Decade of warnings about growing monkeypox threat ignored

A second alarm was raised in late 2017 when Nigerian health officials confirmed the country’s first case in nearly 40 years: an 11-year-old boy with lesions on his face and limbs, suspected of chickenpox. was taken to hospital in one case.

“His symptoms were very unusual compared to chickenpox,” Dimmy Ogoina, the doctor who treated the boy, said in an email. Bigger than chickenpox, doctors quickly learned they were dealing with more than isolated cases. Two relatives said they had experienced similar symptoms in Niger, where he Ogoina and his colleagues at Delta University Teaching Hospital diagnosed monkeypox and alerted health officials.

their published report Two years later, I concluded that the virus is not only spreading from animals to people, but from people to people. And it appeared to be transmitted through a potentially dangerous new way: sexual contact.many Many of those infected were young men, and previous monkeypox outbreaks in the area had a significant impact on children.

The World Health Organization says: in your own report Regarding the 2017 outbreak in Nigeria, it said: Some may suspect sexual transmission.

But the broader health community paid little attention. Within eight months of Ogoina’s report, the novel coronavirus had circled the globe, overshadowing virtually every other global health problem.

The 2017 Nigerian outbreak, believed to be the source of the current epidemic, has attracted serious concern this spring when monkeypox spread to dozens of countries in the West, including the United States.By then the world’s carelessness had left him with two clades, or types Virus Smoldering: The West African version of Ogoina’s encounter in Nigeria is now being replicated around the world. with a mortality rate of less than 1%, Mortality is around 10% in the more severe Congo Basin version. In the United States, mostly gay and bisexual men, he has more than 10,760 confirmed cases and no monkeypox-related deaths.

“I should have listened to people like Dimmy Ogoina who said, ‘This is circulating, and it seems to be circulating mostly through sexual transmission.'” “The epidemic should have been eradicated before monkeypox appeared,” said the University of Arizona, which is conducting the study.

Worobey, who once fought bushfires in British Columbia, says the same approach is needed to stop the epidemic.

When lightning struck, he said: What we’ve done here has allowed us to be 1,000 acres on every continent instead of one tree here and there. ”

W. Ian Lipkin, an epidemiologist at Columbia University, He argued that the monkeypox outbreak did not represent a public health failure, but an example of the “massive challenge” of predicting which of the 100 global outbreaks poses the greatest threat.

“It’s a fire hose,” he said of the myriad of viruses and pathogens. “How do you decide where to look?”

In a statement, WHO defended its record on monkeypox, saying, “For decades, even before the first human case was identified, we worked with relevant ministries of health, research institutes and communities to identify monkeypox. I have been working on it,” he said. In Nigeria in 2017, WHO helped her CDC in the country launch a response, he said. Given the increasing risk of monkeypox, officials are also advocating for the development of additional treatments, vaccines and clinical trials, the statement said.

“Big warning signal”

Monkeypox virus was first identified and named after a Danish laboratory monkey in 1958.. The first human case It was not reported in Congo until 1970.

By 1980, study A World Health Organization bulletin recorded just 47 cases scattered across Central and West Africa in the past decade. Monkeypox had been found in laboratory and zoo animals, but the authors of the paper wrote: The source of human monkeypox infection is still unknown. They noted that “human-to-human transmission” may have occurred in four of the 47 cases.

That same year, world health leaders declared smallpox eradicated, and Congo stopped vaccinating against a more serious disease, although it belongs to the same virus family as monkeypox.

In 1987, researchers using computer models predicted The lack of smallpox vaccination, which has protected people from similar viruses, will lead to more monkeypox cases. “Very unlikely,” he concluded.

Rimoin’s findings suggest low certainty. She and her colleagues reported 760 confirmed cases in the Congo between 2005 and 2007, most of which were preventable for smallpox. These were children born after vaccination was discontinued in 1980.

So far, the virus has only penetrated once. to the United States — The 2003 outbreak resulted in 71 confirmed and suspected cases in six states, the majority in Wisconsin. These cases spread to people from pet prairie dogs kept near infected small mammals imported from Ghana.

However, in 2003 it was unclear whether the virus was transmitted exclusively from animals. While all infected people are interacting, In animals, two also reported contact with another patient’s lesion or ocular fluid.In contrast to the current outbreak, the virus It will disappear in a little over a month in 2003.

DNA viruses such as monkeypox have a much larger genetic blueprint than RNA viruses such as SARS-CoV-2 and typically evolve more slowly. But evolutionary biologist Trevor Bedford at Fred Hutchinson Cancer Center says the monkeypox mutations are occurring much more rapidly than expected, and that he’s not once a year but once a month. It has occurred about once.

Viruses are opportunistic and all you need is To Find the right environment to grow.

“When it comes to HIV, it’s almost certain that these viruses jumped into humans from chimpanzees and possibly gorillas probably for thousands of years,” Worobey said. Steamboats have started to operate on the Congo River, on railways, on roads, in cities, and in cities there is such a thing as prostitution that really helps the transmission of sexually transmitted disease viruses.”

“We get the same virus that for thousands of years we couldn’t make a living in humans, but now we can,” he added.

Several factors in recent decades seem to have provided an opportunity to exploit monkeypox.

The first is likely to have eradicated smallpox, one of only two diseases humans have wiped from the planet (the other is rinderpest, an animal disease).

In addition, repeated civil wars in Congo, deforestation for logging and agriculture, and slaughter of animals for meat have increased contact with virus-carrying animals. However, these trends and their impact on monkeypox infections have failed to generate a significant response from health officials.

“It’s much easier to get out of trouble than out of trouble. Didn’t we heed these warnings?” Limoyne said. “What happened in Nigeria should have been a big warning signal.”

Instead, she said, “everybody in the world was pushing the snooze button for a pathogen that could obviously take off.”

Researchers believe that the current outbreak started in Nigeria because the mutational pattern in virus samples taken from patients in 2017 persisted and has spread to date.These mutations were different from those It is found in the animal version of the virus. They showed traces of encountering human proteins that fight viruses as part of the immune response.

While some viruses are transmitted from animals to humans and do not cause sustained outbreaks, Bedford said: Human-to-human transmission is a concern. “It creates evolutionary pressure to make the virus better at transmitting between humans,” he said.

The success of monkeypox depends not only on human behavior, but also on where the mutation infects the virus. Most mutations alter the genetic characteristics of monkeypox but not its ability to function. This will allow health officials to track the virus and identify clusters of infected people. in Nigeria since 2017 and from other countries this spring.

In the worst-case scenario, mutations could make the virus more deadly and infectious. At best, accumulating mutations at a rate ten times faster than normal can lead to changes that threaten the viability of the virus.

“But don’t hold your breath to stop this epidemic,” Worobey said. “It’s not an instant process.”

Scientists’ biggest fear is that monkeypox may take hold forever It has gained a foothold in the United States and other countries, joining viruses such as HIV and influenza. Finding a reliable animal reservoir in the United States or elsewhere increases the chances of that.

“I think it’s certainly possible,” Rimowan said.

In 2010, she and her colleagues warned that American ground squirrels are highly susceptible to viruses. “If monkeypox becomes established in wildlife reservoirs outside of Africa, it will be difficult to reverse public health setbacks,” they wrote.