together that can foster and work hand in hand with the region’s member states public health policy makers, healthcare workers and social sector resources in a new and exciting SEARO public health venture. These are qualities not easily come by, and at the time of writing this, Saima Wazed seems to bring the type of mental health background and experience as will needed drive, dedication and expertise.
Comment
Prominent
Eye Specialist Prof. Deen Mohd. Noorul Haq was invited as a speaker at the 38th
congress of the Asia Pacific Academy of Ophthalmology (APAO) help in Malaysia
from 23–26 February 2023, where he delivered speech on “Universal Eye Health
Coverage” The Bangladesh Perspective.
Mentioning
that the Universal Health Coverage is a Priority for Bangladesh Prof. Deen
Mohd. said, the government of Bangladesh is committed to recognizing all people’s
rights to the highest attainable standard of physical and mental health under
the International Covenant on Economic, Social and Cultural rights and the
convention on the Rights of the child.
He also
said that, these fundamental human rights could be established through
universal health coverage (UHC), which would ensure that all people have access
to the full range of quality health services they need, when and where they
need them, without financial hardship.
Deen Mohd.
said that, the Bangladesh Ministry of Health & Family Welfare (MOHFW)
delivers its services through Health Population and Nutrition Sector Program
(HPNSP). National Eye Care (NEC) is one of the operational plans (OP) of the
HPNSP and it follows the guidelines of the Bangladesh National Council for the
Blind (BNCB).
Prof. Deen
Mohd. Noorul Haq is known for his great contribution to Community Ophthalmology
in Bangladesh. He received many awards for his contribution in his field.
Comment
The number of dengue patients in the country every day and
the panic among the common people is also increasing. Added to this are the new
symptoms of dengue. The new symptoms seen in dengue patients this year are not
similar to traditional dengue symptoms. These symptoms include diarrhea,
pneumonia and headache. Due to these new symptoms, many patients are delaying
coming to the hospital without realizing that they are infected with dengue. As
a result, there is a risk of death due to delayed treatment. Many are dying
after being hospitalized.
On Thursday (October 20), the Directorate General of Health
Services reported the death of four people due to dengue. On this day, 896
people were admitted to the hospital due to dengue. With this, the number of
patients admitted in various government and private hospitals in the country
has reached 3 thousand 174 people. Apart from this, the number of dengue deaths
has increased to 110 this year. Earlier on Wednesday, the Department of Health
reported the death of seven people infected with dengue.
The dengue situation has suddenly worsened in the past few
weeks. Infected patients are increasing in the hospital every day. As a result,
the hospital authorities are struggling to provide treatment. Even by creating
a separate ward for dengue patients, they are struggling to handle the pressure.
The 10th floor of the capital's Mugda General Hospital has
been reserved only for dengue patients. The open area outside the ward also
been declared as Dengue dedicated war. But still, many of the hospitalized
patients are receiving treatment from the floor without getting a bed.
Mugda General Hospital has a separate ward for children. Two
rooms of this ward have been declared dengue ward. But still there are patients
on the balcony outside the ward.
Meanwhile, the Department of Health said that most of the
dengue victims this year are over 20 years old. But 40-50 years old are dying
more. Still, 35 percent of the patients who died were children, that is, those
under the age of 18. Many of the affected patients are taken to the hospital
late, as a result most of them are dying within three days of admission. This
year there are more deaths outside Dhaka. Besides, the mortality rate of women
is higher than that of men.
Comment
The United States
sent Gilead Sciences' remdesivir and Mapp Biopharmaceutical Inc's experimental
Ebola antibody drug MBP134 to Uganda last week to help safeguard healthcare
workers responding to an outbreak that has infected 60 people and killed 44,
U.S. government sources told Reuters.
There are currently no proven vaccines or treatments for the
Sudan species of Ebola, one of four known Ebola viruses to cause hemorrhagic
fever in humans. The outbreak confirmed by the Ugandan health ministry on Sept.
20 is the largest of the Sudan species since 2000.
Uganda health minister Jane Ruth Aceng disclosed the U.S.
shipments at a meeting of African region health officials last week in Kampala
and said remdesivir, which has been widely used as a COVID-19 treatment, and an
undisclosed monoclonal antibody had been given to healthcare workers.
Providing treatment that protects the lives of healthcare
workers could be central to containing the outbreak, said Joel Montgomery, the
U.S. Centers for Disease Control and Prevention's chief of the viral special
pathogens branch and incident manager for the outbreak.
"If healthcare workers start to fall ill and die, it's
going to negatively impact the response," said Montgomery, who had just
returned from a trip to Uganda.
For instance, healthcare workers may be reluctant to assist
in the response, he said in a phone interview.
The World Health Organization said in a statement the agency
is working with partners in Uganda to set up the infrastructure for a clinical
trial and is supporting use of the untested antivirals and monoclonal
antibodies and will collect data on their efficacy.
A large outbreak of the Zaire species of Ebola in West
Africa from 2014-2016 led to effective vaccines and treatment, but there are no
proven treatments or vaccines for the Sudan species.
San Diego-based Mapp Biopharmaceutical received a $110
million contract from the U.S. government's Biomedical Advanced Research and
Development Authority (BARDA) on October 4 for advanced development and
potential purchases of MBP134, a combination of monoclonal antibodies.
Gilead did not immediately respond to a request for comment.
A study of MBP134 and remdesivir in non-human primates
showed that either drug given individually rescued 20% of animals infected with
the Sudan species of Ebola, but when given in combination, 80% of infected
animals survived.
MBP134 is currently being tested in early safety trials in
healthy human volunteers, Mapp President Larry Zeitlin said in an email. All
participants have completed the study, and the data are currently being
analyzed. Overall, MBP134 was well tolerated, he said.
Zeitlin said when requested, the company does provide its
drug for free for compassionate use, pending regulatory and ethics approvals.
He declined to say how many doses the company provided.
- Reuters
Comment
Over the past few decades, the countries of WHO’s South East Asia region have made major strides in both clinical medicine and public health. They have benefitted from government commitment and the strong human resource capacity of healthcare and health-related personnel, many of whom have led a successful fight against TB, leprosy, polio,
The number of dengue patients in the country every day and the panic among the common people is also increasing. Added to this are the new symptoms of dengue. The new symptoms seen in dengue patients this year are not similar to traditional dengue symptoms. These symptoms include diarrhea, pneumonia and headache. Due to these new symptoms, many patients are delaying coming to the hospital without realizing that they are infected with dengue.