New substrain of monkeypox virus emerges

Monkeypox was a neglected disease until earlier this year. The disease has been endemic in Central and East Africa for many years, although there have been few reports of cases, some from travelers. Monkeypox, first identified as an imported monkey disease in Denmark in 1958, is a zoonotic disease that infects humans and other animals. However, the name “monkeypox” is still a misnomer for the disease, as the origin and cause of the disease are unknown.

The World Health Organization (WHO) has raised international concern about the monkeypox outbreak after a series of cases linked to a super-spreader event in Europe in May-June of this year were identified and then spread rapidly around the world. has been declared a public health emergency. (PHEIC). As of September 2022, more than 50,000 cases of monkeypox virus infection have been reported from more than 99 countries. More than 15 of his deaths attributed to the disease have been reported, eight from places historically where monkeypox has not been reported, including one of his from India. increase.

world affairs

As of September 2022, 10 countries – US, Brazil, Peru, Canada, Spain, France, Germany, UK, Netherlands and Portugal – account for the majority of cases (over 88%). Although the disease primarily affects men aged 30-43, we know that demographics vary by region. For example, West and Central Africa are reporting more cases among young people.

Decrease in Europe

The number of reported monkeypox virus infections worldwide fell by more than 20% in the last week of August 2022, despite an increase in the number of global cases for the fourth consecutive week. Cases in European countries.

Since the outbreak began, European countries have reported a cumulative total of more than 20,000 monkeypox cases, including two deaths reported from Spain. The first case of an outbreak in the region was reported in May 2022 in the United Kingdom, in a man with travel history to Nigeria. Increased awareness and public health measures, including vaccination, are likely responsible for the observed decline.

As cases show a declining trend globally, the number continues to rise in the United States. Cumulatively, the United States accounts for more than 30% of her global cases, with more than 18,000 infections reported from the country to date. The first death in the United States associated with monkeypox was reported from Texas. The case remains under investigation by health officials to determine what role monkeypox played in the patient’s death, but early reports from the country indicate that the patient is severely immunocompromised. I was falling into A small proportion of pediatric cases of monkeypox have also been reported from the United States, and as cases rise in the country, more cases may be found among young children and other vulnerable groups.

Cases continue to rise in the United States, but the rate of increase in cases has plateaued and is probably declining. In recent weeks, major US cities, including New York, San Francisco and Chicago, have seen a drop in cases following trends in Europe. As in Europe, this decline could be attributed to the impact of vaccination campaigns and changes in behavior and awareness among high-risk populations, although more data over the next few days will reconfirm the trend. will be done.

Despite a slow decline in the number of cases worldwide, monkeypox cases continue to rise rapidly in Latin America, likely due to a lack of awareness of the disease and insufficient vaccine availability. Brazil and Peru reported the majority of cases, with a total of three deaths reported from Brazil, Ecuador and Peru, among all countries in the region. The case is still under investigation to confirm that monkeypox was the cause of death. Peru also has the third highest monkeypox infection rate per million people in the world.

Currently, only a minority (5%) of monkeypox cases are reported among healthcare workers worldwide, but most cases are reported to have been transmitted in the community. So far, he has only had three cases of monkeypox attributed to occupational exposure, but further investigation is needed to confirm the risk of HCAI.

Variant Tracking

As genomic surveillance continues to provide an opportunity to track the evolution of the monkeypox virus, WHO has decided to give names to the different variants of the virus, taking into account suggestions put forward by scientists for a promiscuous naming system. stipulated a process for attaching Following the new nomenclature, the subspecies of monkeypox virus formerly known as the Congo Basin or Central African clade is designated as clade I, with the former West African variant being the major clade circulating in the current outbreak. is designated as clade II. Clade II of monkeypox viruses includes two subclades called clade IIa and clade IIb.

Continuous genome surveillance of monkeypox yielded over 1,500 genomes available in the public domain that provide unique insights into viral evolution and spread. At least two different strains of the virus are known to be circulating in the current outbreak. The European outbreak was primarily caused by his IIb.B.1 lineage of the virus, but now also a separate, smaller lineage (IIb.A.2) containing genomes from India, Britain, the United States, and Thailand. identified. This lineage likely predates the European outbreak and may have been inexplicably spread for nearly a year. The continued spread of the IIb.B.1 lineage, which contains most of the genome, has given rise to many substrains. Most recently, Peru (B.1.6), Great Britain (B.1.7) and Germany (B.1.8).

The current monkeypox outbreak exposes many gaps while many lessons have been put into practice from the ongoing COVID-19 pandemic. Even if cases are brought under control in countries in Europe and North America, a global effort will be needed to curb the spread of the virus in regions such as Latin America and Africa.

Required steps

While more in-depth science will be needed to better understand pathogens, evolution, disease mechanisms, and vaccine efficacy, continued surveillance is key to preventing future outbreaks of disease. . For example, the volume of asymptomatic monkeypox infections and the effectiveness of vaccinia vaccines in preventing spread are of urgent importance. While the current outbreak calls for global unity and cooperation, it is unfortunately testing many of these concepts. Despite the fervor of wealthy governments to monopolize a greater proportion, if not all, of vaccines produced, the lack of vaccine availability in Africa, where vaccines are most needed, is a global threat. It calls into question the integrity of our efforts for health and equity.

As we look forward to fighting more outbreaks in the future, we must keep in mind that no one is safe until everyone is safe.

( The authors are researchers at the CSIR Genome Integrative Biology Institute (CSIR-IGIB), Delhi. All views expressed are personal.)