Ukrainian President Volodymyr Zelenskyy said “victory will be ours” Friday as the conflict with Russia entered its 100th day.

Zelenskyy appeared in a video filmed outside the presidential palace in Kyiv, flanked by the same officials who appeared in a similar video on the day of the invasion, February 24.

“Our team is much bigger. The Armed Forces of Ukraine are here. The most important — the people, the people of our state are here. Defending Ukraine for 100 days already. Victory will be ours,” he said.

European leaders also voiced solidarity with Ukraine. “100 days ago Russia unleashed its unjustifiable war on Ukraine. The bravery of Ukrainians commands our respect and our admiration. The EU stands with Ukraine,” EU Commission President Ursula von der Leyen wrote on Twitter.

Russian President Vladimir Putin delivers a video address announcing the start of the military operation in eastern Ukraine, in Moscow, in a still image taken from video footage released Feb. 24, 2022.

Invasion

Russia began building up troops along the border in the fall of 2021 but repeatedly denied it planned to attack its neighbor. Then, on February 24, Russian President Vladimir Putin gave a televised address announcing what he called a “special military operation” in Ukraine.

“We will strive to de-militarize and de-Nazify Ukraine and will bring to justice those who committed multiple bloody crimes against civilians, including Russian citizens,” Putin said.

That night, explosions echoed across Kyiv. Russian tanks and armored vehicles began crossing the border. A sovereign European nation had been invaded, triggering the continent’s worst conflict since 1945.

U.S. President Joe Biden said it was a pre-meditated attack. “The Russian military has begun a brutal assault on the people of Ukraine, without provocation, without justification, without necessity,” Biden said.

Cars pass by destroyed Russian tanks in a recent battle against Ukrainians in the village of Dmytrivka, close to Kyiv, Ukraine, May 23, 2022.

Russian failures

A 64-kilometer-long Russian armored column approached Kyiv from the north. But tactical mistakes saw the Russian advance on Kyiv stall as Ukraine’s armed forces put up fierce resistance, aided by Western weapons, including anti-tank missiles and drones.

By April, Russian forces were in retreat from the capital. They left behind scenes of horror. In towns like Bucha, advancing Ukrainian forces uncovered mass civilian graves and widespread evidence of torture and mass rape by Russian soldiers. Moscow claimed the evidence was fabricated.

French Foreign Minister Catherine Colonn, center, visits the site of a mass grave in the Ukrainian town of Bucha, near Kyiv on May 30, 2022.

War crimes

Visiting the site of the mass graves in Bucha, Ukrainian President Zelenskyy said the world must take action. “These are war crimes and they will be recognized by the world as genocide,” he said.

The atrocities prompted NATO and Western countries to beef up their deployments in eastern Europe and increase weapons supplies to Ukraine. “We agreed that we must further strengthen and sustain our support to Ukraine so that Ukraine prevails in the face of Russia’s invasion,” NATO Secretary-General Jens Stoltenberg said April 7.

The United States has so far pledged $53 billion in military, economic and humanitarian aid.

Finland and Sweden – which for decades have remained neutral – applied to join NATO in the face of Russia’s aggression.

Ukrainian refugees depart from the border crossing in Medyka, southeastern Poland, March 30, 2022.

Refugee exodus

Meanwhile, the war prompted a huge exodus of Ukrainian refugees, with some six million fleeing to neighboring countries so far, and a further eight million internally displaced within Ukraine.

Russia is weaponizing refugees, says Afzal Ashraf, a professor of international affairs at Britain’s Loughborough University. “The shelling of civilian areas and driving out large amounts of civilian populations may well be part of the Russian plan, because that serves them well. It puts pressure, long term economic and political pressure, on Western governments,” Ashraf told AFP.

Western sanctions have tightened the economic noose on Russia, causing its currency to plummet. The U.S. banned imports of Russian energy. Europe – which is far more reliant on such imports – agreed to phase out Russian coal by the end of 2022 and ban most oil imports. However, European countries have so far failed to agree on a gas embargo and continue to pay hundreds of millions of dollars to Russia every day.

A rescuer walks among ruins of a school in Kharkiv, partially destroyed by a rocket on June 2, 2022 as Russian forces are solidifying their hold on the eastern Donbas region.

Eastern offensive

Facing mounting military losses, the Kremlin had redirected its forces to the eastern Donbas region by early May and began a new offensive to take the regions of Luhansk and Donetsk, which had been partly controlled by pro-Russian rebels since Moscow’s forceful annexation of Crimea in 2013.

The strategic port of Mariupol was all but destroyed. It fell to Russian forces in late May, after the last 2,000 Ukrainian soldiers sheltering in the giant Azovstal steelworks surrendered. Tens of thousands of civilians were killed in the city under indiscriminate Russian shelling and missile strikes.

Fighting continues to rage in the east and south of Ukraine. The governor of the Luhansk region said Friday that Russia now controls around 70 percent of the eastern city of Sievierodonetsk. Russian forces have been making steady gains across Donbas in recent days.

Ukrainian troops use U.S.-supplied M777 howitzer artillery in this photo tweeted by the Ukrainian defense ministry on May 13, 2022.

New weapons

The U.S. is to begin sending long-range GPS-guided artillery systems to Ukraine, something Kyiv has long demanded, says Bradley Bowman of the Foundation for the Defense of Democracies in Washington.

“If you combine Ukrainian bravery and skill and a willingness to defend their homes against this unprovoked invasion with Western support, which frankly we’re going to have to be able to provide for the long haul, then I think over the long run this will be a grand strategic disaster for Putin. But in the short term, let’s be clear, the picture is mixed,” Bowman told VOA.

FRIDAY, June 10, 2022 (HealthDay News) — Monkeypox cases continue to climb in the United States, although gradually, federal health officials said Friday.

Public health officials have identified 45 cases of monkeypox across 15 states and the District of Columbia, up from 21 the week before, U.S. Centers for Disease Control and Prevention director Rochelle Walensky, M.D., said during a media briefing, while more than 1,300 cases have been detected globally in 31 countries. However, no deaths have been reported and no community transmission of monkeypox has yet been detected in any U.S. cities, CDC officials said.

The majority of cases, 75 percent or more, appear to have been contracted during international travel, officials said. Others have developed infection here through close contact with a known monkeypox case.

During the briefing, Walensky knocked down concerns that monkeypox could be transmitted through airborne particles. “Monkeypox is not thought to linger in the air and is not typically transmitted during short periods of shared airspace,” Walensky said. “The virus is not thought to spread through interactions such as having a casual conversation, passing in the grocery store, or touching the same items, such as a doorknob.”

But people can contract monkeypox through respiratory secretions during “close, sustained face-to-face contact,” Walensky added. However, the virus most often “spreads through direct contact with bodily fluids or sores on the body of someone who has monkeypox, or with direct contact with materials that have touched these bodily fluids and stores such as clothing or linen.”

The monkeypox virus involved in this global outbreak appears to be milder than other strains, which can cause a rash on multiple places across the body as well as flu-like symptoms, Walensky said. The rash can look like sexually transmitted diseases (STDs) such as herpes or syphilis, Walensky warned. Doctors should test for the monkeypox virus in suspected STD cases.

The United States has enough smallpox vaccine to “vaccinate millions of Americans if needed” against monkeypox, Dawn O’Connell, assistant secretary for preparedness and response with the U.S. Department of Health and Human Services, said during the briefing.

More Information

Copyright © 2022 HealthDay. All rights reserved.

Genetic modifications

The use of genetic tools can lead to the creation of new germs; this is called “genetic biological warfare”. It would be characterized by the following effects: make vaccines ineffective by modifying the antigens used for immunization, make bacteria resistant to all antibiotics or viruses resistant to all antivirals, artificially increase the virulence of a microbe, make an avirulent germ pathogenic, increase the transmissibility of a germ so that infection spreads more easily in the population, modify the range of usual hosts of a germ to make it pathogenic in a host usually insensitive, make the germ undetectable and not identifiable with existing means. The main innovation in synthetic biology is undoubtedly the CRISPR/cas9 system, representing a kind of “black biology”. It makes it possible to produce deadly genetic material from viruses. We have already talked about what could be a real threat.

It is therefore more necessary than ever to work on detection systems, personal protective equipment, medical countermeasures such as the development of new antibiotics or vaccines.

Biological attack

It is necessary to know the common epidemiological indicators that may indicate a biological attack; the appearance of a disease caused by an uncommonly encountered germ, a genetically modified agent, abnormally high morbidity or mortality rates, the geographically or seasonally abnormal appearance of a known disease, an endemic disease whose cases would increase too significantly. Suspicious should also be considered cases of transmission that are generally rare, such as aerosols, food or water, or contamination by a known ventilation system that has never had any problems before, a rare disease affecting a large population or a particular age group.

The diagnosis of a biological attack will therefore be based on epidemiological, clinical and laboratory evidence. The means of detection and identification are currently the subject of intense research, which we will discuss in a future article.

The surveillance

An effective surveillance system must be put in place, involving the medical sector and in particular clinicians, health experts and veterinarians. One of the main problems is that, everywhere in the world, emerging infectious diseases of unknown origin can appear, which can, like any classic epidemic phenomenon, be confused with a terrorist attack. Early identification of the germ would help to quickly initiate appropriate prophylactic and antibiotic measures.

Advantages and disadvantages

It can be produced quickly and at a moderate cost. Spread over a large area, it could lead to high morbidity and mortality, especially if transmission from one person to another is easy. One can imagine that the psychological devastation and panic would aggravate the purely infectious aspect.

Conclusion

Major military research organizations, such as Unit 731, have put a lot of resources into the subject of biological weapons with a large number of financial and human resources. Militarization leading to a weapon of mass destruction is very difficult, but various studies show that terrorist use is quite possible.

It is usual to say that the first world war was chemical, the second nuclear and the next…biological.

References

Shringarpure KS and Brahme K, biowarfare: where do we stand ? Int. J. Com. Med. Public Health, 2018,  10, 4637-4640.

Microbes at war: from antiquity to September 11, 2001. Jean Freney and François Renaud Editions ESKA 

This current Disease Outbreak News on the multi-country monkeypox outbreak is an update to the previously published Disease Outbreak News of 4 June, with updated data, some further detail on clinical description of cases, measures to increase the safety of gatherings, and again provides summaries of guidance, including on vaccination.

Outbreak at a glance

Since 13 May 2022, cases of monkeypox have been reported to WHO from 28 Member States across four WHO regions (the Region of the Americas as well as the European, Eastern Mediterranean, and Western Pacific Regions) where monkeypox is not usual or has not previously been reported (Figure 1). In addition, since the beginning of the year, there are 1536 suspected cases reported from eight countries in the WHO African Region, of which 59 cases have been confirmed and 72 deaths reported.

The continuous detection of the virus and deaths reported in some countries in the African Region highlight the need to better understand the source, transmission dynamics and provide people with the information and support they need to protect themselves and others in a range of different contexts.

While epidemiological investigations are ongoing, most reported cases in the newly affected countries have presented through sexual health or other health services in primary or secondary health care facilities with travel history to countries in Europe and North America rather than to countries where the virus is known to be present. In the countries that have long experienced monkeypox, more analysis is needed to understand the ongoing and new sources of infection.

The sudden and unexpected appearance of monkeypox simultaneously in several regions without direct immediate travel links to areas that have long experienced monkeypox suggests that there may have been undetected transmission for several weeks or longer.

WHO assesses the risk at the global level as moderate considering this is the first time that many monkeypox cases and clusters are reported concurrently in many countries in widely disparate WHO geographical areas.

Description of the outbreak

As of 8 June, 1285 laboratory confirmed cases and one probable case have been reported to WHO from 28 countries in four WHO Regions where monkeypox is not usual or had not previously been reported. This represents an increase of 505 laboratory confirmed cases since the previous Disease Outbreak News on 4 June 2022 when 780 cases were reported. As of 8 June 2022, there have been no associated reported deaths in these four Regions.

Of the cases reported in these regions, the majority (87%) of confirmed cases are from the WHO European Region (1112). Confirmed cases have also been reported from the Region of the Americas (153), Eastern Mediterranean Region (14) and Western Pacific Region (6). The case count fluctuates as more information is reported and becomes available daily and data is verified under the International Health Regulations (IHR 2005) (Table 1).

To date, the clinical presentation of monkeypox cases associated with this outbreak has been variable. Many cases in this outbreak are not presenting with the classically described clinical picture for monkeypox (fever, swollen lymph nodes, followed by rash concentrated on the face and extremities). Atypical features described include: presentation of only a few lesions or even just a single lesion; lesions that begin in the genital or perineal/perianal area and do not spread further; lesions appearing at different (asynchronous) stages of development; and the appearance of lesions before the onset of swollen lymph nodes, fever, malaise or other symptoms. The modes of transmission during sexual contact remain unknown; while it is known that close physical contact can lead to transmission, it is not clear what role sexual bodily fluids, including semen and vaginal fluids, play in the transmission of monkeypox.

The situation is evolving and WHO expects that there will be more cases of monkeypox identified as surveillance expands in all regions and countries.

Figure 1. Geographic distribution of cases of monkeypox reported to or identified by WHO from official public sources, between 13 May and 8 June 2022, 5 PM CEST

In addition to the cases reported from or identified in newly affected countries, WHO continues to receive updates on the status of ongoing monkeypox outbreaks and newly reported cases in countries [1] in the African Region through established surveillance mechanisms (including Integrated Disease Surveillance and Response). Since the beginning of 2022, 1536 suspected cases with 72 deaths were reported from eight countries as of 8 June 2022; 59 confirmed cases were reported from six countries during this same period (Table 2). This now includes cases from Ghana that had not previously reported human cases. Although an outbreak of monkeypox in the United States of America in 2003 was linked to small mammals which been imported from Ghana. Laboratory strengthening in countries that have long experienced monkeypox is a priority to enable confirmation of suspected cases.

The case fatality ratio seen in the African Region underlines the need for support for all elements of the response including but not limited to, awareness-raising, risk communication, surveillance, diagnostic and laboratory support, and research and analysis in the Region. WHO is providing guidance and reporting forms to countries that have long experienced monkeypox as well as countries that have newly been affected.

Public health response

WHO continues to support sharing of information. Clinical and public health incident response has been activated to coordinate comprehensive case finding, contact tracing, laboratory investigation, clinical management, isolation, and implementation of infection prevention and control measures. Genomic sequencing of viral DNA, where available, is being undertaken. Several European countries (Belgium, Finland, France, Germany, Israel, Italy, the Netherlands, Portugal, Slovenia, Spain, Switzerland, the United Kingdom of Great Britain and Northern Ireland) and the United States of America have published full-length or partial genome sequences of the monkeypox virus found in the current outbreak. While investigations are ongoing, preliminary data from polymerase chain reaction (PCR) assays indicate that the monkeypox virus genes detected belong to the West African clade. Two types of vaccines (ACAM-2000 and MVA-BN) are being deployed by some Member States to serve as prophylaxis for close contacts. Others may hold supplies of other types of vaccines (e.g., LC16).

Interim guidance is being or has been developed to support Member States with raising awareness, surveillance, laboratory diagnostics and testing, case investigation and contact-tracing, clinical management and infection prevention control, vaccines and immunization, and risk communication and community engagement.

WHO has developed the following documents:

Information for the public and groups at risk

Technical guidance for countries

Documents under development (for more information see WHO Advice section below)

• Vaccines and immunization for monkeypox

• Public health advice for gatherings during the current monkeypox outbreak

• Homecare infographic for monkeypox patients

• Interim risk communication and community engagement guidance for the multi-country monkeypox outbreak

WHO risk assessment

Currently, the public health risk at the global level is assessed as moderate considering this is the first time that monkeypox cases and clusters are reported concurrently in many countries in widely disparate WHO geographical areas and without known epidemiological links to countries where monkeypox has been reported for many years. Cases have mainly, but not exclusively, been identified amongst men self-identified as part of extended sexual networks. The sudden appearance and wide geographic scale indicate that widespread human-to-human transmission is underway, for the time being still primarily in one demographic and social group, and the virus may have been present and undetected for several weeks or longer. Additionally, there is currently limited epidemiological and laboratory information, and the actual number of cases is likely an underestimate. This may in part be due to the lack of early clinical recognition of an infection previously known to occur mostly in West and Central Africa, limited surveillance and a lack of rapid diagnostics.

At present transmission in newly affected countries is primarily linked to recent sexual contacts. There is a high likelihood that further cases will be found without identified chains of transmission, including potentially in other population groups. Given the number of countries across several WHO regions reporting cases of monkeypox, it is highly likely that other countries will identify cases and there will be further spread of the virus. Human-to-human transmission occurs through close or direct physical contact with infectious lesions or mucocutaneous sores (through face-to-face, skin-to-skin, mouth-to-mouth, mouth-to-skin transmission) including during sexual activity, respiratory droplets (and possibly short-range aerosols), or contact with contaminated materials (e.g., linens, bedding and clothing).

Although the current risk to human health and to the general public remains low, the public health risk would be greater if this virus exploits the opportunity to establish itself as a widespread human pathogen. There is also a risk to health workers if they are not wearing appropriate personal protective equipment (PPE) to prevent contracting an infection; though not reported in this current outbreak, the risk of health care-associated infections has been documented in the past. There is the potential for increased health impact with wider dissemination in vulnerable groups, as the risk of severe disease and mortality is recognized to be higher among children and immunocompromised individuals, including persons with poorly controlled HIV. Infection with monkeypox in pregnancy is poorly understood, although limited data suggests that infection may lead to adverse outcomes for the foetus or newborn infant.

To date, all cases identified in newly affected countries whose samples were confirmed by PCR have been identified as being infected with the West African clade. There are two known clades of monkeypox, one identified in West Africa (WA) and one in the Congo Basin (CB) region. The WA clade has in the past been associated with overall lower mortality fewer than one in a hundred cases while the CB clade appears to cause more severe disease with a case fatality ratio (CFR) previously reported of up to one in ten; both estimates are based on infections among a generally younger population in the African setting.

Vaccination against smallpox was shown in the past to be cross-protective against monkeypox. However, any immunity from smallpox vaccination will only be present in persons over the age of 42 to 50 years or older, depending on the country, since smallpox vaccination programmes ended worldwide in 1980 after the eradication of smallpox. The original (first generation) smallpox vaccines from the eradication programme are no longer available to the general public. In addition, protection for those who were vaccinated may have waned over time.

Smallpox and monkeypox vaccines, where available, are being deployed in a limited number of countries to manage close contacts. While smallpox vaccines have been shown to be protective against monkeypox, one vaccine exists that is approved for prevention of monkeypox. This vaccine is based on a strain of vaccinia virus (known generically as modified vaccinia Ankara Bavarian Nordic strain, or MVA-BN). This vaccine has been approved for prevention of monkeypox in Canada and the United States of America. In the European Union, this vaccine has been approved for prevention of smallpox under exceptional circumstances. An antiviral to treat orthopoxviruses, tecovirimat, has been approved by the European Medicines Agency, the United States Food and Drug Administration and Health Canada. WHO has convened experts to review the latest data on smallpox and monkeypox vaccines, and to provide guidance on how and in what circumstances they should be used.

WHO advice

The advice provided hereafter by the WHO on actions required to respond to the multi-country monkeypox outbreak, is based on its technical work, and informed by frequent consultations with the following existing WHO advisory bodies: the Strategic and Technical Advisory Group on Infectious Hazards (STAG-IH); the ad-hoc Strategic Advisory Group of Experts on Immunization (SAGE) working group on smallpox and monkeypox vaccines; the Emergencies Social Science Technical Working Group; the Advisory Committee on Variola Virus Research; WHO Research & Development (R&D) Blueprint consultation: monkeypox research; the Scientific Advisory Group for the Origins of Novel Pathogens (SAGO); as well as by the outcome of ad-hoc meetings of experts.

All countries should be on the alert for signals related to patients presenting with a rash that progresses in sequential stages — macules, papules, vesicles, pustules, scabs, at the same stage of development or over all affected areas of the body — that may be associated with fever, enlarged lymph nodes, back pain, and muscle aches. During this current outbreak, many individuals are presenting with localized rash that may be in different stages of development (which is atypical for monkeypox) with peri-genital and/or peri-anal distribution associated with local, painful swollen lymph nodes. Some cases may have secondary bacterial infections, including sexually transmitted infections. These individuals may present to various community and health care settings including but not limited to primary and secondary care, fever clinics, sexual health services, infectious disease units, obstetrics and gynaecology, emergency departments, and dermatology clinics.

Increasing awareness among potentially affected communities, as well as health care providers and laboratory workers, is essential for identifying and preventing further cases and effective management of the current outbreak.

Any individual meeting the definition for a suspected case should be offered testing. The decision to test should be based on both clinical and epidemiological factors, linked to an assessment of the likelihood of infection. Due to the range of conditions that cause skin rashes and because clinical presentation may more often be atypical in this outbreak, it can be challenging to differentiate monkeypox solely based on the clinical presentation.

Caring for patients with suspected or confirmed monkeypox requires early recognition through screening protocols adapted to local settings, prompt, isolation and rapid implementation of appropriate infection, prevention and control (IPC) measures (standard and transmission-based precautions), physical examination of the patient, testing to confirm diagnosis, symptomatic management of patients with mild or uncomplicated monkeypox and monitoring for and treatment of complications and life-threatening conditions such as progression of skin lesions, secondary infection of skin lesions, and rarely, severe dehydration, severe pneumonia or sepsis.

Precautions (isolation) should remain in place until lesions have crusted, scabs have fallen off and a fresh layer of skin has formed underneath.

Information should reach those who need it most during upcoming small and large gatherings, particularly among social and sexual networks where there may be close, frequent or prolonged physical or sexual contact, particularly if this involves more than one partner. All efforts should be made to avoid the unnecessary stigmatization of individuals and communities potentially affected by monkeypox.

WHO is closely monitoring the situation and supporting international coordination working with Member States and partners.

For related WHO documents, please see the Public Health Response section above. Key updates from these documents and highlights from guidance under development are provided below for ease of reference.

Surveillance and reporting

An updated format of the minimum data set (formatted as a case report form) is available, as well as the WHO Monkeypox minimum dataset case reporting form (CRF) published online.

A separate Case Investigation and Contact Tracing form for Member States’ own use is currently being finalized and will be shared as soon as available.

Laboratory testing and sample management

Details can be found in Laboratory testing for the monkeypox virus: Interim guidance (23 May 2022)

Risk communication and community engagement

Communicating monkeypox-related risks and engaging at-risk and affected communities, community leaders, civil society organizations, and health care providers, including those at sexual health clinics, on prevention, detection and care, is essential for preventing further secondary cases and effective management of the current outbreak. Providing public health advice on how the disease transmits, its symptoms and preventive measures and targeting community engagement to the population groups who are most at risk, is critical to minimize spread. Communication must be direct, explicit and engaging for the intended audience.

Anyone who has direct contact (e.g., face-to-face, skin-to-skin, mouth-to-mouth, mouth-to-skin) including but not limited to sexual contact, with an infected person can get monkeypox. Steps for self-protection include avoiding sexual contact with someone with a localized anogenital rash or skin lesions and limiting the number of sex partners; avoiding close contact with someone who has symptoms consistent with possible monkeypox infection; keeping hands clean with water and soap or alcohol-based gels; and maintaining respiratory etiquette.

As the summer festival, concert and other events season is beginning in the northern hemisphere, it is important to work with event planners to ensure safe gatherings. Some settings which entail close, prolonged and frequent interactions between people may pose a higher risk of disease transmission. However, such events can be used as opportunities to conduct outreach for specific population groups with public health messaging. It is important to communicate early, often, and consistently through known and trusted communication channels and in language and terminology used by the affected populations. Public health authorities and event managers should work together to ensure targeted information reaches event-goers before, during and after the event. Working closely with community-based and civil society organizations that have direct and trusted relationships with affected populations is highly recommended.

If a person develops symptoms such as a rash with blisters on the face, hands, feet, eyes, mouth, and/or genitals and peri-anal areas; fever; swollen lymph nodes; headaches; muscle aches; and fatigue they should contact their health care provider and get tested for monkeypox. If someone is suspected or confirmed as having monkeypox, they should self-isolate, be tested, undergo clinical evaluation to assess for complications, avoid skin-to-skin and face-to-face contact with others and abstain from sex, including insertive/receptive oral, anal, vaginal sexual intercourse, until all lesions have crusted, the scabs have fallen off and a fresh layer of skin has formed underneath. (See Clinical management and infection prevention and control for monkeypox). During this period, cases can get supportive treatment to ease monkeypox symptoms. Anyone caring for a person sick with monkeypox should use appropriate personal protective measures as mentioned above. Based on the precautionary principle, WHO suggests the use of condoms consistently during sexual activity (receptive and insertive oral/anal/vaginal) for 12 weeks after recovery to prevent the potential transmission of monkeypox.

Residents and travellers to countries that have long experienced monkeypox should avoid contact with sick mammals such as rodents, marsupials, non-human primates (dead or alive) that could harbour monkeypox virus and should refrain from eating or handling wild game (bush meat).

WHO is continually updating its content through the monkeypox Q&A, public communication platforms, and other materials. Please see links in Public Health Response section above.

Infection, prevention and control in healthcare settings

Implementation of appropriate IPC measures is essential to mitigate and control transmission of monkeypox, in health care and community settings; this includes application of a hierarchy of controls (administrative, environmental and engineering controls) and the use of PPE in reducing the risk of exposure to monkeypox within health care settings.

Health workers should apply standard precautions regularly, this includes conducting a risk assessment for every patient interaction, respiratory hygiene and cough etiquette, patient placement, PPE, aseptic technique, safe injections and sharps injury prevention, environmental cleaning and disinfection, proper handling of laundry and linen, decontamination and reprocessing or reusable patient care items and equipment, and waste management.

WHO advises that transmission-based precautions be implemented for any suspected or confirmed case of monkeypox.

Clinical management and treatment

Patients with monkeypox should be given symptomatic treatment for mild symptoms such as antipyretics for fever and analgesics for pain. Skin lesions should be kept clean and adequate nutrition and rehydration is important. Patients should be counselled about signs and symptoms of complications that require urgent care.

Though uncommon, patients with monkeypox may develop severe and life-threatening complications. For example, the confluence of skin lesions is susceptible to bacterial skin and soft tissue infections such as cellulitis, abscesses, and necrotizing soft tissue infections requiring meticulous local wound care and, in some cases, antimicrobial therapy. Subcutaneous accumulation of fluid in the crusting phase may lead to intravascular depletion and shock as well as exfoliation resulting in areas of skin that may require surgical debridement and grafting. Other complications which are rare, include severe pneumonia and respiratory distress; corneal infection which may lead leading to vision loss; loss of appetite; vomiting and diarrhoea leading to severe dehydration, electrolyte abnormalities and shock; cervical lymphadenopathy leading to retropharyngeal abscess or respiratory compromise; sepsis or septic shock; and in rare cases encephalitis and death. It therefore follows that clinical care should focus on management of clinical syndrome, maintenance of nutritional and hydration status and prevention of complications and sequelae, as and when needed.

In patients with monkeypox, antivirals should be used under randomized clinical trials with collection of standardized clinical and patient outcome data to rapidly increase evidence generation on efficacy and safety. If this is not possible, antivirals may be used under expanded access protocols, such as Monitored Emergency Use of Unregistered and Investigational Interventions (MEURI). See reference for WHO R&D blueprint for additional information.

For further information, see Clinical management and infection prevention and control for monkeypox: Interim rapid response guidance, 10 June 2022

Vaccines

The goal of the global outbreak response for monkeypox is to control the outbreak, and to effectively use public health measures to prevent onward spread of the disease. Judicious use of vaccines can support this response.

One vaccine was recently approved for monkeypox. Some countries may hold smallpox vaccine products which could be considered for use according to national guidance. Vaccines may potentially be available in limited quantities through national authorities, depending on the country.

• Control of monkeypox outbreaks primarily relies on public health measures including surveillance, contact-tracing, isolation and care of patients. While smallpox vaccines are expected to provide some protection against monkeypox, clinical data are limited.

• Most interim vaccination recommendations provided here concern off-label use.

• Some countries have maintained strategic supplies of older smallpox vaccines from the Smallpox Eradication Programme (SEP) which concluded in 1980. These first-generation vaccines held in national reserves are not recommended for monkeypox at this time, as they do not meet current safety and manufacturing standards.

• Many years of research have led to the development of new and safer (second- and third-generation) vaccines for smallpox, some of which may be useful for monkeypox and one of which (MVA-BN) has been approved for the prevention of monkeypox.

• The supply of newer vaccines is limited and access strategies are under discussion.

• Based on currently assessed risks and benefits and regardless of vaccine supply, mass vaccination is not required nor recommended for monkeypox at this time.

• Human-to-human spread of monkeypox can be controlled by public health measures including early case-finding, diagnosis and care, isolation and contact-tracing.

• All decisions around immunization with smallpox or monkeypox vaccines should be by shared clinical decision-making, based on a joint assessment of risks and benefits, between a health care provider and prospective vaccinee, on a case-by-case basis.

• Post-exposure prophylaxis (PEP): For contacts of cases, PEP is recommended with an appropriate second- or third-generation vaccine, ideally within four days of first exposure (and up to 14 days in the absence of symptoms), to prevent the onset of disease.

• Pre-exposure prophylaxis is recommended for health workers at high risk of exposure, laboratory personnel working with orthopoxviruses, clinical laboratory personnel performing diagnostic testing for monkeypox, and outbreak response team members as may be designated by national public health authorities.

• Vaccination programmes should be accompanied by a strong information campaign, robust pharmacovigilance, and conduct of vaccine effectiveness studies under rigorous clinical trial protocols with standardized collection of clinical and outcome data.

One Health

Various wild mammals have been identified as susceptible to monkeypox virus in areas that have long experienced monkeypox. These include rope squirrels, tree squirrels, Gambian pouched rats, dormice, non-human primates, among others. Some species are asymptomatic, especially those suspected of being reservoirs (rodents). Other species, such as monkeys and great apes, show skin rashes typical of those found in humans. Thus far, there is no documented evidence of domestic animals or livestock being affected by monkeypox virus. There is also no documented evidence of human-to-animal transmission of monkeypox. However, there remains a hypothetical risk of human-to-animal transmission, as such appropriate measures such as physical distancing from persons with monkeypox to domestic pets, proper waste management to prevent the disease from being transmitted from infected humans to susceptible animals at home (including pets), in zoos and wildlife reserves, and also to peri-domestic animals, especially rodents.

Gatherings

Gatherings may represent a conducive environment for the transmission of monkeypox virus if they entail close, prolonged and frequent interactions among people, which in turn could expose attendees to contact with lesions, body fluids, respiratory droplets and contaminated materials. Postponing or cancelling gatherings in areas where monkeypox cases have been detected is currently not required as a default measure. The following precautionary measure can be considered to decrease risk of monkeypox transmission associated with such events:

• Event organizers should be aware of the epidemiology of monkeypox in the host area, its modes of transmission and prevention, and what action should be taken if a person develops signs and symptoms compatible with monkeypox, including where appropriate care can be sought. This information should be shared with prospective attendees and all those involved in the event planning and delivery.

• Gatherings should be used as opportunities for information outreach and community engagement; attention should also be dedicated to the social context in which the event takes place, with a focus on individual risk behaviours associated with side gatherings, unplanned congregation, and unstructured socialization in public or private spaces.

• People with signs and symptoms consistent with monkeypox should refrain from close contact with any other individual and should avoid attending gatherings. They should follow advice issued by relevant health authorities.

• Although monkeypox and COVID-19 spread between people differently, some of the COVID-19 measures applied during social gatherings, such as keeping a physical distance and practicing regular handwashing, are also effective against the transmission of monkeypox virus.

• As skin-to-skin, mouth-to-mouth and mouth-to-skin transmission during sexual activity has been frequently reported as a likely source of infection during the current monkeypox outbreak, close contact with someone who has signs and symptoms consistent with monkeypox should be avoided, including sexual contact; overall risk can be lowered by engaging in safe sexual practices, limiting the number of sexual partners, and practicing good personal hygiene. Attendance lists for participants in gatherings can be introduced, if applicable, to facilitate contact tracing if a monkeypox case is identified.

• Staff responsible for dealing with attendees who fall ill at the event should be provided with information on how to identify and manage people with signs and symptoms consistent with monkeypox.

• Risk communication and community engagement activities, as well as measures for early detection of international travelers with signs and symptoms consistent with monkeypox at points of entry should be considered in host countries where monkeypox cases have been reported.

• Attendees should always be reminded to apply individual-level responsibility to their decisions and actions, with the aim of preserving their health, that of the people they interact with, and ultimately that of their community. This is especially important for spontaneous or unplanned gatherings.

As it is standard practice for gatherings, and even more so during the COVID-19 pandemic, authorities and event organizers are invited to apply the WHO-recommended risk-based approach to decision-making, and tailor it to the large or small social events under consideration. In the context of the current outbreak, monkeypox-associated risks should be considered and factored in.

International travel and points of entry

Based on available information at this time, WHO does not recommend that States Parties adopt any international travel-related measures for either incoming or outgoing travellers.

Any individual feeling unwell, including fever with rash-like illness, or being considered a suspected or confirmed case of monkeypox by jurisdictional health authorities, should avoid undertaking any travel, including international, until declared as no longer constituting a public health risk. Any individual who has developed a rash-like illness during travel or upon return should immediately report to a health professional, providing information about all recent travel, smallpox immunization history, and information on close contacts as per WHO interim guidance on surveillance, case investigation and contact tracing for monkeypox. Individuals who have been identified as contacts of monkeypox cases and, therefore, are subject to health monitoring, should avoid undertaking any travel, including international, until completion of their health monitoring period.

Public health officials should work with travel operators and public health counterparts in other locations to contact passengers and others who may have had contact with an infectious person while travelling. Health promotion and risk communication materials should be available at points of entry, including information on how to identify signs and symptoms consistent with monkeypox; on the precautionary measures recommended to prevent its spread; and on how to seek medical care at the place of destination when needed.

WHO urges all Member States, health authorities at all levels, clinicians, health and social sector partners, and academic, research and commercial partners to respond quickly to contain local spread and, by extension, the multi-country outbreak of monkeypox. Rapid action must be taken before the virus can be allowed to establish itself as a human pathogen with efficient person-to-person transmission in areas that have long experienced monkeypox, as well as in newly affected areas.

Further information

For more information on monkeypox, please see:

WHO Guidance and Public Health Recommendations

Resources 

• WHO disease outbreak news: Monkeypox, all items related to multi-country outbreak: https://www.who.int/emergencies/emergency-events/item/2022-e000121 

• WHO disease outbreak news: Monkeypox, all previous items: https://www.who.int/emergencies/emergency-events/item/monkeypox 

• WHO AFRO Weekly Bulletin on Outbreaks and Other Emergencies, Epidemiological Week 21, 2022: https://apps.who.int/iris/bitstream/handle/10665/354552/OEW21-1622052022.pdf 

• WHO AFRO Weekly Bulletin on Outbreaks and Other Emergencies, Week 22, 2022 https://apps.who.int/iris/bitstream/handle/10665/354782/OEW22-2329052022.pdf  

• WHO factsheet on monkeypox, publishing date, 19 May 2022.  http://www.who.int/news-room/fact-sheets/detail/monkeypox 

• WHO Health topics — Monkeypox:   https://www.who.int/health-topics/monkeypox#tab=tab_1  

• WHO monkeypox outbreak tool kit. https://www.who.int/docs/default-source/documents/emergencies/outbreak-toolkit/monkeypox-toolbox-20112019.pdf?sfvrsn=c849bd8b_2 

• Open WHO. Online training module. Monkeypox: Introduction. 2020 English:  https://openwho.org/courses/variole-du-singe-introduction

• Open WHO. Extended training. Monkeypox epidemiology, preparedness and response. 2021.English:  https://openwho.org/courses/monkeypox-introduction;  Français:  https://openwho.org/courses/variole-du-singe-int%C3%A9roduction  

• WHO 5 moments for hand hygiene. https://www.who.int/campaigns/world-hand-hygiene-day 

• WHO One health GLOBAL. https://www.who.int/health-topics/one-health#tab=tab_1 

• World Organisation for Animal Health, founded as OIE: Monkeypox. https://www.oie.int/en/disease/monkeypox/ 

• Risk Communication and Community Engagement. Public health advice on the recent outbreak of monkeypox in the WHO European Region, 24 May 2022: https://www.euro.who.int/__data/assets/pdf_file/0004/538537/public-health-advice-monkeypox-eng.pdf  Interim advice on Risk Communication and Community Engagement during the monkeypox outbreak in Europe, 2022 Joint report by WHO Regional office for Europe/ECDC 2 June 2022. https://www.euro.who.int/__data/assets/pdf_file/0009/539046/ECDC-WHO-interim-advice-RCCE-Monkeypox-2-06-2022-eng.pdf   United Kingdom Health Security Agency. Monkeypox guidance. https://www.gov.uk/guidance/monkeypox

• Nigeria Centre for Disease Control. Monkeypox. https://ncdc.gov.ng/diseases/info/M and https://ncdc.gov.ng/diseases/sitreps/?cat=8&name=An%20Update%20of%20Monkeypox%20Outbreak%20in%20Nigeria  

• Weekly epidemiological record (WER) no.11, 16 March 2018, Emergence of monkeypox in West Africa and Central Africa 1970-2017.   http://apps.who.int/iris/bitstream/handle/10665/260497/WER9311.pdf;jsessionid=7AB72F28D04CFE6CE24996192FC478FF?sequence=1  

• First draft genome sequence of Monkeypox virus associated with the suspected multi-country outbreak, May 2022 (confirmed case in Portugal). https://virological.org/t/first-draft-genome-sequence-of-monkeypox-virus-associated-with-the-suspected-multi-country-outbreak-may-2022-confirmed-case-in-portugal/799 

• Belgian case of monkeypox virus linked to outbreak in Portugal. https://virological.org/t/belgian-case-of-monkeypox-virus-linked-to-outbreak-in-portugal/801

• A monkeypox virus genome from a second Belgian case. https://virological.org/t/a-monkeypox-virus-genome-from-a-second-belgian-case/807

• First French draft genome sequence of monkeypox virus, May 2022. https://virological.org/t/first-french-draft-genome-sequence-of-monkeypox-virus-may-2022/819 

• Illumina whole-genome sequence of Monkeypox virus in a patient travelling from the Canary Islands to France. https://virological.org/t/illumina-whole-genome-sequence-of-monkeypox-virus-in-a-patient-travelling-from-the-canary-islands-to-france/829/7 

• First German genome sequence of Monkeypox virus associated to multi-country outbreak in May 2022. https://virological.org/t/first-german-genome-sequence-of-monkeypox-virus-associated-to-multi-country-outbreak-in-may-2022/812  

• First Monkeypox genome sequence from Italy. https://virological.org/t/first-monkeypox-genome-sequence-from-italy/824 

• First monkeypox genome sequence from the Netherlands. https://virological.org/t/first-monkeypox-genome-sequence-from-the-netherlands/821

• Spanish draft genome sequence of Monkeypox virus related to multi-country outbreak (May 2022).https://virological.org/t/spanish-draft-genome-sequence-of-monkeypox-virus-related-to-multi-country outbreak-may-2022/825  

• First 2022 monkeypox outbreak genome sequences from Slovenia. https://virological.org/t/first-2022-monkeypox-outbreak-genome-sequences-from-slovenia/841  

• First Israeli whole genome sequence of monkeypox virus associated with the May 2022 multi-country outbreak. https://virological.org/t/first-israeli-whole-genome-sequence-of-monkeypox-virus-associated-with-the-may-2022-multi-country-outbreak/843 

• Initial observations about putative APOBEC3 deaminase editing driving short-term evolution of MONKEYPOXV since 2017, published on 30 May 2022. https://virological.org/t/initial-observations-about-putative-apobec3-deaminase-editing-driving-short-term-evolution-of-monkeypoxv-since-2017/830  

• Multicolour, multiplex real-time PCR assay for the detection of human-pathogenic poxviruses. 10.1016/j.mcp.2009.10.008   

• Real-time PCR assays for the specific detection of monkeypox virus West African and Congo Basin strain DNA. 10.1016/j.jviromet.2010.07.012 

• Species-specific differentiation of variola, monkeypox, and varicella-zoster viruses by multiplex real-time PCR assay.10.1016/j.jviromet.2016.07.024 

• Genomic epidemiology of monkeypox virus. https://nextstrain.org/monkeypox?c=country 

• Global.health data on monkeypox: Monkeypox_Public_www.global.health – Google Sheets   

• BNONEWS- Monkeypox tracker: https://bnonews.com/monkeypox/ 

• Ministry of Health of Argentina. Health reports that the result of the PCR sample derived from the ANLIS Malbrán of the second suspected case of monkeypox was positive. 27 May 2022. Available at: https://bit.ly/3tpxLiS

• Public Health Agency of Canada (PHAC) Monkeypox: Outbreak update. 9 June. Available at: https://bit.ly/3NGdWvF

• US Centers for Disease Control and Prevention (US CDC). Monkeypox in the United States 2022: Situation Summary. 8 June 2022. Available at: https://bit.ly/3NyqwwR

• Press release from the Mexico Secretary of Health. Mexico confirms first imported case of monkeypox. 28 May 2022. Available at: https://bit.ly/3tpxLiS

RUSSIA has lost vital military equipment after a warehouse for battle-damaged repairs mysteriously burst into flames.

Footage released on Telegram, an instant messaging service popular in Ukraine and Russia, has shown a Russian warehouse located 50km away from the Ukrainian border engulfed in flames.

Huge plumes of black smoke are seen billowing from the site in Klintsy, Bryansk Oblast, Russia in mysterious circumstances.

The Russian military warehouse is believed to house scores of vital equipment for the conflict in Ukraine.

The footage depicts two major fires at the warehouse, both parallel to each other.

The smoke is first seen rising above a canopy before a closer shot shows the warehouse ablaze on two fronts.

The site appears abandoned as Russia’s battle-damaged repairs succumb to the scalding fires.

READ MORE HERE

Once upon a time, Alex Berenson was a New York Times journalist covering major stories, from the Iraq War to Hurricane Katrina to the Bernie Madoff scandal. But over the last several years, he’s increasingly focused on a new pet project: owning the libs. In his Substack newsletter “Unreported Truths” he rails against Joe Biden, derides the pro-choice movement, and complains about inflation to his “tens of thousands of subscribers.”

One of Berenson’s favorite themes has been to downplay the effectiveness of the Covid vaccines—and it’s this work in particular that has made him a star. Before Twitter kicked him off the platform for spreading vaccine disinformation last year, he had hundreds of thousands of followers. Berenson’s Substack newsletters over the last month have mostly been more of the same: He rails against “woke media whoppers about Covid vaccines” and describes Pennsylvania Democratic Senate nominee John Fetterman as a “fat vaccinated cannabis activist.”

But earlier this week, Berenson took aim at a new target: the growing global outbreak of the monkeypox virus. In a post titled “Is It Monkeypox or Crystalpox?” Berenson writes that public health authorities have “almost got another epidemic on the go—the perfect way to distract the shiny-haired robots in the media from the complete failure of the mRNA vaccines.” He then goes on to argue that monkeypox is strictly a disease of gay men. “Are you a gay man who likes sex with lots of other gay men?” he wrote. “Maybe in a bathhouse? Maybe names optional? Maybe with a meth bump on the side? No? Are you sure?… Okay. Don’t worry about the monkeypox thing then.”

With those two points—a supposedly overblown illness plus some homophobia—Berenson did what anti-vaccine activists do best. He managed to build upon his previous talking points and pivot to the current news cycle, neatly weaving the latest headlines into a grand conspiracy theory with necessary villains and egregious profiteering.

There is seemingly no topic too far afield for these zealots to exploit. Recently, I’ve reported on anti-vaccine influencers’ embrace of pro-Kremlin ideology and their promotion of dangerous disinformation about the baby formula shortage. But the monkeypox outbreak offers especially fertile ground because it allows the purveyors of misinformation to recycle many of the same talking points that they developed for Covid. The addition of homophobic rhetoric is particularly toxic, as it’s likely to unite anti-LGBTQ extremists with Covid denialists. As Yale epidemiologist and AIDS activist Gregg Gonsalves put it on Twitter earlier this week, this might be “that moment when homophobia meets far right pandemic politics.”

Let’s dispense with a few facts for some context: The monkeypox outbreak isn’t even a month old; the World Health Organization reported the first cases on May 13. The total count now exceeds 250 across 16 countries. The disease, which causes flu-like symptoms and painful lesions and is fatal in about 3-6 percent of cases, is endemic in parts of Africa, where outbreaks can often be traced back to contact with animals. Though monkeypox can be transmitted between humans, it isn’t nearly as transmissible as Covid—it usually requires close contact to spread, says Derek Walsh, a microbiology and immunology professor at Northwestern University’s Feinberg School of Medicine. Walsh, whose lab studies poxviruses, a class of illnesses that includes both monkeypox and its deadlier cousin, smallpox, emphasized in an email that although many of the cases in the current outbreak happen to be among men in the LGBTQ community, “There is no reason to believe now it has mutated to only spread sexually amongst men who have sex with men.”

“There is no reason to believe now it has mutated to only spread sexually amongst men who have sex with men.”

Contrary to what Berenson claimed, Walsh said, the fact that thus far the disease has spread in this particular population is likely a coincidence. The initial patients probably “passed it on simply due to the close contact of sex, not necessarily sex itself and sex alone, before we became aware of the outbreak.” Indeed, a top adviser to the World Health Organization told the Associated Press earlier this week that he believed the outbreak was a “random event” that happened to spread at two raves in Spain and Belgium.

The rumors that monkeypox is a disease of gay men are a visceral reminder to public health experts of the terrifying early days of the HIV epidemic in the mid-80s. Gonsalves warned of this dynamic in a tweet thread on monkeypox earlier this week. “There are always people ready to use disease to stigmatize and scapegoat,” he wrote. The United Nations issued a similar warning this week saying that “lessons from the AIDS response show that stigma and blame directed at certain groups of people can rapidly undermine outbreak response.”

One current and far-fetched conspiracy theory that links homophobia with the antivax movement is that monkeypox isn’t monkeypox at all—rather, influencers claim that it’s a side effect of HIV caused by the Covid vaccines. In a lengthy Instagram story called H(!)V/pox, an anti-vaccine account called @theshinedontstop, which has 88,000 followers and has also dabbled in pro-Putin rhetoric, put forth this theory, using alternative spellings to evade disinformation algorithms. “There are many reports of people who received the c(0)^!d v*(c)(!ne, and then were diagnosed with A!D$,” the story says. (That’s not true.) “Now…they claim for the FIRST TIME EVER…their munkeepox is sexually transmitted AND being spread by gays and gay pride festivals. Feels like a disclosure of h(!)v to me.”

Other accounts have shared disinformation that may not be explicitly homophobic, but is still troubling. For example, one widely shared meme shows a sign reading “Monkeypox is a cover story for vaccine-acquired shingles. Change my mind.” Another meme showing a still from the movie Austin Powers reads, “Fear of covid is receding. Release the monkeypox!!!”

“Monkeypox is a cover story for vaccine-acquired shingles. Change my mind.”

Influencers aren’t the only ones promoting myths around monkeypox. Far-right radio personality and Trump ally Alex Jones claimed that Covid vaccines caused it. Last week, Rep. Marjorie Taylor Greene (R-GA) took an old conspiracy theory—that Bill Gates engineered Covid for profit—and simply replaced the disease. “Bill Gates is very concerned about monkeypox because this is something, apparently, he can make a lot of money off of,” she said on her Facebook Live show. Prominent antivaccine physicians have also taken up the cause. In his recent Substack newsletter, Dr. Paul Alexander, a former Trump adviser who was also an ardent supporter of the anti-vaccine trucker convoys in Canada and the United States, speculated that Covid vaccines may have left us vulnerable to other diseases. “Our immune systems may now be seriously compromised (in vaccinated persons) due to the Covid vaccine,” he wrote. “Monkeypox may be the tip.” (The idea that Covid vaccines weaken the immune system has been debunked.)

On May 20, Dr. Aaron Kheriaty, a professor of psychiatry and human behavior who was fired from his post at the University of California-Irvine for refusing to get vaccinated against Covid, suggested in a Twitter thread to his 157,000 followers that the monkeypox virus had been intentionally released by powerful global public health authorities in order to enrich the pharmaceutical companies who make vaccines and treatments. As evidence for this theory, he cited a simulation exercise conducted last year, in which epidemiologists practiced planning a pandemic response using a hypothetical monkeypox outbreak as an example. This particular conspiracy theory has been repeated widely, including by Robert F. Kennedy’s antivaccine group Children’s Health Defense and the Covid-minimizing think tank the Brownstone Institute.  

The reality, not surprisingly, is much less exciting. Epidemiologists frequently use simulations to prepare for outbreaks—this kind of planning is a crucial public health tool. The very fact that experts included a monkeypox outbreak simulation suggests that they considered it a possibility. “While you might hear on the news that scientists are surprised by this outbreak, that’s not entirely true,” said Walsh. “We have been watching monkeypox adapt to human-to-human transmission in Africa for several decades, so it was just a matter of time before this happened.” Walsh said he was appalled by the suggestion that monkeypox was in any way related to Covid vaccines. “We are testing people,” he said, “so the simple fact is we know it’s pox, not herpes or HIV.” 

Yet undramatic facts don’t seem to gain traction as easily as sweeping narratives about powerful people with nefarious motives. Social media platforms seem to be struggling to keep up with the onslaught of monkeypox content. Twitter says in its community guidelines that users may not “share false or misleading information about Covid-19 which may lead to harm.” Substack has no such policies. Neither of those companies responded to a request for comment about their policies regarding monkeypox disinformation or homophobic rhetoric. A spokesperson from Meta, the parent company of Facebook and Instagram, noted that the fact-checking organizations that it works with have been monitoring monkeypox content. Punishments for sharing such content range from demotion in the visibility algorithm to removal. The spokesperson didn’t specifically address the homophobic narratives around monkeypox, but my quick Facebook search turned up several examples of posts that called monkeypox a consequence of a “sinful” lifestyle.

It’s possible that the social media platforms simply aren’t monitoring monkeypox content as carefully for homophobia as they are for more straightforward disinformation. In his Substack post, Berenson rejected the idea that Covid vaccines cause monkeypox. “[Y]ou can go full Alex Jones and start screaming about how the DNA/AAV Covid vaccines are giving us monkeypox!” he wrote. “Do you know what happens to my blood pressure when woke morons on Twitter compare me to Alex #@$%TG$ Jones? If I stroke out, you’ll know why.” This is a tactic: By distancing himself from some of the wildest conspiracy theories, Berenson, who didn’t respond to my request for comment, makes his own homophobic take look reasonable by comparison. Throughout the pandemic, rogue scientists and other influential contrarians have leveraged their credentials to gain credibility and separate themselves from the tin-hat-wearing masses. 

The proliferation of this kind of disinformation on social media is a particular frustration for Walsh, who is watching in horror as the truth about a disease he has studied for years becomes distorted by conspiracy theorists. “It’s really disappointing that some people maliciously spread this kind of stuff, but I guess that’s their intent,” he said. “They probably know full well what they are doing.”

Images from left: Engin Akyurt/Unsplash, Radek Pestka/Unsplash, Christian Buehner/Unsplash, Daniel Schludi/Unsplash, BSIP/UIG/Getty, Martin Sanchez/Unsplash, Sushil Nash/Unsplash

Black smoke billows over the Azot chemical plant in Syevyerodonetsk in this still image obtained from a handout video released on June 9.

Shelling by Russian forces has caused a massive fire at a chemical plant in the besieged eastern Ukrainian city of Syevyerodonetsk, the local governor said, as Ukrainian leaders continued to plea for additional weapons to fight off the onslaught by invading forces throughout the region.

Speaking on June 11 on national television, Luhansk regional governor Serhiy Hayday did not indicate if the fire at the Azot chemical plant had yet been extinguished, but he said fighting continued to rage in the city, where Ukrainian forces were attempting to push back Russian troops conducting a major offensive against the city.

RFE/RL’s Live Briefing gives you all of the major developments on Russia’s invasion, how Kyiv is fighting back, the plight of civilians, and Western reaction. For all of RFE/RL’s coverage of the war, click here.

Hayday said Russian forces controlled some 90 percent of the strategic city but that Ukrainian troops were holding out at the chemical plant. Pro-Russian fighters earlier said they had surrounded the site and that the defenders were trapped.

“A small group of Ukrainian formations on the territory of the Azot chemical plant can no longer leave the factory. All escape routes are cut off for them,” Rodion Miroshnik, an official in what the separatists call the Luhansk People’s Republic, wrote on Telegram. He acknowledged that civilians could also be holding out in the plant.

The claims could not be independently confirmed. The siege was reminiscent of what occurred in the port city of Mariupol, where residents and fighters took cover in and below the Azovstal steel plant before being surrounded and eventually surrendering to Russian forces after brutal fighting.

Ukrainian President Volodymyr Zelenskiy, meanwhile, renewed his call for Western countries to speed deliveries of weapons as Russian forces pounded much of the east of the country.

Ukrainian troops “are doing everything to stop the offensive, as much as they possibly can, as long as there are enough heavy weapons, modern artillery — all that we have asked for and continue to ask for from our partners,” Ukrainian President Volodymyr Zelenskiy said in his nightly video address on June 10.

Zelenskiy said “very difficult battles” were ongoing, including in the eastern Donbas region where Moscow has concentrated its firepower.

Zelenskiy said Russia wants to destroy every city in the Donbas.

“Every city, that’s not an exaggeration. Like Volnovakha, like Mariupol. All of these ruins of once-happy cities, the black traces of fires, the craters from explosions — this is all that Russia can give to its neighbors, to Europe, to the world.”

The fiercest fighting remains around Syevyerodonetsk, a small industrial city that has become the focus of Russia’s advance in eastern Ukraine.

Britain’s Ministry of Defense said in its daily intelligence bulletin on June 11 that the Russians had not made advances into the south of the city.

“Intense street to street fighting is ongoing and both sides are likely suffering high numbers of casualties,” the ministry said in an intelligence update posted on Twitter.

The update said Russian bombers have likely been launching 1960s-era heavy, anti-ship missiles meant to destroy aircraft carriers with nuclear warheads against land targets in Ukraine. It added that Russia is likely using such weapons because it is running short of more precise modern missiles.

Also on June 11, the Ukrainian Army said that Russian forces were regrouping to launch an offensive on the city of Slovyansk in Ukraine’s eastern Donetsk region.

Ukraine Territorial Control

In its regular operational update, the Ukraine’s General Staff said Moscow managed to get a foothold overnight in the village of Bohorodychne, 24 kilometers northwest of Slovyansk, and was preparing to attack the city.

The war in the east is now primarily an artillery battle in which Kyiv is severely outgunned, Ukrainian officials say.

“This is an artillery war now,” Vadym Skibitsky, Ukraine’s deputy head of military intelligence, told The Guardian.

“Everything now depends on what [the West] gives us. Ukraine has one artillery piece to 10 to 15 Russian artillery pieces.”

Germany plans to revise its rules on arms exports to make it easier to arm democracies like Ukraine, Der Spiegel reported on June 10. Berlin has been among the largest suppliers of weapons since Russia invaded but criticized for being slow to supply heavy weaponry to Kyiv.

Another German publication, Bild am Sonntag, reported on June 11 that Scholz will travel to Kyiv along with Emmanuel Macron and Italian Prime Minister Mario Draghi sometime before the Group of Seven summit at the end of June. German officials said they could not confirm the report.

Ukraine also asked for humanitarian support to combat an outbreak of dysentery and cholera in the port city of Mariupol, which has been reduced to ruins.

Mayor Vadym Boychenko told national television that sanitation systems were broken and corpses were rotting in the streets.

“Unfortunately…these infection outbreaks will claim thousands more Mariupolites,” Boychenko said.

The office of Ukraine’s prosecutor-general said on June 11 that it has learned about the deaths of 24 more children in Mariupol as the result of shelling by Russian forces.

In total, the office said that at least 287 children have died since the start of the Russian invasion of Ukraine on February 24. More than 492 have been wounded, according to the tally.

Meanwhile, on June 11, U.S. Defense Secretary Lloyd Austin reinforced Washington’s commitment to the region in light of the war.

“Russia’s invasion of Ukraine is what happens when oppressors trample the rules that protect us all,” Austin told an Asian security forum in Singapore. “It’s a preview of a possible world of chaos and turmoil that none of us would want to live in.”

With reporting by Reuters, AFP, and AP