The Centers for Disease Control and Prevention on Tuesday expressed concern over an unusual outbreak of monkeypox in the UK, suggesting there appeared to be at least some undetected transmission of the virus there and warned of the possibility of the outbreak spreading across the UK.
“We have a certain level of concern that this is very different from what we usually think of monkeypox. And I think we have some concerns that it could spread beyond the UK, “Jennifer McQueston, a senior CDC official, told STAT in an interview.
Seven confirmed and one probable cases of monkeypox have been detected in the United Kingdom since early May – an unusually large number, given that cases of monkeypox in humans are uncommon and particularly rare outside West and Central Africa. While one case recently traveled to Nigeria, where monkeypox is endemic, the others appear to have contracted the virus in the United Kingdom. None of the people infected in the country have any known links to the traveler, and the timing of the cases suggests he was not the source of these infections.
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Complicating the situation – and heightening the concern – is the fact that the other cases consist of two separate groups that have no visible links to each other. Two of the confirmed cases and the only probable case are a family unit, said Maria Van Kerkhove, an expert with the World Health Organization, at a news conference on Tuesday. The other four confirmed cases recently uncovered were identified by the UK Health Security Agency as gay, bisexual or other men having sex with men – three from London and a fourth from Newcastle, nearly 300 miles north. All four were probably infected in London, the agency said.
It is not known how any of these people became infected with the virus. Transmission is thought to occur mainly through virus droplets, but direct contact with lesions or body fluids from an infected person or indirect contact through contaminated clothing or underwear can also lead to transmission.
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The fact that there are two apparently unrelated clusters suggests that there may be more than one transmission chain in the country, each of which may contain additional cases that have not yet been identified. Van Kerkhove, head of the WHO’s Emerging Diseases and Zoonoses Emerging Health Division, said virus sequencing was being carried out in the UK to try to determine if the cases were genetically linked.
There is no suggestion that monkeypox is spreading to a large number of people in the United Kingdom. However, the evidence that there may be some undetected cases fuels concerns about how many transmissions there may be and whether the virus has traveled further.
“You have two clusters that have nothing to do with travel or other people known to be involved in a recognized epidemic. That suggests there are unknown transmission chains, “McQueston said. “If there seem to be unknown transmission chains, it just makes us think: Is it possible that this is spreading outside the UK?”
Although cases of human monkeypox outside Africa are rare, there have been a number of exports in recent years to the United States (two in 2021), the United Kingdom, Israel and Singapore. The four most recent cases have been infected with West African monkey pox, which causes a milder disease than Central African pox, UKHSA reported.
Smallpox has symptoms similar to smallpox, but milder than smallpox, which was declared eradicated in 1980. In addition to flu-like symptoms, the infection causes a distinctive rash. Many conditions can cause rashes, but smallpox rash has some unusual features, especially the fact that vesicles can form on the palms of the hands.
There are no drugs or vaccines specific for smallpox, but the smallpox vaccine has been used in the past to help stop the transmission of smallpox, such as during a 2003 epidemic in the United States traced to imported exotic animals. In this outbreak, 71 people in six states became infected with monkeypox.
In Africa, monkeypox was fatal in about 1 in 10 cases, more likely to be a serious illness and death among children.
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Due to the discovery of cases among people who are gay, bisexual or other men who have sex with men, public health authorities in the UK have warned sexual health clinics to look for people with unexplained rashes. McQueston said the CDC was considering sending a health warning to medical professions and sexually transmitted disease clinics in the country.
“There are many trips between the United Kingdom and the United States and other global areas. So I think our concern is that given that you have four cases of men having sex with men, we should probably think about reports to our STI clinics … what to look out for, what to look for we are careful, “she said.
Van Kerkhove said the WHO had contacted European countries through its European office in Copenhagen to raise awareness of the risk of detecting monkeypox cases.
Communications around the outbreak need to be worked out carefully, McQueston said.
“This is certainly a population that has been stigmatized in the past for sexually transmitted infections such as HIV. And I think we’ve learned a little bit from that experience of how to approach it with the kind of sensitivity it requires, “she said.
UK public health researchers are working to track who has been in contact with confirmed cases before they become ill to try to find the source of their infections. But they also seek to identify the contacts of those infected to see if they have transmitted the virus to others.
McQueston said that to date, the CDC has not been notified that Americans have appeared on the UKHSA’s contact list for these cases. But she revealed that six people in the United States were being watched because they were on the same flight as the man traveling from Nigeria to the United Kingdom on May 4. within a radius of three rows from his place – the six people will be monitored for 21 days, she said.
The outbreak in the United Kingdom is a reminder of the need to pay more attention to monkeypox, the dynamics of which are poorly understood, said Ibrahima Sose Fol, WHO’s assistant director general for emergency response.
“Obviously, the main problem we need to look at is really knowing the true extent of monkeypox transmission in Africa and making sure we invest in tools to prevent and treat the people most exposed to Africa,” he said. .
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