Symptoms and causes of monkeypox infections, which the CDC calls an “emerging problem”

New cases of monkeypox were reported in the UK, Spain, Portugal, Italy and the US this week, a rare occurrence for a virus largely confined to central and west Africa.

United States reported its first case of monkeypox of the year Wednesday: a man from Massachusetts. The New York Health Department said Thursday it is also investigating a possible case. UK, nine cases have been detected since early May. On Thursday, Italy confirmed one recent case, Portugal confirmed 14 and Spain confirmed seven, along with 22 suspected cases. France also reported a suspected case on Thursday.

“This is the largest outbreak in history of monkeypox in the Western Hemisphere,” said Anne Rimoin, professor of epidemiology at the UCLA Fielding School of Public Health.

The last time the Western Hemisphere saw a monkeypox outbreak of this magnitude was in 2003, she said, when the United States identified 47 cases.

These patients had contact with infected prairie dogs and none died. But disease experts have not pinpointed exactly how the virus is currently spreading.

“What we are facing right now appears to be at least a subset of cases that have no travel history to any of these countries in Africa where monkeypox virus naturally occurs, and who don’t report any exposure to someone who has been diagnosed with monkeypox. So what we’re seeing right now is unusual,” said Dr Agam Rao, a physician in the Division of High Consequence Pathogens and Pathologies. from the Centers for Disease Control and Prevention.

Although monkeypox doesn’t spread easily between people, the CDC is preparing for additional cases in the United States, Rao said.

“We tell people this is an emerging issue,” she said. “Some emergent issues eventually become benign. Others are intensifying. As an emerging issue, we ask people to keep it in mind for now.

What is monkey pox?

Monkeypox belongs to the poxvirus family, which includes smallpox. The disease got its name after scientists discovered it in laboratory monkeys in 1958. The first human case of monkeypox was diagnosed in 1970.

Since then, most infections have been concentrated in the Democratic Republic of Congo and Nigeria. DRC reports thousands of cases annually and Nigeria has reported over 200 confirmed cases and over 500 suspected cases since 2017.

The type of monkeypox identified in recent cases in the United States and Europe tends to produce milder disease than the other common branch of the virus.

“All of the virus strains that we know of from all of these cases that have occurred in the past two weeks belong to the West African clade. The West African monkeypox clade is much more benign than the Congo Basin clade,” Rao said. “That’s good news in that hopefully there won’t be a lot of clinically bad things happening to people who might be infected.”

About 1% of people who contract the West African clade die, compared to up to 10% of people who contract the Congo Basin clade, according to the World Health Organization.

Rao said people who contract the West African clade “usually recover quite well” and return “to their normal lives when it’s over.”

According to CDC.

Person-to-person transmission can occur through the exchange of large respiratory droplets during prolonged face-to-face contact. People can also be exposed through direct contact with bodily fluids, lesions that form during an infection, or contaminated objects such as clothing or bedding.

Many newly identified cases in Europe involve men who have sex with men, but monkeypox is not considered a sexually transmitted infection.

“It is probably premature and potentially even dangerous to assume that there are only cases within this community,” Rao said.

She added that the overrepresentation of this group may simply be a product of skin-to-skin contact within a tight-knit community.

“There are going to be studies related to trying to isolate the virus from seminal fluid or vaginal fluid. There really is a lot of work to be done before it can be said to be sexually transmitted,” she said.

Monkeypox usually begins with flu-like symptoms such as fever, headache, muscle aches, and exhaustion. Patients may develop a rash on the face or other parts of the body within one to three days after the fever.

The rash can look like chickenpox, syphilis, or herpes, but is distinguished by fluid-filled blisters called vesicles on the palms of the hands.

The arms and legs of a 4-year-old girl infected with monkeypox in Bondua, Liberia.BSIP/UIG Via Getty Images File

Symptoms can develop anywhere from five to 21 days after a person is infected. Most people recover after two to four weeks.

Following the identification of the first U.S. case, the CDC asked health care providers to look for patients with the characteristic monkeypox rash.

“We recommend all clinicians do this, but especially those caring for patients in STD clinics,” Rao said, referring to sexually transmitted diseases.

So far, Rimoin said, the recent infections “appear to be reasonably mild cases that were discovered in clinics, and not because people are showing up seriously ill at the emergency room.”

Rimoin said it made sense that new cases of monkeypox would continue to appear because there is less immunity to poxviruses than before 1980, when people were still getting smallpox vaccines.

“It is not surprising that we see infections following exposure, given that we no longer have this immunity that we relied on in the era of smallpox eradication,” he said. she declared.

There is no proven treatment for monkeypox, but doctors can treat its symptoms. Rimoin said supportive care is quite effective for the West African clade. Beyond that, she said, there are experimental drugs that have not been widely tested in humans.

Physicians who identify a suspected case of monkeypox should report it to the CDC, Rao said, because “any potential treatments that might be provided to the patient are really only available in consultation with public health authorities.”

Smallpox vaccines could help control an outbreak of monkeypox, the CDC says, but the United States stopped vaccinating the general public against smallpox in 1972. In 2019, the Food and Drug Administration approved a vaccine for smallpox. smallpox. which also protects people from monkeypox, but it is not widely available. Experts believe the vaccine could help reduce symptoms or prevent disease if given soon after a person is infected. the CDC website states that “in the event of a new outbreak of monkeypox in the United States, the CDC will establish guidelines explaining who should be vaccinated”.

For now, Rao said, the risk to the general population is very low.

“I wouldn’t want people to be too terribly alarmed right now and change their behavior too much,” she said.

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