Electron microscope image of monkeypox virus particles. Image: Cynthia C. Goldsmith, Russell Regner / CDC via AP (AP)
Outbreaks of a rare disease called monkeypox have put public health experts on the brink. Several countries, including the United States, have reported cases of viral infection recently. No deaths have been reported so far. Although the risk seems low to the general public so far, it is possible that something has changed about the virus or its relationship to humans, making it more susceptible than before.
Countries with reported cases of monkeypox
Since Thursday afternoon, the United Kingdom, Canada, Spain, Portugal, Italy, Sweden and the United States have documented cases of monkeypox. The case in the United States involves a Massachusetts resident who recently traveled from Canada, where there are 13 alleged cases. In the United Kingdom, at least seven people are thought to have been infected with it, with the first reported case being thought to have been infected while in Nigeria.
Monkeypox was first documented in Africa in the 1970s and has been seen on the continent ever since. But it is a zoonotic disease, which means that infections are usually transmitted from animals to humans (despite the name, rodents are thought to be the main vector) and not between humans. So these many outbreaks in several countries, with evidence of local transmission in some, are very different from what we’ve seen before, according to Andrew Pavia, a physician in infectious diseases at the University of Utah. But there is still no clear answer as to why this is happening, he added.
“In the past, human-to-human distribution has existed, but it has been quite limited. We still don’t know that it spreads more easily from person to person. This is one possible explanation, but I am still not aware of any evidence to support this idea, “Pavia told Gizmodo in an email.
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What is the monkeypox virus?
Smallpox is caused by a virus of the same name, a member of the poxvirus family. He is a close cousin of the smallpox virus, the only human embryo ever to be completely destroyed. Like smallpox, monkeypox infection causes pronounced uneven rashes that usually start on the face and spread throughout the body, along with flu-like symptoms.
It takes one to three weeks after exposure for symptoms to begin and people are usually ill for about two weeks. Up to 10% of victims can die from it, although the cases documented in the UK appear to be caused by a line of the virus that is known to be less virulent, with a mortality rate of close to 1%.
“Given what we know today, there is no reason to panic or most people have any worries, but it is too early, so that can change.”
There are tools available against monkeypox that we could use if these outbreaks expand and become a greater threat. Smallpox vaccines must remain protective against monkeypox and can be given after exposure to prevent disease so that they can be used as part of a ring vaccination strategy to prevent outbreaks. There are approved antivirals that have also been shown to be effective against poxvirus infections.
Why is monkeypox spreading now?
It is likely that the virus has evolved in some way to become more commonly infected among humans. But some scientists, such as Joe Walker, an infectious disease epidemiologist and modeler at Yale School of Public Health, speculate that this seemingly increased prevalence may actually be related to our victory over smallpox decades ago.
Smallpox was declared eradicated in 1980 through the efforts of a global mass vaccination program that created a broad network of population immunity. Poxviruses are known to cause cross-immunity to other related viruses (in fact, the attenuated virus in the classic smallpox vaccine is not even smallpox). And this buffer of smallpox immunity may also have prevented the spread of monkeypox in humans. Over time, however, our collective defenses have weakened over time for a variety of reasons, which may have allowed monkeypox to finally spread more widely without the need to change in any important way.
Patient with monkey lesions. Image: CDC (Getty Images)
“This ‘diminishing immunity’ is due less to weakening immunity on an individual level and more to dying people with immunity and giving birth to people without immunity and then remaining without immunity,” Walker told Gizmodo in a Twitter message.
Walker notes that some researchers have long warned that monkeypox or similar viruses will one day fill a niche left behind by smallpox, and some argue that this is a major factor in why the microbe reappeared in Nigeria in 2017. after four decades of zero reported cases.
Another possibility that Pavia mentions is that some mysterious animal played a huge role in planting these hearths. In 2003, he said, the largest known but still small outbreak of monkeypox in the United States (a total of 47 cases) was traced entirely to contact with infected domestic prairie dogs – a vector unknown at the time.
At the same time, there is evidence of human-to-human transmission in at least some of these cases. In the United Kingdom and Spain, the majority of cases are found in young gays and bisexual men, which increases the possibility of these infections being sexually transmitted. Other studies suggest that monkeypox could theoretically survive in the environment in sufficiently intact aerosol particles to be considered transported in the air.
Getting to the bottom of this monkeypox mystery will require classic medical detective work, Pavia said. Epidemiological studies will try to understand the type of contact that led to human infections and the number of infections that appear to result from each index case. In the laboratory, scientists will look for possible genetic changes in viral samples taken from patients, or test whether these infections behave differently in model animals.
“Given what we know today, there is no reason to panic or most people have any worries, but it is too early, so that may change,” Pavia said.
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