In May 2022, the monkeypox virus began to spread around the world, which usually does not go beyond endemic countries. How the virus is transmitted, what its characteristic symptoms are, and whether there is a vaccine against it – RBC understood
Where the monkeypox virus was found
In Europe, the first case of monkeypox infection was detected in the UK on 7 May. The infected person recently returned from Nigeria, which is characterized by the spread of this virus. It is the countries of West and Central Africa— breeding grounds for this virus. The virus was discovered in 1958, and was first detected in humans in 1970 in the Democratic Republic of the Congo (DRC).
By May 20, there were already 20 cases in the UK. After the UK, the virus was found in Portugal, Spain, Sweden, Italy, Germany, France, Belgium and other countries. The virus has also been detected in patients in the United States, Australia, Canada, where examinations are carried out in 13 people who are presumably infected.
Some of the cases identified in the UK were not directly related to travel to Africa, meaning that the virus was already transmitted within the country. The Ministry of Health notes that a significant proportion of the identified cases were among gay and bisexual men, because of this, the ministry calls on this part of society to be especially on the alert. Until now, it was not believed that the virus was transmitted sexually, the department draws attention. The virus is transmitted through close contact with the sick person, as well as through contact with the clothes or bedding of an infected person, the materials indicate. “The virus does not usually spread easily between people. Population risk remains low,— government release says.
Outbreaks in Africa
In May 2018, an outbreak was in Cameroon— one confirmed case, another 15 suspected, no one died.
Nigeria— from September to December 2017— 172 suspected cases, 61 confirmed, no death reported.
Central African Republic— September—October 2016, there were 26 suspected cases, three confirmed, one person died.
Source: African Union data.
By May 21, WHO had confirmed 92 cases of monkeypox from 12 non-endemic countries. The organization further clarified that the confirmed and suspected cases of monkeypox were not associated with the travel of infected people to endemic areas, which is a “highly unusual event.” The cases now identified are of the West African variant of monkeypox— they are similar to what was recorded in the UK, Israel and Singapore in 2018-2019, the WHO reported.
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How the virus is transmitted
The so-called natural reservoir of the virus are monkeys and some rodents (African squirrels, prairie dogs), from which the virus can be transmitted to humans. Experts interviewed by RBC note that outbreaks of monkeypox have happened before, they occurred mainly in endemic countries, but cases of importation to Europe were also known and occurred annually.
The type of transmission of the virus is similar to the type of transmission of smallpox— close contact of a person with a person, you can also become infected by contact with human body fluids, by contact with secretions from the patient's pustules and by interacting with his personal belongings. Due to the fact that transmission requires close contact, Konstantin Severinov, head of the laboratory at the Institute of Molecular Genetics and the Institute of Gene Biology of the Russian Academy of Sciences, explains to RBC, the rate of spread of this infection is much lower than with coronavirus, which is transmitted by airborne droplets.
The possibility of airborne transmission is now being discussed, but to date it is not known how effectively it is being implemented, says the director of the Institute of Medical Parasitology, Tropical and Vector-borne Diseases. E.I.Martsinovsky Sechenov University Alexander Lukashev.
Experts note that monkeypox, like other infectious diseases, has an incubation period. Identified 92 cases— this is the result of an infection about a week ago, so it can be argued that there are others infected, and expect an increase in the number of cases, regardless of the efforts of doctors, warns Lukashev.
The fact that there are more gay and bisexual males among monkeys with smallpox than statistically expected may be due to the fact that sexual contacts of people from this group are more traumatic and often lead to damage to the mucous membranes and skin, due to which the virus is transmitted. says Severinov. According to him, this may simply be an accident, since there are not so many infected yet. “In heterosexual intercourse, the same thing will happen if there are cracks or damage to the outer integument and mucous membranes,” — the expert explains. The WHO also notes that the identified cases are mainly, but not exclusively, recorded among men who have sex with men.
Will monkeypox appear in Russia
The official health departments, the Ministry of Health and Rospotrebnadzor, said on May 22 that there were no cases of monkeypox in Russia. Rospotrebnadzor considered the risk of importation “extremely low”.
Despite the fact that experts interviewed by RBC consider the risk of importation of the virus unlikely, Alexander Lukashev notes that monkeypox can spread among various ethnic groups.
Among the measures to be taken to minimize the risk of a wide spread of the disease in Russia, the Deputy General Director for Research at the Center. Chumakov Ilya Gordeychuk calls: PCR diagnostics, isolation of infected and contact persons— at the health system level. On an individual level— careful monitoring of flu-like respiratory symptoms in yourself and others, wearing masks and cleaning hands with disinfectants.
How the disease progresses
The initial symptoms of monkeypox include fever, headache, muscle aches, back pain, swollen lymph nodes, chills, and fatigue. A rash may develop, often beginning on the face, then spreading to other parts of the body, including the genitals. The rash changes and goes through different stages and may look like the varicella or syphilis rash before finally forming a scab that later falls off, UK Department of Health describes symptoms.
According to WHO, the incubation period ranges from six to 13 days, but can be from five to 21. Two periods can be distinguished during the course of the disease. The first lasts up to five days and is characterized by fever, severe headache, swollen lymph nodes, back pain, myalgia, and fatigue. Abnormal sizes of lymph nodes— a characteristic sign of this particular type of smallpox, with chickenpox, measles and smallpox this is not. After one to three days after the onset of the heat, rashes begin on the skin.
The rash tends to be more concentrated on the face and limbs than on the trunk. The rash develops in succession from macules (lesions with a flat base) to papules (slightly raised firm lesions), vesicles (clear fluid-filled lesions), pustules (yellowish fluid-filled lesions), and crusts that dry up and fall off. The number of lesions ranges from several tens to several thousand. In severe cases, lesions may coalesce until large areas of skin are shed.
Monkeypox, the WHO continues, usually— self-limiting disease with symptoms lasting two to four weeks. Severe cases are more common among children and are related to the degree of exposure to the virus, the health of the patient, and the nature of the complications. The case fatality rate for monkeypox has historically ranged from 0% to 11% in the general population and has been higher among young children. Recently, the fatality rate has been around 3–6%.
With damage to the cornea, loss of vision is possible, added in a conversation with RBC, the chief researcher of the Center. N.F. Gamalei Viktor Zuev, who took part in the suppression of an outbreak of smallpox in Moscow in the 1960s.
Is there a vaccine for monkeypox
While smallpox vaccination was a protection in the past, today people younger than 40-50 years old (depending on the country) may be more susceptible to monkeypox due to for ending smallpox vaccination campaigns around the world after the eradication of the disease, says WHO.
“I started working on monkeypox in 2002 in the DRC. Now, 20 years later, the vast majority of people in the world do not have immunity to smallpox viruses, — noted in an interview with The Telegraph Anne Rimouin, professor of epidemiology at the University of California at Los Angeles. She estimates that as the world becomes more susceptible to poxviruses (smallpox viruses) and as travel increases, the number of cases could increase.
The smallpox vaccine also works against monkeypox, Vector said earlier, as all poxviruses provide good cross-protection. “The two viruses are similar, so the immune response generated by the smallpox vaccine is effective against monkeypox,” confirms RBC Gordeychuk.
Also in Vector; spoke about their own previously developed test system, which allows to detect cases of monkeypox infection. According to the center's experts, the test is specific and does not detect cross-reactions with rubella and chickenpox viruses.
The experts with whom RBC spoke explained that in the Vector center contains a strain of smallpox, but it is not needed to create the smallpox vaccine itself. “A vaccinia virus is used, similar to the vaccinia virus, which the physician Edward Jenner used to vaccinate back in the 18th century. The same vaccine can protect against monkeypox, & mdash; says Severinov.
Such a vaccine, if necessary, can be quickly developed, since the technology is not new. Experts confirm that there is no independent vaccine against monkeypox in the world.
Vaccination against smallpox was carried out in the USSR. Will the vaccinated be protected now
In 1979, the World Health Assembly issued a declaration declaring the world's victory over smallpox. In the USSR, vaccination was carried out until about 1982, after which it stopped. The smallpox vaccine is expected to provide protection against monkeypox, Lukashev says. “Perhaps, the inhabitants of Russia, vaccinated before the 80s, will be partially protected when they meet with monkeypox, but we do not know how effective their immunity is, because more than 40 years have passed after vaccination,” — he says. Chief Researcher at the Center N.F. Gamalei Viktor Zuev doubts that the vaccinated still have protection.
The smallpox vaccine gave sterile immunity, that is, the vaccinated person ceased to be a source of new viruses, and vaccination gave lifelong immunity, Konstantin Severinov believes. “Since young children were vaccinated, it can be assumed that almost everyone born before the 80s will be resistant to monkeypox,” — explains the expert.
Nevertheless, one cannot speak of significant herd immunity, since the vast majority of people under 40 years of age have not been vaccinated against smallpox, Gordeychuk summarizes.
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