Monkeypox is not a global health emergency for now, WHO says

Monkeypox is not yet a global public health emergency, the World Health Organization said on June 25.

The decision comes as the outbreak of the smallpox-related disease continues to spread, affecting at least 4,100 people in 46 countries as of June 24. This includes at least 201 cases in the United States. Those cases were found in 25 states and the District of Columbia, according to the US Centers for Disease Control and Prevention.

“Controlling the further spread of the outbreak requires intensive response efforts,” and the situation should be reassessed in a few weeks, the WHO committee assessing the outbreak said in an announcement.

Declaring a public health emergency would have potentially made it easier to get treatments and vaccines for people infected with or exposed to the virus. Some drugs and vaccines that might help stave off monkeypox are approved for use against smallpox and can only be used with a special permit against monkeypox.

The virus that causes monkeypox, named after its discovery in monkeys in 1958, although likely a virus that primarily infects rodents, is not a new threat. Countries in central Africa where monkeypox is endemic have had sporadic outbreaks since researchers found the first human case in 1970. Places in West Africa had few cases as of 2017. But most cases outside the continent have been travel-related, with limited spread to others (SN: 05/26/22).

“Monkeypox has been circulating in a number of African countries for decades and has been neglected in terms of research, attention and funding,” WHO Director-General Tedros Ghebreyesus said in a statement announcing the decision. “This needs to change not only for monkeypox, but for other neglected diseases in low-income countries as well, as the world is once again reminded that health is a connected issue.”

Monkeypox typically kills less than 10 percent of people who contract it. At least one person has died in the global outbreak.

As case numbers mount, researchers are working to unravel the virus’s genetic blueprint in hopes of finding out if some viral mutations might explain why the virus has quickly taken hold in new places.

detecting the mutations

The closest known relative of the versions of the virus behind the global outbreak is from Nigeria, suggesting the outbreak may have started there.

In the latest wave of cases, scientists have detected more viral changes than expected – a sign the virus may have been circulating undetected among humans for a while, possibly since the 2017-2018 monkeypox outbreak in Nigeria, new research suggests. Additionally, a group of enzymes known for their abilities to fight viruses in the body could be responsible for many of these mutations.

A genetic analysis of monkeypox viruses implicated in the global outbreak from 15 people in seven countries shows that these viruses have an average of 50 more genetic changes than the versions that circulated in 2018 and 2019, researchers reported June 24 naturopathy. That’s about six to 12 times as many mutations as scientists would have expected the virus to evolve in that time. Unlike some other virus types, smallpox viruses, which include smallpox and monkeypox viruses, usually mutate fairly slowly.

The changes have a pattern that’s hallmark of a family of enzymes called APOBEC3, the researchers say. These enzymes work on the building blocks of DNA — represented by the letters G, C, A, and T — in a specific way: Gs become As and Cs become Ts. The analysis found this particular pattern in the viral sequences, suggesting it that APOBEC3s are responsible for the mutations.

Ideally, so many DNA building blocks are exchanged for others that a virus is effectively destroyed and cannot infect any other cells. But sometimes APOBEC3 enzymes don’t make enough changes to knock out the virus. Such mutated but still functional viruses can infect other cells and possibly another person.

A big question, however, is whether the genetic changes seen in the monkeypox virus are helpful, harmful, or have no effect on the virus at all.

Although it’s still unknown whether the enzymes are directly responsible for changes in the monkeypox virus, similar mutations still appear, the team found. So APOBEC3s can still help the virus change as it continues to spread. A member of the enzyme family is found in skin cells, where people with monkeypox can develop infectious smallpox lesions.

During the current outbreak, lesions on the skin that can spread monkeypox have been smaller than those seen in earlier outbreaks. Some examples are shown.

” data-medium-file=”×383.png” data-large-file=”” loading=”lazy” width=”680″ height=”449″ alt=”six images of different types of skin lesions caused by monkeypox” class=”wp-image-3114970″ srcset=” 680w,×383.png 580w,×186.png 282w” sizes=”(max-width: 680px) 100vw, 680px”/>

During the current outbreak, lesions on the skin that can spread monkeypox were smaller than in previous outbreaks. Some examples are shown.UK Health Security Agency

Various symptoms

Symptoms reported in the global outbreak have generally been milder than previous outbreaks, potentially allowing the disease to spread before a person knows they are infected.

It’s not clear if these differences in symptoms are related to changes in the virus, Inger Damon, director of the CDC’s Division of Pathogens and Serious Consequences Pathology, said June 21 in a news release provided by SciLine, a service for journalists and scientists. hosted press conference sponsored by the American Association for the Advancement of Science.

Typically, in previous outbreaks, people developed flu-like symptoms, including fever, headache, muscle aches and fatigue, about a week or two after exposure to the virus. Then, one to three days after the onset of these symptoms, a rash of large, pus-filled lesions appears, beginning generally on the face and limbs, especially the hands, and spreading throughout the body. Although these symptoms are generally milder, they resemble smallpox, but people with monkeypox also tend to develop swollen lymph nodes.

All patients in the U.S. outbreak have developed rashes, Damon said, “but the lesions were scattered or localized to a specific body site rather than diffuse and generally did not involve the face or … palms or soles of the feet.” Instead, they can Rashes start in the genital or anal areas, where they can be confused with STDs like syphilis or herpes, she said.

In many cases, the rashes have not spread to other parts of the body. And the classic early symptoms like fever were “mild and sometimes absent before a rash appears,” Damon said.

Monkeypox is transmitted from person to person through close skin contact or through contact with contaminated towels, clothing, or bedding. It can also be transmitted through saliva droplets exchanged during kissing or other intimate contacts. The CDC is investigating whether the virus could be spread both through semen and through skin-to-skin contact during sex, Agam Rao, a captain in the US Public Health Service, said on March 23.

“We have no reason to believe it will be spread in any other way,” such as through the air, Rao said.

More cases of monkeypox have been recorded in women in Nigeria, while the global outbreak has mostly affected men, particularly men who have sex with men. Experts warn that anyone can be infected with monkeypox, and some people are at increased risk of serious illness. People at increased risk include children, people with weakened immune systems, pregnant women and people with eczema.

The risk of contracting monkeypox through casual exposure is still low in the United States, Rao said. However, the data she presented shows that while people in the country contracted monkeypox while traveling abroad, the cases also spread locally.

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