Monkeypox: 25K cases, a batch of new deaths, and 3 state emergencies

As global monkeypox cases continue to climb, health officials are investigating reports of several new deaths, which include the first batch of deaths reported from countries outside of where the virus is endemic in animals. The global case count is now over 25,000, with more than 6,000 in the US. The global death toll is now at least 10. Previously, officials reported three deaths from Nigeria and two from the Central African Republic, both of which have historically reported monkeypox spillover cases. On Monday, Ghana, which has also historically had cases, reported its first death. At the same time, four new deaths have been reported in Spain (2), Brazil (1), and India (1). Officials at the World Health Organization are still waiting for more clinical information on the cases. Initial media reports suggest that the death in Brazil was a 41-year-old man who had lymphoma and was immunocompromised and was therefore at higher risk of severe disease. The other three cases reportedly died from encephalitis—inflammation of the brain—which is a known potential complication of monkeypox. In India, officials said a 22-year-old man died after returning from a trip to United Arab Emirates, where he initially tested positive for the virus. He delayed treatment while he was in the UAE but then deteriorated upon his return to India, dying in the hospital after being placed on a ventilator. Officials there told reporters that he had also tested positive for Epstein-Barr virus, the cause of infectious mononucleosis, and that they were still investigating other possible underlying health conditions. In Spain, a 31-year-old and a 44-year-old reportedly died of monkeypox-associated encephalitis. Reports so far suggest that both were previously healthy and not immunocompromised. The clade of monkeypox virus spreading in the multinational outbreak is historically thought to have a fatality rate of up to 3 percent in endemic countries. Though deaths remain rare in the current multinational outbreak, health officials say they're seeing a broader spectrum of disease.

New clinical data

"We're seeing new manifestations of illness," Rosamund Lewis, WHO's technical lead for monkeypox, said in a question-and-answer video on Tuesday. Those new manifestations include conditions "that can be extremely painful and need medical care, such as secondary infections or such as inflammation or swelling of the rectum," she said. Lewis went on to note the reports of deaths, including encephalitis cases. "This is very tragic; it is not totally surprising," she said. The WHO will release more information on the cases as it comes in from countries, she said. More illness data and possibly deaths may come in as the outbreak continues to grow. Some countries, such as Germany and the UK, are seeing plateaus or possibly slow declines. But others, such as the US, Peru, and Brazil, are still seeing dramatic rises. In the US, the case total is now up to 6,326, the largest tally in the world, according to the Centers for Disease Control and Prevention. The US confirmed its first case on May 18 and has added more than 2,500 cases in the past week or so. Cases have now been reported in every state, except for Wyoming and Montana. So far, no deaths have been reported. On Monday, the governors of California and Illinois declared states of emergency over the outbreak. New York's governor declared a statewide emergency Friday. The declarations are intended to mobilize resources and efforts to combat the public health threat, which is largely spreading among men who have sex with men. It's unclear if federal officials will declare a public health emergency over the outbreak. But on Tuesday, the White House announced that President Biden had named two long-time FEMA employees to lead the country's response. WHO declared the multinational monkeypox outbreak a public health emergency of international concern (PHEIC) on July 23. It is the agency's highest level of alert.