A growing number of countries have reported cases of monkeypox, a rare viral disease commonly found in parts of Africa. On May 7, Britain reported a case of a passenger from Nigeria. By May 20, the United States, Australia, Canada and at least eight European countries had reported dozens of confirmed or suspected cases. Britain reported 11 new cases on May 20, more than in the previous two weeks. Many of them have no connection to African travel, which means that they were handed over locally. In the past, sporadic cases were almost always imported. All this is alarming. But the world is far from helpless.
Monkeypox is caused by a smallpox-like virus that was declared eradicated in 1980. Infections are usually mild, with flu-like symptoms. A rash can develop that spreads throughout the body, turning into blisters and scabs. Infected people usually recover in a few weeks. As with other poxviruses, the disease is more severe in young children and people with weaker immune systems. How dangerous it is depends on which of the two strains of the virus is affected. One, mostly found in past outbreaks in the Congo Basin, is fatal about 10% of the time. The other, the West African strain, is less severe, with a mortality rate estimated at about 1%. These estimates come from outbreaks in remote areas of poor health in Africa. In rich countries, monkeypox would probably be much less deadly.
A monkey vaccine developed by Bavarian Nordic, a Danish biotech company, was approved by US regulators in 2019. The vaccine has also been approved for smallpox, and data from Africa show that previous smallpox vaccination is at least 85% effective in preventing smallpox. smallpox. The U.S. Centers for Disease Control and Prevention says the sting is most helpful if given before or within four days of exposure. Even if applied up to 14 days after exposure, it can still help by reducing symptoms. Evidence from animal studies suggests that some antiviral drugs used for other poxviruses may also be helpful.
It is also encouraging that the monkeypox virus is not very good at spreading between humans and is not as contagious as (for example) measles. It was first found in Denmark in a laboratory monkey (hence the name), but is thought to be hiding mainly from small rodents in Africa. On this continent, many cases are acquired from wild animals when people hunt them, process raw meat or eat it. Close contact is needed to spread the virus from one person to another. It is spread by drops of cough and sneeze that enter the nose, throat or eyes. It can also be taken by contact with the skin, clothing or bedding of an infected person who is shedding the virus from pustules or scabs. Symptoms usually appear five to 21 days after infection.
The hard part is the diagnosis. The monkeypox rash is very similar to chickenpox. Confirmation requires sending samples to a specialized laboratory equipped to work with extremely dangerous pathogens. Currently, the UK has only one laboratory for rare pathogens designed to test for monkeypox.
However, limiting outbreaks of monkeypox should be relatively easy. Isolating confirmed or suspected cases and tracking their potentially infected contacts can stop transmission chains. Smallpox is likely to be used for the “ring” vaccination of close contacts of infected people and high-risk health professionals. Britain and Spain are already looking to stock up on the vaccine. Ring vaccination of close contacts has been successful in curbing some of the last Ebola outbreaks in Africa.
Over the next few days and weeks, more cases of monkeypox will surely be discovered. But outbreaks are unlikely to spread out of control. Covid-19 caught the world unprepared, with no drugs or vaccines on hand. However, monkeypox is in a completely different – and smaller – league
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