Monday, August 15, 2022

Monkeypox not a global health emergency for now, says WHO

The World Health Organization said on June 25 that monkeypox is not yet a global public health emergency.

The decision comes as outbreaks of a disease related to smallpox continue to spread, affecting at least 4,100 people in 46 countries as of June 24. This includes at least 201 cases in the United States. Those cases have been found in 25 states and the District of Columbia, according to the US Centers for Disease Control and Prevention.

“Controlling further spread of the outbreak requires intensive response efforts,” and the situation should be re-evaluated in a few weeks, the WHO committee evaluating the outbreak said in an announcement.

The declaration of a public health emergency would have made it easier for people potentially infected with or exposed to the virus to receive treatment and vaccines. Some drugs and vaccines that can help prevent monkeypox are approved for use against smallpox, and can only be used against monkeypox with special authorization.

The virus that causes monkeypox, was named in 1958 for its discovery in monkeys, although it is probably a virus that primarily infects rodents, it is not a new threat. The country in Central Africa, where monkeypox is endemic, has had sporadic outbreaks since researchers found the first human case in 1970. As of 2017 there were few cases in locations in West Africa. But the majority of cases outside the continent were related to travel, with limited spread to others. ,SN: 5/26/22,

“Monkeypox has been spreading in many African countries for decades and has been neglected in terms of research, attention and funding,” WHO Director-General Tedros Ghebreyesus said in a statement announcing the decision. “This must change not only for monkeypox but also for other neglected diseases in low-income countries as the world is again reminded that health is a mutual proposition.”

Monkeypox usually kills less than 10 percent of people who contract it. At least one person has died in the global outbreak.

As cases rise, researchers are working to understand the genetic blueprint of the virus, in the hope of finding out whether certain viral mutations may explain whether the virus has quickly taken a foothold in new places. .

mutation detection

The closest known relative of the versions of the virus behind the global outbreak comes from Nigeria, indicating that the outbreak may have originated there.

In the latest surge in cases, scientists have uncovered more viral changes than anticipated – a sign that the virus has been spreading undetected among people for some time, perhaps since Nigeria’s 2017-2018 monkeypox outbreak, new Research shows. In addition, a group of enzymes known to have the ability to fight viruses in the body may be responsible for many of those mutations.

Genetic analysis of monkeypox viruses involved in a global outbreak of 15 people in seven countries shows that these viruses have an average of 50 more genetic variations than the versions circulating in 2018 and 2019, researchers reported June 24 . nature medicine, That’s about six to 12 times as many mutations as scientists would have expected the virus to have evolved at that time. Unlike some other types of virus, poxviruses, which include smallpox and monkeypox viruses, usually mutate fairly slowly.

The researchers say there is a pattern in the changes that is a hallmark of an enzyme family called APOBEC3. These enzymes edit the building blocks of DNA – represented by the letters G, C, A and T – in a specific way: GS changes from AS and CS to TS. The analysis found particular patterns in the viral sequences, suggesting that APOBEC3s are responsible for the mutation.

Ideally, so many DNA building blocks are replaced for another that one virus is effectively destroyed and cannot infect more cells. But, sometimes, the APOBEC3 enzymes do not change enough to eliminate the virus. Such mutated, although still functional, viruses can infect additional cells and possibly another person.

However, a big question is whether the genetic variations seen in monkeypox virus are helpful, harmful, or do not affect the virus at all.

While it is still unknown whether the enzymes are directly responsible for the changes in the monkeypox virus, similar mutations are still popping up, the team found. Therefore, APOBEC3s are still helping to transform the virus as it continues to spread. A member of the enzyme family is found in skin cells, where people with monkeypox can develop infectious chickenpox lesions.

Six images of different types of skin lesions caused by monkeypox
During the current outbreak, the skin lesions that monkeypox can spread were smaller than those seen in earlier outbreaks. Some examples are shown.UK Health Protection Agency

different symptoms

Reported symptoms in global outbreaks are generally mild compared to previous outbreaks, perhaps spreading disease before a person realizes they are infected.

It’s not clear whether those differences in symptoms are related to changes in the virus, Inger Damon, director of the CDC’s Division of High-Outcome Pathogens and Pathology, said June 21 at a news briefing organized by SciLine, a service for journalists and scientists. Sponsored by the American Association for the Advancement of Science.

Typically, in previous outbreaks, people develop flu-like symptoms, including fever, headache, muscle aches, and tiredness about a week or two after exposure to the virus. Then, one to three days after those symptoms begin, a rash including large pus-filled sores usually spreads to the face and limbs, especially the hands, and spread to the entire body. Although generally mild, the symptoms are similar to chickenpox, but people with monkeypox also develop swollen lymph nodes.

Damon said, “All patients in the US outbreak have had rashes, but the lesions are scattered or localized to a specific body site, rather than spreading, and are usually on the face or … the palms or soles of the hands.” Has not included the foot.” Instead, rashes may start in the genital or anal area where they can be mistaken for sexually transmitted diseases, such as syphilis or herpes, she said.

In many cases, the rash has not spread to other parts of the body. And classical early symptoms such as fever are “mild and sometimes nonexistent before a rash appears,” Damon said.

Monkeypox is spread from person to person by close skin-to-skin contact or by contact with contaminated towels, clothing or bedding. It can also be spread by droplets of saliva exchanged during kissing or other intimate contact. The CDC is investigating whether semen during sex as well as skin-to-skin contact can spread the virus, said Agam Rao, a captain of the US Public Health Service, on June 23 at a meeting of the CDC’s advisory committee on vaccination practices. Told. ,

“We have no reason to suspect that it has spread in any other way,” Rao said.

In Nigeria, more cases of monkeypox have been reported in women, while the global outbreak has mainly affected men, especially men who have sex with men. Experts warn that anyone can become infected with monkeypox, and some people are at increased risk of serious illness. People at higher risk include children, immunocompromised people, pregnant people, and people with eczema.

The risk of catching monkeypox through casual contact in the United States is still low, Rao said. But the data he presented shows that people in the country have contracted monkeypox while traveling abroad, but cases have spread locally as well.

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