It has been three weeks since public health officials confirmed the monkey case in the United Kingdom. Since then, more than 400 confirmed or suspected cases have appeared in at least 20 non-African countries, including Canada, Portugal, Spain and the United Kingdom – the largest outbreak ever outside Africa. This situation has alarmed scientists because the monolypox virus has spread to different populations in many countries, and there is no clear link between the various groups, suggesting that the virus may be undetectable, local.”We need to act quickly and decisively, but we still have a lot to learn,” said Anne Rimoin, an epidemiologist at the University of California, Los Angeles, who has been studying monoconxin in the Democratic Republic of the Congo for over a year ten.Some of the most important questions about the recent emergence that researchers are rushing to answer.
How did the current outbreak begin?
Since the onset of the recent outbreak, researchers have sequenced genetically modified genes from people with monocytes in countries including Belgium, France, Germany, Portugal, and the United States. The most important understanding they have gained so far is that each sequence is very similar to the monopoly species found in west Africa. This type is less deadly – with a mortality rate of less than 1% for poor, rural people – than any other found in central Africa and with a mortality rate of up to 10%.
There are also clues as to how the outbreak may have started. Although researchers need more data to substantiate their allegations, the sequence they have examined so far is almost identical, suggesting that the recent outbreak outside Africa may be linked to a single case with a thorough epidemic investigation.
The current sequence is very similar to the outbreak of monopoly events that occurred outside Africa in 2018 and 2019 and were linked to travel to west Africa. The simplest explanation is that the person who first had a non-African case this year – undisclosed – became infected by contact with an animal or a person infected with the virus during a visit to the same place in Africa, said Bernie Moss, a virologist at the National Institute of Allergy and Infectious Disease. Bethesda, Maryland.But other explanations cannot be ruled out, says Gustavo Palacios, a gynecologist at Icahn School of Medicine in Mount Sinai in New York City. It is possible, however, that the virus was already circulating, unseen, outside of Africa in humans or animals, introduced during an earlier outbreak. This theory, however, is unlikely to cause the monocytes virus often causing visible lesions in the human body – possibly brought to a physician.
Could a mutation in a virus predispose to a recent outbreak?
Understanding whether there is a genetic basis for the spread of the virus that has never been seen outside of Africa will be very difficult, says Elliot Lefkowitz, a computational virologist at the University of Alabama in Birmingham who studied the emergence of poxvirus. Researchers are still struggling to pinpoint exactly what genes are responsible for the high tide and spread of species in central Africa, compared to West Africa, more than 17 years after discovering the differences between the two.One reason for this is that poxvirus genomes contain many mysteries, said Lefkowitz. The monkeypox genome is much larger than most other viruses – six times larger than the SARS-CoV-2 coronavirus genome. That means “at least six times as difficult as self-examination,” says Rachel Roper, a physician at East Carolina University in Greenville, North Carolina.
Palacios says another reason is that few resources have been devoted to genomic experiments in Africa, where monkeypox has been a public concern for many years. So virologists are somewhat blind right now, because they have fewer sequences that they can compare with the monopoly sequence, he said. Funding institutions have not heeded scientists for more than a decade warning of possible outbreaks of other monopoly diseases, he adds.
IfedayoAdetifa, head of the Nigeria Center for Disease Control, says the African virus experts he spoke to expressed frustration that they were struggling to find funding and publishing studies on the monopoly for years – but now that it has spread across the continent, public health. suddenly the authorities all over the world seem to be very interested. Understanding how the virus originated can be helpful in tracking the virus in animals, says Palacios. The virus is known to infect animals – especially rats like squirrels and mice – but scientists have not yet discovered its natural habitat in the affected areas of Africa.
Can the rash be prevented?
Ever since the outbreak began, some tribes have been buying smallpox vaccines, which are thought to be very effective in combating monkeys, because they are related. Unlike the COVID-19 vaccine, which lasts for two weeks to provide full protection, smallpox vaccines are thought to protect against monocypox infection if given within four days of exposure due to prolonged exposure to the virus, according to the US Centers for Disease. Control and Prevention (CDC) in Atlanta, Georgia.
When used, vaccines can be used using a ‘ring vaccine’ strategy, which can vaccinate people close to and infected with the virus. Andrea McCollum, an epidemiologist leading the poxvirus team at the CDC, says the organization has not yet implemented the ring vaccination strategy. But in the meantime, CNN reports that the United States plans to offer smallpox vaccines to other health workers who treat people with the virus. It may also be necessary to look at vaccine groups that are at greater risk of infection than people close to and infected with the virus, Rimoin said.
Although public health officials have stopped the spread of monkeypox in humans during the current outbreak, virologists are also concerned that the virus may return to animals. Having new sources of the virus in animals can increase the chances of it being transmitted to humans over and over again, including in countries without known pools of the virus. On May 23, the European Center for Disease Prevention and Control highlighted this possibility, but took the chances as “very low”. However, European health officials highly recommend that domestic mice such as hamsters and guinea pigs belonging to certified monkeypox cases be isolated and housed in government facilities or integrated to avoid possible bloodshed.Although the risk is low, Moss says it is very worrying that scientists would not have known that such an incident had taken place so late, because infected animals often do not show the same symptoms as humans.
Is the virus spreading differently now compared to previous outbreaks?
Monkeypox virus is known to spread through close contact with wounds, body fluids and respiratory droplets of infected people or animals. But health officials were investigating sexual acts on two raves in Spain and Belgium as drivers of the monopoly transmission, according to the Associated Press, raising speculation that the virus had already emerged to be effective in transmitting sex.Sexually transmitted infections do not mean that the virus is highly contagious or sexually transmitted, however – that the virus is easily spread through close contact, says Rimoin. Unlike SARS-CoV-2, which is not considered to be localized, poxviruses can live longer without the body, making areas such as sheets and door bins a vector for transmission, Roper said.
Although health officials point out that most cases were homosexual (MSM) cases, Rimoin emphasizes that the possible explanation for the virus spread to MSM groups is that the virus was introduced into the community immediately, and is still ongoing. spread out there.All the new attention to the moxypox has revealed how much scientists still do not understand about the virus, McCollum said. “Once all is well, I think we will have to think for a long time about what the research priorities are,” he said.
Source Journal Reference: Max Kozlov, Monkeypox outbreaks: 4 key questions researchers have, Nature News Explainer (2022), doi: https://doi.org/10.1038/d41586-022-01493-6, https://www.nature.com/articles/d41586-022-01493-6
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