Monkeypox Q&A 1. What is monkeypox? Monkeypox is a viral zoonotic disease first discovered in 1958 and typically occurs in tropical areas in central and west Africa. In May 2022, multiple cases of monkeypox were identified in non-endemic countries, and the number of cases and countries where infection has spread has continued to increase to over 16,000 cases over the past 2 months. This is the first time many monkeypox cases have been reported concurrently in non-endemic and endemic countries in different geographical areas. Previously, almost all monkeypox cases in people outside of Africa were linked to international travel to countries where the disease commonly occurs or through imported animals. Most cases so far have been identified through sexual health and other services at primary healthcare facilities, and have involved mainly, but not exclusively, men who have sex with men. Studies are underway to understand the epidemiology of the current spread of disease. Despite being named “monkeypox,” the source of the disease remains unknown. African rodents and non-human primates (like monkeys) are the animals most likely to harbor the virus and infect people. 2. What are the symptoms? The incubation period is between 6-13 days, with a range of 5-21 days. Initially, infection is followed by 0-5 days of fever, intense headache, lymphadenopathy, back pain, myalgia and fatigue. The skin lesions appear 1-3 days after the fever. The rash affects almost all infected people, beginning on the face (95%) and then spreading to other parts of the body, most commonly the palms of the hands and soles of the feet. It also may develop on mucosal membranes and genitalia. The rash begins from macules and progresses to papules, then to vesicles and pustules which dry up and fall off. The lesions may be itchy or painful, and in some cases cause scarring. The infection is self-limited and symptoms generally last 14-21 days. 3. How is it transmitted? The transmission can be spread from human to human via: - Direct contact with the infected areas: rash, scabs or body fluid. This also include the contact during physical intimacy. Respiratory secretions, usually requires prolonged face-to-face contact such as kissing. - Contaminated via infected items such as clothing, bedclothes - Infected pregnant mother to their fetus via placenta It may also be contracted through an animal host, generally through scratching or biting or by preparing or eating meat or using products from an infected animal, in endemic countries. 4. How dangerous is it? Most cases of the virus are mild, sometimes resembling an illness like chickenpox, and resolve without treatment within a few weeks. The risk of transmitting disease is much greater for the infected person than developing severe disease or dying. The case fatality ratio of monkeypox has ranged from 0 to 11 % in the general population and has been higher among children. Recently, the case fatality ratio has been around 3–6%. Severe cases occur most commonly among children and those with underlying immune deficiencies. 5. How can it be prevented? Avoiding close, skin-to-skin contact with people who have a rash that looks like monkeypox. - Avoid handling bedding, towels or clothing or sharing utensils or cups with a person with monkeypox. - Follow normal infection-prevention protocols and behaviors, such as washing hands often with soap and water. Health care providers should use personal protective equipment when monkeypox is suspected. - People with monkeypox should isolate at home for the duration of symptoms of illness and refrain from close physical contact, including sexual activity - Avoid unprotected contact with wild animals, especially those sick or dead, in countries where it is endemic. Additionally, cook well all foods containing animal meat or parts. Vaccination may be available for those who have been exposed to monkeypox through close contact or sexual contact, within 2 weeks of exposure. Prior vaccination against smallpox (which is in the same virus family) is 85% effective in preventing development of disease; however, only persons older than 40 or so may benefit from prior vaccination given that routine smallpox vaccination ceased around 1980 when it was declared eradicated. A newer vaccine based on modified attenuated vaccina virus was approved for the prevention of monkeypox in 2019. This is a two-dose vaccine currently with limited availability. 6. What is the treatment? Clinical care for monkeypox should have a goal to alleviate symptoms, manage complications, and prevent long-term sequelae. Most infected people can manage their symptoms at home without specialized or hospital care. Severe cases or complications arising from the disease, such as pneumonitis or superimposed bacterial infections and sepsis require medical treatment. Patients should be offered fluids and food to maintain nutritional status. Secondary bacterial infections should be treated as needed or indicated. An antiviral agent known as tecovirimat that was developed for smallpox was licensed by the European Medicines Agency (EMA) for monkeypox in 2022 based on data in animal and human studies. It is not yet widely available. 7. How is monkeypox diagnosed? The clinical differential diagnosis that must be considered includes other rash illnesses, such as chickenpox, measles, bacterial skin infections, scabies, syphilis, and medication-associated allergies. Lymphadenopathy during the prodromal stage of illness can be a clinical feature to distinguish monkeypox from chickenpox or smallpox. If monkeypox is suspected, health workers should collect an appropriate sample; polymerase chain reaction (PCR) Assays is the preferred laboratory test as it is most accurate and sensitive. Optimal sampling is from skin lesions: the roof or fluid from vesicles or pustules, or from dry crusts. Specimens should be packaged and shipped to appropriate laboratories in accordance with national and international requirements. 8. Are gay men at greater risk? Although many of the cases have been seen in gay and bisexual men, anyone who comes into close contact with someone who has monkeypox could be infected with the virus. All patients regardless of their history or characteristics who need diagnosis and treatment should receive stigma-free care and/or referrals free of discrimination. For any questions, please contact Nathalie Kapp, [email protected].  

The US Supreme Court has overturned Roe v. Wade in the biggest blow to women's health and rights in recent US history, removing 50 years of constitutional protection for abortion across America, meaning individual states will now decide the legality of abortion within their jurisdiction. Twenty-six states, including Mississippi, Oklahoma, Texas and Georgia, are now poised to enact "trigger laws" that will severely limit or ban abortion, putting approximately 40 million women and girls of reproductive age at risk of losing abortion access, with lower-income people and people of color most severely affected.  The patchwork of state abortion bans means those without funds to travel for safe and legal abortion services or access medical abortion pills will be forced underground to unsafe and unregulated methods, with no guarantee of quality of care or aftercare if things go wrong. The devastating rollback of reproductive rights resulted from the Dobbs v. Jackson Women's Health Organization case, a 2018 ruling that banned abortion in Mississippi after 15 weeks of pregnancy. Of the nine federal Supreme Court Justices, six voted to uphold the Mississippi law, effectively overturning Roe v. Wade, and three dissented. Dr Alvaro Bermejo, Director-General of the International Planned Parenthood Federation, said: "The Supreme Court's decision to overturn Roe v. Wade is the biggest blow to women's health and rights in recent US history and an outrageous and devastating conclusion to what was already an unconstitutional removal of life-saving healthcare. "By continuing its unbridled attack on women's bodies and forcing them to carry pregnancies to term, the highest court in the land has reached its lowest point, robbing millions of their liberty, bodily autonomy and freedom – the very values the United States prides itself on. "We know for a fact that banning abortion does not mean fewer abortions and that when abortion bans are enacted, women and pregnant people die, as we have seen across the globe, most recently in Poland. We also know that those who cannot access safe abortion care legally, including medical abortion pills, will be forced into unregulated and unsafe methods, potentially resulting in serious harm or even death and costing lives for decades to come. "The fallout from this calculated decision will also reverberate worldwide, emboldening other anti-abortion, anti-woman and anti-gender movements and impacting other reproductive freedoms. The justices who put their personal beliefs ahead of American will, precedent, and law will soon have blood on their hands, and we are devastated for the millions of people who will suffer from this cruel judgment." The overturning of Roe v. Wade also flies in the face of democracy and against the values of those the Supreme Court is meant to represent and protect, with the majority (60%) of Americans supporting Roe v. Wade and 70% believing the decision to end a pregnancy is between a woman or pregnant person and their doctor. Elizabeth Schlachter, Director of Advocacy and US representative for the International Planned Parenthood Federation, said: "The Supreme Court's perilous ruling is not just regressive but also wildly out of step with most Americans, who we know support access to abortion care. It is also at odds with much of the world, where access to abortion is expanding to reach all who need this vital health service. "By overriding the constitutional right to abortion across the US and handing the decision to each state, many parts of the US will now join El Salvador, Nicaragua, and Poland with some of the most restrictive, extremist, and life-threatening bans on abortion care in the world. "But this is not just about the anti-abortion movement in the US; this is concerted and calculated global effort by anti-women, anti-gender, anti-LGBTQI+ conservative and religious, white supremacist extremists, who are using dark money and undemocratic means to deny people their human right to healthcare, equality, bodily autonomy and ultimately, freedom. "With long-held rights under sustained attack, the International Planned Parenthood Federation is imploring governments across the globe to do more to protect democracy and peoples' freedoms from the interference and influence of these extremist groups." The International Planned Parenthood Federation's (IPPF) Member Association, the Planned Parenthood Federation of America (PPFA), continues to provide services to all who need them where legally possible, including via telemedicine for medical abortion pills. IPPF and PPFA will also continue to work around the clock to protect the rights of all people both in the US and globally, fighting extremism at its core and ensuring that women and pregnant people will not be forced to carry a pregnancy or give birth against their will. To help keep abortion legal, safe, and accessible, you can donate to the International Planned Parenthood Federation or Planned Parenthood Federation of America. For media enquiries, please contact Karmen Ivey on [email protected] or [email protected]   About the International Planned Parenthood Federation The International Planned Parenthood Federation (IPPF) is a global service provider and advocate of sexual and reproductive health and rights for all.   For over 65 years, IPPF, through its 118 Member Associations and 15 partners, has delivered high-quality sexual and reproductive healthcare and helped advance sexual rights, especially for people with intersectional and diverse needs that are currently unmet. Our Member Associations and partners are independent organizations that are locally owned, which means the support and care they provide is informed by local expertise and context. We advocate for a world where people are provided with the information they need to make informed decisions about their sexual health and bodies. We stand up and fight for sexual and reproductive rights against those who seek to deny people their human right to bodily autonomy and freedom. We deliver care rooted in rights, respect, and dignity - no matter what.