Regarding monkeypox, which had been spreading mainly in Europe and the United States, WHO = World Health Organization announced on the 11th that it would end the declaration of a "public health emergency of international concern". Globally, the number of infected people is decreasing, but in Japan, the number of cases reported has increased since the beginning of this year.

We have summarized the latest situation, future prospects, and how to prepare. (As of May 2023, 5)

WHO ends state of emergency

"We are pleased to declare that monkeypox is no longer a 'public health emergency of international concern,'"

said WHO Director-General Tedros at a press conference on May 2023, 5, announcing the end of the declaration of a "state of emergency."

Since May 2022, the spread of monkeypox (M-Pox) has spread mainly in Europe and the United States, and in July 5, the WHO declared the spread of infection to be a "public health emergency of international concern."

According to the WHO, more than 2022,7 cases have been reported in 111 countries and regions so far, and the number of deaths has reached 8.

At its peak in mid-August 7000, more than 140,2022 new cases were reported in one week, but in recent months, the number of infections per week has dropped to just over 8.

Commenting on the background to the decision to end the declaration, Director-General Tedros explained that the number of infected people in the last three months had decreased by almost 1% compared to the previous three months, and that "we confirmed steady progress in controlling the spread of infection."

On the other hand, he said it is affecting all regions, including Africa, where the detailed route of infection is unknown, saying, "Like the new coronavirus, this is not 'done of the job', it continues to pose a significant public health problem and requires a strong, proactive and sustainable response."

What is monkeypox (M-Pox) in this infection

According to the National Institute of Infectious Diseases, monkeypox is a disease caused by infection with the "monkeypox virus", which is similar to the smallpox virus, and the incubation period of the virus is usually 6 to 13 days, and after the incubation period, fever, headache, swollen lymph nodes, muscle pain, etc. continue for 1 to 5 days, and then a rash appears.

The rash typically starts on the face and spreads throughout the body.

It gradually swells into blisters (blisters), swelling, and scabs, which usually heal in 2~4 weeks from onset.

In many cases, it is mild and recovers on its own, but it can cause complications such as pneumonia and sepsis, and it is said that the younger the age, the more severe it may be.

In the past, it was an infectious disease that occasionally circulated in central and western Africa, but in the epidemic that began in May 2022, mainly in Europe and the United States, the majority of the people confirmed to be infected were men.

The virus can infect anyone, but it is believed to have spread through communities of men who engage in sexual contact.

The symptoms of patients in regions other than Africa are characterized by cases where the rash is confined to some areas, such as around the genitals and anus, or the rash appears before fever.

Also, some patients complain of strong pain in the rash.

The "basic reproduction number", which indicates how many people can be infected from one patient, is said to be less than 5, and it is not so contagious compared to the new coronavirus, which is said to exceed 1.

Although the risk of severe illness is not high, 1 deaths have been reported in the Americas (including South America), 2 in Africa, and 114 in Europe.

Japan has seen an increase in patient reports this year.

In Japan, the first case was confirmed in July 2022.

After that, sporadic cases were confirmed, but in 2023, the number of patients began to increase, and as of May 2023, 5, 2 infections have been confirmed.

According to the National Institute of Infectious Diseases, the initial number of cases were from areas where infections were spreading, but since then, the number of confirmed cases among people who have not traveled abroad has increased, reaching 129, or 129.96%, of the 9 confirmed infections so far.

All of the people confirmed to be infected in the country are men, and no one has become seriously ill or died.

According to the National Institute of Infectious Diseases, 125 of the infected people reported so far have had sexual contact in the 100 days before the onset of the disease, "suggesting that transmission by sexual contact between men may be occurring in Japan as well."

In addition, monkeypox is an infectious disease that is at risk of infecting anyone, and discrimination and prejudice against specific groups, infected people, suspected infections, etc. not only lead to violations of human rights, but may also hinder consultation behavior and delay the control of the spread of infection. We should make decisions and act without biased information or misunderstandings.

The Ministry of Health, Labour and Welfare urges people to consult the nearest medical institution if they have any suspicious symptoms, regardless of whether they have traveled abroad.

How is the infection route?

Monkeypox is generally transmitted by being bitten by an infected animal such as a rat or squirrel, or by touching blood, body fluids, or a rash.

It has also been pointed out that anyone can become infected by coming into contact with an infected person's rash, body fluids, scabs, bedding or clothing used by the patient, or exposure to flying at close range.

The CDC = Centers for Disease Control and Prevention in the United States says that patients who are considered to be so-called "community-acquired infections" whose infection route cannot be identified, as well as women and children, have also been confirmed, and that they should be vigilant and not regarded as diseases of specific groups of people.

The WHO also states that anyone who has been in close contact with an infected person is at risk of contracting the disease, and that "no one should be treated unfairly because of illness."

The origin of the name and the infection so far

Monkeypox was first discovered in 1958 in cynomolgus monkeys in a facility where primates from around the world were collected to produce a polio vaccine, hence the name monkeypox.

However, it is believed that the natural hosts that carry this virus in normal conditions are not monkeys, but rodents.

Human infection was first confirmed in 1970 in what is now the Democratic Republic of the Congo, and infections are still occurring in Africa.

The WHO recommended that the name "monkeypox" be called "Mpox" in November last year due to racist expressions on the Internet.

Japan In February, the Infectious Diseases Subcommittee of the Health and Welfare Science Council approved the policy of changing the name to "M-Pox," and it will be changed to "M-Pox" through a revision of the Cabinet Order.

Vaccines are

The smallpox vaccine that was once inoculated is highly effective, and according to the WHO and others, the effectiveness of preventing the onset of monkeypox (M-Pox) reaches 85%.

It is said that vaccination within
▼4 days after infection with the virus is effective in preventing the onset of the disease, and
vaccination within ▼14 days is effective in preventing severe illness.

In previous vaccinations and studies, convulsions may occur in rare cases as a side reaction, but most are considered mild, and the WHO recommends use for people who may be infected or medical professionals who are treating them.

However, as a result of active vaccination, smallpox was eradicated from the face of the earth in 1980.

The last time the smallpox vaccine was administered in Japan in Japan was in 1976, and the generation of children in their late 40s and older who were children at that time may be immune to MPOX if they have been vaccinated.

On August 2022, 8, the Ministry of Health, Labour and Welfare approved the smallpox vaccine from KM Biologics, a vaccine manufacturer in Kumamoto Prefecture, for use as a prophylaxis against M-Pox.

At the National Center for Global Health and Medicine Hospital in Tokyo, where many patients are examined, doctors and nurses who come into contact with patients are vaccinated, and a research group at the hospital administers the partners and family members of patients who have been in close contact with them in the framework of observational studies.

The remedy is

Therapeutic drugs are also being administered in clinical research in Japan.

The drug used is an oral drug called "Tecobilimat" developed by an American pharmaceutical company as a treatment for smallpox, and is approved as an antiviral drug for monkeypox (M-Pox) in Europe.

At present, seven medical institutions nationwide are able to administer "specific clinical research" to patients, including the National Center for Global Health and Medicine in Tokyo, Rinku General Medical Center in Osaka, Fujita Health University Hospital in Aichi, and the University of the Ryukyus Hospital in Okinawa.

Although it has been administered to patients in Japan, it has been reported that no serious side effects have occurred, and it has been reported that symptoms have improved quickly and the virus has disappeared, and verification of efficacy and safety is continuing.

U.S. Promotes Vaccination

According to the CDC, the United States, which has the highest number of infected people by country, has confirmed more than 2023,5 infections by May 9, 3.

In response to this situation, the U.S. government is focusing on expanding vaccinations.

The vaccine used is "JYNNEOS", which was developed by a Danish company as a smallpox vaccine, and as of May 5, 9.122 million doses of the vaccine have been administered. In the United States, studies have reported that the risk of developing the disease was 1.7 times higher in people who did not receive this vaccine than in people who received a single dose.

Japan domestic response

Monkeypox is designated as a "Class 4 infectious disease" under the Infectious Diseases Act, the same as rabies, and the doctor who diagnosed it must report the patient's outbreak to the public health center.

The Monkeypox virus can be examined by PCR test in the same way as the new coronavirus from the liquid contained in the blisters.

The Ministry of Health, Labour and Welfare (MHLW) has established a system that can be implemented at the National Institute of Infectious Diseases and all prefectural regional public health institutes, and requires local governments to promptly report any suspected cases.

In addition, if an infection is confirmed, it is preferentially accepted at 58 designated medical institutions for infectious diseases nationwide, and if there are people at high risk of infection, such as family members of patients, they are required to check their health status through public health centers every day.

Expert views are

We interviewed Dr. Shinichiro Morioka of the National Center for Global Health and Medicine, who is also conducting specific clinical research on therapeutic drugs in Japan, about the infection situation and countermeasures.

Q.WHO has announced the end of the "state of emergency". How do you evaluate the current global infection situation?
A. A committee was previously convened in February to advise whether the WHO would lift the "emergency" for monkeypox (MPOX). Comparing the number of newly infected people in the previous three months and the last three months until May, the number of newly infected people has decreased by 90%, and I think it can be assumed that the infection situation has stabilized worldwide. I think the end of the "emergency" is a reasonable decision.

Q.Why has the number of infected people decreased worldwide?
A.It is said that there are complex elements. One is that the route of infection may have been clarified to some extent and people's behavior may have changed. The second is that the infection spread in people who behave in a way that makes them susceptible to infection, and they may have already acquired immunity and suppressed it. Third, vaccination has progressed in Europe and the United States, and this effect is also thought to be significant.

Q.The "state of emergency" has ended, but what is the infection situation in Japan?
A.In Japan, the number of infected people increased from 2023 onwards, and after peaking in March, the number of infected people decreased slightly and is now leveling off. It is not clear why the infection spread later than overseas, but it is presumed that contact between people may have increased for some reason. There is a possibility that the number of infected people will continue to increase in Japan, and overseas experts and the media are also closely monitoring the infection situation in Japan.

Q.On the other hand, the number of deaths is not Japan, but it has risen to more than 100 overseas.
A.The number of infected people has reached 87,000 worldwide, and the mortality rate is low, but caution is required. Looking closely at the Japan data, more than 60% of people infected with monkeypox (M-Pox) are infected with HIV = human immunodeficiency virus, and the trend is similar overseas, but it has been pointed out that most of the people who have died or become seriously ill are people whose HIV is not under control. Such people are at high risk of becoming seriously ill, so be careful. In addition, people taking immunosuppressants, children under the age of 12, pregnant or breastfeeding are also at high risk, so be careful.

Q.What measures should be taken in the future?
A.It is important for medical institutions and public health centers and other governments to work closely together to ensure that patients are examined and diagnosed. Early diagnosis can prevent the chain of infection. It is also important to further verify the efficacy and safety of therapeutic drugs and vaccines and establish a system that can be delivered to as many people as possible.

Q.Finally, what should we pay attention to?
A. Monkeypox is a disease that can infect anyone, including women and children. In particular, if you have been in contact with an infected person or a suspected patient, or if you have sexual contact with an unspecified number of people and have suspicious symptoms such as fever or rash, do not hesitate to visit your family medical institution or consult a public health center. It is emphasized that discrimination and prejudice against certain groups of people or those who are infected or suspected of being infected may hinder consultation behavior or delay the control of the spread of infection. I believe that it will be important to act and make decisions based on objective information without preconceived notions.