Some of the world's foremost experts on infectious diseases are lobbying for more immediate action byglobal health authorities to tackle the escalating outbreak of monkeypox, which has spread to at least 20 countries.
Experts argue that governments and the World Health Organization (WHO) should not repeat the mistakes made at the start of the COVID-19 pandemic, resulting in a delay in identifying cases of infection that helped the virus spread.
Clearer guidelines
Although monkeypox is not as contagious and as dangerous as COVID-19, these scientists argue that there is a need for clearer guidelines on how to isolate someone infected with monkeypox.
They also call for more specific information on how to protect people facing possible infection, as well as improved diagnostic tests and the tracing of cases.
Four critical questions
At the same time, scientists around the world are trying to understand the latest outbreak of monkeypox, as more than 400 now-confirmed cases have been detected in at least 20 non-African countries and the disease is trending towards further international expansion. Never before has monkeypox had such a spread outside Africa.
This is of concern to the scientific community, as the virus has 'hit' different populations in different countries, with no apparent link between the distant clusters of cases, indicating multiple localised transmission of the disease under the health radar.
"We need to act quickly and decisively, but there is still a lot to learn," epidemiologist Anne Rymone of the University of California, Los Angeles (UCLA), who has been studying smallpox in monkeys in the Republic of the Congo for more than a decade, told Nature.
Four main scientific questions are seeking answers:
How did the current outbreak start?
The researchers have analysed the viral genome collected from monkeypox patients in several countries (USA, France, Germany, Germany, Belgium, Portugal, etc.). The main conclusion so far is that all genomes have close similarity to the West African strain of the virus which is less lethal (less than 1% mortality in all cases in poor rural populations, compared to up to 10% for the more lethal Central African strain).
Although more data are needed to confirm scientists' suspicions, because the samples analyzed genetically so far are almost identical, it appears that the current international outbreak spreading out of Africa was triggered by a single case. The simplest explanation, according to virologist Bernie Moss of the US National Institute of Allergy and Infectious Diseases, is that a non-African (yet to be identified) who had visited Africa became infected with the monkeypox virus through contact with an infected animal or human carrier of the virus.
But alternative explanations cannot be ruled out, according to virologist Gustavo Palathios of the Icahn School of Medicine at Mount Sinai in New York. It is possible that the virus was already circulating invisibly outside Africa among humans or animals, having been exported from the 'black' continent during a previous local outbreak there. This hypothesis is less likely, however, because the disease usually causes visible rashes on the body, so it would probably have come to the attention of doctors in the past.
Can a genetic mutation explain the latest outbreak?
Understanding whether there is a genetic basis for the new unprecedented international outbreak of the disease outside Africa is considered incredibly difficult, according to University of Alabama computational biologist Elliot Lefkowitz. Scientists are still struggling to determine precisely which genes are responsible for the Central African strain's greater lethality and transmissibility than that of the West African strain. Although more than 17 years have passed, they have not reached a definitive conclusion.[/P]This is partly because the genomes of the virus in question contain many mysteries. Moreover, the genome of the simian smallpox virus is huge compared to that of many other viruses - for example, at least six times larger than that of the SARS-CoV-2 coronavirus. "So it's also six times harder to analyse," according to East Carolina University virologist Rachel Roper.
Another difficulty, according to Palathios, is that little effort has been made to date on genomic surveillance within Africa, where monkey smallpox has been a public health problem for years, with the result that virologists are now proceeding somewhat blindly, with few sequences of past genomes available to compare with recent ones. African virologists, according to Dr Iftedayo Adetifa of the Nigerian Centre for Disease Control, have always struggled to find funding for studies on monkey smallpox, but only now, with the problem directly affecting other continents, are health authorities worldwide showing unprecedented interest.
Furthermore, in order to understand the evolution of the virus, it will be useful to genetically analyse the virus in animals, which it also infects, especially rodents. However, so far the "reservoir" of the virus in the animal kingdom of Africa has not been discovered.
Is it possible to control the current outbreak?
Some countries have started to supply smallpox vaccines, which are considered quite effective also against monkeypox, because the two viruses are related. Unlike coronavirus vaccines, which take up to two weeks after administration to generate sufficient antibodies and provide maximum protection, smallpox vaccines are believed to protect against monkeypox infection if given within only four days of a person's exposure to the virus because of its long incubation period, according to the US Centers for Disease Control and Prevention (CDC).
If the vaccination strategy is adopted, it will likely primarily affect close contacts of people who are already infected, as well as some healthcare workers who come into contact with monkeypox patients. Groups considered at high risk for infection may also be vaccinated.
But even if a "brake" is put on the transmission of the virus to humans, virologists are concerned that the virus may be re-transmitted to animals, which in turn may increase the likelihood of the virus re-infecting humans. The European CDC considers this to have a "low probability", but European health authorities recommend isolation and surveillance - or even euthanasia - of pets belonging to people who have fallen ill with monkeypox in order to avoid the human-animal-human chain of transmission. The fact that animals do not have as visible symptoms as humans when infected with monkeypox is a cause for extra concern that such a route of transmission will be detected too late, when it is too late.
Is the virus spreading differently in this outbreak compared to previous ones?
Monkeypox virus is spread through close contact with rashes, body fluids and respiratory droplets of infected humans or animals. The new cases linked to sexual activity do not mean that the virus has become more contagious or that it is a sexually transmitted disease. It's just that the virus seems to spread more easily through close contact, according to Rymone.
Unlike coronavirus, which doesn't stay on surfaces for very long, according to Roper, smallpox viruses can survive for long periods of time outside the body, making various objects, such as clothing, doorknobs and bedding, a potential route of transmission.
Although several cases have been observed among men who have sex with other men, according to Rymone, the most likely cause of virus spread in this group is that the virus accidentally infiltrated this community, where it then spread through various intimate contacts.
Source: APE
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