Monkeypox virus: There was an outbreak of monkeypox in 71 cases in the United States in 2003 (File)
The World Health Organization has revealed that there are currently 131 confirmed cases of monkeypox and another 106 suspected cases in 19 countries. Experts describe the event as “accidental” but “delayed” and probably originally caused by sexual activity at recent raves in Spain and Belgium.
However, as the world is still rocked by the effects of the covid pandemic, the rise of various diseases puts many people at risk.
Bobby Ghosh of Bloomberg Opinion hosted a live Twitter discussion with senior pharmaceutical analyst at Bloomberg Intelligence Sam Fazeli to get information about the disease and find out if we should worry.
Bobby Ghosh: Let me start by asking the most basic possible question: What is monkeypox?
Sam Fazeli: There seem to be an infinite number of viruses circulating in nature. This happens to be one of them. It is an orthopoxvirus, like other well-known diseases such as chickenpox and smallpox. Smallpox is less problematic than smallpox in terms of mortality. The virus that is currently circulating appears to be the endemic strain in West Africa.
We have known about two strains for several decades. Both are endemic in different parts of Africa – Central Africa and West Africa respectively – and there are occasional cases reported outside the African continent, usually by someone traveling from the affected area. This outbreak seems quite unusual, as cases are reported in so many different parts of the world at the same time. What is happening?
In fact, there was an outbreak of 71 cases in the United States in 2003, not because of human travel, but because of imported rodents from Ghana. These rodents then infected domestic prairie dogs, which then infected humans. There was a possibility of local transmission then, but it was certainly transmitted from animals to humans. This is a problem that we deal with in many of these viral outbreaks, from bird flu to covid.
With regard to today’s unusual outbreak, we must be aware that it is too early to be sure whether the virus was indeed sown separately in different countries or at least most of the cases came from a super-spread event. The best way to find out how related the cases are is to sort them out. The first genome was published by Portuguese scientists and they found that the virus seems to be quite close to the virus that was discovered in several countries in 2018 and 2019. This already tells you that it does not necessarily have changed much. Although all of this is subject to review, this suggests that we hope to find that most of these cases are in fact related.
Incidentally, it is worth simply unpacking that although it is called monkeypox, it does not actually come from monkeys. We only started paying attention to him when the monkeys started getting it. Does it come from monkeys now? What do we know about how the disease is transmitted?
Orthopox viruses, especially monkeypox, are considered universal. This means that this virus can and does infect different species. Rodents are the most common vehicles for infection, then jump to monkeys and now humans. Transmission can be relatively easy, not necessarily on a specific route. In this case, the view is that it is spread by contact with contaminated fluids from an infected person and must be relatively close contact.
Most of the transmission is likely to be when you are either very close to someone who has the virus, so you take the droplets you exhale, or you are in physical contact with them. It can also be transmitted through fomiti – touching a surface that someone infected has touched.
There are some reports that suggest that this happens mostly through intimate contact, including really close intimacy or having sex with a person.
I think we need to be very careful not to misinterpret the conversation and the information that comes out. The fact that the majority of cases are found in men who have sex with men does not mean anything about sexual transmission. We are only looking at the way in which this particular spread took place. It could easily have been some other kind of intimate contact, heterosexual or whatever.
What are the symptoms of monkeypox?
It starts with headaches and fever, the usual things you do when you get a viral infection. These symptoms are basically triggering your immune system. Many viruses do not like higher temperatures, which is why the body raises its temperature. We get headaches and muscle aches because of all the chemicals – like cytokines – that are released to fight infection. Then, within a week or two, some people get a rash that develops into pustules.
If you are covered with these pustules, then you will be at risk of bacterial infection and in some cases sepsis. That is where mortality can come from.
There have been zero deaths in this particular cluster so far. The mortality rate of 1-3 percent or the mortality rate of 10-13 percent for the Central African strain is mentioned a lot, but you have to remember that just like a covid it depends on how you take care of the patients. If the patient is at home without oxygen, without intensive treatment, without medical professionals who care for him, the risk of death is higher. This may be the situation in rural Africa, where these numbers are calculated, but in countries with good health and medicines, I am sure that the mortality rate will remain below 1 percent – 0 percent, I hope!
The symptoms remind me of my childhood when I got chickenpox. I was bedridden for a few days and I remember being very uncomfortable. Then he left.
Do we have a sense of whether monkeypox is more painful or more threatening than chickenpox?
This is a much more uncomfortable infection if you get full pustules on your skin, but it varies. I have heard of a case where someone who had previously been vaccinated against smallpox was infected. They only had one or two lesions, which is nothing. This you assume and hope will be the case with most people who have already been vaccinated. The question is about people who have not been vaccinated. How bad are they getting it?
I grew up in India in the 1970s and 1980s and was vaccinated against smallpox as a child. Smallpox was then eradicated and vaccines are no longer given in many countries.
Does that make us more vulnerable to monkeypox?
Yes, I think so, which is probably what is happening here. It has been suggested that blocking covid may increase our susceptibility to disease. It can be said that influenza and coronavirus, both of which are respiratory viruses. Indeed, in this case I think it is just a coincidence. We have an endemic virus in Central and West Africa that has then been able to spread to a population of people who have never seen an infection or vaccine that protects them against the virus.
The good news is that the vaccine already exists, unlike covid. We have vaccines that work both prophylactically and after a person becomes ill.
So can they be preventative as well as curative?
That’s right, a few days after the infection is diagnosed, the vaccine still seems to be working. Interestingly, both vaccines are in production today. Stocks may not be as high as one would like in situations like this, but many countries are already stockpiling them, not out of fear of monkeypox, but out of fear of a bioterrorist attack on smallpox.
The disease is less transmitted than covid, not everyone needs to be vaccinated. You can use it to treat people who have been diagnosed and to vaccinate people around them. This method is called ring vaccination and has been shown to be successful in controlling smallpox before.
There has been much debate about whether poor countries will be able to afford covid vaccines. Is this a problem for smallpox vaccines?
Pfizer’s covid vaccine was between $ 15 and $ 20 per vaccination. For most of us who live in England, Sweden or the United States, this is not expensive given the protection it provides. I expect that in order to control and better manage the global spread of this virus, the equivalence of COVAX will buy vaccines for countries that cannot afford it. At the same time, the price is clearly determined by volume. If we only need one million doses, as opposed to 400 million doses, then companies will probably have to charge a little higher because the margins will be lower for these types of volumes. I don’t expect this to be a very expensive vaccine.
This is reassuring. How do leaders react to monkeypox? President Biden was forced to answer a question about this during his trip abroad to South Korea. Have we learned anything from our fight against covid at the policy level that is particularly helpful in dealing with monkeypox?
The good thing is, as we have already said, that this is not a disease we have never dealt with before, even if it is not necessarily the living memory of many people. Only about 50 years ago, we stopped smallpox vaccination programs. Bavarian Nordic, one of the manufacturers of the smallpox vaccine, has apparently already had meetings with health authorities in several countries in just the last few days, which were arranged six months ago. This shows that the countries have already thought about it – whether they thought more about smallpox than monkeypox does not really matter.
Is there a reason to think that monkeypox is seasonal?
During the year, when people are more outdoors than indoors, you would expect most infections, especially respiratory ones, to decrease. This is transmitted through contact. So I don’t think we can classify it as seasonal.
How about the options – which were a real problem with covid? Did the monkeypox virus show any signs of developing new variants that …
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