Document Type : Letter
Emergency Department, Hunter New England Local Health District, Cambridge, United Kingdom
Department of Health Education and Health Promotion, Faculty of Public Health, Iran University of Medical Sciences, Tehran, Iran
Iran, with a population of approximately 85 million in the Middle East region of West Asia, has not yet fully recovered from the COVID-19 pandemic, which has raised concerns about the new outbreak of “monkeypox”.
Increased cases of monkeypox in some European non-endemic countries such as the United Kingdom, Spain, Portugal, Italy, France, Sweden, Belgium, and Germany, as well as the United States have been worrying and serve as a warning to other countries.1 These countries have high-quality health systems, therefore other countries are also certainly at risk of monkeypox outbreaks.
The emergence and reemergence of rare diseases can be worrisome, however despite the potential increased psychosocial stress felt by society, communities and health systems need to be made more aware of them.1 As of August 16, 2022, officials of the Ministry of Health of Iran have confirmed first case of monkeypox within the country. A 34-year-old woman visited a hospital in the city of Ahvaz in southwest Iran after seeing skin lesions. By confirming the initial and final tests, the disease of monkey pox has been proven and now this patient is under quarantine and treatment.2
In recent weeks, due to high economic inflation and rising prices for some basic goods in Iran, the level of tolerance of the community has decreased, so it may be considered to be increasingly difficult for the Iranian people to face a new disaster. For this reason, one of the concerns in Iran surrounding monkeypox is that due to the COVID-19 pandemic and economic difficulties in the community, it is possible that a monkeypox outbreak is neglected.
Monkeypox is a rare viral infection similar to human pox, first discovered in 1958 in monkeys kept for scientific research. The first case of monkeypox in humans was identified in 1970, and has been found to cause fever, body aches, swollen lymph nodes, and eventually painful fluid-filled blisters on the face, hands, and feet. The incubation period of this disease is usually between 5 to 21 days. It is mentioned that there is currently no specific treatment for monkeypox and the patient should be admitted to a specialist hospital so that the infection does not spread and symptomatic treatments are given. An adapted version of a vaccine developed to prevent and eradicate smallpox may provide 85 percent effective coverage in preventing contraction of this condition, however this is not yet sufficiently available.3,4
As an approach to this potential public health disaster, officials of the Iranian Ministry of Health could control the country’s entrances so that travelers entering the country do not transmit the virus to the country. They could also buy vaccines in advance and should increase the laboratory facilities in the country to diagnose monkeypox. Finally, preparation of the necessary protocols for the prevention and treatment of monkeypox should be prioritized.
As of yet, the Iranian Ministry of Health has not taken any official action in this regard and appears to be concealing information about the spread of this new communicable disease from a currently fragile society. It is worth mentioning that at the beginning of the COVID-19 outbreak in Iran, officials first concealed it before it was made globally public via the World Health Organization (WHO).5
Finally monkeypox reach Iran, however the consequences of which are uncertain. Good news is that monkeypox does not spread easily among humans, and the overall risk to the general public is low.3,4 However, to avoid surprises, it is suggested that officials make a plan of action in this regard.
The WHO’s concern about the spread of monkeypox worldwide has led to the general approach of countries aiming to control it by preventing the spread. The WHO has called for a series of increased measures to prevent the spread of such infectious diseases, given the increase in cases in recent weeks. In response, some countries in addition to simple preventative measures have also begun preparations for vaccines and potential treatments.6
Recommended measures to prevent COVID-19 can also be effective in preventing other viral diseases - for example, the use of masks and social distancing. The most important way to prevent the spread of monkeypox is to identify people associated with the disease to break the chain. It should be advised to the population that those citizens with suspicious symptoms including inflammatory skin reactions should seek medical advice, the same thing this lady did in Ahvaz city, Iran and she was identified and recorded as the first case of monkeypox disease. According to the UN headquarters in Geneva, raising public awareness of monkeypox is an “urgent need”.6 We urge officials of the Iranian Ministry of Health to pay more attention to it as they reported the first case of monkeypox in Iran.