analysis | How are we prepared for a monkey chickenpox outbreak?


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According to the World Health Organization (WHO), there are currently 131 confirmed cases and 106 suspected cases of monkey pox in 19 countries. Experts describe the incident as “random,” but “controllable,” and may have initially been triggered by sexual activity at recent raves in Spain and Belgium. And yet, as the world continues to wrestle with the effects of the coronavirus pandemic, the rise of other diseases is putting many at risk.

Bloomberg Opinion’s Bobby Ghosh and Bloomberg Intelligence’s Senior Pharmaceutical Analyst Sam Fazeli have a live Twitter space discussion to get information about the disease and what we should be concerned about. I found out whether or not

Bobby Ghosh: Let’s start with the most basic question possible. What is a monkey head?

Sam Fazeli: The number of viruses circulating in nature seems endless. This is one of them. It is an orthopox virus like smallpox. Monkeypox is less of a problem than smallpox in terms of mortality. The current virus appears to be a strain prevalent in West Africa.

We’ve known about both variants for decades. Both are endemic in other parts of Africa, such as Central and West Africa, respectively, with occasional reports of cases outside the continent, and usually people traveling from affected areas. However, this outbreak seems very unusual in that it is being reported simultaneously from many parts of the world. What’s up?

In fact, there were 71 outbreaks in the United States in 2003, not from people traveling, but from rodents imported from Ghana. The rodent infects pet prairie dogs and then infects people. There was some local transmission potential at the time, but it certainly passed from animals to humans. That’s the problem we’re dealing with in many virus outbreaks, from avian flu to covid.

In view of today’s exceptional outbreaks, we must recognize that it is too early to be certain whether the virus has truly been seeded separately from other countries, or at least most cases have arisen from superspreader events. The best way to know how related the cases are is to order them. The first genomes were released by Portuguese scientists and found that the virus closely resembles those found in several countries in 2018 and 2019. This tells us that not much has changed already. All of this is going to be fixed, but hopefully you can see that most of these cases are actually relevant.

As a side note, it’s worth resolving that although it’s called monkeypox, it doesn’t actually come from a monkey. We only began to pay attention to it when the monkeys began to understand it. Does it now come from apes? What do you know about how diseases are transmitted?

Orthopox viruses, especially monkeypox, are considered generalists. This means that this virus can and can infect a variety of species. Rodents were the most common carriers of infection, followed by monkeys and now humans. Transmission can occur relatively easily, not necessarily via a specific path. In this case, the position is that relatively close contact is necessary because it is spread through contact with the contaminated body fluids of an infected person.

Chances are that most transmission is with someone who has the virus so close that you pick up their exhaled droplets or come into physical contact with them. It can also be transmitted by a vector that touches surfaces touched by an infected person.

In fact, there are reports that most of it occurs through close contact or intimate contact, including sexual intercourse with people.

I think we have to be very careful not to misinterpret conversations and the information that comes out. Just because most cases have been found in men who have had sex with men doesn’t mean anything about STDs. We are only looking at how this particular outbreak occurred. Heterosexual or anything else can easily be another kind of intimate contact.

What are the symptoms of monkey chickenpox?

It starts with a headache and fever, common things to do when you have a viral infection. These symptoms are basically defense systems working. The body raises the temperature because many viruses do not like higher temperatures. Headaches and muscle aches are caused by all the chemicals, like cytokines, that are released to fight infection. Then, within 1 to 2 weeks, some people develop a rash that develops into pustules.

If covered with these pustules, there is a risk of bacterial infection and, in some cases, sepsis. It can be fatal there.

There have been 0 deaths so far in this particular cluster. A lot has been said about 1-3% mortality or 10-13% mortality in Central Africa, but it should be remembered that, like the corona virus, it depends on how you take care of the patient. The risk of death is higher if the patient is at home with no oxygen available, no ICU, and no medical professionals to care for them. This may be the situation in rural Africa where these numbers are calculated, but in countries with good health and drugs, we are confident that the mortality rate will remain below 1%. Hopefully!

The symptoms remind me of my childhood when I had chickenpox. I remember being in bed for several days and being very uncomfortable. Then it disappeared. Do we know if monkey chickenpox is more painful or more threatening than chickenpox?

If the skin is full of pustules, it is a much more uncomfortable infection. But it depends on the situation. I’ve heard stories about people who have previously been vaccinated against smallpox. They had only one or two lesions and nothing. I assume and hope that most people who have already been vaccinated will. The question concerns people who are not vaccinated. How bad do they get it?

I was vaccinated against smallpox as a child because I grew up in India in the 1970s and 80s. Since then, smallpox has been eradicated and the vaccine is no longer available in many countries. Does it make us more susceptible to monkey pox?

Yes, I think so. This is what is happening here. There have been suggestions that the COVID-19 lockdown may have increased our vulnerability to disease. It can be said that the flu and coronavirus are both respiratory viruses. But in reality, I think this is a coincidence. We have a virus endemic to Central and West Africa and have been given a chance to spread it among people who have never seen an infection or a vaccine that provides protection against the virus.

The good news is that, unlike coronavirus, a vaccine already exists. We have a vaccine that works both prophylactically and after illness. So it can be both preventive and curative at the same time.

you’re right. A few days after the infection was diagnosed, the vaccine still seems to work. Interestingly, both vaccines are available today. In these circumstances, stocks may not be as high as desired, but many countries are already stockpiling them out of fear of monkey pox and fear of bioterrorism attacks by smallpox.

Because the disease is less contagious than Covid, not everyone needs to be vaccinated. It can be used to treat people who have been diagnosed and to vaccinate those around them. This method is called the ring vaccine and has previously been proven to be successful in controlling smallpox.

There has been a lot of discussion about whether poor countries can afford a COVID-19 vaccine. Is it a problem with the monkeypox vaccine?

Pfizer’s coronavirus vaccine was between $15 and $20. For most people living in the UK, Sweden or the US, they offer protection, so it won’t cost you much. I expect to purchase vaccines for countries that cannot afford to afford vaccines equivalent to COVAX in order to control and better manage the global spread of this virus. At the same time, the cost is clearly determined by the volume. If you only need 1 million doses instead of 400 million doses, the company will probably have to charge a bit higher because margins are lower on this kind of volume. But I don’t expect this to be a very expensive vaccine.

It’s safe. How did the leaders respond to the monkey head? President Biden felt compelled to answer questions about it during his visit to Korea. Did we learn anything particularly useful about dealing with monkey heads in the fight against coronavirus at the policy level?

The good thing is, as we’ve already said, this isn’t necessarily a living memory of many, but it’s not a disease we haven’t dealt with before. It’s only been 50 years since we stopped the smallpox vaccination program. Bavarian Nordic, one of the smallpox vaccine manufacturers, has already held meetings with national health authorities in the last few days, scheduled six months ago. This shows that countries are already thinking about it. It doesn’t really matter if what they’re thinking is closer to smallpox than monkeypox.

Is there any reason to think monkey chickenpox is seasonal?

During the season when more people are outdoors than indoors, we expect a decrease in most infections, especially respiratory infections. However, it is transmitted by contact. So I don’t think it can be classified as a season system.

How about the variant that was the real problem with Covid? Has the simian varicella virus shown signs of developing new variants that are resistant to existing therapies?

It’s too early to know. Nigeria collects good epidemiologic data, but not close to the SARS-CoV-2 scale, with the number of monkey chickenpox cases. Since SARS-CoV-2 is also an RNA virus, it would be more likely to mutate.

The initial data we got from Portuguese scientists suggest that the virus’ genome is similar to what it had in 2018 and 2019, which is quite reassuring. However, the fact that mutations occur when the virus multiplies to a high level is unavoidable. So we have to monitor it.

What do we do to protect ourselves from monkey pox?

We’ve been through this with Corona. We all have choices like putting on a mask depending on our circumstances. If you feel anxious or threatened, you can take precautions. But I think most scientists expect this to eventually limit itself. Especially since awareness is not easily communicated when it is so heightened.

Several weeks have passed since the rumors and cases have been reported in several countries. Are we seeing more research already being done on this outbreak?

I know that genomics people are working 24/7 on the genome sequencing of viruses to better understand their epidemiology. This is best when you only know 200 cases of how these events are potentially related to each other. We already have at least two drugs and at least two vaccines to treat the virus. So I don’t think we need to do a ton of research. What we have to do here is to put in place the right medical public health policy to manage it and decide where we’re going next. Would you like to go back and vaccinate everyone who hasn’t been vaccinated? Or is it managed using a ring vaccine?

See More Works with Bloomberg Opinions

• Monkey chickenpox doesn’t look like a coronavirus-sized threat: Lisa Jarvis

• Women who made Britain the world’s best in genomics: Raphael & Fazeli

• SIDS remains a heartbreaking and unexplored mystery: Lisa Jarvis

((Remove the reference to non-orthopoxvirus chickenpox in paragraph 4))

This column does not necessarily reflect the views of the editorial board or Bloomberg LP or its owners.

Sam Fazeli is a Senior Pharmaceutical Analyst at Bloomberg Intelligence and Research Director at EMEA.

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