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Monkeypox in the Region of the Americas - Risk assessment (13 September 2022)

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Date of assessment: 9 September 2022

Overall risk and confidence (based on information available at the time of assessment)

Level of confidence in the available information: Moderate

Level of overall risk: High

Overall Risk statement

In the Region of the Americas, as of 9 September 2022, a total of 33,162 confirmed cases of monkeypox have been reported in 31 countries and territories of the Region, indicating a rapid geographical spread in the Region. Moreover, currently the Region of the Americas has reported the highest proportion of confirmed cases for the past seven consecutive weeks, surpassing the cumulative number of cases reported in Europe and representing 58% of the cases reported globally.

In the Region of the Americas, among 5,764 cases with data available on gender and age, 98% are male between 18 and 44 years old; and 61 cases were reported among under 18-year-olds in 7 countries of the Region; of those 62% (38 cases) were reported in Brazil, all recovered. Among 3,234 cases with available information on sexual behaviour, 86% (2,798 cases) identified themselves as men who have sex with men (MSM) and of these, 52% (1,441 cases) are HIV-positive. A total of 177 cases were reported among women, of those 5 are pregnant. Among 2,374 cases with available information on the exposure setting, 91% were reported with unknown exposure setting and 4 cases were exposed during their work. Among 3,527 cases with available information on occupation, 7% (259 cases) are healthcare workers, and only one of them has been exposed at work, the rest of the cases are being investigated to determine if the infection was caused by occupational exposure.

Additionally, out of 10,138 cases with available information on hospitalization, 11% were hospitalized, of which 4% were hospitalized for isolation purposes, 0.1% for treatment, and 6% had no information available about the reason for hospitalization; 6 cases were admitted to an intensive care unit (ICU). As of 9 September 2022, a total of 2 confirmed deaths were reported in Brazil (1) and Cuba (1), and 4 additional deaths (in the United States of America (2), Brazil (1) and Peru (1)) are under investigation.

Additionally, 2 cases among indigenous people from the same community have been reported in Brazil, and outbreaks among inmates have been reported in the United States of America (a Harris County jail in Texas) and in Brazil (unverified report, under investigation). Considering the rapidly evolving situation in the Region, additional cases among risk groups might be reported and severe cases/deaths may occur.

The outbreak of monkeypox is ongoing and additional cases are expected to be identified as surveillance and laboratory capacity is implemented in the countries/territories within the Region of the Americas, and as healthcare-seeking behaviour and diagnosis is promoted among the most affected populations. Furthermore, the limited availability of vaccines and potential treatment as part of the main countermeasures for most of the countries/territories within the Region represents a challenge to control the outbreak in many countries/territories. Moreover, some countries and territories in the Region might have delays in assessing risk and implementing public health measures across all levels and sectors. Based on the currently available resources and considering the complex epidemiological situation and capacities of detection and response in countries/territories within the Region of the Americas, the overall risk at the Regional level is assessed as High.