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Thursday, December 01, 2022

4 answers to key questions about the monkeypox outbreak

The monkeypox outbreak has worried some people that the world is on the verge of another pandemic. This is unlikely, experts say.

Concern has been fueled by more than 300 confirmed or suspected cases of the disease in 21 countries outside Africa, where the disease is endemic, since May 7. It is the most widespread outbreak of the disease, causing flu-like symptoms, such as fever, headache and body aches, as well as deep weakness, back pain, swollen lymph nodes and rashes that burst into pus-filled blisters. And more cases are being added daily to the database maintained by Global.health, an infectious diseases tracking group.

Spain, Portugal, Canada and England have reported most cases. In the United States, one person each in Massachusetts, California and New York City, and two people in Utah have been confirmed to have monkeypox, and four others have been confirmed to have. orthopoxvirus Infection, genus that includes monkeypox and smallpox. Those cases – one in New York City and Washington state and two in Florida – are thought to be monkeypox and are being confirmed at the US Centers for Disease Control and Prevention.

Monkeypox is spread by close contact. “Anybody – anyone – can develop and spread monkeypox infection,” John Brooks, a medical epidemiologist at the CDC, said during a news briefing on May 23. But “many of those affected in the current global outbreak identify as gay or bisexual men.”

Some of those cases have been linked to a pride festival and sauna in Spain and a fetish festival in Belgium. CDC officials hope to raise awareness of the sometimes-fatal disease before June, Pride Month in the United States and many other countries, Brooks said.

Right now, men who have sex with men may have a higher risk of contracting the virus, but “contagious diseases don’t seem to care about borders or social networks,” Brooks said. He said that most people are at low risk of getting monkeypox, but they should still be aware that it is spreading in the community.

“There is no need to panic. There is no need to fear, and no one needs to stigmatize the disease,” said Adesola Yinka-Ogunle, an epidemiologist at the Institute for Global Health at University College London and the Nigeria Center He is a Monkeypox specialist with For Disease Control.

But with cases rising, here’s what to know.

What is monkeypox?

Monkeypox is a DNA virus orthopoxvirus The genus, which includes smallpox, smallpox, and camels. This is not a new disease, says Yinka-Ogunle. This virus was first discovered in monkeys in 1958. The first human case was reported in 1970.

Most often, monkeypox is a disease that humans catch from animals. This is what happened in the United States in 2003 when 47 people in the Midwest got monkeypox from pet prairie dogs that were kept with infected rodents from West Africa (SN: 06/11/03,

There are two different types or groups of monkeypox. The more lethal type is the Central African or Congo Basin clade, which sickens hundreds of people each year in the Congo and Central African Republic. Yinka-Ogunle says that clade, which infects about 10 percent of people, has not spread beyond the area where it is commonly found.

The West African clade is behind the current global outbreak. The illness it causes is usually mild, killing about 1 percent to 3.6 percent of infected people.

How did the current outbreak begin?

The outbreak is the latest resurgence of monkeypox, Yinka-Ogunle says. “Before 2017, it was known as a rare disease,” she says. Earlier, less than 10 cases had been reported in West Africa. For example, Nigeria has had no cases since 1978. But then the 2017 outbreak led to 42 confirmed cases and 146 suspected cases, as he and his colleagues reported in 2018. emerging infectious diseases,

Researchers found evidence that the virus was being passed from person to person through close contact with family members, although most cases probably came from animals. No one knows which animals are reservoirs for monkeypox, although many rodents and other small animals are suspected to be carrying the virus.

Monkeypox Blisters On A Person'S Hands And Head
Blisters that appear on a person’s hands and face are hallmarks of monkeypox. These sores release the infectious virus and can spread to others.A. yinka-ogunli et al/emerging infectious diseases 2018

Since 2017, sporadic cases of monkeypox have been reported in Nigeria, mostly in rural areas where people may have come into contact with infected animals, she says. In 2022 till April 30, 46 cases have been reported in the country.

From time to time, travelers from Nigeria to other countries have had monkeypox, but they are mainly isolated cases. This outbreak can also be triggered by a traveler.

Genetic evidence of the virus isolated from patients in Portugal, the United Kingdom and the United States suggests that the multinational outbreak may have a single source, researchers in Portugal reported May 23 in Virological.org.

“Our virus definitely comes from Portugal,” says Philippe Selhorst, a virologist at the Institute of Tropical Medicine in Antwerp, Belgium, who posted the genetic makeup of monkeypox virus on Virological.org on May 20 from a Belgian patient. The DNA sequence of the virus is very similar to that of the Portuguese. The patient had traveled to Lisbon shortly before developing the rash, further cementing the link.

Because monkeypox contains DNA as its genetic material, it mutates more slowly than RNA viruses, such as dengue or SARS-CoV-2, the coronaviruses that cause COVID-19. “I would expect all cases … to be very similar across outbreaks,” Selhorst says.

Nevertheless, virologists have noted mutations in viruses taken from different patients. This is to be expected. “There’s always going to be a difference between viruses,” he says. “The question is: ‘Is that difference relevant?'” Nothing in the viral DNA indicates that the virus has mutated to spread more easily from person to person, Selhorst says.

How is the virus spreading?

The outbreak appears to be driven by human-to-human transmission. “This virus has used a sexual network to spread around the world,” says Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security and an infectious disease physician.

This doesn’t mean that monkeypox is a sexually transmitted disease—one that occurs when semen or other bodily fluids are exchanged during sex, he says. “If you have a relationship with someone, and people kiss during sex, you can catch the flu, but that doesn’t make influenza a sexually transmitted infection.” Similarly, monkeypox can be spread through close skin-to-skin contact during sex.

The CDC’s Brooks said people infected with monkeypox may not have a visible rash, but they may have sores in their mouth or throat that block the virus and the infection from passing on. Selhorst and his colleagues are collecting semen and other body fluids from people infected with monkeypox to see if it is possible for the virus to be transmitted sexually.

Brooks said during the news briefing that in this outbreak, the rash first appeared in people’s groin and anal areas, and has been mistaken for herpes or other STDs. And cases of monkeypox are sometimes confused with chicken pox, Yinka-Ogunle says. Doctors need to be aware that there may be something more foreign in the patient with the rash, Adalja and Hopkins colleague Tom Ingelsby warned on May 23. history of internal medicine, If monkeypox is suspected, doctors should contact their state or local health department.

How can the outbreak be stopped?

In Nigeria, monkeypox outbreaks are controlled by isolating infected people and isolating close contacts, Yinka-Ogunle says. Vaccines and antiviral drugs are not available to limit the effect or spread of the disease, she says. Most of the time medication is not needed, as the body eventually clears the virus on its own.

In Europe and the United States, close contacts of infected people can be vaccinated with either ACAM2000, an older vaccine against smallpox, or a newer vaccine called Jynneos. Manufactured by the vaccine company Bavarian Nordic, Jynneos was approved by the US Food and Drug Administration in 2019 for use against smallpox and monkeypox. That vaccine has fewer side effects than the older vaccine and is safer for people with eczema or a weakened immune system.

A Vial Of Smallpox Vaccine
Vaccines against smallpox can also help protect against monkeypox. In the United States, close contacts of people infected with monkeypox can be vaccinated against the disease.James Gathany / CDC

There are more than 1,000 doses of Geneos available, Jennifer McQuiston, deputy director of the CDC’s Division of High Consequence Pathogens and Pathology, told the United States Strategic National Stockpile during a CDC news briefing. And the company expects to produce more soon. More than 100 million doses of the older vaccine are available.

So far the cases of this outbreak have been mild. But two antiviral drugs developed against smallpox, brincidofovir and tecovirimat, can be used to treat severe cases of monkeypox (SN: 5/2/18,

Most of the evidence that the drug will work against monkeypox comes from animal studies. But in a small study in the United Kingdom, three people who received brincidofovir as a treatment for monkeypox developed liver problems and had to come off the drug, researchers report May 24. lancet infectious disease, One person given tecovirimat spent only 10 days in the hospital, compared to six other patients who stayed in the hospital for between 22 and 39 days because they still contracted the virus. Those numbers are too small to draw any conclusions about the effectiveness of the treatment.

People previously vaccinated against smallpox may still have some protection against monkeypox, says Aaron Glatt, an infectious disease epidemiologist at Mount Sinai South Nassau in Oceanside, NY and spokesman for the Infectious Diseases Society of America. But those numbers are dwindling. Smallpox was declared eradicated in 1980 and most countries stopped vaccination against the virus in the 1970s. This means that many people 50 and younger have no immunity to smallpox or monkeypox.

“It’s a negative for the eradication of smallpox,” he says. “But in the overall scheme of things, it is positive that we eradicated smallpox. Even if we have had a handful of monkeypox cases as a result of not getting the smallpox vaccine, it is [still] A very, very good exchange. ,

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