Asia On High Alert Of Monkeypox

Beware the global outbreak of monkeypox.

As of 26 May, two dozen countries in the Americas, Europe, North Africa, the Middle East, and Australia had reported more than 350 suspected and confirmed cases of the disease, a much milder cousin of smallpox, the deadly scourge that the World Health Organization (WHO) deemed eradicated in 1980. A disproportionate number of cases are in men who have sex with men (MSM), an unusual twist given that researchers have never convincingly shown sexual transmission occurs in monkeypox.


The 2022 monkeypox outbreak in Asia is a part of the ongoing outbreak of human monkeypox caused by the West African clade of the monkeypox virus. The outbreak was reported in Asia on 20 May 2022 when Israel reported a suspected case of Monkeypox, which was confirmed on 21 May. As of 25 July 2022, seven West Asian, two Southeast Asian, three East Asian and one South Asian country, along with Russia, have reported confirmed cases. As of 24 July 2022, a total of 156 cases were confirmed. Most of them were concentrated in the region of West Asia, with 141 of the total 156 cases (≈90.38%) being reported in the region. Israel alone has reported 114 cases (≈73.07%). Israel reported the first community transmission of the disease on 21 June 2022.


Countries across Asia are on high alert for monkeypox, screening travelers and scrambling teams of medics, as they report their first cases of the virus, now identified as a global health emergency by the World Health Organization (WHO). Japanese authorities on Monday announced the first detected case of monkeypox in the country — a Tokyo resident in his 30s who had returned from Europe in mid-July. The man had developed fatigue followed by a fever, rash, and headache, Health Ministry officials told reporters. He is currently receiving treatment in hospital and was “in a stable condition,” officials added, declining to reveal further details about the patient, including his nationality.


Initial symptoms of monkeypox infection include fever, headache, swelling of the lymph nodes, back pain, muscle aches, and lack of energy, according to WHO. The disease later progresses into a rash and lesions that can blister and scab all over the body — usually lasting two to four weeks. Antiviral treatments and vaccines already exist for monkeypox, including those used in the eradication of smallpox, according to WHO. Japan’s first identified case comes after its Foreign Ministry this week urged travelers to exercise caution regarding the disease. Officials said clinical studies into treatment and preventive measures have been launched, and vaccine shots administered to frontline medical workers in Tokyo.


A large portion of those infected was believed to have not recently traveled to areas of Africa where monkeypox is normally found, such as Nigeria, the Democratic Republic of the Congo as well as central and western Africa. It is believed to be transmitted by close contact with sick people, with extra caution for those individuals with lesions on their skin or genitals, along with their bedding and clothing. The CDC has also stated that individuals should avoid contact and consumption of dead animals such as rats, squirrels, monkeys, and apes along with a wild game or lotions derived from animals in Africa. In addition to more common symptoms, such as fever, headache, swollen lymph nodes, and rashes or lesions, some patients have also experienced proctitis, an inflammation of the rectum lining. CDC has also warned clinicians to not rule out monkeypox in patients with sexually transmitted infections since there have been reports of co-infections with syphilis, gonorrhea, chlamydia, and herpes.


Caseloads in Asia remain low but experts say the region could see “a likely rise” in the coming weeks. “Like Covid-19, border and travel restrictions didn’t really stop the spread of monkeypox, only delaying it. The disease will (continue to) spread globally,” said Khoo Yoong Khean, a scientific officer from the Duke-NUS Centre for Outbreak Preparedness in Singapore. “Cases in the US and Europe have been rising rapidly because of travel, trade and tourism. We will likely see more monkeypox cases being reported in Asia over the next few weeks to months.” According to Khoo, it’s only a matter of time before more countries in Asia identify monkeypox cases.


“The real issue for countries in Asia now is whether the early detection and surveillance systems and processes are robust enough to handle the positive cases when they come through,” he said.

But he cautioned against border restrictions. “While (somewhat) useful as a stop-gap measure, these are not sustainable and something not many countries can endure again after their experiences with the Covid-19 pandemic,” he said. More than 19,000 monkeypox cases have been reported in at least 76 territories globally — the vast majority in places where the virus is non-endemic, according to the US Centres for Disease Control and Prevention (CDC). About a dozen of these new locations are in Asia and the Pacific.


Thailand last week reported its first case in a 27-year-old foreign national in the resort island of Phuket. The Southeast Asian country raised health alerts and stepped up screenings at border checkpoints after the patient fled for neighboring Cambodia following news of his positive test result. He was later detained in the Cambodian capital Phnom Penh. Thai hospitals have also been told to scan potential patients for monkeypox and immediately undergo lab tests, Health Minister Anutin Charnvirakul told reporters on Monday.


Elsewhere in Asia, countries including Singapore and India reported new cases. Singapore’s Ministry of Health has confirmed 10 cases in total, including locally transmitted infections and patients who had recently traveled from Canada, the United Kingdom, and Germany. India is also on high alert after confirming its fourth monkeypox case in the capital Delhi on Monday. A 34-year-old man was admitted to the hospital with rashes and a fever that had lasted two weeks. The first three cases were detected in the southern state of Kerala in travelers who had arrived from the United Arab Emirates.

Another alert to be aware of

A medical staffer in Munich, Germany prepares a syringe with the Bavarian Nordic’s vaccine against monkeypox. Airport screenings have since been stepped up and a high-level medical team deployed to Kerala to assist state health authorities with medical research, Indian authorities said. In a statement Tuesday, WHO regional director Poonam K. Singh said the risk of a monkeypox outbreak in Southeast Asia was “moderate but the potential of its further international spread is real.”


Anyone can get monkeypox, but a “notable fraction” of cases in the global outbreak are among gay and bisexual men, according to the CDC. That doesn’t mean the virus is sexually transmitted, but officials say it shows that prolonged skin-to-skin contact is one of the major ways monkeypox is now spreading. “We need to stay alert and be prepared to roll out an intense response to curtail the spread of monkeypox,” said Singh from WHO. “Our efforts and measures should be sensitive and devoid of stigma and discrimination.”