analysis | Why eradicating smallpox triggers risk of monkey chickenpox

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The global eradication of smallpox more than 40 years ago is one of the greatest achievements in public health history, ending the deaths, blindness and deformities that have plagued humanity for at least 3,000 years. On the negative side, however, it has led to the end of a global antivirus program that provides protection against other varicella viruses. This includes monkey heads shed from animal hosts to infect humans in Africa with increasing frequency since the 1970s. More recently, monkeypox triggered outbreaks in Europe and North America and reached Israel, Australia and Argentina, again demonstrating how easily an epidemic emerging from a single country can become an international problem.

Monkeypox is a misnomer given the fact that it was first discovered in 1958 when monkeys bred for research developed a disease similar to chickenpox. Monkeys are susceptible to it, but like humans, they are not a source. This virus belongs to the genus Orthopoxvirus, which includes the variola virus that causes smallpox. vaccinia virus used in smallpox vaccine; and vaccinia virus. Monkey pox is less contagious than smallpox and has milder symptoms. According to the World Health Organization (WHO), about 30% of cases of smallpox have died, and the mortality rate of recent monkey chickenpox is about 3-6%.

2. What does monkey pox do?

Usually after an incubation period of one to two weeks, the disease usually begins with fever, muscle aches, fatigue, and other flu-like symptoms. Unlike smallpox, monkeypox also causes swelling of the lymph nodes. Within a few days of developing a fever, patients develop a rash, often starting on the face and spreading to other parts of the body. The lesion grows into a fluid-containing pustule that forms a scab. Lesions in the eye can lead to blindness. According to the WHO, the disease usually lasts 2 to 4 weeks. The person is contagious from the onset of symptoms until the scab falls off. Mortality rates are higher in children and young adults, and people with compromised immune systems are particularly at risk of serious illness.

3. How is it delivered normally?

Monkeys do not spread easily from person to person. Contact with the virus from animals, people, or contaminated objects is the main route. The virus enters the body through damaged skin, respiratory tract, or mucous membranes of the eyes, nose, or mouth. Transmission from one person to another is thought to occur through respiratory droplets during direct and prolonged face-to-face contact. However, it can also occur indirectly through contact with body fluids or lesions, or through contact with contaminated clothing or linen. It can be killed with common household disinfectants.

4. What’s special this time around?

There have been several transport chains in clusters from different countries that do not normally report monkey pox.

• Cases do not include recent travel to areas of West and Central Africa where the disease is endemic.

• Flu-like symptoms do not always precede the rash, and some patients have been treated first for genital and perianal lesions that may be difficult to distinguish from syphilis, herpes simplex virus, herpes zoster, and other common infections. to the U.S. Centers for Disease Control and Prevention.

• Many cases have occurred in men who have had sex with men, and many have occurred within sexual networks.

• Analysis of the gene sequence of the virus collected from some patients in Europe indicates that the spreading strain is of a single origin. It belongs to a branch of the West African tree or evolutionary tree and is most closely related to the virus found in cases exported from Nigeria to the UK, Israel and Singapore in recent years. Monkey head virus strains of this strain have a mortality rate of 1% to 3.6%. (This compares to 10% for the Congo Basin, a second clade that appears likely to pose a serious threat to the US government’s list of bioterrorism agents.)

5. Where does monkey pox come from?

Although rodents are suspected to be involved in transmission, the storage host or major vector of monkeypox disease has not yet been identified. It was first diagnosed in humans in 1970 in a 9-year-old boy in the Democratic Republic of Congo. Since then, most human cases have occurred in the rainforests of Central and West Africa. In 2003, the first outbreak outside of Africa occurred in the United States and involved animals imported from Ghana to Texas and infected pet prairie dogs. Dozens of cases have been recorded in that outbreak.

6. Is monkey pox an epidemic threat?

Outbreaks are rare outside of Africa. There have been at least eight known export cases since 2017, usually involving overseas travelers, but generally no transmission since. Person-to-person transmission raises concerns that the virus may undergo genetic changes that allow it to spread more efficiently from person to person. The DNA sequences of viruses collected during a recent epidemic contain a larger set of mutations than would be expected given the natural evolution of the viruses involved, researchers in Portugal said in a report published on May 23. It is not yet known whether there are genetic changes. However, it has some clinical implications.

7. How to treat and prevent?

The disease is usually mild, and most people recover within a few weeks. Treatment is primarily aimed at relieving symptoms. The CDC says smallpox vaccine, antiviral drugs, and vaccinia immunoglobulin can be used to control monkeypox outbreaks. Smallpox vaccination can be used both before and after exposure, and according to the UK Health Security Agency, which provides the Imvanex smallpox vaccine to people who have been in close contact with someone diagnosed with monkeypox, it can reduce monkeypox prevention by 85%. Effective. It lists cidofovir and tecovirimat as antiviral agents that can be used to control monkeypox outbreaks. Tecovirimat was approved for European monkey chickenpox in 2022 based on animal and human study data, but has not yet been widely used, according to the WHO. A newer vaccine based on a non-replicated version of the vaccinia virus has been developed, one of which is approved for the prevention of monkeypox. The main way to prevent infection is to isolate a patient suspected of having monkey head in a negative pressure room and ensure that medical staff wear appropriate personal protective equipment.

8. Is there testing for monkey head?

yes. Monkey chickenpox is diagnosed using a polymerase chain reaction (PCR) test to detect viral DNA in a sample taken from a scab or swab from a patient’s lesion. In the United States, it is available from the State Department of Health and the CDC.

(Adding details of spread in the first paragraph, information on early signs in section 4, gene mutations in section 6, and information on smallpox vaccine use in the UK in section 7.)

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