The quiet spread of monkeypox may be a call to the world to awaken

CNN
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Outbreaks of monkeypox continue to increase in countries where the virus is not normally found, and health officials around the world are on the alert.

Currently, more than 643 monkeypox cases have occurred in dozens of countries where the virus is not prevalent, and “the sudden appearance of monkeypox in many countries at the same time may have been an undetected infection for some time. It suggests that there is sex, “said Tedros Adhanom Gebreyes, director of the World Health Organization, Wednesday.

The virus has been epidemic for decades in several places, including parts of West Africa and Central Africa.Ahead of time Studies posted this weekScientists at the Institute of Evolutionary Biology at the University of Edinburgh suggest how the genetic patterns they see suggest that “human-to-human transmission has been sustained since at least 2017.” explained.

The study showed that the gene sequence appeared to result from the first monkeypox cases in 2022 that resulted in cases in Singapore, Israel, Nigeria, and the United Kingdom from 2017 to 2019. ..

Michael Worobey, an evolutionary biologist at the University of Arizona and a professor who wasn’t involved in the study, said that “this outbreak has been going on for a long time locally,” as well as where the virus is endemic. Said suggesting. And that means the world has protected people in resource-limited areas where it was endemic and failed to control it at its source before it spread globally. He added.

“It’s really a story of two outbreaks,” Warobib said. “We really need to pay attention to where it’s spread … and care about its population as much as we care about what’s happening in every other country in the world. You need to start calling. ”

If studies continue to show that the virus is more widespread among humans than previously thought, that is, far from the source of the animal, Warobi is one of the “really good questions” for monkeys. Why doesn’t the world think that monkeypox is unique to the place? Beyond West Africa and Central Africa?

Epidemiologist Ann Limoan has been studying monkeypox for about 20 years and has long warned that the spread of monkeypox in places like the Democratic Republic of the Congo could have widespread impact on global health. rice field.

“If monkeypox settles in non-African wildlife reservoirs, it is difficult to reverse the public health recession,” said Limoin, now a professor of epidemiology at the UCLA Fielding School of Public Health. Warning in 2010 article It was published in the bulletin of the National Academy of Sciences.

Recent outbreaks of monkeypox have proven difficult to predict, as their origin may not be completely traced.

“I don’t even know how widespread this is,” Limoin said. “This may have spread quietly for some time.

“It looks like you’ve decided to watch a new series, but I’m not sure exactly which episode you’ve reached. So are we in episode 2 or we’re in episode 2? Episode 4 or Episode 10? And how many episodes are there in this series? I do not understand. ”

Previous human cases of monkeypox were not considered to be far from initial exposure to infected animals (usually rodents). When the virus circulates among these animals, it can continue to jump back, for example, to humans who may come into contact with infected squirrels and guinea pigs.

If this outbreak continues to be seen at low levels of persistent human-to-human transmission, the spillover effect may return. Animals in non-epidemic countries told CNN “from existing threats to clear possibilities.” Such spillover can cause the virus to stay in the environment and fly between animals and humans over time.

“Canon was, monkeypox will burn itself out,” Limoin said.But our knowledge of viruses dates back decades and is now widespread. New location and population.. For epidemiologists, it means being open.

“We know quite a bit about this virus, but we don’t know everything about it,” she said. “This needs to be studied very carefully.”

WHO officials say the global public health risk is moderate.

“If the virus takes advantage of the opportunity to establish itself as a human pathogen and spreads to groups at high risk of serious illness, such as infants and immunosuppressors, it can increase public health risk. “When, WHO risk assessment Published on Sunday, “to curb further spread among risky groups, prevent spread to the general population, and avoid the establishment of monkeypox as a clinical condition and public health problem in currently non-epidemic countries. Immediate action from is needed. ”

At a news briefing last week, Centers for Disease Control and Prevention officials said it was “premature to tell” if the virus could become endemic in the United States, but experts said it wouldn’t happen. Said that he was “hoping”.

“I think we are in the very early stages of the investigation,” said Dr. Jennifer McQuiston, Deputy Director of the CDC’s Department of High-Result Pathogens and Pathology.

McQuiston pointed out that the virus did not spread after the epidemic. Outbreak of the last monkeypox In the United States, in 2003, pet prairie dogs caused dozens of infected people in multiple states.

“We hope we can contain this as well,” said McQuiston.

European CDC seemed to agree with McQuiston With your own evaluation Last week, officials said there was no evidence that the virus had settled in US wildlife after conducting an “aggressive campaign against animals exposed during the 2003 outbreak.”

According to European institutions, “the possibility of this spillover event is very low.”

Still, it may not be the first virus to inhabit US animal populations, said Dr. Ameshua Dalha, a senior scholar at the Johns Hopkins Health and Security Center at the Bloomberg School of Public Health. Before 1999, West Nile virus was unheard of in the United States. Currently, it is the leading cause of mosquito-borne diseases in the country.

“It was able to sow a population of mosquitoes and … a population of birds and establish itself,” Adalja said.

Still, I agree that this is far from the necessity of monkeypox, as “2003 was a good opportunity for it to happen”, but it wasn’t.

Warobib says there are too many unknowns to understand where this monkeypox outbreak is heading.

“What we’re finding here in real time is that we know very little about what’s going on, and I think it’s too early to give us total peace of mind,” he says. I did.

It is not only the muddy beginning and quiet spread that make it difficult to predict the occurrence of this monkeypox.

“It’s a very different epidemiological landscape,” Limoin added.

“What we know about monkeypox comes primarily from studies in very remote rural areas of Central Africa, where the dynamics of infection should be very different,” she said. Told.

And while a full-blown pandemic isn’t a concern yet, that doesn’t mean that a particular group isn’t at risk, WHO officials said Monday.

“At this point, we are not concerned about the pandemic,” said Rosamund Lewis, technical lead for monkeypox in the WHO Health Emergencies Program.

However, “I’m concerned that individuals can get this infection from high-risk exposure if they don’t have the information they need to protect themselves,” she said. “And since the end of smallpox eradication, the world’s population is not immune to the orthopox virus, so we are worried that the virus may try to exploit the niche and spread more easily among people. doing.”

Health officials say that anyone can get the virus, Members of the LGBTQ community At this point, the risk of exposure seems to be high.

“What we are seeing now begins with a small population of cases, after which the investigation has rapidly led to the discovery of infections in a group of men who have sex with men … and we are still the actual cause. I don’t know what the outbreak is, “Lewis said on Tuesday.

“The most important thing right now is not to be stigmatized,” she said.

Many other protracted questions can also change our understanding of how well the virus spreads from person to person. For example, it is unclear how widespread it will be if the symptoms are minimal and how mutations can affect the virus.

Adalja said there was no reason to worry about these points yet.

For one thing, the fact that doctors see many cases with lesions in the crotch, as opposed to more common areas such as the face, hands, and feet, is the fact that symptomatic people with skin lesions. Spread, Adalja said, suggesting to him that close contact with him is more likely.

It is important to remove all mutations in the virus found in monkeypox, but the virus is relatively slow because its genome is made up of double-stranded DNA, which is more stable than coronavirus single-stranded RNA. Mutates.

Warobib said in an early study of Edinburgh that the pace of these mutations seemed to be somewhat faster. However, he added, the global outbreak is probably related to access to new circles that are susceptible to the virus, not “a relatively small number of mutations that have accumulated since 2017.”

“There is no answer to this, I really don’t know,” Lewis said last week as to whether the virus is currently changing in a significant way.

“There is still no evidence that the virus itself has a mutation. We are starting to collect that information,” she said. “We will convene a group of virologists and other experts to discuss this very question based on the genomic sequences of some of the cases that have been detected.”

Meanwhile, health authorities around the world continue to track cases and their contacts to better understand how the virus is spreading and how to stop it.

“Now we have to do everything we can to stop the infection in the community,” Limoin said.