Bhutan is one of the few countries in the South-East Asian Region (SEAR) where travelers are asked to fill out the form to declare whether any passengers have the monkeypox signs and symptoms, which means there is a very high level of surveillance.
So, with this, it is very unlikely that cases will be picked up by Bhutan, said Regional Emergency Director of WHO Health Emergencies Programme, WHO SEAR, Dr Edwin Salvador. Dr Salvador said from the emergency point of view, Bhutan’s health workers are trained in an emergency, and the infrastructure is there where Bhutan can scale up to respond to an emergency, a buffer stock of medicines, diagnostics, and treatment for emergencies, and the public are very educated on health issues. So, the likelihood of anything slipping is very small.
If any monkeypox case is detected, it is very likely that the Ministry of Health (MoH) will be able to pick it up and contain it.
Dr Salvador said, “I don’t see Bhutan will have a mass outbreak of monkeypox since Bhutan’s health system is very strong.”
He said it is very important for MoH in Bhutan and other health ministries of the member states to educate the health practitioners on how to deal with monkeypox. It looks like chickenpox but it is not. It is also important to work with the media to educate the public. If any person is unwell, go and see medical practitioners, just to make sure it is nothing serious. The government must work on the management, diagnostics, case management, and surveillance. So, if these are in place, the non-endemic countries most likely will be able to pick up cases, he added.
Dr Salvador also said as far as the current outbreak continues globally, travel-related or locally acquired monkeypox is possible in the SEA region, in any country, and at any time.
As of 31 August 2022, 17 laboratory-confirmed monkeypox cases (including 1 death in India) have been verified. 9 cases in India (5 in Kerala, 4 in Delhi); (+1 pending verification); 7 cases in Thailand (2 in Phuket; 4 in Bangkok; 1 in Maha Sarakham); 1 case in Indonesia (1 in Jakarta)
Out of 17 confirmed cases, 2 cases were reported from men having sex with men (MSM), 4 hetero-sexual and 9 are imported cases (6 from UAE, 1 from Germany, 1 from France, 1 from Qatar) and 8 are likely locally acquired.
He said viruses will continue to come because the animal-human interface is increasing.
“We have to start educating ourselves more that diseases that are in animals are more likely to be in humans,” Dr Salvador said. Since 1 January 2022, cases of monkeypox are being reported to WHO from 101 member states across all 6 WHO regions. As of 30 August 2022, a total of 48,895 laboratory-confirmed cases and 301 probable cases, including 15 deaths, have been reported to WHO. The number of weekly reported new cases globally has increased about 14 percent in week 34 (22 -28 August) and that is around 6,000 cases compared to week 33 (15 -21 August).
The majority of cases reported in the past 4 weeks were notified from the Region of the Americas (66.9 percent) followed by the European Region (32.3 percent).
Among cases with known data on sexual orientation, 95.2 percent identified as men who have sex with men. Among those with known HIV status, 44.6 percent were HIV-positive. Of all reported types of transmission, a sexual encounter was reported most commonly, with 91.8 percent of all reported transmission events.
“We are all vulnerable to monkeypox, and it can not only be transmitted through sexual but also through other ways,” said Dr Salvador.
In terms of severity, monkeypox can cause severe disease among immunocompromised people. Even cause or contribute to death.
The challenge associated with monkeypox is that in some regions, monkeypox is very new and it will be very difficult to detect the case. So, vigilance for case detection is needed in health care workers. And, there has to be a safer environment and access to care for suspect Monkeypox cases. The stigma on men having sex with men will actually make it very difficult to seek healthcare. Anyone can get monkeypox, regardless of their sexuality, said Dr Salvador.
“One reason we are currently hearing reports of cases of monkeypox from sexual health clinics in communities of men who have sex with men, maybe because of their positive health-seeking behavior. Monkeypox rashes can resemble some sexually transmitted diseases, including herpes and syphilis, which may explain why these cases are being picked up at sexual health clinics. It is likely that as we may learn more, we may find monkeypox cases in the border population, not only among MSM communities,” he further said.