Monkeypox: 25,000 cases, a batch of new deaths and 3 state emergencies

The NYC Monkeypox Vaccine Clinic sign is displayed August 2 in the Bronx borough of New York City.  Mayor Eric Adams has declared a state of emergency due to Monkeypox, allowing him to suspend certain laws and regulations to enact rules and policies to combat the fast-spreading virus.
Enlarge / The NYC Monkeypox Vaccine Clinic sign is displayed August 2 in the Bronx borough of New York City. Mayor Eric Adams has declared a state of emergency due to Monkeypox, allowing him to suspend certain laws and regulations to enact rules and policies to combat the fast-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 outside countries where the virus is endemic in animals.

The number of cases worldwide now exceeds 25,000, including more than 6,000 in the United States. The global death toll is now at least 10. Earlier, authorities reported three deaths in Nigeria and two in the Central African Republic, both of which reported cases of monkeypox spreading. On Monday, Ghana, which has also historically had cases, reported its first death. At the same time, four new deaths were reported in Spain (2), Brazil (1) and India (1). World Health Organization officials are still awaiting more clinical information on the cases.

Early media reports suggest the fatality in Brazil was a 41-year-old man who had lymphoma and was immunocompromised and was therefore at higher risk of serious illness.

The other three cases are believed to have died of encephalitis, an inflammation of the brain, which is a known potential complication of monkeypox. In India, officials said a 22-year-old man 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 United Arab Emirates, but then deteriorated upon his return to India, dying in hospital after being placed on a ventilator. Officials told reporters he had also tested positive for Epstein-Barr virus, the cause of infectious mononucleosis, and 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 encephalitis associated with monkeypox. Reports so far suggest the two were previously healthy and not immunocompromised.

The monkeypox virus clade spreading in the multinational epidemic is historically believed to have a mortality rate of up to 3% in endemic countries. Although deaths remain rare in the current multinational epidemic, health officials say they are seeing a wider range of illnesses.

New clinical data

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

Lewis then noted death reports, including cases of encephalitis. “It’s very tragic, it’s not totally surprising,” she said. The WHO will release more information on cases as they arrive from countries, she said.

More data on illnesses and possibly deaths could come 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 United States, Peru and Brazil, are still seeing dramatic increases.

In the United States, the total number of cases now stands at 6,326, the highest 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 over the past week. 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. The governor of New York declared a statewide emergency on Friday. The statements aim to mobilize resources and efforts to address the public health threat, which is spreading widely among men who have sex with men. It is unclear whether federal authorities will declare a public health emergency during 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 (USPPI) on July 23. This is the agency’s highest alert level.

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