explained | Brief description of the monkeypox outbreak

the story So Far: Monkeypox, an uncommon viral infection that was mainly confined to some countries in western and central Africa, as well as travelers to these countries, has now been triggered by zoonotic events. The disease has so far made headlines with its international spread with more than 16,000 cases in more than 75 countries, driven primarily by human-to-human contact, mainly by homosexuals, bisexuals and MSM (men who have sex with men). men) not in communities. On July 23, 2022, amidst a rapid increase in monkeypox cases across the world, the Director-General of the World Health Organization (WHO) Dr. Tedros Adhanom declared the outbreak of the disease a Public Health Emergency of International Concern (PHEIC).

What is monkeypox and what is the cause of the disease?

First discovered in 1958 in monkeys at the Statens Serum Institute in Denmark, monkeypox is a zoonotic virus that can infect humans as well as other animals, including rodents and other primate species. Since the first case in humans was identified in 1970, in the present-day Democratic Republic of the Congo, the virus has been endemic in parts of Central and West Africa, driven primarily by zoonotic spillover. Despite being denoted as ‘monkeypox’, the actual origin and source of the disease is unknown and is therefore in many ways a misnomer. The virus belongs to the same family of viruses as variola – the virus that causes smallpox. The disease presents with symptoms similar to those previously seen in patients with smallpox, although it is less contagious and less severe.

Symptoms of monkeypox include fever, headache, muscle aches and lethargy, as well as rashes and blisters on the face, palms, feet, mouth, eyes, or genitals. These symptoms usually appear within two weeks of infection, but can last for two to four weeks, with severe cases occurring mostly in children. In most cases, monkeypox is a self-limiting disease that gets better on its own without any specific treatment. However, newborns, young children and people with underlying immune deficiencies may be at greater risk of developing more severe symptoms.

How does the virus spread?

This virus can spread from animals to both humans and humans. Animal-to-human transmission of the virus can result from close contact with blood, fluids, or skin wounds from infected animals. Human-to-human transmission can occur through close contact, and through body secretions, skin sores, or contaminated articles from individuals infected with monkeypox.

Close human contact during sexual activity is believed to be a driver of the current spread of the disease, as evidenced by its predominant prevalence in gay, bisexual and MSM communities.

How is the current outbreak different?

Since its initial detection in humans in Africa in 1970, the first outbreak of monkeypox outside Africa was reported in the Americas in 2003, where many cases were found to be linked to close contact with infected imported animals. More recently, in May 2022, several cases of the disease were reported from areas where monkeypox was not endemic, and most cases had a travel history to Europe or North America, not Africa. Prior to the current outbreak, monkeypox was mainly reported from Africa, while all cases reported in patients from other countries were linked to travel to areas where the disease was commonly found or to contact with imported animals. The reason was So far, no association has been established between these new cases of contact with infected animals. The number of confirmed monkeypox cases increased by more than 70% from the end of June to the beginning of July 2022, with the majority of the case burden in Europe. However, there is limited knowledge about the source and transmission routes of the 2022 outbreak, as well as the changes in the virus that helped it to infect humans more than ever before, making monkeypox a disease of global public health importance.

What is involved in declaring monkeypox as a health emergency?

WHO defines PHEIC as a disease outbreak that “constitutes a public health risk through the international spread of disease” that may require an immediate and coordinated international response. Since 2009, WHO has made seven PHEIC declarations, including the ongoing COVID-19 pandemic. This designation emphasizes accelerating international efforts to stop the spread of the disease before it escalates into a pandemic. This would mean boosting countries’ efforts to control transmission and the sharing of key resources such as vaccines and therapeutics, as well as increased coordination of contact tracing, diagnosis and vaccination. While studies are underway to understand the epidemiology, transmission routes and clinical presentations of the disease, the World Health Organization will provide assistance to affected countries to develop an effective outbreak response and surveillance as well as prevention and therapeutic strategies. .

There are some factors that are beneficial. First thanks to researchers in Africa, who have been able to contain outbreaks for decades, there is a wealth of information about the virus and ways to stop the spread, as well as how to manage the disease. Additionally, the COVID-19 pandemic has led to the availability of a fairly effective vaccine, despite the widely available infrastructure for molecular diagnostics as well as logistics issues. Genomic surveillance of the pathogen provides a unique opportunity to trace the contact network as well as evaluate the continued evolution of the virus. While it is heartening to note that a large number of monkeypox genomes from the current outbreak are available in the public domain, there is a significant disparity in numbers from developing countries, particularly from Asia, including India.

What are the current prevention and treatment options against monkeypox?

There are no specific treatments available for monkeypox. Clinical management of monkeypox includes relieving symptoms and managing complications and preventing long-term effects. It is also not currently understood whether previous monkeypox infection confers protective immunity against future infections. However, due to the genetic similarity of smallpox and monkeypox viruses, vaccines and antiviral agents used for the worldwide eradication of smallpox may also protect against monkeypox. WHO reports that vaccination against smallpox is about 85% effective in preventing monkeypox and thus prior vaccination against smallpox may cause mild illness. Although the original smallpox vaccine is not available to the general public, new vaccines have been developed, one of which was approved in 2019 for the prevention of monkeypox. Studies are now being conducted to understand the effectiveness and feasibility of vaccination in preventing monkeypox.

While the world discusses the specifics of why Dr. Tedros declared monkeypox as a global health emergency despite the committee’s vote almost a month ago, it is probably time for the world to realize that global warming With, the human-wildlife conflict is on the rise. There has never been a better time for global and universal global travel, global public health collaboration and resource-sharing efforts. As we come out of a global pandemic, there can never be a better time to be prepared for new challenges.

The author is a researcher at CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi