Until recently, monkeypox or monkey flower it was a viral disease of which we western countries know very little, that only occurs in rural areas of Central and West Africa. The situation completely changed on 14 May when the UK’s National Health Security Agency reported two cases with no recent travel or history of contact with an imported case. It has since become an infection that everyone talks about.

As of 20 June, one month after these first cases appeared, the total of confirmed cases in Spain had reached 500 and there were more than 1,800 cases across Europe, to be added by more than 300 in the rest of the world.

Most have mild symptoms that do not require admission, and none have died. Almost all are young men with a median age of 36 and a history of sexual intercourse considered risky.

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Currently moderate risk

WHO currently considers the public health risk of this outbreak to be moderate. After all, this is the first time that multiple cases of this infection have been reported simultaneously in endemic and non-endemic countries from very different geographic regions (28 countries).

However, although the current risk to human health and the general population is low, the risk to public health may become high if this virus is established in non-endemic countries.

Likewise, failure to take appropriate infection prevention and control measures or lack of adequate personal protective equipment may pose a risk to healthcare personnel, as well as to other vulnerable population groups such as children or immunocompromised persons.

Ensuring early detection and diagnosis

This pandemic has become a new challenge that needs to be addressed worldwide. In Spain, the Ministry of Health has worked to ensure early detection and diagnosis of monkeypox cases.

First, the alarm was raised at the national level and a risk assessment was made. A procedure for early detection and management of cases was also approved in response to the monkeypox alert. Availability and usefulness of vaccines were then reviewed, and vaccine recommendations for the current situation were developed.

Vaccines return to the scene against an unexpected infection. But is vaccine the solution in this epidemic?

Over 50 protected

On the one hand, it has been shown that prevaccination against smallpox can protect against monkey disease. In Spain, the vaccine against smallpox was administered between 1903 and 1979. However, vaccination coverage has dwindled since 1972, when smallpox was eradicated in Spain. For this reason, it is thought that the population over the age of 50 can at least be protected against serious diseases.

On the other hand, there is no authorized vaccine against monkeypox in the European Union. The IMVANEX vaccine (from Bavarian Nordic), authorized by the European Commission in 2013, is indicated for active immunization against smallpox in adults (≥18 years). However, in 2019 this same vaccine was licensed in the United States (tradename JYNNEOS) for the prevention of smallpox and monkeypox.

We also have experience using the ACAM2000 and IMVANEX smallpox vaccines in previous outbreaks in the United States and the United Kingdom, suggesting that early post-contact smallpox vaccination can prevent monkeypox virus infection. And if not, at least reduce the severity of the symptoms.

Vaccinate identified close contacts within 4 days

Given the current limited vaccine availability scenario, it is recommended that vaccination be offered to identified close contacts within 4 days of contact with a confirmed case. The Ministry of Health will monitor the evolution of the outbreak and more vaccines may be available soon, but it seems unlikely that the vaccine will spread to the general population even if sufficient doses are available.

These recommendations are in line with those of the ECDC and WHO. It is a good time to remember that we are always working internationally, sharing available information and discussing between countries to achieve a common and coherent response.

Mª Aurora Limia Sánchez, Head of Vaccination Programs of the General Directorate of Public Health, Ministry of Health (Spain) and Laura Sánchez-Cambronero Cejudo, Head of Vaccine Programs Area, Ministry of Health (Spain)

This article was originally published on The Conversation. Read the original.