IMO warns on monkeypox outbreak

The IMO has issued a Circular Letter (No.4575) that offers information and guidance on the monkeypox disease, based on recommendations developed by the World Health Organization (WHO).

Entitled “Multi-country monkeypox outbreak in non-endemic countries”, the circular noted that, since the first human case was reported in 1970, the vast majority of infections had been concentrated in the Democratic Republic of the Congo (DRC) and Nigeria. However, in recent months more cases had been reported in countries not normally associated with outbreaks.

Since May 13th cases of monkeypox had been reported to WHO by 23 Member States that are not endemic for monkeypox virus, across three WHO regions. The vast majority of reported cases so far have no established travel links to an endemic area and have presented through primary care or sexual health services. The sudden appearance of monkeypox simultaneously in several non-endemic countries suggested that there may have been undetected transmission for some time, as well as recent amplifying events.

As May 26th there had been 257 laboratory confirmed cases and around 120 suspected cases reported to WHO, none of which had been fatal.

The case fatality ratio of monkeypox has historically ranged from 0 to 11% in the general population and has been higher among young children. In recent times the case fatality ratio has been around 3 to 6%. Severe cases occur more commonly among children and are related to the extent of virus exposure, patient health status and the nature of complications. Underlying immune deficiencies may lead to worse outcomes.

The WHO has noted that there are two clades of monkeypox virus: the West African clade and the Congo Basin (Central African) clade. The Congo Basin clade appears to cause severe disease more frequently, with case fatality ratio of up to around 10%. Currently, the Democratic Republic of the Congo is reporting a CFR among suspected cases of around 3%. The West African clade has in the past been associated with an overall lower CFR, of around 1% in a generally younger population in the African setting. Diagnostic assays specific for monkeypox have so far found that the less dangerous West African clade of the monkeypox virus is the clade present in this multi-country outbreak.

It had been noted that vaccination against smallpox was demonstrated to be about 85% effective in preventing monkeypox. However, IMO warned that people younger than 40 to 50 years of age (depending on the country) might be more susceptible to monkeypox due to cessation of smallpox vaccination campaigns globally, following the eradication of the disease.

Meanwhile, Bangladesh has introduced restrictions, with the port of Chittagong banning shore leave for all crew unless in the case of an emergency, and requiring signed-off crew to undergo health checks.

Shipping agency GAC advises that according to Mongla Port Authority Emergency Circular No.03/2022 (dated June 2nd 2022), all ships arriving to Mongla Port in Bangladesh must note the following:

  • No officer/crew shall be granted shore pass unless emergency and with prior approval of the Port Health Officer (PHO).
  • Signed off crew shall remain under health check up by PHO prior out pass from immigration office near MPA main jetty gate.
  • Any information regarding Monkeypox symptomatic patient on board ship shall be informed to Mongla Port Control Room and Port Health Office  immediately. In such case ship’s movement/cargo operation will be subjected to the report of PHO inspection.