Monkeypox declared PHEIC – Impact on fixed covers

North of England Club has noted that on July 23rd the World Health Organization (WHO) declared the current monkeypox outbreak to be a Public Health Emergency of International Concern (PHEIC). WHO has noted that the vast majority of reported cases were in the WHO European Region.

North said that this would have an effect on the fixed premium covers provided to some Members, as the exclusion notified by Circular 2022/006 dated February 16th 2022 would now be triggered. With effect from July 23rd 2022 there would be an exclusion for any loss, damage, liability, cost or expense directly arising from any transmission or alleged transmission of the Declared Communicable Disease, i.e., monkeypox.

The exclusion does not apply to instances of a transmission which took place before this date.

However, as also notified in that circular, the Club will provide a limited level of cover (currently $5m each vessel and arising from each event, but always limited to a maximum in the aggregate per fleet as defined in accordance with Rule 10, to $5m per annum).

UK Club late last week also published an article on the disease, printing a bulletin from Crew Health Partner Red Square Medical

There are two strains (clades) of Monkeypox. The Congo Basin clade has a 10% fatality rate, and the West African clade runs at about 1% fatality rate. In this outbreak, all cases have been confirmed to be the West African clade. Fatalities are largely due to limited resources and poor access to healthcare.

Fatalities outside Africa are rare as people have access to better healthcare and drugs.

Monkeypox is zoonotic, which means it normally passes from monkeys and small mammals, such as rodents, to humans.

Most outbreaks in humans can be traced back to travel in affected areas (Central/West Africa), consuming contaminated meat or importing exotic pets (generally illegal activity). For instance, an outbreak of 71 cases in the USA in 2003 was traced back to Gambian rats sold as exotic pets.

It rarely passes from human to human, but it can do so.

Anyone who has had the smallpox vaccine (if you were born prior to 1971 in the UK) may already have some immunity. But, the effectiveness of vaccines does reduce over time and cases of monkeypox were predicted to increase to fill the gap left by the eradication of smallpox.

With monkeypox people develop some very specific and distinctive symptoms before they become infectious. This helps massively in keeping cases contained.

The incubation period is between five to 21 days from infection to the onset of symptoms and it generally starts with flu-like symptoms. Victims can expect to see fever, aches and pains and distinctive swollen lymph nodes.

The rash develops within one to three days of the fever starting. It goes through five stages – macules, papules, vesicles, pustules and finally scabs that will fall off.

Pox viruses rarely transmit before the onset of symptoms which helps to contain the spread. Monkeypox is most likely to transmit through being scratched or bitten by something small and furry – rats, squirrels, non-human primates, black-tailed prairie dogs, African brush-tailed porcupines, pigs, shrews or rabbits. But it can spread from person to person through:

  • Respiratory droplets and aerosols from prolonged face-to-face contact
  • Direct contact with bodily fluids or monkeypox lesions
  • Indirect contact with contaminated items such as clothing or bedding

This means that the most common person to person infection is of people sharing a home with someone who has monkeypox, or healthcare workers. However it takes a lot of viral load to transmit.

It’s also an “enveloped” virus, which means that normal soap, detergent and disinfectants will kill it.

This most recent outbreak had been traced back to a large superspreader “Darklands” festival in Antwerp, said Red Square (a source in Spain was reported to have been an adult sauna). While monkeypox is not a specifically sexually transmitted disease, a considerable amount of direct contact and interchange of air droplets from lung exhalations will help it to be passed on.

Red Square said that “the word in medical circles is it’s unlikely that the virus has mutated and thought that the outbreak is being driven by more environmental, social and behavioural factors”.

  • Be vigilant and aware of the symptoms.
  • Personal hygiene is paramount… something we already know from COVID. Wash and/or sanitise your hands regularly.
  • Be careful with who you are in very intimate contact.
  • If you’re bitten or scratched by any African rodents or small mammals, seek medical advice.
  • On ship, especially if you’ve called into port in West Africa, be alert for vermin onboard.
  • If you suspect you are developing symptoms, isolate straight away and seek medical advice.