Monkeypox: 25K cases, a batch of new deaths and 3 state emergencies

The sign for the New York City Monkeypox Vaccine Clinic is displayed on August 2 in the Bronx borough of New York.  Mayor Eric Adams declared a state of emergency due to monkeypox, allowing him to waive certain laws and regulations to enact rules and policies aimed at combating the rapidly spreading virus.
Enlarge / The sign for the New York City Monkeypox Vaccine Clinic is displayed on August 2 in the Bronx borough of New York. Mayor Eric Adams declared a state of emergency due to monkeypox, allowing him to waive certain laws and regulations to enact rules and policies aimed at combating the rapidly spreading virus.

As global cases of monkeypox continue to rise, health officials are investigating reports of several new deaths, including the first batch of deaths reported in countries outside of where the virus is endemic in animals.

The global case count is now over 25,000, with more than 6,000 in the US. The global death toll is now at least 10. Previously, officials reported three deaths in Nigeria and two in the Central African Republic, both of which have historically reported cases of contagion of monkeypox. On Monday, Ghana, which has also historically had cases, reported its first death. At the same time, four new deaths have been reported in Spain (2), Brazil (1), and India (1). World Health Organization officials are still awaiting more clinical information on the cases.

Initial media reports suggest that the death in Brazil was a 41-year-old man who had lymphoma and was immunocompromised and therefore at increased risk of severe disease.

The other three cases reportedly died of encephalitis, an inflammation of the brain, which is a known potential complication of monkeypox. In India, authorities said a 22-year-old man has died after returning from a trip to the United Arab Emirates, where he initially tested positive for the virus. He delayed treatment while in the UAE, but then deteriorated upon his return to India and died in hospital after being put on a ventilator. Officials there told reporters that he had also tested positive for the Epstein-Barr virus, the cause of infectious mononucleosis, and that they were still investigating other possible underlying health conditions.

In Spain, a 31-year-old man and a 44-year-old man reportedly died of monkeypox-associated encephalitis. Reports so far suggest that they were both previously healthy and not immunocompromised.

Historically, the monkeypox virus clade spreading in the multinational outbreak is believed to have a mortality rate of up to 3 percent in endemic countries. Although deaths remain rare in the current multinational outbreak, health officials say they are seeing a broader spectrum of illness.

New clinical data

“We are seeing new manifestations of the disease,” Rosamund Lewis, the WHO technical lead for monkeypox, said in a video question-and-answer on Tuesday. Those new manifestations include conditions “that can be extremely painful and need medical attention, such as secondary infections or inflammation or swelling of the rectum,” she said.

Lewis went on to point to reports of deaths, including cases of encephalitis. “This is very tragic; it’s not at all surprising,” he said. The WHO will release more information on cases as it comes in from countries, he said.

More data on illnesses and possibly deaths may be forthcoming as the outbreak continues to grow. Some countries, such as Germany and the UK, are experiencing plateaus or possibly slow declines. But others, like the US, Peru and Brazil, are still seeing dramatic increases.

In the US, total cases now stand at 6,326, the largest tally in the world, according to the Centers for Disease Control and Prevention. The United States confirmed its first case on May 18 and has added more than 2,500 cases in the last week or so. Cases have now been reported in every state except Wyoming and Montana. So far, no deaths have been reported.

On Monday, the governors of California and Illinois declared states of emergency over the outbreak. New York’s governor declared a statewide emergency on Friday. The statements are intended to mobilize resources and efforts to combat the public health threat, which is spreading largely among men who have sex with men. It’s unclear whether federal officials will declare a public health emergency over the outbreak. But on Tuesday, the White House announced that President Biden had appointed two longtime FEMA employees to lead the country’s response.

The WHO declared the multinational outbreak of monkeypox a Public Health Emergency of International Concern (PHEIC) on July 23. It is the agency’s highest alert level.

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