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Monkeypox: WHO to rename disease to prevent stigma

BMJ 2022; 377 doi: (Published 16 June 2022) Cite this as: BMJ 2022;377:o1489
  1. Luke Taylor

World Health Organization officials are working on a new name for the virus and disease commonly known as monkeypox in order to reduce racism and stigma.

The UN health body announced on Monday that it will rename the virus and the disease it causes after more than 30 scientists from around the world published a letter on 10 June requesting that their nomenclature be revised.1

Historically, the monkeypox virus is most commonly found in Africa, but recent outbreaks in 28 countries across four WHO regions (the Americas, Europe, Eastern Mediterranean, and Western Pacific regions)—areas where monkeypox is not normally detected—has caused alarm and confusion from public health specialists.2 More than 1285 cases of the viral disease have been confirmed by WHO in those regions, with no deaths caused so far.2

Small outbreaks of monkeypox have been detected in humans in the past, though mostly in Central and West Africa, from where the infection is believed to have originated.3

Monkeypox infections in Europe and the US are typically isolated cases where someone has travelled from Africa or come into contact with an exotic animal such as a rodent, squirrel, or non-human primate. In 2003 Gambian pouched rats imported to the US passed the disease on to prairie dogs, which subsequently infected more than 70 people there.2

Unlike the cases found in Africa, the current outbreak in Europe and North America is likely sustained by human-to-human transmission, the authors of the letter said. The virus can be transmitted from one person to another by close contact with lesions, body fluids, respiratory droplets, and contaminated materials, but in most cases in Africa it is spread from animals to humans.

The scientists called for an “urgent” change1 to monkeypox’s denomination in order to counter widespread misinformation.

Though the disease was named after monkeys after it was first detected in a primate in a Danish laboratory in 1958, its true origin is unknown.2

Researchers used the term “hMPXV,” or human monkeypox virus, to refer to the virus driving the current outbreak in Europe and North America—distinguishing it from the virus more commonly found in animals in Africa.

“The prevailing perception in the international media and scientific literature is that MPXV is endemic in people in some African countries,” the scientists said. “However, it is well established that nearly all MPXV outbreaks in Africa prior to the 2022 outbreak have been the result of spillover from animals to humans and only rarely have there been reports of sustained human-to-human transmissions.”

Two strains, the “West African” and the “Congo Basin (Central African) Central” have been widely referenced by WHO and in media reports. The labels are “misleading and inaccurate because very limited surveillance and limited diagnostic capacity means that the full range of the pathogen is not known,” the letter added. “It is important to consider appropriate, non-discriminatory, and non-stigmatising nomenclature and classification of MPXV clades.”

The group proposed naming MPXV clades 1, 2, and 3 order by date of detection. Clade 1 would correspond to what has been referred to as the “Congo Basin clade,” while clades 2 and 3 would correspond to the “West African clade.”

The scientists also proposed defining a new clade for sequences of the virus that contain genomes sampled between 2017 and 2019 from Israel, Nigeria, Singapore, the UK, and the US, as well as genomes from the nascent 2022 global outbreak.

WHO’s decision to opt for a new denomination for the illness comes after the Foreign Press Association of Africa expressed concern in May that western media were using photos of black people in stories on monkeypox, despite the current outbreak sustaining itself in predominantly white, western nations.4 The association also highlighted that the lesions caused in the current outbreak have largely been different from those typically seen in Africa.

The new name is under consideration, WHO officials confirmed in a statement to The BMJ. On the disease, “Names should be given with the aim to minimise unnecessary negative impact on trade, travel, tourism, or animal welfare, and avoid causing offence to any cultural, social, national, regional, professional, or ethnic groups,” WHO told The BMJ. The naming of the virus is the responsibility of the International Committee on the Taxonomy of Viruses, it added.

It added, “WHO is in discussion with experts and technical advisory groups in poxvirology and viral evolution on the possible renaming of monkeypox virus clades. This will include consultation with the WHO Advisory Committee for Variola Virus Research.”

WHO’s director general Tedros Adhanom Ghebreyesus told reporters on 14 June that a decision would be made “as soon as possible.”

In February 2020 the public health body swiftly named the virus that causes covid-19 “SARS-CoV-2” in order to reduce the use of monikers with geographic references that generated stigma, such as the “China” or “Wuhan” virus.5

WHO will hold an emergency meeting next week to decide whether the current monkeypox outbreak should be deemed a public health emergency of international concern. So far, only swine flu, polio, Ebola, Zika, and covid-19 have been deemed concerning enough to receive such a classification.