It is a virus and a disease of yesteryear. But, although monkeypox has been known for half a century, this new outbreak, which already has dozens of cases in multiple countries, is strange due to its international spread. We review what this ailment is and why we should be vigilant but not worried, according to experts.
Both the name and the symptoms seem alarming: monkeypox is making European and American headlines after several dozen cases have been detected since May 7 in countries where the disease had never been recorded before.
This virus, which is endemic in several countries in central and western Africa, was discovered in 1958 in monkeys and was first found in humans in 1970. Since then, there have been several outbreaks in countries such as Nigeria and the Democratic Republic of the Congo that they have successfully contained, “even during the Covid-19 pandemic”, as the director of the Africa Centers for Disease Control (CDC Africa), Ahmed Ogwell Ouma, recalled last week.
Those outbreaks have gone largely unnoticed, in part because they are so much more common. This, on the other hand, is unusual because of its international reach and because, in many cases, there is an unknown travel link to countries where monkeypox is endemic.
What are the symptoms of monkeypox?
monkey pox (Monkeypox) is caused by a virus of the family of Poxviridae. In some ways, it’s as if it’s a cousin of the smallpox virus, which plagued humanity for centuries and was finally eradicated in 1980 thanks to a massive global vaccination campaign. The symptoms are similar, although in monkeypox they are much milder.
From exposure to the first symptoms, it can take between 6 and 15 days, the so-called incubation period, although on average it is around 12 days. In principle, during this period the disease is not transmitted. The first signs of infection are fever, muscle aches, exhaustion, and swollen lymph nodes.
One to three days later, the skin lesions that also characterized smallpox appear: these lesions turn into sores, then pustules, and finally develop a scab that falls off. The lesions appear mainly on the extremities, on the face and in the genital area. In total, the patient can be sick between two and four weeks.
How serious is monkeypox?
It is difficult to accurately estimate the mortality rate of this infection because the number not only changes according to the virus but also according to the conditions of the health system that treats patients.
In general, the scientific consensus is that the virus has two different lineages with two different mortality rates. The Congo Basin lineage is associated with greater virulence and transmission capacity and is estimated to have a mortality rate of around 10%. The West African lineage, on the other hand, is milder and causes less severe disease, with a mortality of 1%.
The virus is somewhat more serious in minors.
For now, the viruses sequenced in Portugal, one of the countries affected by the new outbreak, place these infections in the West African lineage.
In some regions of the African continent, it has even been recorded that approximately 20% of infected people die, but it is believed that this figure is conditioned by the high inability to receive treatment in the region.
How is monkeypox spread?
The virus of this disease circulates in animals in forested areas of the central belt of Africa, although it is not yet known exactly which species is the reservoir (contrary to what the name indicates, it seems that they are small rodents and not apes). Human interaction with these animals, whether by eating their undercooked meat, injuries and wounds, or contact with waste, can cause the virus to jump from the animal to the person.
Between people, monkeypox is considered to be poorly transmissible, much less so than the Covid-19 virus, for example. The longest chain of transmission that has been found is six people. Infection occurs through close contact between people, either by droplets of saliva, by contact with skin wounds or with materials that have become infected, such as sheets.
It is important to note that monkeypox is not a sexually transmitted disease and that, epidemiologically, there is no data linking it to the LGTBI community. The fact that many cases have occurred in young men who identify as homosexual or bisexual has confused public opinion and contributes to stigmatizing this population group and its practices, without a clear causal relationship.
Why has monkeypox grown this way?
On February 11 of this same year, the journal ‘PLOS Neglected Tropical Diseases’ warned that such an outbreak could happen. It pointed out, for example, that during the decade between 2010 and 2020, almost 20,000 cases were registered, practically twice as many as in the previous decade. In the 1970s, when it was discovered in humans, only a few dozen cases were detected.
This increase may be due to different ways of counting and better surveillance systems, but it is not the only explanation. Without a firm answer yet, the scientific community is considering several theories for this growth. For starters, the virus has mutated and changed to become more transmissible. However, the fact that early sequencing shows genetic material virtually identical to the variants found in Nigeria in 2018 makes this explanation more unlikely.
On the other hand, many also point to the increased interaction between humans and animal virus reservoirs, especially as a result of deforestation and mining, which causes more and more cases of “jumps” between these animals and people.
Finally, it is essential to remember that the smallpox vaccine provided fairly robust protection against monkeypox. After its successful eradication, this vaccine has been out of use for three decades, something that could explain why the younger population does not have any type of immunity against the disease.
Do we have vaccines against monkeypox? Are these necessary?
Potential drugs specifically against monkeypox are still in the experimental phase, so they could not be administered yet. However, one tool that has been used before is precisely the smallpox vaccine. In addition to pharmaceutical companies ready to prepare it, the World Health Organization was left with emergency reserves.
That means that vaccines are available but not widely accessible. But it is probable that, for now, they are not needed, not even on a massive scale: in case of wanting to vaccinate to control the outbreak, something that is not even known if it will be necessary, it could be vaccinated following a “ring” strategy, a way of immunization that is used when the vaccine breaks the chain of transmission, as is the case.
Contrary to what happens with the Covid-19 vaccines, the smallpox vaccine lasts for life and makes people not infect anyone else, so patients could be inoculated, contacts of patients and respectively to their close contacts to interrupt the transmission of monkeypox.
This “ring” strategy is the one used to definitively eradicate smallpox and is the one currently applied against Ebola outbreaks.
#Health #Monkeypox #alarmed #unusual #outbreak