I should have seen monkeypox coming

Almost 5 years before the rare Cluster of monkeypox cases in the United Kingdom What surprised the world was that doctors were dealing with a rare monkeypox herd in another unexpected country, Nigeria. Although the virus is endemic to Central Africa, no cases of monkeypox have been recorded in Nigeria, far west. Since 1978.. Doctors first suspected chickenpox when an 11-year-old boy presented with skin lesions in September 2017. But no, the test pointed out a much rarer monkeypox. From 2017 to 2022, Nigeria 500 confirmed monkeypox cases.. Suddenly, it seemed that the virus had begun to spread somewhere new.

Even in Nigeria, first of all, a doctor Pick up new pattern tips It will be repeated all over the world. Most of the patients are male and many have genital lesions, suggesting infection by sexual contact. 4 years later Many cases in Europe and the Americas It is also found in men and is also characterized by genital lesions. “It looks like déjà vu to me,” says Dimy Ogoina, a doctor at the Niger Delta University Teaching Hospital, who treated the first and many cases of monkeypox in Nigeria in 2017. Infectious pain and physical contact with scabs — but gender in particular was never high on the list of infectious risks. (Past cases have usually been associated with wildlife or home contact.) Abnormal patterns and scales of outbreaks in Nigeria indicate that something has changed to monkeypox. There should be. But the world ignores it until it’s too late, and the global outbreak is now on track.

“What happened in Nigeria in 2017 was an absolute warning sign,” says Anne Rimoin, an epidemiologist at UCLA who studied the virus. But as long as monkeypox remains in Africa The illness received little attention.. The United Kingdom, Singapore and Israel have taken up occasional incidents related to their trip to Nigeria. 2018 and 2019.. “There could have been a lot of imported goods that were overlooked,” says Limoin. And it seeded the local transmission that is currently finally detected. The exact route the virus has taken around the world is unknown, but the viral genomes so far sequenced from Europe and the United States are most closely associated with those associated with the development of Nigeria.

In fact, spare Genetic analysis Scientists at the University of Edinburgh suggest that the evolution of this monkeypox line has suddenly accelerated between 2017 and 2022. Poxviruses tend to accumulate mutations at a fairly slow rate, once or twice a year, but there are a whopping 47 mutations in the 2022 genome. Interestingly, almost all changes to the genetic code are TC to TT or GA to AA. This is unlikely to be caused by a random copy error. Instead, it resembles the characteristics of the immune system mechanism found in both humans and animals that introduce mutations in an attempt to nullify the virus. This signature is found in many common viruses. Including SARS-CoV-2Said Nicholas Gillet, a biologist at the University of Namur who studied this. Defense mechanism.. Richard Neher, a biologist at the University of Basel, can think of most mutations as “scars” from the fight against the host’s immune system, but it’s unclear if they are adaptable. In any case, monkeypox seems to have discovered a new host since 2017. Another animal that infects humans directly or spreads the virus to humans.

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The lack of attention to monkeypox means that basic questions such as which animals actually spread the virus remain unanswered.Despite the name, monkeypox is more Commonly found in rodentsCan infect a wide range of species, including primates and primates rabbit.. Bogma Titanji, an infectious disease doctor at Emory University, says “I don’t know” about the natural animal reservoir of the virus. In addition to the outbreak in Nigeria that began in 2017, another outbreak of more severe monkeypox is intensifying around the Democratic Republic of the Congo, where the virus has been endemic for a long time.Congo saw 1200 cases and 58 deaths this year alone..

There are hundreds of cases outside of Africa, especially in developed countries, and “there is only a noticeable change” now, “says Titanji. Early investments in research may have identified strategies to prevent spillover from reservoirs before they occur. And now, scientists around the world are struggling to understand the full range of monkeypox transmission and symptoms in the midst of a global outbreak. “We could have done this faster and more preemptively,” she says.

“Most of our information on epidemiology and clinical symptoms [comes from] “Early 80’s,” says Limoin. Monkeypox was of particular interest because doctors were worried that it would be wiped out following a more serious eradication of smallpox. But since then, monkeypox has been “sadly ignored,” said David Hayman, an epidemiologist at the London School of Hygiene and Tropical Medicine, who studied the virus in Congo. He checked the list of basic questions he wanted to answer. Are there asymptomatic infections? Is its asymptomatic form transmitted to others? Are you infected by a vector when you sneeze or cough? No such thing is known. “

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In particular, Heymann states that the milder West African virus clade in Nigeria and now around the world can behave differently than the more serious and slightly characteristic ones found in Congo. Very sick people are less likely to travel, so their relatively mildness may have helped spread it. Heymann adds that not all people infected with the West African clade usually develop a common virus-related rash. And the potential for sexual communication is not fully understood. Since monkeypox pain can occur in many parts of the body, the appearance of monkeypox in the genital area begins as a random event and can be spread by physical contact during sexual intercourse. However, it is unclear whether the virus spreads through semen or vaginal fluid. The 2017 outbreak in Nigeria had already suggested the role of infection during sex, but no such studies have been conducted.

As monkeypox becomes more widespread worldwide, patients in Europe and North America are taking antiviral drugs. health care worker When Close contact with the patient Vaccines are provided. But at his hospital in Nigeria, doctors didn’t have antivirals or vaccines, Ogoina says. All they had for monkeypox patients was supportive care. In addition, the number of cases may currently be underestimated. “We need to increase surveillance,” he said, with more laboratories capable of diagnosing the virus, antibody studies to study its prevalence, and surveillance of potential animal carriers. Point out the need.

s country With Europe North America It may be possible to tame their monkeypox outbreak. But “the possibility of getting infected everywhere can get infected everywhere,” says Limoin. As long as monkeypox is endemic in Africa, monkeypox will continue to sow cases elsewhere. And it will make African people sick and continue to kill them. Signs of early warning of monkeypox have been there for a long time, and they should now not be negligible.