Maroc - NEWSDAY.CO.TT - A la Une - 17/Aug 05:40

Epidemiologist: Trinidad and Tobago at low-risk for mpox arrival

Epidemiologist and infectious disease specialist Dr Farley Cleghorn says while there is little to no risk of the current monkeypox (mpox) outbreak arriving in TT, vigilance is required to ensure it remains so. WHO director-general Dr Tedros Adhanom Ghebreyesus declared mpox a public-health emergency of international concern (PHEIC) on August 14 owing to the upsurge of the virus in the Democratic Republic of the Congo and other African countries. It was also declared a PHEIC from July 2022-May 2023. Speaking to Newsday on Friday via WhatsApp call, Cleghorn said there was very little risk of the virus arriving on TT’s shores. “I want to make it clear it’s very low-risk around the world. TT is at no- or low-risk. What TT is trying to do is to stop the importation of cases, as happened in 2022-2023. That really becomes about our public health responses that are managed under our international public health regulation obligations, which every country is a signatory to. “We have obligations to raise awareness, enact policies that detect and limit transmission should a case show up at the TT borders. Those are most likely to come from London or the US, but we haven’t seen any yet, except for one case under isolation in England.” He said depending on the level of risk, countries must inform all incoming visitors to be on the lookout for symptoms and signs and report what they have experienced. “I don’t think we’ve gotten to the point where we need to do that. What you really need to do is have the infrastructure on hand should a case need diagnosis. This infrastructure was what we used for the 2022-2023 outbreak. You train clinical workers to have high clinical suspicion, ie they’re aware mpox is possible, they know what kind of samples to take and what kinds of tests to request.” He said a PCR test would be needed to determine if someone had mpox, which could distinguish between the clades and give a precise report of what the organism is. He said the infrastructure was already available in TT, as PCR testing was available at UWI and through CARPHA. “It’s when you put everything together that you make diagnoses. You put the clinical presentation, the examination finding, and the laboratory results together, along with travel and sexual history, and then you make the diagnosis.” Cleghorn said some patients would need antivirals as they were sick. He said some people just had the skin lesions and no other effects. He said the antivirals were available according to the Health Minister. Cleghorn said the mpox vaccine could be used against any clade of the virus. He said the mpox virus was related to the smallpox virus and so countries which had used smallpox vaccines would have protection against mpox. He said since TT had stopped its smallpox vaccination in the 1980s, older people would be protected against the virus. He said there would be discussions at the local and regional levels as to how to prevent transmission and spread, led by the Health Ministry and CARPHA respectively. “The PHEIC triggers certain actions in each member state of the World Health Organization (WHO) and they are mandated to take those actions, so I’m sure that is what is happening.” Cleghorn said the current strain of mpox is a genetically distinct version of the virus or clade of the 2022 strain. He said the two clades are the West African (Clade 2) and the Central African (Clade 1) strains of the virus. The clade causing the current outbreak is Clade 1. He said the mpox strain which was present in 2022 was Clade 2, which was spread mainly through sexual contact between gay and bisexual men. He said it was still ongoing, with over 700-plus cases in the US over the last year, with less than two per cent mortality. He said it has mostly become entrenched in unvaccinated individuals who are having sexual contact. He said the current PHEIC meant that the countries affected would be able to coordinate and raise the resources necessary to combat the current spread and restrict its spread to other countries. He said the Democratic Republic of the Congo (DRC) has reported 16,000 cases and 500 deaths. He said it had different characteristics from the 2022 epidemic, as there had been a lot of women and children affected. “It is postulated that one way the virus is travelling is through heterosexual sex between sex workers and truck drivers, so it can get out of the remote areas in which the initial outbreak started in eastern DRC. DRC is a massive country subject to conflict, poverty and poor health systems. “Because it’s a different clade and it seems to have become more infectious in that it’s become adapted for human to human transmission, it’s primarily transmitted through close contact in households, which is how children are getting it, and it’s also being transmitted through heterosexual sex between sex workers and truck drivers, and then the truck drivers take it out to other places.” He said four countries in Africa, including Burundi, Kenya and Rwanda, have reported cases of Clade 1 on their borders, and two imported cases had been reported in Sweden and Pakistan. Cleghorn said he did not’t think the virus could not be transmitted during air travel, as it was usually spread in crowded homes. “When you’re living in crowded conditions, it’s possible to transmit through respiratory secretions, but this is not a major mode of transmission. I don’t think people would be travelling to the DRC for tourism. They would be more likely to travel to Kenya or Tanzania or Rwanda. The idea would be to control transmission at those borders. There isn’t going to be casual transmission of any kind. It’s about close contact and primarily about sexual contact.” The post Epidemiologist: Trinidad and Tobago at low-risk for mpox arrival appeared first on Trinidad and Tobago Newsday.