Antonio Camiro

Monkeypox represents the latest emerging pathogen mostly affecting the LGBTQ2A+ community, mainly people who have sex with men. This session covered important topics related to its epidemiology, treatment and public health response.

Dr. Dimie Ogoina talked about the epidemiology of Monkeypox in western African regions particularly Nigeria and the DRC. Less vaccine coverage and more contact are likely responsible for the increase in reports during the past years. Meg Doherty talked about the epidemiology of the current global outbreak, which is mostly occurring in America and Europe. Five deaths (related to immunosuppression) have been reported. >98% of cases have occurred through close contact during sex in MSM. One third of them were living with HIV. Dr. Nicolo Girometti talked about the symptoms and treatment. The lesions are mostly anogenital. 10% of patients require hospitalization. Treatment with tecovirimat or cidofovir/brancidofovir for severe cases and post exposure immunization is recommended. Genevieve Bergeron talked about the outbreak in Montreal, since May 12th, with 317 confirmed cases. Montreal is currently rolling-out PEP and PrEP, as well as vaccination to at-risk population. Demetre Daskalakis talked about community education and stigma in the USA, which has been led by a collaboration amongst government agencies and LGBTQ+ community influencers and associations. A protest occurred during the session, in which US public health management of the Monkeypox outbreak was criticised as more access to vaccine was demanded locally and globally.

The monkeypox pandemic is currently expanding, affecting more countries and patients every day. Recognition of risk factors and the new clinical presentations are paramount for detecting cases. Model public health responses like the one mounted in Montreal, with wide access to vaccination and treatment are sorely needed in the rest of the world in order to curb the pandemic now that it is in its early stages. Effective communication and collaborations between governments and community influencers will be key in educating the public and preventing stigma.

Keerti Gedela

We heard four global settings outlining current data and public health challenges regarding monkeypox (MPXV); Nigeria; London; Montreal, Canada and the USA. Presenters highlighted epidemiological/demographic data, public health control and equity gaps, and the importance of community education and reducing stigma. The voices from the community protested for vaccine equity.

Prof Ogoina, Nigeria reviewed the epidemiology of MPXV in western and central Africa, including a historical context. Since 2022, cases have been detected in 27 states in Nigeria, predominantly in males from urban/semi-urban settings. Previously, the region observed a higher prevalence in children (11%). He acknowledged gaps in case detection and knowledge and emphasized not to leave Africa behind in the global response. Meg Doherty, WHO provided a global snapshot. Updates included ten deaths reported in 2022, in Africa, also in India and Brazil. She encouraged vaccine implementation within research trials to understand prophylaxis efficacy and dosing. Dr Girometti, London described data from a large sexual-health service of 620 confirmed cases up to 19/7/2022 (42% of all London cases; 4% globally); 99% were in MSM, 31% people living with HIV, median-age 35years; 43% recently travelled but none to endemic countries. Importantly, 93% experienced ano-genital lesions, 66% fever and 35% had con-concomitant STI. Montreal utilised robust community engagement and a pre-exposure vaccination campaign for at-risk communities, which has provided 11,756 vaccine doses. Dr Daskalakis highlighted the CDC’s multi-layered approach in the USA to tailor messaging and outreach to communities disproportionately affected by MPXV, leveraging on community engagement and STI prevention work.

We heard from three global north settings and one from Africa; our colleague from Nigeria highlighted a potential gross underestimation of MPXV cases in his setting. The current outbreak has key demographic and clinical differences to previous outbreaks in Africa, with a disproportionate impact in MSM. It is vital to enable an equitable response for Africa and other LMICs. We heard a strong response from the community, actively protesting for vaccines in the US and admirable vaccine campaigns in Montreal; we must ensure LMICs are enabled to strengthen their response pathways from MPXV testing, treatment/prevention, control and community education.