Canadian leading WHO fight against monkeypox

A Canadian is playing a major role in the World Health Organizations' fight against monkeypox.

Dr. Rosamund Lewis, the technical lead for the effort to combat a global outbreak of the virus at the WHO's Health Emergencies Programme, grew up in Thunder Bay, Ont., and Ottawa.

A graduate of McGill University's school of medicine, Lewis practiced in Montreal before joining the WHO. The organization is currently working to quell the spread of monkeypox, which comes from the same family of viruses as smallpox.

The Canadian Press reached Lewis in Geneva, Switzerland for an interview.

What do we know about the propagation of this disease?
We think it's spread by rodents, but we don't know what species it naturally lives in. In Africa, we find the virus in the Congo Rope Squirrel, the Gambian pouched rat, the dormouse and things like that. People hunt in the forest and bring back this while meat that they need to prepare. That's the traditional type of exposure (to the virus). It's also possible the family is eating undercooked meat. This meat could also be sold in a market, so even people who don't have any direct exposure to the forest can be exposed.

But an other major factor is that smallpox was eradicated in 1980, so people who were born after 1980, or in certain countries after 1960 or 1970, didn't have the opportunity to be vaccinated against smallpox.

Has monkeypox been seen in the west before?
There were two cases in the United Kingdom in 2021 and two in the United States, also in 2021. There was also an outbreak in the U.S. in 2003, but it had nothing in common with the current situation. It was very strange. It involved prairie dogs that were imported to be sold as pets, and children started to get sick after being scratched or bitten. It took around three months to understand the nature of the outbreak and to contain it.

How did the current outbreak begin?
We received reports from the United Kingdom, once again. It was a traveller who returned from Nigeria and discovered that she had monkeypox and I said to myself, "okay, it's started." The U.K. found an outbreak in a family, and it was completely unexpected because it involved three members of the same family. It was the first time that we saw monkeypox outside of Africa in someone who had not recently travelled, so that was new. (The British) then found it in their laboratories' samples that tested positive and that came from men who had sexual relations with other men.

At the same time, Portugal reported an outbreak of people with undiagnosed lesions. They were negative for herpes, negative for syphilis, so the Portuguese were searching for information, and relatively quickly, Portugal and the U.K. realized that they were facing the same thing.

It was men having who had sex with men, who had participated in certain events and then returned home.

The first cases were all associated with travel from central Europe. That's about where we are now, except that we're seing a lot of cases and it's spreading in this group of people who have frequent physical contact with more than one person, possibly in a very short period of time, so the conditions are right for rapid transmission and propagation.

So there is an opportunity to act that should not be missed?
Yes, and it's crucial to take advantage (of this time) before the virus affects a more general population, family members, children, vulnerable people, for example, people who are HIV-positive. But we can't be alarmist. The vast majority of cases are still being reported in this group, so it's there that the transmission is happening, it's not too late to stop the outbreak in this group, although it might be difficult. That said, there are still a lot of things that we don't know about the virus, and we have to be honest and admit that. The virus itself might have gone through changes that make it more transmissible, but we have certainty seen behaviours that make it more transmissible. This disease presents as an infectious disease that spreads through close contact, including sexual contact. So the message to the public is this: educate yourself, learn to recognize the signs and symptoms, know in what circumstances you could be infected, protect yourself and protect others and, when in doubt, seek a diagnosis.

This interview, which took place June 6, 2022, has been edited and condensed for length and clarity.

This report by The Canadian Press was first published June 11, 2022.