As the world continues to fight COVID-19 and many countries look for ways to recover from the pandemic, a new virus is making headlines around the world.
It is now estimated that the monkeypox virus is approaching 100 cases in 12 countries and more are expected as surveillance intensifies. The first case of this current outbreak was discovered in the United Kingdom on May 7, and infections have so far been confirmed in nine European countries: the United Kingdom, Spain, Portugal, Germany, Belgium, France, the Netherlands, Italy and Sweden, and the United States, Canada and Australia. .
Although the first case found in the UK involved a trip to Nigeria – which reports about 3,000 cases of monkeypox a year – the following cases have not been traced back to Africa, much to the puzzles of scientists and doctors.
What is unusual about the current epidemic is that cases are being diagnosed in countries where smallpox is rare, and the fact that many of the identified cases are not related to West and Central Africa makes this outbreak unprecedented.
What is monkeypox?
Smallpox is caused by a virus endemic to tropical parts of Africa. Despite its name, monkeypox is rarely spread by infected monkeys, but is more common in rodents such as squirrels, rats and mice. The virus is known to be zoonotic – meaning that it spreads to humans through infected animals through blood, contaminated fluids or lesions on the animal.
Human-to-human transmission may be the result of close contact with respiratory secretions, skin lesions of an infected person, or recently infected objects. Droplet respiratory transmission usually requires prolonged face-to-face contact, which puts healthcare workers, household members and other close contacts with active cases at greater risk. An investigation is currently underway into whether the virus can be spread by airborne droplets, but there is currently no evidence to support this.
Although first identified in laboratory monkeys in 1958, monkeypox was first identified in humans in 1970 and is a disease usually confined to parts of Africa, most common in rural rural areas. Republic of the Congo, although outbreaks have been reported in Gabon, Côte d’Ivoire, Liberia, Nigeria, Benin, Cameroon, Sierra Leone and South Sudan. The first outbreak outside Africa occurred in 2003 and affected people in the United States; it is associated with infected domestic prairie dogs that were imported from Ghana and housed with infected rodents. Small travel-related numbers have been reported worldwide since then.
Initial symptoms of monkeypox include fever, headache, muscle aches, back pain, swollen lymph nodes, chills and exhaustion. A rash can develop, often starting in the face and then spreading to other parts of the body, including the genitals. The rash changes and goes through different stages – initially it can be filled with a fluid rash with blisters that resembles chickenpox or syphilis, before finally forming scabs, which later disappear. Most people recover from monkeypox in a few weeks without treatment.
The diagnosis is usually clinical, which means that the signs and symptoms are sufficient for clinicians to make the diagnosis without the need for tests. However, if monkeypox is suspected, clinicians should take a fluid sample from one of the lesions and send it to the polymerase chain reaction (PCR) laboratory to confirm the diagnosis. It is believed that blood tests are not as accurate and should not be used routinely.
The monkeypox virus is part of a family of viruses known as “DNA viruses”. Unlike SARS-CoV-2, which causes COVID-19, which is an RNA virus, DNA viruses mutate at a much slower rate because they are better at identifying and correcting errors in their genetic makeup. of the replication process. This is important because it will help scientists better understand why the current monkeypox epidemic is happening – has the virus itself changed or is it just in the right place at the right time? It is too early to be sure. The current strain is thought to be associated with a strain commonly found in West Africa, which is associated with mild symptoms and low mortality, about one percent.
Who gets infected?
This outbreak certainly feels different from previous outbreaks outside Africa.
Apart from the initial cases, many of the infected people have no connection to travel or to anyone in Africa. Unusually, the virus has been found in a disproportionate number of men who have sex with men. It is not known that smallpox is a sexually transmitted virus, but sexual contact would be close contact, one of the main ways in which the virus is known to spread.
It may be that members of the LGBTQ community are better at examining sexual health, so the virus is simply more prevalent here than in the heterosexual community. Whatever the reason, it remains important that no one who is infected is stigmatized, both for their well-being and to help continue to monitor cases and outbreaks.
Increased travel after a period of travel restrictions during the COVID pandemic may also be a factor.
Worryingly, the cases found in Europe and the world are not related, which means that there is no part of the puzzle in how this virus spreads.
The monkeypox virus is part of the same family as the smallpox virus. Older generations will be vaccinated against smallpox, which will eliminate the disease and offer some protection against monkeypox. It may be that because most young generations have not been vaccinated against smallpox, the monkeypox virus has spread more easily.
Is there a cure or vaccine for monkeypox?
For most people, the signs and symptoms of smallpox will go away on their own, without any treatment. Rest, plenty of fluids and good nutrition are all that is usually required.
The risk of serious illness may be higher in pregnant women, children and those with weaker immune systems.
There is currently no specific vaccine for monkeypox, but the smallpox vaccine has been shown to offer 85 percent protection against monkeypox. At present, the original (first generation) smallpox vaccines are no longer available to the general public. Research is currently underway to assess the feasibility and appropriateness of vaccination for the prevention and control of monkeypox. Some countries have or are developing policies to offer vaccines to people who may be at risk, such as laboratory staff, rapid response teams and health professionals.
An antiviral drug known as tecovirimate, which was developed for smallpox, was licensed by the European Medical Association (EMA) for monkeypox in 2022 based on data from animal and human studies. It is not yet widespread.
Understanding how this epidemic is spreading will be key to breaking the transmission chain and mastering numbers. In the future, our relationship with animals must be valued. The zoonotic spread of viruses will continue to be a concern as we encroach on and deal with the wildlife environment as part of science, food and the pet trade.
How worried should we be?
Most scientists agree that the current smallpox epidemic, while important to understand, is unlikely to cause another pandemic similar to SARS-CoV-2.
This is not a new virus, we have known about it for many years and have a good understanding of its structure and the process of replication. We already have a good vaccine available in the form of smallpox vaccine and treatment options if we need them. The virus spreads more slowly than the COVID virus, and most people show symptoms, including a distinctive rash that is easier to recognize than some of the vague symptoms that COVID causes. This means that we can identify those who are infected and vaccinate or isolate their close contacts if necessary.
However, there is some concern that as summer approaches and large gatherings such as festivals and congresses become more frequent, close contact is likely to occur and the virus may spread.
But even when the virus shows some new behavior and the obvious likelihood that more cases will be identified in the coming weeks and months, there is no reason to panic.
The World Health Organization has started holding daily emergency meetings on the infection and continues to monitor the situation worldwide. There are still many things to understand about the current epidemic, and although this is not another COVID, more research and follow-up prevention strategies need to be put in place to prevent the virus from spreading.
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