As of July 27, that assessment was based on European Center for Disease Control and WHO Regional Europe surveillance, which reported 12,689 confirmed cases across 37 countries and European regions.
Cases also continue to spread throughout the majority of the United States and its territories. There were 5189 CDC-confirmed cases as of July 29. But US experts appear not to be unduly alarmed by the European fatalities.
Should US clinicians start worrying? Not yet, according to public health experts.
While monkeypox is generally self-limiting and nonthreatening in otherwise healthy people, Catherine Smallwood, a senior emergency official at WHO Europe, acknowledged in a statement to the Associated Press that monkeypox “can cause severe complications.” Still, “the notification of deaths due to monkeypox does not change our assessment of the outbreak in Europe,” she said; in most cases, the disease is self-limiting and does not require treatment.
“I think that when you have tens of thousands of cases worldwide, there are going to be some cases that are fatal,” Amesh Adalja, MD, a senior scholar at the Johns Hopkins University Center for Health Security, told News Agency. “But this doesn’t seem to be very common outside the endemic countries…and the hospitalization numbers are not very alarming,” he said.
Brazilian and Spanish authorities have shared limited information about the case fatalities (eg, two people were young, one had encephalitis, and one had lymphoma and a weakened immune system). Adalja said that the reports are missing certain key pieces of data.
“These are important for clinicians to know to be able to understand what is happening in this new situation,” Adalja said.
Clinicians should be on the lookout for red flags, he said.
Factors linked to fatalities include underlying medical conditions and immunosuppression. Some manifestations have led to death (eg, a brain infection or superinfection of a skin lesion), and some patients have died despite receiving antiviral therapy.
Four fatalities from the escalating global monkeypox outbreak have been confirmed since last week: two in Spain, one in India, and one in Brazil, according to public health authorities in those countries.
Parvathy Sukumaran 
