In a post on social media, Elias Mosialos, professor of Health Policy at Imperial College and the London School of Economics and Political Science (LSE), answers 14 questions about her virus. smallpox of monkeys.
The following is the full text of Elias Mosialos’s post:
“On May 7, the United Kingdom Health Insurance Agency (UKHSA) announced that someone who had recently traveled to Nigeria had contracted the monkey pox virus. Regarding the patient’s history: he developed a rash on April 29 and returned to the United Kingdom on May 4, where he was hospitalized. Two days later, it was laboratory confirmed that the person had a smallpox virus infection. The contact detection started on May 11 and to date the contacts have reported no symptoms. In England, 7 out of 8 cases do not involve a recent trip to Africa, suggesting that patients involved in these cases have contracted the virus in England. In addition, these individuals had no contact with the patient who traveled to Nigeria.
Currently, there are less than 100 recorded cases worldwide (in some European countries, Canada, America, etc.). I believe that we will soon have thorough information from the responsible health agencies (UKHSA, ECDC, CDC, WHO).
But what do we know so far?
1. Is this a new virus?
No, it is a zoonotic disease, endemic to many parts of Africa. Although it was first detected in monkeys in 1958 (hence its name) it is highly transmitted among rodents.
In Portugal, the first analysis and mapping of the genetic material of the virus from a patient sample has already been done, which confirms that it is the monkey pox virus (https://virological.org/t/first-draft-genome-sequence-of- monkeypox-virus-associated-with-the-suspected-multi-country-outbreak-may-2022-confirmed-case-in-portugal / 799).
2. How is it transmitted?
From animals through close contact with humans, mainly from biting, scratching or contact with any animal body fluid. It is rare but can also be transmitted between people who have very close contact. Transmission can occur through contact with body fluids and respiratory droplets, for example from fluid blisters appearing on a patient’s skin, or if one approaches large enough to inhale large airborne droplets. These droplets generally can not travel more than about 1 meter (according to the US Centers for Disease Control and Prevention). In addition, touching clothes, bedding or towels used by monkey pox can also be a risk.
3. What symptoms does it cause?
It causes fever, body aches, swollen lymph nodes, and eventually “smallpox” – these painful, fluid-filled blisters on the face, arms and legs. Monkey pox is usually mild, with most people recovering without treatment in 14 to 28 days. THE infection can be divided into two periods:
A. period of invasion (lasting up to 5 days) and is characterized by fever, severe headache, swollen lymph nodes, back pain, muscle aches and severe weakness (lack of energy). This swollen lymph nodes are a hallmark of monkey pox compared to other diseases that may initially appear similar (such as chickenpox, measles, smallpox).
B. skin rash usually begins within 1-3 days of the onset of fever. The rash tends to be more concentrated on the face and limbs than on the torso. Also affected are the oral mucosa (in 70% of cases), the genitals (30%), the eyes (conjunctiva by 20%), and the cornea. The rash develops sequentially from spots, which gradually develop into vesicles (filled with clear liquid), blisters (filled with yellowish liquid) and crusts that dry and fall off.
4. Do blisters cause itching, as in chickenpox?
No, and there is one point where these diseases are different: in smallpox the monkeys have blisters, while in chickenpox the patient has itching. Only during the healing phase when the skin regenerates, in monkey pox, do patients report itching.
5. How contagious is the detected strain?
The virus that circulates belongs to a mild strain (West African) and the mortality rate it can cause is 3-6% if there is no therapeutic intervention or vaccination. Monkey pox is less contagious than smallpox and causes less serious illness.
6. But why do we see a reappearance?
People under the age of 40-50 (depending on the country) may be more susceptible to smallpox due to the cessation of smallpox vaccination campaigns worldwide after the eradication of the disease.
7. How contagious is the virus compared to the coronavirus?
It is not as contagious as the coronavirus, and has a different transmission curve. That is, it is much less contagious in the initial -asymptomatic- phase and becomes more contagious when the symptoms begin.
That is, it is really contagious from the moment symptoms appear. And the definition of the “course of the disease” is until the wounds heal and a new layer of skin is formed. This can take quite a long time, maybe several weeks.
8. Is there a vaccine?
Yes, there is a vaccine (the smallpox vaccine) which is about 85% effective in preventing serious illness and can also be given to immunosuppressed people. Early smallpox vaccination can lead to a milder illness.
9. So this virus can be treated?
Yes, with the immediate and selective vaccination of the contacts of someone who got stuck.
10. Are there any treatment methods?
Clinical care for patients with smallpox in monkeys should be fully optimized to relieve symptoms, manage complications, and prevent long-term consequences. Patients should be provided with fluids and food to maintain a proper nutritional status. It is very important to treat any secondary bacterial infections that may occur. An antiviral – known as tecovirimat – developed for smallpox was licensed by the European Medicines Agency (EMA) for aphids in 2022, based on data from animal and human studies but is not yet widely available. If used, tecovirimat should ideally be monitored in a clinical trial with prospective data collection.
11. When should someone be vaccinated?
Vaccination is effective even after exposure to monkey pox virus. However, the sooner an exposed person gets the vaccine, the better. The US Centers for Disease Control and Prevention (CDC) recommends that the vaccine be given within 4 days of exposure to prevent the onset of the disease. If given between 4-14 days after exposure, the vaccine reduces the symptoms, but usually can not prevent the disease.
12. How can the risk of transmission be reduced?
Surveillance, rapid detection and detection of new cases are, as we know, vital to reducing the epidemic. Close contact with infected individuals is the most important risk factor for monkey pox virus infection. Health workers and household members are at greater risk of infection than someone who is ill. Healthcare professionals caring for patients with suspected or confirmed monkey pox virus infection or handling specimens of them should apply standard infection control precautions. Ideally, people who have previously been vaccinated against smallpox should be selected to care for such patients.
13. But why is there concern?
The total danger remains very low. But any disease that circulates in animals and can be transmitted to humans has the potential to cause a new pandemic if it mutates and becomes more contagious. And again, monkey pox has no specific treatment or special vaccine. However, the smallpox vaccine gives immunity to monkeypox and can be used as a treatment if given immediately after exposure.
14. Are we in danger of a new pandemic?
There is no significant risk of a new pandemic from this virus. But the more humans are infected, the more likely it is that monkey pox will adapt to the human body. In addition, the more time the virus spends in the human body, the more time it has to evolve. In other words, it could possibly evolve so that it spreads faster among humans. “
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