Canadian heading World Health Organization’s fight against monkeypox

The Canadian heading the World Health Organization’s fight against monkeypox says it’s crucial to act before the virus begin spreading in the general population.

Dr. Rosamund Lewis, the WHO’s technical lead for monkeypox, grew up in Thunder Bay, Ont., and Ottawa before studying medicine at McGill University.

Lewis says it’s important not to be alarmist about the virus which spreads through close contact, including sexual contact, and has so far primarily affected men who have sex with men.

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She says it’s important for people to be aware of the symptoms and risks associated with the virus and take precautions if they are at risk.

She says a situation like the current outbreak has never been seen before, its possible the virus has mutated to become more transmissible, and many of the current cases are less severe than those stemming from the “classic” presentation of the virus.

Lewis says in the past, people have usually been exposed to the virus after eating wild meat.

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The following is a condensed interview Lewis gave in Geneva, Switzerland for The Canadian Press on June 6, 2022

What do we know about the propagation of this disease?

We think it’s spread by rodents, but we don’t know what species it naturally lives in. In Africa, we find the virus in the Congo Rope Squirrel, the Gambian pouched rat, the dormouse and things like that. People hunt in the forest and bring back this while meat that they need to prepare. That’s the traditional type of exposure (to the virus). It’s also possible the family is eating undercooked meat. This meat could also be sold in a market, so even people who don’t have any direct exposure to the forest can be exposed.

But an other major factor is that smallpox was eradicated in 1980, so people who were born after 1980, or in certain countries after 1960 or 1970, didn’t have the opportunity to be vaccinated against smallpox.

Has monkeypox been seen in the west before?

There were two cases in the United Kingdom in 2021 and two in the United States, also in 2021. There was also an outbreak in the U.S. in 2003, but it had nothing in common with the current situation. It was very strange. It involved prairie dogs that were imported to be sold as pets, and children started to get sick after being scratched or bitten. It took around three months to understand the nature of the outbreak and to contain it.

How did the current outbreak begin?

We received reports from the United Kingdom, once again. It was a traveller who returned from Nigeria and discovered that she had monkeypox and I said to myself, “okay, it’s started.” The U.K. found an outbreak in a family, and it was completely unexpected because it involved three members of the same family. It was the first time that we saw monkeypox outside of Africa in someone who had not recently travelled, so that was new. (The British) then found it in their laboratories’ samples that tested positive and that came from men who had sexual relations with other men.

At the same time, Portugal reported an outbreak of people with undiagnosed lesions. They were negative for herpes, negative for syphilis, so the Portuguese were searching for information, and relatively quickly, Portugal and the U.K. realized that they were facing the same thing.

It was men having who had sex with men, who had participated in certain events and then returned home.

The first cases were all associated with travel from central Europe. That’s about where we are now, except that we’re seing a lot of cases and it’s spreading in this group of people who have frequent physical contact with more than one person, possibly in a very short period of time, so the conditions are right for rapid transmission and propagation.

So there is an opportunity to act that should not be missed?

Yes, and it’s crucial to take advantage (of this time) before the virus affects a more general population, family members, children, vulnerable people, for example, people who are HIV-positive. But we can’t be alarmist. The vast majority of cases are still being reported in this group, so it’s there that the transmission is happening, it’s not too late to stop the outbreak in this group, although it might be difficult. That said, there are still a lot of things that we don’t know about the virus, and we have to be honest and admit that. The virus itself might have gone through changes that make it more transmissible, but we have certainty seen behaviours that make it more transmissible. This disease presents as an infectious disease that spreads through close contact, including sexual contact. So the message to the public is this: educate yourself, learn to recognize the signs and symptoms, know in what circumstances you could be infected, protect yourself and protect others and, when in doubt, seek a diagnosis.