Monkeypox Virus Outbreak

An Overview of the Monkeypox Endemic- Outbreak and Aftermath

A significant monkeypox outbreak that has spread to at least 20 nations has prompted some prominent infectious disease experts to call on global health authorities to act more quickly. However, because of Monkeypox’s sudden and unexpected spread outside of endemic countries, the transmission had gone unnoticed for a long time, albeit it was unknown how long it had gone unnoticed.

The city of Sao Paulo in Brazil reported the country’s first incidence of monkeypox virus on June 9, 2022. Another possible monkeypox case is being investigated in Sao Paulo, involving a 26-year-old woman who is presently hospitalised. Meanwhile, the Centers for Disease Control and Prevention in the United States warned that global cases of Monkeypox had surpassed 1,000, encouraging people to take extra precautions.

As of June 6, the Centers for Disease Control and Prevention (CDC) reported 1,019 confirmed and suspected cases of Monkeypox in 29 countries. According to CNBC, the United Kingdom has the most suspected and confirmed illnesses, with 302, followed by Spain (198), Portugal (153), and Canada (151). (80).

Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, asked afflicted countries to identify all cases and contacts to manage the outbreak. On the other hand, global health experts are concerned about the growing outbreak in non-endemic countries. According to the WHO, the numbers are projected to rise as surveillance improves.

What is Monkeypox?

Monkeypox
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Monkeypox is a viral zoonosis (a virus transmitted from animals to humans) with symptoms comparable to smallpox but a milder clinical course. Since eradicating smallpox in 1980 and the subsequent suspension of smallpox immunisation, Monkeypox has emerged as a major orthopoxvirus for public health. Monkeypox is primarily found in Central and West Africa, especially around tropical rainforests, and is becoming more prevalent in urban areas.

History of the Outbreak

In 1970, a 9-month-old boy was found with human Monkeypox in a region where smallpox had been eradicated in 1968. Since then, most instances have been found in the Congo Basin’s rural rainforest districts, primarily in the Democratic Republic of Congo. However, human instances have also been documented in Central and West Africa.

Since 1970, instances of Human Monkeypox have been reported in 11 African countries: Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Cote d’Ivoire, Liberia, Nigeria, the Republic of Congo, Sierra Leone, and South Sudan. However, the true scope of Monkeypox’s impact is still unknown.

Because it affects countries in West and Central Africa and the rest of the world, Monkeypox is a global public health concern. The first monkeypox outbreak outside of Africa occurred in the United States in 2003, and it was linked to contact with infected pet prairie dogs. As a result of the outbreak, over 70 cases of Monkeypox have been documented in the United States.

Monkeypox Transmission

Monkeypox Transmission
Credit: OP India

The disease spreads in a variety of ways, including:

  • Rope squirrels, tree squirrels, Gambian poached rats, dormice, and other monkey species have all been affected by the monkeypox virus in Africa. The natural reservoir for Monkeypox has yet to be identified, but rats are the most plausible possibility.
  • Monkeypox has yet to find a specific reservoir. Despite the name, monkeys are not a major source of water. African rodents are thought to be the true reservoir.
  • Animal-to-human (zoonotic) transmission can occur through direct contact with infected animals’ blood, bodily fluids, or cutaneous or mucosal sores.
  • Consumption of undercooked meat and other animal products from infected animals is a possible risk factor.
  • People living in or near forested areas may inadvertently be exposed to diseased animals.
  • The virus is spread through contact with infected humans, animals, or items. It can enter the body through broken skin, the respiratory tract, the eyes, nose, and mouth.
  • Because droplet respiratory particle transmission usually requires prolonged face-to-face contact, health workers, household members, and other close contacts of active cases are at risk.
  • Monkeypox can be transmitted from mother to foetus through the placenta; however, while physical contact is a risk factor for transmission, it is still unknown if Monkeypox can be transmitted sexually.

In addition, further research is needed to understand this danger better.

Symptoms of Monkeypox

Monkeypox has an incubation period of 6 to 13 days from infection to the onset of symptoms.

The infection is divided into two stages:

  1. Fever, severe headaches, lymphadenopathy, back pain, muscle aches, and exhaustion (which lasts between 0 and 5 days). Monkeypox also has a characteristic of lymphadenopathy (chickenpox, measles, smallpox).
  2. The skin eruption usually begins one to three days after the fever has appeared. The rash appears to be concentrated on the face and extremities rather than the trunk. It affects the face, palms of the hands, and soles of the feet. The number of lesions could be somewhere between a few and thousands.

Complications

Secondary infections, pneumonia, sepsis, encephalitis, and vision loss can all occur due to a severe eye infection. The baby of a mother suffering from monkeypox may be stillborn or have birth abnormalities if an infection arises during pregnancy. People who were immunised against smallpox as children may have a lesser case.

Monkeypox is usually a self-limiting illness with symptoms lasting two to four weeks. On the other hand, severe cases are more common in children and are linked to the amount of virus exposure, the patient’s health, and the type of issues. Immune deficiencies may also have a role in the outcome. Although smallpox immunisation was used to protect people, the global halt of smallpox immunisation programmes following the disease’s elimination may now make those younger than 40 to 50 more susceptible to Monkeypox.

As a result, vaccines protect persons who may be exposed, such as healthcare workers, in the few areas where they are available. In addition, according to Sylvie Briand, the WHO’s director of epidemic and pandemic planning and prevention, the smallpox vaccine might be used with high efficacy against Monkeypox, a companion orthopoxvirus.

The WHO is attempting to determine how many dosages are now available, the companies manufacturing them and their distribution capacities.

Diagnosis of Monkeypox

Other rash disorders, such as chickenpox, measles, bacterial skin infections, scabies, syphilis, and medication-related allergies, must be considered in the clinical differential diagnosis. Monkeypox can be distinguished from chickenpox or smallpox by lymphadenopathy during the prodromal stage of illness. The virus can be tested to confirm the diagnosis.

The primary laboratory test is polymerase chain reaction (PCR) testing samples from skin lesions. Unfortunately, PCR blood tests are frequently inconclusive because the virus does not stay in the blood for very long. Therefore, the date of commencement of fever, date of the beginning of rash, date of specimen collection, current stage of rash, and patient age are all needed to interpret test results.

Outbreak Situation

Outbreak
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New monkeypox outbreaks, which now number over 1,000 cases in 29 countries, are raising fears that the virus will spread to areas where it has never been seen. To avoid infection, the Centers for Disease Control and Prevention recommends that travellers take extra measures. Even though the danger to the public is low, the CDC recommends avoiding contact with sick or injured individuals and wild animals that may have the disease. In addition, travelling to areas with a high number of cases, working with animals, and males who have sex with men are all in danger, according to the report. Researchers worldwide have been discussing how to proceed as a result of the latest outbreak. The following is a list of what is known about the virus.

Is it endemic in any particular location?

For decades, the virus has been discovered in Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Ghana, the Ivory Coast, Liberia, Nigeria, and Sierra Leone. Researchers said more observation is needed to determine if the virus is endemic but undiagnosed in other nearby countries. In some endemic regions, such as Nigeria, instances have recently increased, with studies pointing to declining immunity to smallpox and climate change (which causes more interaction with animals) as possible explanations.

Is Monkeypox lethal?

According to the WHO, there are two monkeypox viral clades: the West African clade causes milder disease, while the Central African clade causes more severe disease and is thought to be more transmissible. Cameroon, the only country to have both clades, was where the two clades were geographically separated.

To date, no deaths from Monkeypox have been reported outside of endemic countries. A West African clade causes the current outbreak outside of endemic nations with a death rate of less than 3%. The Central African clade’s death rate, estimated to be between 1 and 10% of cases, could be greater—however, the WHO cautioned that these statistics are based on infections. In addition, Thr infections were among a younger population in African countries than in Western countries.

Monkeypox Vaccinations

Vaccine
Credit: CNBC

Several vaccines are available to defend against Monkeypox. However, several were developed for smallpox.

In 2007, the FDA authorised Emergent’s one-dose ACAM2000 smallpox vaccine, while Bavarian Nordic’s two-dose Jynneos vaccine to prevent smallpox and Monkeypox in adults was licenced in 2019. However, according to the FDA, ACAM2000 can cause serious side effects such as heart or brain inflammation, blindness, and foetal fatalities. Hence its usage is restricted.

According to Marion Gruber, vice president of public health and regulatory science at IAVI, a nonprofit research organisation, Bavarian Nordic requested that the FDA approve Jynneos only for smallpox. Still, the agency approved it for Monkeypox because the two viruses belong to the same family and vaccines for one offer cross-protection.

Even though the United States and other nations have enormous stockpiles of smallpox vaccines, side effects and other hazards have rendered newer vaccines — currently in limited supply — far preferable to the hundreds of millions of older doses in stockpiles. Also, although vaccinations are critical in preventing the spread of the disease, WHO officials have stated that only people who have been exposed or are at high risk of being exposed should be vaccinated.

Treatment Options for Monkeypox

According to studies, there are a few antiviral treatments for Monkeypox. According to previous trials, Tecovirimat is a healthy option, but it must be given early, fewer than six days after exposure. The treatment has been approved in the EU for smallpox and Monkeypox, although it cannot be administered with several medications. In addition, the medicine has been approved by the FDA for treating smallpox. On the other hand, researchers are concerned about the possibility of viruses developing resistance to the medicine in the future.

Another candidate is brincidofovir, which is not approved in the EU. Smallpox has received FDA approval under the animal rule, which allows medications to be approved based on results from animal research when human trials are deemed unethical.

It’s unclear which animals are carriers and spreaders of the virus. So researchers will also focus on determining the causes of the unexpected transmission and the emergence of additional hotspots. Even some basic elements of Monkeypox require additional research, such as which therapies work best, how the virus spreads, and how serious the sickness can become.

Can Monkeypox be the new pandemic?

Monkeypox
Credit: Reuters

The disease is no longer regarded to be as uncommon as it formerly was;

  • Maybe as a result of diminishing immunity since systematic smallpox immunisation was discontinued.
  • Since the 1980s, the number of cases has risen dramatically.
  • Sporadic occurrences are common in Central and West Africa, and the Democratic Republic of Congo is largely endemic (DRC).
  • Hunters in Central and West Africa’s tropical woods are the most vulnerable.
  • It was first identified as a separate sickness in 1958 in Copenhagen, Denmark, among experimental monkeys.
  • The virus does not have a natural reservoir in monkeys.
  •  The first human cases were discovered in the Democratic Republic of the Congo in 1970.

An outbreak in the United States in 2003 links to the sale of rodents imported from Ghana at a pet store. Nigeria has been experiencing a significant outbreak since 2017. The 2022 monkeypox outbreak is the first instance of widespread community transmission outside of Africa, with cases confirmed in at least 20 countries across Europe, North America, South America, Asia, Africa, and Australia. It was first identified in the United Kingdom in May 2022, with subsequent cases confirmed in at least 20 countries across Europe, North America, South America, Asia, Africa, and Australia.

Monkeypox

Monkeypox is not known to spread easily between humans, as it is spread mostly through animal-to-human contact. Most people infected with Monkeypox only infect one or two other people. Therefore outbreaks are usually short-lived. As a result, the fact that outbreaks are occurring in multiple nations simultaneously worries health officials and organisations that track viral transmission. Experts are considering if the virus’s rate of transmission has accelerated.

People are naturally anxious about the virus after seeing images of people covered in monkeypox sores. Still, the good news is that the general public has little to fear at this point.

Conclusion

According to the UK Health Security Agency, Monkeypox is now a notifiable infectious disease under the Health Protection (Notification) Regulations 2010. (UKHSA). If a doctor suspects a patient has Monkeypox, they must notify the local council or the Health Protection Team (HPT). In addition, laboratories must notify the UKHSA if the monkeypox virus is discovered in a laboratory sample.

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