Global health officials have sounded the alarm about the rise in monkeypox cases in Europe and elsewhere.
Since the first case of monkeypox was confirmed in London on 7 May (the patient was a traveller from Nigeria with a recent monkeypox epidemic), in the days and weeks that followed, an increasing number of countries reported such cases, which are "atypical" for monkeypox.
Monkeypox is an infection caused by the monkeypox virus, which has previously been endemic mainly in West and Central Africa.
The World Health Organization (WHO) said that as of May 21, 12 non-monkeypox epidemic countries around the world have reported 92 confirmed cases of monkeypox and 28 suspected cases of monkeypox, and there have been no deaths. At the same time, the WHO has expanded surveillance in non-endemic countries and will provide guidance to countries on monkeypox prevention in the coming days.
The WHO said the available information indicates that human-to-human transmission is taking place in people who have had close physical contact with symptomatic cases, and it is expected that more cases may be reported in the coming days as surveillance expands.
01 Source of monkeypox virus
Monkeypox is a viral zoonotic disease that belongs to the same genus as smallpox and cowpox viruses, and is usually not as severe as smallpox. Mature monkeypox viruses are oval in shape and can be cultured and grown in African green monkey kidney cells, causing cell lesions.
In 1958, monkeypox was first found in monkey populations that were raised for research (hence the name). In 1970, more than a decade after being discovered, the virus eventually spread to humans, and the Democratic Republic of the Congo now records its first human case.
Since then, sporadic cases have been reported in 10 African countries, including Nigeria. Cases outside Of Africa have historically been less common and are often associated with international travel or imported animals.
In 2003, 35 cases of monkeypox were confirmed in the United States, and several more were suspected, the first time an infection outside Africa had occurred.
According to the U.S. Centers for Disease Control and Prevention (CDC), the virus was traced back to pet marmots, which were once in a temporary animal distribution center with a group of rodents imported from Ghana, Africa. It is also the first time that it has been known that in addition to monkeys, other animals can also be hosts.
In addition, Nigeria experienced the largest infection on record in 2017, with 172 suspected cases and 61 confirmed cases reported, with three-quarters of patients being men aged 21 to 40 years.
Since 2018, countries such as the United Kingdom and Israel have had cases of monkeypox, infected by travelers from Africa.
Pictured is an electron microscope image provided by CDC in 2003 showing mature oval monkeypox virus bodies (left) and spherical immature virus bodies (right) from human skin samples associated with the 2003 marmot outbreak.
02 Which countries are currently reporting monkeypox cases?
According to the latest data from BNO News, a Dutch media outlet that is closely tracking monkeypox cases around the world, confirmed and suspected cases of monkeypox have now appeared in 18 countries, with a total of 260 cases, of which the United Kingdom, Spain and Portugal have 57, 41 and 37 confirmed cases respectively;
The United States confirmed 7 cases, the Netherlands and Germany confirmed 6 cases, Canada confirmed 5 cases, Belgium, Italy confirmed 4 cases, France confirmed 3 cases, Australia confirmed 2 cases.
Previously, the German military said it was the largest ever monkeypox outbreak on the European continent.
Image credit: BNO News
03 What are the symptoms of the monkeypox infection process?
The incubation period of monkeypox can reach 5-21 days, and it is also said that it is 6-16 days, and the process of infection is generally divided into two stages:
1. Onset period (0~5 days)
Symptoms include fever, severe headache, swollen lymph nodes, back pain, muscle pain, and feeling of weakness (lack of energy).
2. Rash phase
Usually within 1 to 3 days of fever, patients develop rashes of varying degrees that spread from the face to other parts of the body. The rash evolves from the initial flat maculopapular rash to small, fluid-filled blisters, to pustules, scabs after about 10 days, and about three weeks after the scabs fall off before they disappear completely.
When a rash appears, the patient is contagious. The rash affects the face (95%), palms and soles of the feet (75%), oral mucosa (70%), genitals (30%) and conjunctiva (20%). The rash can be very itchy, with lesions occurring in locations ranging from a few to thousands, and in severe cases, lesions can combine to cause large patches of skin to fall off.
Some patients develop severe lymphadenopathy before the rash appears, which may be helpful in identifying monkeypox, as neither smallpox nor chickenpox has this feature.
The monkeypox infection period usually lasts 2 to 4 weeks. Most infected people recover within a few weeks, but some will develop serious illness.
Image credit: Visual Capitalist
04 How is monkeypox transmitted?
The WHO notes that monkeypox needs to be transmitted through close contact with people, animals or objects infected with the virus, and it can enter the human body through broken skin, respiratory tract, eyes, nose and mouth.
The study believes that the most common route of human-to-human transmission occurs through respiratory droplets, but according to the CDC, the conditions in which respiratory droplets spread usually require a longer period of face-to-face contact because the droplets cannot travel more than a few feet.
At the same time, animal-to-human transmission can also occur through bites or scratches; it can also be spread through eating the meat of undercooked infected animals.
Monkeypox viruses may also pass through the placenta or through close contact during childbirth, leading to mother-to-child transmission.
In addition, while monkeypox is not generally considered a sexually transmitted disease, the WHO website shows that the monkeypox virus may resemble some sexually transmitted diseases such as herpes and syphilis, which may explain why most cases are detected in sexual health clinics. Most current cases of monkeypox are found in men who have sex with men, but the possibility of community transmission is not ruled out.
05 Is monkeypox dangerous? Does the virus mutate?
Infection with monkeypox is usually mild and most people recover within a few weeks without treatment.
But like the coronavirus, monkeypox viruses have different variants. There are two main variants of monkeypox virus, and the risks of the two are very different:
1. West African strains: weak pathogenicity, case fatality rate of 1-3%.
2. Central African (Congo Basin) strains: strong pathogenicity, case fatality rate of 10%.
In addition, the WHO said that children infected with monkeypox are more likely to develop severe diseases than adults. Infections during pregnancy can also lead to complications that affect fetal development.
In addition to the case fatality rate, monkeypox's biggest harm to people may come from vision - the most obvious feature of this disease is the appearance of a very scary looking rash, once the disease will have a greater impact on the psychology.
At present, only west African branches of the strain have been found in the UK, and British health authorities say local patients have mild symptoms.
On May 21, studies also pointed out that the genome sequences of three monkeypox viruses in Portugal, Belgium and the United States initially showed homology, the same mild West African strain, which is closely related to the monkeypox virus found in the United Kingdom, Singapore and Israel in 2018 and 2019.
The belgian monkeypox virus genome sequence initially showed homology with the 2018 BRITISH MT903344.1 virus
The results of the Portuguese monkeypox virus genome sequence are the same as above
Monkeypox virus is similar to smallpox virus and is a DNA virus. DNA viruses are characterized by relatively stable and rare mutations, and it is precisely because of this characteristic that humans have defeated smallpox.
However, according to the latest analysis of American scholars, the monkeypox virus in this outbreak has indeed produced a great variation compared with the previous monkeypox virus, with a total of 94 nucleotide changes and 51 amino acid changes, which seems to be very high for DNA viruses.
Scientists are worried that DNA viruses accumulate a large number of mutations in a short period of time, which is rare and unknown, and whether the mutation will affect the spread and fatality of the virus, which remains to be seen.
Some analysts believe that as the number of monkeypox infected humans increases, based on evolution, its adaptability and pathogenicity to humans will gradually increase (strains that are more adapted to humans are screened out).
06 Is monkeypox more contagious?
Was the recent infection caused by a new monkeypox strain?
In previous studies, it has been found that monkeypox viruses are not highly contagious and can even be said to be 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 Omex R0 is around 7).
In past cases, there has been little confirmed human-to-human transmission. However, according to the sequencing analysis of American scholars above, the virus mutation may make it more contagious.
So, were recent infections caused by new monkeypox strains? It is not yet known, and further authoritative conclusions are awaited.
More than 100 cases have been confirmed in less than a month since the first case was detected on 7 May, which may indicate that this strain is more capable of spreading than other strains, but occasional events, such as the virus being carried by "super-spreaders," can also lead to wider spread.
07 Will monkeypox develop into the next epidemic?
While the researchers did not completely rule out the possibility of a monkeypox pandemic, they believe it is low.
Michael Head, a senior researcher in global health at the University of Southampton in the United Kingdom, said a large-scale monkeypox outbreak in developed countries is very unlikely, "there will be no new coronavirus-like transmission rate." ”
Tom Inglesby, director of the Johns Hopkins Center for Health and Safety, also said: "I think from the information we have, the risk to the public right now is very, very low. ”
The study believes that unlike the new crown virus, the transmission path of the monkeypox virus is relatively easy to cut.
But the main concern right now is that there has been community transmission. According to Agence France-Presse, on May 22, local time, a monkeypox virus community infection cluster has emerged in the United Kingdom, and many cases have no contact with cases with a history of travel to West Africa. UK health officials say community transmission of the virus has become the norm in the UK, with new cases every day.
For people, it's not necessarily a global pandemic like covid-19 or the flu that's worrying. But if there are more and more confirmed cases of monkeypox, especially if screening diagnoses are delayed, it will be a concern.
In particular, now that travel restrictions are being lifted in many parts of the world, the virus can once again spread between countries. With the arrival of summer, people participate in more activities such as gatherings, and more infections may occur.
In the past, monkeypox cases have been rare, largely because smallpox viruses are close to monkeypox viruses, and humans vaccinated against smallpox have also gained some resistance to monkeypox viruses. As humans eradicate smallpox and are no longer vaccinated against smallpox, this opens the door to new viral threats. Now, more and more people are no longer immune to the monkeypox virus.
Therefore, it is of the utmost importance to inform our community and healthcare providers of clinical manifestations, incubation periods, so that people can be diagnosed early, isolate and protect contacts.
08 What are the treatments or vaccines?
"Business Insider" website pointed out on the 21st that there is no standard treatment for monkeypox, but the monkeypox virus is closely related to the smallpox virus, and the effective rate of smallpox vaccine for monkeypox is about 85%.
According to the Financial Times reported on the 22nd, the European Centre for Disease Prevention and Control (ECDC) will recommend that EU member states develop vaccination plans to use existing smallpox vaccines to provide some form of cross-protection before developing monkeypox vaccines. After the eradication of smallpox worldwide in 1980, countries stopped vaccinateing children against smallpox.
Reuters said the UK had begun vaccinate healthcare workers who came into contact with monkeypox patients. The U.S. government says it already has enough smallpox vaccine stored in the U.S. National Strategic Reserve (SNS) to vaccinate all Americans. The U.S. Department of Health and Human Services has announced that, in some cases, antiviral drugs used for smallpox can also be used to treat monkeypox.
The mainland produces several quantities of smallpox vaccines each year as reserves. At present, the state arranges for the Sinopharm Zhongsheng Beijing Institute of Biological Products to produce a certain number of "Temple of Heaven strain" smallpox vaccines as reserves every year.
In addition, TPOXX (tecovirimat) is the first new drug approved to treat smallpox, and its oral dosage form was approved by the FDA in 2018. After approval in the United States, oral TPOXX was also approved for the treatment of smallpox in Canada and Europe. Approvals in Europe also include the treatment of complications caused by monkeypox, cowpox and cowpox immunity. The antiviral mechanism of the drug is to prevent the release of the virus from within the cell by binding to the virus gene.
On May 12, SIGA Technologies announced that it has received a new contract from the U.S. Department of Defense to award $7.5 million for oral TPOXX®, of which approximately $3.6 million for oral TPOXX will be delivered in 2022.
On May 19, the FDA approved an intravenous injection of TPOXX (tecovirimat) for patients who cannot swallow capsules. SIGA Technologies said, "The recent U.S. president's budget request cites TPOXX's intravenous injection for the treatment of monkeypox patients in the United States. ”
09 How to prevent monkeypox infection?
First of all, we don't have to be too nervous. Based on the fact that no obvious human-to-human transmission has been found for the time being, the total number of cases is still very small, and it will not actually have a particularly large impact on our lives, and there is no need for additional burden.
Public health experts recommend avoiding close contact with patients with diseases such as rashes, and if you suspect that you are infected with monkeypox, you should isolate in time and take the initiative to seek medical treatment.
For daily prevention, you can refer to:
Avoid contact with animals that may carry monkeypox virus (mainly primates, rodents, marsupials from southern Africa);
Avoid eating wild game, especially when traveling in southern Africa;
Avoid contact with any items that have come into contact with sick animals, such as bedding;
Isolating infected patients from other people who may be at risk of infection;
After contact with infected animals or humans, pay attention to disinfection. For example, washing hands with soap and water, or using alcohol-based hand sanitizer;
Personal protective equipment (PPE) is used when caring for monkeypox patients.
Key References:
1. "International public health experts determine whether the monkeypox virus is mutated?" How to deal with it? Source: The Paper
2. Monkeypox: Will It Be the Next Global Pandemic? There are 10 questions you should know", Source: Metz Medical
3.《World Health Organization confirms 92 cases of monkeypox with outbreaks in 12 countries》，来源：CNBC
4.《Everything You Want To Know About Monkeypox, But Were Afraid To Ask》，来源：ZeroHedge
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