Understanding monkeypox and the spread of outbreaks

Monkeypox is a misnomer due to the fact that it was first discovered in 1958 when the outbreak of Pox-like disease occurred in monkeys kept for research. Monkeys are as susceptible to it as humans, but they are not the source. This virus belongs to the genus Ortopoxvirus, which contains the smallpox virus that causes smallpox. Vaccinia virus used in smallpox vaccine. Cowpox virus. Monkeypox is less contagious than smallpox and has milder symptoms. According to the World Health Organization, about 30% of smallpox patients have died, but the case fatality rate of monkeypox these days is about 3% to 6%.

2. What does monkeypox do?

After an incubation period of usually 1 to 2 weeks, the illness usually begins with fever, muscle aches, malaise, and other flu-like symptoms. Unlike smallpox, monkeypox also causes swelling of the lymph nodes. Within days of fever, patients develop a rash, often starting on the face and spreading to other parts of the body. Lesions grow into pustules that contain the fluid that forms the scab. The formation of lesions in the eye can cause blindness. According to WHO, the disease usually lasts 2-4 weeks. It is infectious from the onset of symptoms until the scab falls and the pain subsides. Mortality is high between children and young adults, and people with impaired immune systems are at particular risk of serious illness.

3. How is it normally sent?

Monkeypox does not spread easily among people. Contact with the virus from animals, humans, or contaminated objects is the main route. The virus enters the body through broken skin, airways, or mucous membranes of the eyes, nose, and mouth. Transmission from one person to another is thought to occur via respiratory particles during direct and long-term face-to-face contact. However, it can also occur indirectly through contact with body fluids and lesions, or through contact with contaminated clothing and linen. Common household disinfectants can kill it.

4. What is unusual this time?

In multiple countries where monkeypox is not normally present, there were multiple transmission chains within the cluster.

• Cases do not include recent trips to locations in West Africa and Central Africa where the disease is occurring Endemic..

• Symptoms like influenza do not always precede the rash, and some patients have difficulty distinguishing from syphilis, herpes simplex virus, shingles, and other more common infections, the genital organs. And first sought treatment for lesions around the anus. To the US Centers for Disease Control and Prevention.

• The majority of cases are between men and men who have sex, and many occur within the sexual network.

• Analysis of viral gene sequences collected from some European patients shows that strain spread has a single origin. It belongs to the West African clade, or branch of the evolutionary phylogenetic tree, and is most closely associated with the virus found in cases recently exported from Nigeria to the United Kingdom, Israel and Singapore. Case fatality rates for monkeypox virus strains from this clade range from 1% to 3.6%. (This is compared to 10% of the second branch group called the Congo Basin, which has been shown to pose a serious threat to the US government’s bioterrorist agent list.)

5. Where did the monkeypox come from?

Rodents are suspected of being involved in the transmission, but the host or major carrier of monkeypox has not yet been identified. It was first diagnosed in the Democratic Republic of the Congo in 1970 in a human 9-year-old boy. Since then, most human cases have occurred in the rainforest regions of West Africa and Central Africa. In 2003, the first outbreak outside Africa occurred in the United States, was associated with animals imported from Ghana to Texas, and subsequently infected pet prairie dogs. Dozens of cases were recorded in the outbreak.

6. Is monkeypox a pandemic threat?

Outbreaks outside Africa are rare. Since 2017, there have been at least eight known export cases, usually involving international travelers, but usually no further transmissions have occurred. Human-to-human transmission raises concerns that the virus may undergo genetic alterations to allow it to spread more efficiently from person to person. Portuguese researchers said that the viral DNA sequences collected during the recent epidemic contained more mutations than expected to take into account the natural evolution of the associated virus, May 23. Said in a report published in. However, it has clinical significance.

7. How is it treated and prevented?

The illness is usually mild and most patients recover within a few weeks. Treatment is primarily aimed at relieving symptoms. To control the development of monkeypox, the CDC states that smallpox vaccines, antivirals, and vaccinia immunoglobulins can be used. Vaccination against smallpox can be used both pre-exposure and post-exposure, and monkeypox is provided by the British Health and Security Agency, which provides the Imvanex smallpox vaccine to close contact with people diagnosed with monkeypox. It is 85% effective in preventing smallpox. .. Cidofovir and tecobilimat are listed as antiviral drugs that can be used to control outbreaks. According to WHO, Tecovirimat was approved by the European Medical Association for Monkeypox in 2022, based on data from animal and human studies, but is not yet widely available. New vaccines are being developed based on non-replicating versions of the vaccinia virus, one of which has been approved for the prevention of monkeypox. In the United States, a limited supply of two vaccines is available for adults, the journal JAMA reported in late May.

• There are 100 million doses of ACAM2000 approved in 2007 for immunization against smallpox. When used under an investigational drug protocol with expanded access, it can be administered to people exposed to monkeypox, but contains live vaccinia virus associated with some serious potential side effects. I am.

• 1,000 doses of JYNNEOS, a live, non-replicating vaccinia virus vaccine manufactured by the Bavarian Scandinavian A / S for the prevention of smallpox and monkeypox and approved by the U.S. Food and Drug Administration in 2019. increase.

The main way to prevent infection is to isolate patients with suspected monkeypox in a negative pressure chamber and ensure that medical staff wear appropriate personal protective equipment.

8. Is there a monkeypox test?

yes. Monkeypox is diagnosed using the polymerase chain reaction (PCR) test and detects viral DNA in specimens collected from the scab or cotton swab of a patient’s lesion. In the United States, these are available in the state health department and the CDC.

(Add details about the breadth of dissemination in the first paragraph, and add information about vaccines available in the United States in Section 7.)

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