What is monkeypox, the rare virus now confirmed in the United States and Europe?

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Massachusetts health officials said on Wednesday they had confirmed a case of a rare and sometimes serious viral illness called monkeypox – the first infection identified in the United States this year amid a surge of cases outside typical disease territory. .

Monkeypox, which can be transmitted to animals and humans, is usually found in central and western Africa. But European health authorities have confirmed more than a dozen cases this month and are investigating dozens more. The last two infections confirmed in the UK “have no travel link” with a place where monkeypox is regularly found, officials said, suggesting the virus could be spreading in the community.

Scientists are trying to answer questions about the outbreak of a disease that is not known to spread easily between humans. The fact that cases are emerging in multiple countries at once – with signs of “sustained” spread among people – is striking, said Aris Katzourakis, professor of evolution and genomics at the University of Oxford.

“It’s either a lot of bad luck or something quite unusual going on here,” Katzourakis said.

Monkeypox owes its name to the animals in which it was discovered. The disease emerged in 1958 in monkeys kept for research, according to the Centers for Disease Control and Prevention – more than a decade before a human case was identified in the Democratic Republic of Congo.

Mass smallpox vaccination “likely” curbed monkeypox infections for some time in humans, researchers wrote in a 2005 paper. But cases have resurfaced, thanks in part to a lack immunity in subsequent generations, they say. More than 450 cases have been reported in Nigeria since 2017, according to the CDC.

CDC scientists traveled to this remote African village to hunt for the monkeypox virus

Monkeypox infections typically last two to four weeks, according to the CDC, and begin with flu-like symptoms. symptoms and swelling of the lymph nodes. Eventually, fluid-filled bumps – or “pox” – spread across the skin.

The disease can be spread through contact with animals, infected people and materials used by infected people, according to health authorities. Examples listed by the CDC include contact with bodily fluids, contact with monkeypox sores, and infection from “respiratory droplets” in a “close environment” such as a shared household.

Monkeypox can be deadly, but two major strains of the virus pose different risks. According to the World Health Organization, around 1 in 10 people infected with a strain from the Congo Basin have died, while a West African strain appears to be fatal for around 1 in 100 people infected.

This milder strain is the one infecting people in hospital in the UK, health authorities have said. It is not known which strain the Massachusetts patient contracted.

How worried should we be? How does this compare to covid-19?

Experts point out that monkeypox is different from the coronavirus that has turned the world upside down.

Monkeypox is highly visible, making contact tracing and isolation easier. An existing smallpox vaccine could help protect the public if needed, Katzourakis said. And “we don’t have the potential for something to spread across the world at a rate similar to what we’ve seen with covid,” he said, because monkeypox is less easily transmitted. between humans.

Still, the latest wave of cases stands out, Katzourakis said. The longer it lasts, the more likely the virus is to mutate and improve its transmissibility, just like the novel coronavirus.

Monkeypox outbreaks have typically been small, with single-digit patients, said Tom Inglesby, director of the Johns Hopkins Center for Health Security. “So I think the risk to the general public at this point, based on the information we have, is very, very low.”

But he agreed that the latest cases raise many questions. “We don’t really have a sense of what drives him yet. … There is no identified travel link that brings all these cases together,” he said.

Health officials have noted recent cases among men who have sex with men — a pattern that’s crucial to understand, Inglesby said, because officials hadn’t previously viewed sex as a particular risk factor for monkeypox.

Has monkeypox ever arrived in the United States?

Monkeypox first made its way to the United States — and the Western Hemisphere — in 2003, researchers say. More than 70 cases have been reported in the Midwest, mostly among people exposed to prairie dogs apparently infected with rodents from Ghana, according to the CDC.

Two children became seriously ill and recovered, the CDC said.

The infection reported Wednesday in Massachusetts is the first case of monkeypox identified in the United States this year, health officials said. Texas and Maryland reported infection last year in “people with recent travel to Nigeria,” the Massachusetts Department of Public Health said.

Rare monkeypox virus reported in Dallas resident

Where else has monkeypox been identified this month?

The United Kingdom and Portugal have announced confirmed cases, while Spanish authorities said on Wednesday they were investigating more than 20 suspected cases. The first known patient in the UK recently traveled to Nigeria, officials said.

The WHO said the person developed a rash in late April, shortly before leaving Africa. Those identified as contacts have not yet reported “consistent symptoms”, the World Health Organization said on Monday.

But other cases have emerged.

British health authorities announced two new infections on Wednesday, for a total of nine confirmed infections in England since May 6. The agency said there were no clear links between the latest two patients and previous confirmed cases, raising the possibility of community transmission.

The recent cases were “mostly gay, bisexual or men who have sex with men”, the UK Health Security Agency (UKHSA) said. The agency advises members of these groups to be especially “watchful for any unusual rash or lesion on any part of their body.”

Portugal’s general health directorate, meanwhile, said more than 20 “suspected cases” had been identified this month. Five of them are confirmed, the agency said, and the infections are concentrated among young men.

What do we know about the American case?

A man who recently traveled to Canada was tested for the virus on Tuesday, and the infection was confirmed by the CDC on Wednesday, the Massachusetts Department of Public Health said in a statement.

The CDC is monitoring six Americans after they sat on a plane near a British patient, CDC physician Agam Rao told The Washington Post on Wednesday. None of the patients showed symptoms of monkeypox.

U.S. officials said clinicians should consider a diagnosis of monkeypox in people with an otherwise unexplained rash who have traveled to a country that had a confirmed case, have been in contact with someone who may be infected, or is a man who has had sexual contact with other men.

The CDC is working with counterparts in other countries to compile information that can answer many questions from experts.

“We’re still at the beginning of all of this to really understand the scope and the reason for it,” Rao said. “We’re really in response mode where we’re trying to identify cases, identify potential contacts, make sure we’re providing the right recommendations to all of those people, including the healthcare staff who are looking after the patient.”

The disease is so rare, said Johns Hopkins’ Inglesby, that “most American clinicians will never see a case in their lifetime” – so communication about monkeypox will be important to ensure doctors watch for symptoms.

Another top priority, he said: getting more information about any links between distant infections. Is the disease spreading from West and Central Africa to other countries independently? Or are cases spreading through networks of people?

“It’s going to be very important for us to understand that, because once you understand how cases spread…it gives us a chance to intervene,” Inglesby said.

Obtaining the genetic sequence of the virus behind recent cases will help scientists verify whether they are dealing with a new strain of monkeypox. Unlike the flu or the coronavirus, Inglesby said, researchers haven’t seen much change in monkeypox over the years, “and it will be important to make sure that remains the case.”.”

Thanks to global trade and travel, poxviruses can spread further, experts have said. The eradication of smallpox in 1980 helped the remaining poxviruses overcome declining protections, said Anne Rimoin, an epidemiologist at the University of California, Los Angeles who has studied monkeypox for two decades.

“No good deed goes unpunished,” Rimoin said. “You are declaring that you can eradicate one pathogen, but you might leave room for another to emerge.”

Rao said that while researchers have seen an increase in the prevalence of monkeypox since the end of the smallpox vaccination campaign, other factors have been linked to infections, including climate change and other environmental changes that have leads to more human and animal interactions.

“We’re at a point right now where we really need to understand why this is happening before we can start offering solutions, like vaccinations,” Rao said. “It’s just unexpected. It’s not something we would have recommended if you had asked me two weeks ago, because the risk to the general population is extremely rare.

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