The COVID-19 pandemic is still in the global pandemic, but the game between humans and pathogenic objects has emerged a new battlefield. First, "unexplained" children's acute hepatitis broke out in the United States and European countries, and then monkeypox cases were reported in Europe, North America, and Australia.
In various versions of the interpretation, monkeypox is known as the mini version of smallpox, and young people under the age of 40 worldwide are not immune to monkeypox. In the relevant reports from the World Health Organization, "male sex" has become a chain of transmission...
On the evening of the 23rd, Nandu interviewed Wang Ming, an expert in the field of public health special allowances of the State Council and chief expert of the Guangzhou Preventive Medicine Association, and Cai Weiping, chief expert of the Infection Disease Center of the Eighth Affiliated Hospital of Guangzhou Medical University, on issues related to monkeypox. "Based on the stable performance of monkeypox viruses and the low mutation of the virus itself, the possibility of a large-scale epidemic is extremely small, but the potential risk of imported cases does exist."
Even if you have been vaccinated against smallpox
The immune effect after 40 years also remains to be seen
If you want to talk about monkey pox, you must first explain the "smallpox", a bully-level infectious disease. As the only infectious disease that has been completely eliminated by mankind so far, smallpox has killed countless people, and statistics show that it has taken more than 300 million lives throughout the 20th century, and the lives taken between people over thousands of years are calculated in hundreds of millions. Its attacks on susceptible people are indiscriminate, and the pawns of the traffickers will be infected and die, and the prince will not be spared. Not to mention the Egyptian pharaohs in the pyramids, Queen Mary II of England, King Louis XV of France, and the Shunzhi Emperor of the Qing Dynasty on the mainland all died of this disease.
The main manifestations of smallpox are severe symptoms of poisonous blood (chills, high fever, fatigue, headache, sore limbs and lower back, convulsions and coma when body temperature rises sharply), macules, papules, herpes, pustules on the skin in batches, and finally scabs, scabs, and acne scars. Smallpox is fierce and develops rapidly, with a fatality rate of up to 30% within 15 to 20 days of infection in unimmunized populations.
Humans were able to completely eliminate smallpox, and had a great relationship with a doctor named Edward Jenner. He slightly stimulated susceptible people to produce smallpox antibodies through cowpox, and humans completely eliminated smallpox. When the last case of smallpox was reported in the African country of Somalia in 1979, no cases of smallpox were reported globally for 43 years. The few smallpox strains are also allowed to remain only in laboratories in the United States and the former Soviet Union (Russia), and the time for destruction has been delayed.
Since wild strains are hard to trace, it is logical to stop vaccinating smallpox (pox) from the perspective of health economics. What's more, the previous smallpox inoculation was relatively rough, using a special bifurcation needle for intradermal multi-point injection, perpendicular to the skin into the needle, after inoculation will form a characteristic scar.
But the game between humans and pathogenic microorganisms such as viruses is also full of dialectics and trade-offs. Smallpox, which only spreads rapidly from person to person, is eliminated, and when the monkeypox virus, a close relative of the smallpox virus that can cause zoonotic diseases, appears, the immune barrier against it (monkeypox virus) needs to be reconstructed.
Wang Ming said that young people under the age of 40 are not immune to monkeypox, and the occurrence of this situation may be related to the "elimination" of smallpox virus in humans. "Since the global eradication of smallpox, people have no longer been vaccinated against smallpox virus, but this vaccine is also very effective against monkeypox virus, with an effectiveness of about 85%. On 8 May 1980, the WHO announced the global eradication of smallpox and recommended that countries stop vaccinating smallpox. Equivalent to the global population under 45 years of age, most of them have not been vaccinated against smallpox, and the population born thereafter naturally has no immunity against smallpox virus and monkeypox virus (1977-1978 was the last time the mainland was vaccinated against smallpox), so this may lead to an increase in monkeypox cases.
People over the age of 45, look at your upper arm, there is no such little thing, which is a sign after smallpox vaccination.
In Cai Weiping's view, the lack of immunity to monkeypox in people under the age of 40 does have something to do with the global cessation of smallpox vaccination since the 1980s. "Monkeypox is a mini version of smallpox, and the smallpox vaccine is very good at protecting it. What needs to be observed at present is how effective the immunity of people who have been vaccinated against smallpox after 40 years when they encounter monkeypox virus, and they can certainly be immune, but the immune effect remains to be seen. ”
Male male behavior is the clue
But prevention based on this clue alone is certainly not enough
At present, there are still many unknowns in the medical community on the transmission pattern, clinical characteristics and epidemiology of monkeypox, and there are still gaps in treatment and diagnosis. Among the dozens of known European and American cases and dozens of confirmed cases, a chain of transmission through male sex has attracted the attention of the World Health Organization and the media. "WHO has noted the spread of monkeypox among men who have sex with men is a new clue that needs to be properly investigated to better understand the local spread dynamics in the UK and some other countries," public media reports reveal. ”
As an AIDS prevention and control expert, Cai Weiping also paid attention to this information, after all, at a time when the transmission route of AIDS is mainly transmitted through high-risk sexual behavior (male sex), it is easy for people to associate monkeypox and AIDS.
World Health Organization Headquarters (Xinhua)
Cai Weiping said that the World Health Organization revealed that male sex is a clue, but it is manifested in a few cases, they have had male sex. Monkeypox is an infectious disease that is mainly transmitted through physical contact. Male sex is close contact, and other close contact can also be transmitted, such as intimate behaviors such as hugging. "It is not possible to single-handedly assume that only male sex is the mainstream of transmission, and it is especially important to avoid going to this extreme when developing prevention strategies."
Wang Ming also said that the current public information shows that monkeypox is mainly transmitted through contact and droplets. Monkeypox viruses become infected through broken skin, mucous membranes, respiratory droplets, infected bodily fluids, and even after touching contaminated bed sheets. But human-to-human transmission occurs mainly through large respiratory droplets, and because such droplets usually only travel a few feet, it takes long hours of face-to-face contact to become infected.
The virus is relatively stable and has few mutations
The risk of a large-scale epidemic is extremely low
"At present, from the R0 value of the disease, the possibility of large-scale transmission on a global scale is very small. First of all, the virus itself is a double-stranded DNA virus, which has maintained a relatively stable morphological structure since it was discovered by humans, and no major mutations have been observed. Secondly, the R0 value as of now is less than 1, which also explains the problem. Cai Weiping told Nandu reporters that monkeypox is not a new virus, it was found in the 1950s, and central and western Africa are its main endemic areas. The Dr. Congo reported more than 6,000 cases in 2020 and more than 3,000 in 2021; Nigeria is also increasing this year, mainly in rural areas.
Wang Ming also has the same judgment on this, he said that in previous studies, it has been found that the monkeypox virus is not highly contagious, and it can even be said that it is difficult to spread from person to person. The basic number of infections (R0) is considered to be only 0.6 to 1.0. R0 is the average number of people that a person with an infectious disease can transmit, and when R0 <1, the disease will gradually disappear. So it also means that monkeypox doesn't have a pandemic like COVID-19 (COVID-19 Omilon R0 is around 7). The onset of monkeypox is mainly transmitted by humans in close contact with animals, not from humans to humans. In past cases, there have been few confirmed cases of human-to-human transmission.
It is reported that mainland scientists are paying close attention to the virus and the epidemic. "In the mainland, although there have never been reports of confirmed cases of monkeypox, infectious diseases have no borders, the risk of monkeypox virus importing into the mainland will continue to exist, and with the outbreak of the epidemic in Europe and the United States, the risk of imported cases in the mainland will increase accordingly." Therefore, we can not take it lightly, if the proportion of animals carrying viruses is very high, people are completely susceptible, and a large number of animals infect people, there will also be epidemics. ”
However, the necessary protection work when traveling abroad or coming into contact with suspected cases should be done:
1. Avoid contact with animals that may carry monkeypox virus (mainly primates, rodents, marsupials from southern Africa);
2. Avoid wild game, especially when traveling in southern Africa;
3. Avoid contact with any items that have been in contact with monkeypox patients, such as bedding;
4. Isolate infected patients from other people who may be at risk of infection;
5. After contact with infected animals or humans, maintain good hand hygiene. For example, washing hands with soap and water, or using alcohol-based hand sanitizer;
6. Use personal protective equipment when caring for monkeypox patients.
Very sorry
Modern medicine has no specific drugs for monkeypox
Humans have eliminated smallpox, but so far humans have not developed a specific drug to treat smallpox. In the prevention and control of infectious diseases, prevention is always much more economical, effective and direct than clinical treatment.
Wang Ming told Nandu reporters that the main clinical manifestation of monkey pox is that a large area of rash will appear on the face and body surface of the infected person, including the mouth, palms and soles of the feet. The acne that causes the pain is pearl-like bumps, filled with fluid, and the surrounding skin is usually red in a circle, and the lesion eventually scabs and heals within two to three weeks.
Although the case fatality rate after monkeypox infection is not high, the biggest harm to people may come from vision - the most obvious feature of this disease is the appearance of a very scary looking rash, and patients with dense phobia are basically unable to accept this visual effect, and once the disease has a greater impact on psychology. There are currently no specific drugs available for treatment, so supportive care is the mainstay.
In addition, the World Health Organization says children infected with monkeypox are more likely to develop severe diseases than adults. Infections during pregnancy can also lead to complications, including stillbirth.
As of now, most monkeypox cases have mild symptoms. Handwashing, along with other measures implemented during the COVID-19 pandemic, are essential to reduce the spread of monkeypox virus in healthcare settings. According to the U.S. Centers for Disease Control and Prevention, ordinary household disinfectants can effectively remove monkeypox virus from surfaces.
猴痘Q&A
Q1: Is "monkeypox" related to the "chickenpox" we know as well?
A: The first thing to clarify here is that "monkeypox" and "chickenpox" are not close relatives! In terms of biological classification, the full name of the varicella virus is "varicella-zoster virus" belongs to the herpesvirus family, and is closely related to herpes simplex virus, cytomegalovirus, and Epstein-Barr virus; while monkeypox virus belongs to the pox virus family, and is a close relative of smallpox virus, which has been declared extinct more than 40 years ago; they all belong to DNA viruses.
Q2: Similarities and differences between smallpox virus and monkeypox virus?
A: Smallpox virus only infects people; and monkeypox virus is a zoonotic virus, it exists not only in monkeys, but also in rats, squirrels and other animals, mainly through rodents and primates and other wild animals to spread to people, but can also be human-to-human transmission between humans. Because monkeypox virus is similar to smallpox virus, monkeypox virus infection has symptoms of fever, headache, and lymphadenopathy, followed by pus-filled blisters similar to smallpox lesions. The site of monkeypox lesions passes through the following stages before shedding: macules, papules, blisters, pustules, scabs. Monkeypox usually lasts 2-4 weeks. The incubation period for monkeypox is usually 7-14 days, but it can also be 5-21 days.
Q3: Why is there a monkeypox outbreak?
A: Some experts believe that the occurrence of this situation may be related to the "elimination" of smallpox viruses by humans. Since the global eradication of smallpox, people have no longer been vaccinated against smallpox virus, but this vaccine is also very effective against monkeypox virus, with an effectiveness of about 85%. On 8 May 1980, the WHO announced the global eradication of smallpox and recommended that countries stop vaccinating smallpox. Equivalent to the global population under 45 years of age, most of them have not been vaccinated against smallpox, and the population born thereafter naturally has no immunity against smallpox virus and monkeypox virus (1977-1978 was the last time the mainland was vaccinated against smallpox), so this may lead to an increase in monkeypox cases. On the other hand, monkeypox virus is not a new virus, it may exist in the world for centuries or even thousands of years, but this virus is constantly increasingly infectious and pathogenic through mutation, and when the virus has the opportunity to contact the human body, it may cause disease.
Q4: How many types of monkeypox viruses are there?
A: Monkeypox virus, like the new coronavirus, has different variants. There are two variants that currently exist. West African strains have weak pathogenicity, with a case fatality rate of only about 1%, while Central African strains have strong pathogenicity, with a case fatality rate of almost 10%. At present, only west African branches of the virus have been found in the United Kingdom, and the virus sequencing information elsewhere is still unknown.
Q5: Is there a vaccine to prevent monkeypox?
A: Jynneos, a smallpox vaccine developed by Danish-based vaccine company Bavarian Nordic, was approved for marketing by the U.S. FDA in 2018 for the prevention of smallpox and monkeypox infections in high-risk adult populations over the age of 18. It is the only non-replicated smallpox vaccine approved by the FDA and has been approved for the smallpox monkeypox vaccine in Europe and Canada.
This is the only monkeypox vaccine approved in the world. A while ago, the United States, which owns the smallpox strain, urgently procured hundreds of millions of dollars and millions of doses.
Written by: Nandu reporter Wang Daobin