Monkeypox is not a global emergency for the time being, the WHO says. 3 things we need to know about how it mutates and spreads

The World Health Organization (WHO) has decided not to declare monkeypox a public health emergency of international concern. This may change in the future.

WHO Director General Tedros Adhanom Ghebreyesus said he was “deeply concerned” about the evolving threat of monkeypox, which he said had reached more than 50 countries.

There have been more than 4,100 confirmed cases worldwide, including at least 13 in Australia.

The WHO also acknowledged that there were many unknowns about the outbreak.

Here are three things we know about monkey pox and three things we want to know.

3 things we know

1. Monkeypox is caused by a virus

Monkeypox is a large DNA virus that belongs to the orthopox virus family. Unlike the related smallpox virus, variola, which only affects humans, monkeypox virus is found in rodents and other animals in parts of Africa.

We know of two clades (virus groupings), and it is currently the less severe of the two circulating outside Africa.

Orthopoxviruses are stable viruses that do not mutate much. Multiple mutations, but are described in the virus causing the current outbreak.

At least two separate strains are circulating in the United States, suggesting: multiple introductions into the country.

2. You can be infected for more than a week and not know it

It takes a average 8.5 days from infection to showing symptoms such as enlarged lymph nodes, fever, and a rash, which usually looks like fluid-filled blisters that erupt. People are contagious while they have the rash and are usually contagious for about two weeks.

Children are most affected and are at greater risk of dying from the disease. Historically, in the endemic countries of Africa, almost all dead have been with children.

Children with monkey pox, like this four-year-old girl, are at increased risk of serious illness. CDC

The European epidemic is usually in adult malesso this, along with better access to care, may explain the low death rate in these countries.

3. We have vaccines and treatments

Vaccines work. Previous vaccination against smallpox offers 85% protection against monkey pox. Smallpox was declared eradicated in 1980so most mass vaccination programs stopped in the 1970s.

Australia has never had mass smallpox vaccination. However, a estimated 10% of Australians have been vaccinated in the past, mainly migrants.

Vaccines protect for many years, but immunity wanes. So declining protection at population level is likely responsible for the resurgence of monkeypox since 2017 in Nigeria, one of seven endemic hotspots in Africa.

Man shows scar from smallpox vaccine on upper arm

Even if you are vaccinated against smallpox, the protection decreases. Shutterstock

Mass vaccination is not recommended. But vaccines can be given to contacts of confirmed cases (known as post-exposure prophylaxis) and people at high risk of contracting the virus, such as some laboratory or health professionals (pre-exposure prophylaxis).

There are also treatments, such as vaccinia immunoglobulin and antiviral agents. These have been developed against smallpox.

3 things we want to know

1. How important are these new mutations?

The virus causing the current outbreak has different mutations compared to versions of the virus circulating in Africa. However, we don’t know whether these mutations affect clinical disease and how the virus spreads.

The monkeypox virus has a very large genomeis thus more complex to study than smaller RNA viruses, such as influenza and SARS-CoV-2 (the virus that causes COVID).

Experts wonder whether the mutations made it more contagious or changed its clinical pattern to look more like a sexually transmitted infection. A study from Portugal shows that the mutations probably make the virus more transmissible.

2. How is it distributed? Does that change?

Monkeypox has not been described as a sexually transmitted infection in the past. However, the current transmission pattern is unusual. Over there seems to be a very short incubation period (of 24 hours) after sexual contact in some but not all cases.

It is a respiratory virus, so transmission via aerosols is possible. but historically most transmission has been from animal to human. Transfer between people usually involved close contacts.

However, the rapid growth of the epidemic in non-endemic countries in 2022 is all due to spreading between people. there can be many more cases than officially reported.

We don’t know why the pattern has changed, whether it is transmitted sexually or simply through intimate contact in specific and globally connected social networks, or whether the virus has become more contagious.

The virus is found in the rash, mouth and semen, but this does not prove it is sexually transmitted.

3. How far will it spread? Does COVID make a difference?

Will this spread more widely in the community? Is the COVID Pandemic Increasing Risk? Possibly, yes

Nor should we drop the ball on surveillance in the wider community or stigmatize the LGBTQI community

With declining immunity to the smallpox vaccine worldwide and the spread of monkeypox already to many countries, we can see the epidemic spread further.

If it does and starts infecting large numbers of children, we could see more deaths because children get a more serious infection.

So we need to check globally for clusters of fever and rash, and misdiagnosis like chickenpox, foot and mouth diseaseherpes simplex or other diseases with a rash.

Another factor is COVID. As people recover from COVID, their immune systems change is affected† So people who have had COVID may be more susceptible to other infections.

We see the same with measles infection. This weakens the immune system and increases the risk of other infections for: two to three years then.

If the epidemic settles in countries outside the endemic areas, it could infect animals and create new endemic zones around the world.

It is important that we do everything we can to stop this epidemic.

The conversation

C Raina MacIntyreProfessor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW Sydney

This article was republished from The conversation under a Creative Commons license. Read the original article


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