Monkeypox: time to worry or ignore?

If you’re still reeling from the COVID pandemic, sorry, but there’s another virus to keep under control. This time it’s monkeypox and there are around 80 confirmed cases in 11 countries, which you wouldn’t normally expect to have the disease.

So what’s up? Is it time to worry or are we too excited after experiencing Covid?

Let’s be clear: this is not another COVID and we are not days away from lockdowns to contain the spread of monkeypox.

However, this is an unusual and unprecedented outbreak of monkeypox. This completely surprised disease scientists and is always a concern when a virus changes its behavior.

Until now, monkeypox was fairly predictable.

The natural home of the virus is wild animals, which are actually thought to be rodents rather than monkeys. Someone in the rainforests of West and Central Africa comes into contact with an infected creature and the virus makes the species leap. Their skin breaks out into a rash, which blisters and then scabs. The virus is now outside its usual home and struggling to spread, so it needs prolonged close contact to continue. Thus, outbreaks tend to be small and self-extinguishing.

A small number of cases have already appeared elsewhere in the world, but all can be immediately linked to a person traveling to an affected country and bringing them home.

This is no longer the case.

• For the first time, the virus is discovered in people with no clear link to West and Central Africa

• It’s not clear who people are catching it from

• Monkeypox is spread during sexual activity, with most cases showing lesions on the genitals and surrounding area

• Many of those affected are young gay and bisexual men

“We are in a very new situation, it is a surprise and a concern,” said Professor Sir Peter Horby, director of the Pandemic Sciences Institute at the University of Oxford.

Although he says it’s “not COVID-2”, he said “we have to act” to prevent the virus from taking hold as it is “something we really want to avoid”.

Dr Hugh Adler, who has treated patients with monkeypox, agrees: “It’s not a pattern we’ve seen before – it’s a surprise.”

So what’s going on?

We know this epidemic is different, but we don’t know why.

There are two big options: the virus has changed or the same old virus has ended up in the right place at the right time to thrive.

Monkeypox is a DNA virus, so it doesn’t mutate as quickly as COVID or the flu. Very early genetic analysis suggests that the current cases are very closely linked to the forms of the virus seen in 2018 and 2019. It is too early to be sure, but at the moment there is no evidence that it is is a new mutant variant in-game. But a virus doesn’t need to change to take advantage of an opportunity, as the unexpected large outbreaks of Ebola and Zika over the past decade have taught us.

“We always thought Ebola was easy to contain, until it wasn’t,” said Professor Adam Kucharski, from the London School of Hygiene and Tropical Medicine.

It is unclear why gay and bisexual men are disproportionately affected. Do sexual behaviors facilitate spread? Is it just a coincidence? Is it a community that is more aware of sexual health and getting checked out?

It may also be easier for monkeypox to spread. Mass smallpox vaccinations of the past would have given older generations some protection against the closely related monkeypox.

“It’s probably more efficiently transmitted than it was in the smallpox era, but we don’t see anything to suggest it could be spreading,” said Dr Adler, who still expects this outbreak to die down. . Understanding how this outbreak started will help predict what will happen next.

We know that we are only seeing the tip of the iceberg, because the cases detected do not correspond to a clear picture of this person who transmitted it to this person, etc. Instead, many cases seem unrelated, so links are missing. in a chain that seems to stretch across Europe and beyond.

A recent massive superspreader event, in which a large number of people gathered and caught monkeypox in one place, like a festival, and then took it home to different countries, could explain the current situation. .

The other explanation for infecting so many unconnected people is that the virus has actually been bubbling up unnoticed for some time, involving large numbers of people.

Either way, we can expect to continue to find more cases.

“I don’t think the general public should be worried at this stage, but I don’t think we’ve discovered all of this and we’re not in control of this,” said Professor Jimmy Whitworth, from the London School of Hygiene and tropical medicine.

But remember we are not in the same situation we were with COVID.

Monkeypox is a known virus rather than a new one, and we already have vaccines and treatments. It is generally mild, although it can be more dangerous in young children, pregnant women, and people with weakened immune systems.

But it spreads more slowly than COVID and the distinctive, painful rash makes it harder to miss than a cough that could be anything. This makes it easier to find people who may have been infected and vaccinate those at risk of catching it.

However, the World Health Organization (WHO) Regional Director for Europe, Hans Kluge, warned that “as we enter the summer season…with mass gatherings, festivals and parties, I’m afraid the transmission is accelerating”.

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