IATA Medical Contact Group - COVID-19, Monkeypox, other outbreaks


Some articles on COVID-19, mostly confirming the picture of vaccine protection which wanes but remains significant against severe infection consequences.  As time goes on the hybrid immunity (which will become the norm), from having been both vaccinated and infected, is proving to be superior to that from either pathway alone. 

On hybrid immunity vs “natural” immunity - Suryawanshi et al: https://www.nature.com/articles/s41586-022-04865-0   “Our results demonstrate that Omicron infection enhances pre-existing immunity elicited by vaccines but, on its own, may not confer broad protection against non-Omicron variants in unvaccinated individuals.” 

UK Office of National Statistics study on self-reported symptoms showed that chance of long COVID symptoms decreased after vaccination, and evidence suggested sustained improvement after a second dose – Ayoubkhani et al:  https://www.bmj.com/content/377/bmj-2021-069676However, note that there was no control group which is an important weakness of the study (as acknowledged by the authors). 

Rates of COVID-19 cases and deaths, by vaccination status, from the CDC database, are here: https://covid.cdc.gov/covid-data-tracker/#rates-by-vaccine-status
(indicating risk of death reduced approx. 10x by primary vaccination series and 17x by having booster as well as primary). 

Latest UKHSA technical briefing on variants, if a reference is required: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1077180/Technical-Briefing-42-20May2022.pdf

And also from UKHSA, this article on vaccine effectiveness against BA.2 Omicron in UK, Kirsebom et al: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00309-7/fulltext

Note that Hong Kong has announced a change to its procedure of suspending airlines with positive cases identified on arrival – instead there will initially be a financial penalty, with suspension in the event of a second occasion soon after.  Meanwhile in Mainland China, local restrictions are being eased somewhat in both Shanghai and Beijing.  [Sources: IATA, BBC].

And some resources on Monkeypox:

WHO has now published a comprehensive update on the multi-country monkeypox outbreak in non-endemic countries, here: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON388

There are only a few things to add to the information in the previous update (below).  Essentially what is new currently is the fact that most of the cases in the non-endemic countries are NOT linked directly to travel to the endemic regions.  This is in contrast to the situation previously: there were only 9 cases identified outside endemic countries in the previous 5-year period, whereas this outbreak has seen hundreds of cases in non-endemic locations.  This suggests that something has changed, whether in the mode of transmission, the behaviour of the virus, the susceptibility of the hosts, or some other factor.  It is also highly possible that the virus has already been circulating in the affected countries for some time. 

It is important to note that the general public are still considered to be at very low risk, except those with direct close contact with someone who is infected, around the time when they are symptomatic.  Even though there are multiple possible mechanisms of spread they are all associated with close contact.  Many of those aged over 50 may have enduring protection from childhood vaccination against smallpox, although this cannot yet be verified.  The incubation period of monkeypox is somewhat uncertain but thought to be 6-13 days in most cases according to WHO.  I mentioned in the last update that it is much less infectious than the SARS-CoV-2 virus.  The monkeypox virus is a DNA (double stranded) virus, unlike SARS-CoV-2 which is an RNA virus, and it is also several times larger than SARS-CoV-2, so it is thought to mutate much more slowly.  According to WHO, the “public health risk could become high if this virus exploits the opportunity to establish itself as a human pathogen and spreads to groups at higher risk of severe disease such as young children and immunosuppressed persons.”  [Sources: various including WHO, Nature, YLE Your Local Epidemiologist, medCram].

JAMA article “What to know about monkeypox” may be of interest, as a quick read: https://jamanetwork.com/journals/jama/fullarticle/2793012

And similarly this Nature article on four key questions relating to monkeypox https://www.nature.com/articles/d41586-022-01493-6 which are:

How did the current outbreaks start? Can they be contained? Can a genetic change in the virus explain the latest outbreaks?  Is the virus spreading differently now compared with previous outbreaks?

But for greater depth this EPI-WIN seminar, an hour long, recorded yesterday is excellent: https://www.youtube.com/watch?v=2PUW9hfS-Gw

Other outbreak news headlines:

WHO tweeted last week confirming a 4th case of Ebola on 19 May, a 12-year-old boy who has since passed away.

Cholera in Mozambique, as well as a recent outbreak in Cameroon with 140 deaths over the past seven months. 

Bacteria with highly antibiotic resistant genes discovered in Antarctica.

Meningitis outbreak in Raqqa, Syria, with almost 400 cases.

Acute childhood hepatitis cases reported to WHO now at least 650, investigations ongoing.

Doctors note that dengue fever is currently a much bigger threat than Monkeypox.

A second death from Japanese Encephalitis virus in the Australian outbreak. 
Anthrax outbreak declared in Sierra Leone with 3 cases confirmed. 

[Sources: Airfinity, WHO]

Best wishes,
David Powell
IATA Medical Advisor