Monkeypox spreads around the world

Outbreaks of monkeypox caused by the MPXV virus (monkeypox) have set off alarms for rapid growth.

In Central and West Africa, the virus causes thousands of infections and dozens of deaths every year and has been on the rise for over two decades.

In recent months, around 200 cases of the disease have been diagnosed in 16 European countries, the USA, Canada and Australia. In Italy, there are 6 confirmed infections. Until now (May 25, 2022), no deaths associated with the disease have been reported.

The identification of cases not linked to travel to endemic areas is an unusual fact – reports a note from the WHO. Actions immediate for now, are a guide to protect first-line health workers from contagion. Those who have had physical contact with infected people or with symptoms are considered at risk. Cases have been identified mainly, but not exclusively, among men who have had sexual intercourse with men – writes the WHO – which foresees an evolving situation.

Although the disease belongs to the same family as smallpox viruses, symptoms are milder and recovery usually occurs within two to four weeks, without the need for hospitalization. On the other hand, it can cause serious diseases in some population groups, such as young children, pregnant women and immunosuppressed people – specified ECDC, the European Center for Disease Prevention and Control – which found that the probability of spread is very low.

The first genome sequence of the virus arrived from Portugal. For the research team of the Department of Infectious Diseases National Institute of Health, in Lisbon, Monkeypox would be more closely related to the strains found in 2018 and 2019 in the UK, Singapore and Israel. It is a double-stranded DNA virus, the sequence of which shows that it is of the mild West African type, but it is not yet clear whether this virus has undergone changes that make it more transmissible. The European Union has recommended that those infected with MPXV (monkeypox) remain in isolation until the scabs of the skin lesions produced by the virus have fallen off, to reduce the risk of infection. The European Center for Disease Prevention and Control (ECDC), has asked that even mammalian pets, of infected people, remain in quarantine to prevent the monkey virus from becoming an endemic disease even in the Old Continent, as is already happened in central and western Africa. The ECDC concern is important in the sense that there are many animals that are potentially susceptible to monkeypox.

The World Health Organization (WHO) receives updates on monkeypox cases, through established surveillance mechanisms for endemic countries (Benin, Cameroon, Central African Republic, Democratic Republic of Congo, Gabon, Ghana, identified only in animals, Costa of Ivory, Liberia, Nigeria, Republic of Congo, Sierra Leone and South Sudan).

The monkeypox it’s a zoonosesdue to a virus transmitted to humans from animals, with symptoms very similar to those seen in the past in patients with smallpox, although it is clinically less severe.

This disease should be suspected if there is a high fever associated with a rash (vesicles, pustules, crusts). Symptoms can be mild or severe and the lesions very itchy or painful; in addition, headache, muscle pain, lymphadenopathy and asthenia. The skin manifestations start from the head and spread towards the limbs; start with some macules which later become papules and then vesicles inside which there is a liquid that contains the virus. The blister persists for a few days, then ruptures and a small mark remains in its place. It has the same symptomatic pattern as chickenpox.

There diagnosis it is predominantly clinic based on assessment of symptoms, history by travel area, occupation and contact. To establish a definitive diagnosis are necessary: ​​isolation and viral culture, immunohistochemistry for the detection of viral antigen, the immunoabsorbent test for the detection of antibodies (IgG and IgM) and the detection of specific viral DNA by PCR (molecular test).

The monkeypox virus belongs to the genus Orthopoxvirus of the Poxviridae family. The name monkeypox derives from the initial discovery of the virus in monkeys in a Danish laboratory in 1958. It is transmitted from one person to another by close contact with injuries, body fluids, respiratory droplets. The incubation period is generally between 8 and 13 days, but can range from 5 to 21 days.

There smallpox vaccination, suspended in 1977 and abolished in 1982, has been shown to be protective against monkeypox. There is an even more specific vaccine tested directly for monkeypox and human at the same time that appears to protect against both infections. It is an innovative vaccine (Jynneos) that has already been approved by the American FDA and can be used for close contacts with infected people or in the prodromal stages of infection, to reduce the possible severity of the disease. Although also a specific antiviral treatment (tecovirimat) was approved for monkeypox in 2019 and 2022, these countermeasures are not yet widely available.

To date, all cases whose samples have been confirmed by PCR have been identified as infected by the West African clade.

The genome sequence of a swab sample from a confirmed case in Portugal indicated a close match between the monkeypox virus causing the current outbreak and exported cases from Nigeria, the UK, Israel and Singapore in 2018 and in 2019.

Contact monitoring: according to the indications of the Ministry of Health, contacts must be monitored, at least daily for the onset of signs / symptoms referable to the MPXV virus, for a period of 21 days from the last contact with a patient or his contaminated materials during the infectious period.

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