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Massachusetts health officials said Wednesday they have confirmed a case of a rare and sometimes serious viral disease called monkeypox, the first infection identified in the United States this year amid a rash of cases outside the typical territory of the disease.
Monkeypox, which can be transmitted to animals and humans, is common in Central and West Africa. But health authorities in Europe have confirmed more than a dozen cases this month and are investigating dozens more. The last two infections confirmed in the UK “have no connection” to a place where monkeypox is regularly found, officials said, suggesting the virus could spread throughout the community.
It is not known that monkeypox is easily spread among humans. The fact that the cases are occurring in several countries at once – with signs of “long-term” transmission in humans – is striking, said Aris Katsurakis, a professor of evolution and genomics at Oxford University.
“Either it’s very bad luck or something quite unusual is happening here,” Katsurakis said.
Monkeypox is named after the animals in which it was found. The disease appeared in 1958 among monkeys kept for testing, according to the Centers for Disease Control and Prevention, more than a decade before a case of humans was identified in the Democratic Republic of the Congo.
Mass vaccination against smallpox “probably” limits monkeypox infections among humans for some time, researchers wrote in a 2005 article. But cases have revived, thanks in part to a lack of immunity in later generations, they said. More than 450 cases have been reported in Nigeria since 2017, according to the CDC.
CDC scientists travel to this remote African village to look for monkeypox virus
Monkeypox infections usually last two to four weeks, according to the CDC, and begin with flu-like infections. symptoms and swelling of the lymph nodes. Eventually, fluid-filled bumps – or “measles” – spread to the skin.
The disease can be spread through contact with animals, infected people and materials used by infected people, health officials say. Examples listed by the CDC include contact with body fluids, contact with monkeypox wounds, and ‘respiratory droplet’ infection in a ‘close environment’, such as a general household.
Smallpox can be deadly, but two major strains of the virus pose different risks. According to the World Health Organization, about 1 in 10 people infected with a strain in the Congo Basin has been deadly, while a West African strain appears to be fatal to about 1 in 100 people.
This milder strain is the one that infects people who have been hospitalized in the UK, health officials said. It is not clear what strain the patient received from Massachusetts.
How worried should we be? How does this compare to covid-19?
Experts point out that monkeypox is different from the coronavirus that turned the world upside down.
Monkeypox is highly visible, which makes it easier to track contacts and isolate. The existing smallpox vaccine could help protect society if needed, Katsurakis said. And “we don’t have the potential for anything to spread around the globe at any of the speeds we’ve seen in covid,” he said, because monkeypox is less common among humans.
However, the latest stream of cases stands out, Katsurakis said. The longer it lasts, the greater the chance that the virus will mutate and improve its tolerability, just as the new coronavirus has.
Outbreaks of smallpox are usually small, with patients in single digits, said Tom Inglesby, director of the Johns Hopkins Health Security Center. “So I think the risk to the general public at the moment, from the information we have, is very, very low.
But he agreed that recent cases raise many questions. “In fact, we still have no idea what drives him. “There is no identified travel link that unites all these cases,” he said.
Health officials have noted recent cases of men having sex with other men – a model that is crucial to understanding, Inglesby said, because officials had not previously considered sexual orientation a risk factor for monkeypox.
Has monkeypox reached the United States before?
Smallpox made its way to the United States and the Western Hemisphere for the first time in 2003, researchers say. More than 70 cases have been reported in the Midwest, mostly among people who have been exposed to prairie dogs apparently infected by Ghanaian rodents, according to the CDC.
Two children are seriously ill and recovering, the CDC said.
The infection, reported in Massachusetts on Wednesday, is the first case of monkeypox found in the United States this year, health officials said. Texas and Maryland reported one infection each year to “people who have recently traveled to Nigeria,” the Massachusetts Department of Public Health said.
A rare monkeypox virus reported in Dallas
Where else has monkeypox been found this month?
The United Kingdom and Portugal have announced confirmed cases, while Spanish authorities said on Wednesday they were investigating more than 20 alleged cases. The first known patient in the United Kingdom recently traveled to Nigeria, officials said.
The WHO said the person developed a rash in late April, shortly before leaving Africa. People identified as contact have not yet reported “compatible symptoms,” the World Health Organization said Monday.
But more cases have emerged.
British health authorities announced two new infections on Wednesday, for a total of nine infections confirmed in England on 6 May. The agency said there were no clear links between the last two patients and previous confirmed cases, increasing the possibility of transmission to the community.
The latest cases have been “mostly gay, bisexual or men who have sex with men,” said the UK’s Health Security Agency (UKHSA). The agency advises people in these groups to be especially “vigilant for any unusual rashes or lesions on any part of their body.”
Portugal’s Directorate-General for Health, meanwhile, said more than 20 “suspicious cases” had been identified this month. Five of them have been confirmed, the agency said, and the infections are concentrated among young men.
What do we know about the American case?
A man who recently traveled to Canada was tested for the virus on Tuesday, and the infection was confirmed by the CDC on Wednesday, according to a statement from the Massachusetts Department of Public Health.
The CDC is watching six Americans as they board a plane near a British patient, CDC medical officer Agam Rao told The Washington Post on Wednesday. None of the patients showed signs of monkeypox symptoms.
U.S. officials say clinicians should consider diagnosing monkeypox in people with an otherwise unexplained rash who have traveled to a country that has had a confirmed case, had contact with someone who may be infected, or had a man who had sexual contact with other men.
The CDC works with colleagues in other countries to gather information that can answer many of the experts’ questions.
“We are still at the beginning of all this to really understand the scope and reason for this,” Rao said. “We are very much in a response mode, trying to identify cases, identify potential contacts, make sure we provide the right recommendations for all these people, including the healthcare staff who care for the patient.”
The disease is so rare, said Inglesby of John Hopkins, that “most clinicians in America will never see a case in their lifetime” – so communication about monkeypox will be important to ensure that doctors monitor for symptoms.
Another top priority, he said, is getting more information about any links between distant infections. Does the disease spread from West and Central Africa to other countries independently? Or are the cases spread through networks of people?
“It will be really important for us to understand this, because once you understand how cases spread … it gives us a chance to intervene,” Inglesby said.
Obtaining the genetic sequence of the virus behind the latest cases will help scientists test whether they are dealing with a new strain of monkeypox. Unlike the flu or coronavirus, Inglesby said, researchers have not seen much change in monkeypox over the years, “and it will be important to make sure it stays that way.”
Thanks to global trade and travel, poxviruses could spread further, experts said. The elimination of smallpox in 1980 helped other poxviruses go through declining protection, said Ann Remoin, an epidemiologist at the University of California, Los Angeles who has studied monkeypox for two decades.
“No good deed goes unpunished,” Remoin said. “You declare that you can destroy a pathogen, but you can leave room for another.
Rao said that while researchers found an increase in the spread of monkeypox after the end of the smallpox vaccine campaign, other factors were related to infections, including climate change and other environmental changes that have led to more human interactions. and animals.
“Right now, we’re in a moment where we just really need to understand why this is happening before we can start offering solutions, like vaccinations,” Rao said. “It simply came to our notice then. This is not something we would recommend if you asked me two weeks ago, because the risk to the general population is extremely rare. “
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