VIII Ad Hoc Meeting of PAHO’s Technical Advisory Group (TAG) On Vaccine-Preventable Diseases: Technical Briefing on the Multi-Country Monkeypox Outbreak, 31 May 2022 (virtual)
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VIII Ad Hoc Meeting of PAHO’s Technical Advisory Group (TAG) On Vaccine-Preventable Diseases: Technical Briefing on the Multi-Country Monkeypox Outbreak, 31 May 2022 (virtual). (2022). [Meeting reports]. PAHO. https://iris.paho.org/handle/10665.2/56083
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English; 21 pages
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2022
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PAHO/FPL/IM/22-0018
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Monkeypox virus is an orthopoxvirus that causes a disease with symptoms similar, but less severe, to smallpox. While smallpox was eradicated in 1980, monkeypox continues to occur in countries of Central and West Africa. Two distinct clades are identified: the West African clade and the Congo Basin clade. Monkeypox is a zoonosis. Cases are often found close to tropical rainforests where various animals carry the virus including squirrels, rodents, dormice, and monkeys. Most human monkeypox infections in endemic countries result from a primary animal-to-human transmission. Human-to-human transmission does occur, with the longest documented chain of transmission being six generations. Transmission occurs through contact with bodily fluids, lesions on the skin or on internal mucosal surfaces, such as in the mouth or throat, respiratory droplets, and contaminated objects. Close contact with infected people or contaminated materials should be avoided. While human-to-animal transmission is rare, it should be considered as a possible link in the transmission chain. Monkeypox has been endemic in central and west Africa since its first detection in 1958 in the Democratic Republic of the Congo (1). However, since 13 May 2022 multiple countries in Europe have reported the sudden and unexpected appearance of monkeypox. To date, 27 non-endemic countries across four WHO regions have reported cases. Of these, four are countries in the Americas. Multiple suspected cases in these and other countries are currently under investigation. PAHO's Technical Advisory Group (TAG) on Vaccine-Preventable Diseases met for an ad hoc meeting on 31 May 2022 to discuss the implications for monkeypox in the Region of the Americas. The following report summarizes the epidemiological data to date, reviews available information on monkeypox vaccines, and provides recommendations to Member States of the Americas on how to minimize viral transmission and approach vaccination operations.
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Item VIII Ad Hoc Meeting of PAHO’s Technical Advisory Group (TAG) on Vaccine-Preventable Diseases. Technical Briefing on the Multi-Country Monkeypox Outbreak: Recommendations on Monkeypox Vaccines and Vaccination(PAHO, 2022)Monkeypox virus is an orthopoxvirus that causes a disease with symptoms similar, but less severe, to smallpox. While smallpox was eradicated in 1980, monkeypox continues to occur in countries of Central and West Africa. Two distinct clades are identified: the West African clade and the Congo Basin clade. Monkeypox is a zoonosis and cases are often found close to tropical rainforests where various animals carry the virus including squirrels, rodents, dormice, and monkeys. Most human monkeypox infections in endemic countries result from a primary animal-to-human transmission. Human-to-human transmission does occur, with the longest documented chain of transmission being six generations. Transmission occurs through contact with bodily fluids, lesions on the skin or on internal mucosal surfaces, such as in the mouth or throat, respiratory droplets, and contaminated objects. Close contact with infected people or contaminated materials should be avoided. While human-to-animal transmission is rare, it should be considered as a possible link in the transmission chain. Monkeypox has been endemic in central and west Africa since its first detection in 1958 in the Democratic Republic of Congo. However, since 13 May 2022 multiple countries in Europe have reported the sudden and unexpected appearance of monkeypox. To date, 27 non-endemic countries across four WHO regions have reported cases. Of these, four are countries in the Americas. Multiple suspected cases in these and other countries are currently under investigation. PAHO's Technical Advisory Group (TAG) on Vaccine-Preventable Diseases met for an ad hoc meeting on 31 May 2022 to discuss the implications for monkeypox in the Region of the Americas. This executive summary summarizes the contents of the final report generated from this meeting.Item VIIIe réunion ad hoc du Groupe consultatif technique (GCT) de l'OPS sur les maladies évitables par la vaccination. Briefing technique sur l'épidémie multi-pays de variole du singe, 31 mai 2022 (virtual)(OPS, 2022)Le virus de la variole du singe est un orthopoxvirus qui provoque une maladie dont les symptômes sont similaires, mais moins graves, à ceux de la variole. Alors que la variole a été éradiquée en 1980, la variole du singe continue d'être présent dans les pays d'Afrique centrale et occidentale. Deux clades distincts sont identifiés : le clade ouest-africain et le clade du bassin du Congo. La variole du singe est une zoonose. Les cas sont souvent observés en proximité des forêts tropicales humides où divers animaux sont porteurs du virus, notamment les écureuils, les rongeurs, les loirs et les singes. La plupart des infections humaines par le virus de la variole du singe dans les pays endémiques résultent d'une transmission primaire de l'animal à l'homme. La transmission interhumaine existe, la plus longue chaîne de transmission documentée étant de six générations. La transmission se fait par contact avec les fluides corporels, les lésions sur la peau ou sur les surfaces muqueuses internes, comme dans la bouche ou la gorge, les gouttelettes respiratoires et les objets contaminés. Il faut éviter tout contact étroit avec des personnes infectées ou des matériaux contaminés. Bien que la transmission d'homme à animal soit rare, elle doit être considérée comme un lien possible dans la chaîne de transmission. La variole du singe est endémique en Afrique centrale et occidentale depuis sa première détection en 1958 en la République Démocratique du Congo. Néanmoins, depuis le 13 mai 2022, cependant, plusieurs pays d'Europe ont signalé l'apparition soudaine et inattendue de la variole du singe. À ce jour, 27 pays non endémiques répartis dans quatre régions de l'OMS ont signalé des cas. Parmi ceux-ci, quatre sont des pays des Amériques. Plusieurs cas suspects dans ces pays et dans d'autres sont en cours d'investigation. Le Groupe consultatif technique (GCT) sur les maladies évitables par la vaccination s'est réuni le 31 mai 2022 afin de discuter des implications de la variole du singe dans la Région des Amériques. Le rapport résume les données épidémiologiques à ce jour, passe en revue les informations disponibles sur les vaccins contre la variole du singe, et fournit des recommandations aux États Membres des Amériques sur les stratégies pour minimiser la transmission virale et aborder les opérations de vaccination.Item Guidance on the use of mpox vaccines. Revised edition(PAHO, 2024)On 23 July 2022, the WHO Director-General declared the mpox outbreak a public health emergency of international concern (PHEIC). A coordinated response was launched, aimed at interrupting transmission and protecting vulnerable groups, and a number of recommendations were made, including vaccination. These temporary recommendations apply to different groups of countries, based on their epidemiological situation, patterns of transmission, and capacities. These recommendations include different aspects such as: the implementation of a coordinated response, community engagement and protection, surveillance and public health measures, clinical management, and infection control, among others. WHO recommends use of the vaccine for countries that have imported cases of mpox in the population and/or human-to-human transmission of monkeypox virus, including in key population groups and communities at high risk of exposure. The overall goal of the global response to mpox as a PHEIC, is to stop human-to-human transmission and minimize zoonotic transmission of the monkeypox virus wherever it occurs. The use of vaccines can contribute to this response. However, vaccination should be considered a measure to complement primary public health interventions that include surveillance, early case detection, diagnosis and care, isolation and contact tracing and follow-up, and self-monitoring to reduce contacts. This document aims to provide useful accessible, and understandable information about mpox vaccines in order to facilitate deployment of vaccination strategies in the context of the current epidemiological scenario and based on the recommendations of the VIII Ad Hoc Meeting of the PAHO Technical Advisory Group (TAG) on Vaccine-Preventable Diseases.Item VIII Reunión ad hoc del Grupo Técnico Asesor (GTA) sobre Enfermedades Prevenibles por Vacunación de la OPS. Informe técnico sobre el brote de viruela símica en varios países, 31 de mayo del 2022 (virtual)(OPS, 2022)El virus de la viruela símica es un Ortopoxvirus que causa una enfermedad con síntomas similares, pero menos graves, a los de la viruela. Aunque la viruela fue erradicada en 1980, la viruela símica sigue apareciendo en países de África central y occidental. Se han identificado dos clados distintos: el clado de África occidental y el clado de la cuenca del Congo. La viruela símica es una zoonosis. Los casos suelen encontrarse cerca de las selvas tropicales, donde varios animales son portadores del virus, como las ardillas, los roedores, los lirones y los monos. La mayoría de las infecciones humanas por viruela símica en los países endémicos son el resultado de una transmisión primaria de animal a humano. La transmisión de persona a persona se produce, siendo la cadena de transmisión más larga documentada de seis generaciones. La transmisión se produce a través del contacto con fluidos corporales, lesiones en la piel o en superficies mucosas internas, como en la boca o la garganta, gotas respiratorias y objetos contaminados. Debe evitarse el contacto estrecho con personas infectadas o materiales contaminados. Aunque la transmisión de persona a animal es rara, debe considerarse como un posible eslabón en la cadena de transmisión. La viruela símica ha sido endémica en África central y occidental desde su primera detección en 1958 en la República Democrática del Congo. Sin embargo, desde el 13 de mayo de 2022, múltiples países de Europa han notificado la aparición repentina e inesperada de la viruela símica. Hasta la fecha, 27 países no endémicos de cuatro regiones de la OMS han notificado casos. De ellos, cuatro son países de las Américas. Actualmente se están investigando múltiples casos sospechosos en estos y otros países. El Grupo Técnico Asesor (GTA) sobre Enfermedades Prevenibles por Vacunación de la OPS se reunió el 31 de mayo del 2022 para discutir las implicaciones de la viruela símica en la Región de las Américas. El informe los datos epidemiológicos hasta la fecha, revisa la información disponible sobre las vacunas contra la viruela símica y ofrece recomendaciones a los Estados Miembros de las Américas sobre cómo minimizar la transmisión viral y enfocar las operaciones de vacunación.Item Guidelines for surveillance of Zika virus disease and its complications(PAHO, 2016)[Introduction]. Zika virus (ZIKV) is an arbovirus of the genus Flavivirus (family Flaviviridae), phylogenetically very close to other viruses, such as the dengue, yellow fever, Japanese encephalitis, and West Nile viruses. It is a mosquito-borne RNA virus, transmitted mainly by the genus Aedes, and was first isolated in 1947, from a Rhesus macaque, during a study on the transmission of jungle yellow fever in the Zika Forest of Uganda. In 1968, it was first isolated in humans in Uganda and in the United Republic of Tanzania. Subsequently, outbreaks have been recorded in Africa, Asia, the Western Pacific region and, more recently, in the Americas. Sexual and vertical (mother-to-child) transmission of ZIKV have been documented in a limited number of cases, as has transmission through blood transfusion. Transmission through breast milk has not been documented, however it may be possible as viral RNA has been found in the breast milk of women who were infected during the peripartum period; more recently, a report of infective ZIKV particles in breast milk has been published. The symptoms of the disease usually appear after an incubation period of 3 to 12 days, and are similar to those of other arboviral infections; they include rash, fever, conjunctivitis, myalgia, arthralgia, malaise, and headache, and tend to last 4 to 7 days. During an outbreak that occurred in French Polynesia in 2013 and 2014, an increase in cases of Guillain-Barré syndrome (GBS) and other neurological manifestations was observed in association with ZIKV infection and recently, in the Americas, it has also been associated with other neurological manifestations. In October 2015, the health authorities of Brazil confirmed an increase in the prevalence of microcephaly at birth in the Northeast region of the country, which coincided in time with an outbreak of the ZIKV. Subsequently, other birth defects, placental insufficiency, intrauterine growth restriction, and fetal death were described in association with ZIKV infection during pregnancy. The latter event led the World Health Organization (WHO) to declare on 1 February 2016 a public health emergency of international concern (PHEIC) and to recommend enhancement of surveillance and research on the relationship between new clusters of microcephaly and other neurological disorders, including Guillain-Barre syndrome and ZIKV infection.