The outbreak of monkeypox, first detected in Europe in late April, has now reached 75 countries, the vast majority of which have never had significant cases before.
The United States now has the most people infected, with more than 3,500 of the 17,000 diagnoses worldwide. Spain, with a current number of cases of more than 3,100, has one-seventh of our population. New York City, with more than 1,000 cases. , is at the epicenter of the outbreak in the United States.
On Friday, the World Health Organization declared monkeypox a “public emergency of physical interest,” joining COVID-19 and polio in that designation.
Dr. Ashish Jha, the White House coronavirus reaction coordinator, described the resolution at a briefing Tuesday as “a call to action to the global network to prevent the spread of this virus. “
Here are some prevention methods and government moves taken in the midst of the outbreak, as well as non-unusual misconceptions about monkeypox infections.
Monkeypox usually begins with flu-like symptoms: fever, swollen lymph nodes, muscle pain, and headache. A few days later a rash develops, in this outbreak it rarely comes first, said Dr. Marshall Glesby, an infectious disease specialist at Weill Cornell. Medicine and New York-Presbyterian.
In the classic presentation seen in Africa, the lesions begin on the hands and face, he said, but with this outbreak, some of the lesions could be in the mouth or anus and would be difficult to see, and could be concentrated around the genital area, mouth or back.
Injuries can cause severe pain, either persistent and depending on the location, at bath time or feeding time.
Sometimes the rash can lead to permanent scarring and bacterial infections can occur above the skin lesions, Glesby said.
The overwhelming majority of ape pox patients at Weill Cornell were treated on an outpatient basis, he said, and some were hospitalized to manage pain.
Five other people have died worldwide since last April, the risk seems to be decreasing in richer countries. “People with higher nutritional prestige and fitness do better,” said Dr. Ali Khan, an epidemiologist and dean of the School of Public Health at the University of Nebraska Medical Center.
Any skin-to-skin contact can transmit monkeypox.
Yes, the outbreak has mostly affected men who have sex with men, and it’s possibly transmissible semen, Glesby said. But the virus doesn’t care who is infected.
In the United States, two young people in close contact with enraged relatives were diagnosed with the virus.
Many adults diagnosed with monkeypox in this epidemic also have simultaneous sexually transmitted infections. Other infections should be thought of as when performing an apepox test. If an STI is considered a diagnosis, a physical care provider also thinks of apepox, Glesby said.
Monkeypox is not transmitted through an undeniable touch, such as a handshake, a quick kiss on the cheek, or sharing a seat.
In theory, it can be transmitted by touching clothes or sheets worn by other people with open wounds and through the air if someone has sores in their mouth, but there is no evidence that anyone stuck them that way this outbreak, Khan said.
“It turns out it requires close, prolonged skin-to-skin contact,” he said. If it weren’t, “we’d have millions of cases now. “
Homosexuals shouldn’t be stigmatized just because the virus has begun circulating among men who have sex with men, said Dr. Mahdee Sobhanie, an infectious disease specialist at The Ohio State University Medical Center.
“Don’t think of this as a homosexual disease. It’s a disease that can occur through close contact,” he said.
Monkeypox likely spread and evolved silently in and around Nigeria over the past 4 to 5 years, Khan said. the world,” he said.
The communities most affected by monkeypox have struggled to communicate threats and educate people, Khan said. “They are very guilty and show up to get vaccinated. “
However, the United States has been more prepared.
“It seems inexplicable to me that the vaccine has not yet been stored in the United States for this eventuality, so to speak,” he said. “In the most sensible way, (the Department of Health and Human Services) may have done a bigger job as soon as it knew there were cases. “
Currently, the other people most at risk of infection are men who have sex with male partners. “Pay attention to who you have sex with,” Khan said. Making sure they’re not inflamed can reduce the risk.
Men who have sex with men and other high-risk people, in addition to fitness staff who treat monkeypox patients and members of the circle of relatives of those infected, get vaccinated if possible, he said.
“And if you think you’re infected, pass without delay, get a diagnosis and get a remote control and treatment so you can’t infect any more,” he said.
For low-risk individuals, nothing is needed right now for coverage, unless local, state and federal public fitness systems, he and Glesy said.
“The only lesson that will be learned is that you actually want more help for this country’s public fitness infrastructure,” Glesby said. “Basically, the United States has an underfunded public fitness system. “
“Given its spread in the world, it would be a pandemic,” Glesby said.
At first, testing was difficult to access, but advertising labs have recently increased the country’s capacity to more than 70,000 tests per week.
The tests are done on the pus of the lesions, but officials at the Centers for Disease Control and Prevention said they are reading the option of tests on saliva, throat smears and blood.
Vaccines seem very opposite to ape smallpox, they were developed to save you from smallpox, its much more fatal cousin.
Two ape pox vaccines can be used, but only one is widely prescribed in this outbreak and is uncommon.
The U. S. government While the U. S. funded the progression of the Jynneos vaccine and pre-ordered part of the supply, only 2,000 doses were available in early May when it became apparent that the virus was spreading.
At the end of May, there were 72,000 doses available, and this month the government has distributed another 300,000 doses and millions more ordered, Dawn O’Connell, undersecretary for preparedness and reaction at the Department of Health and Human Services, said at a news convention this month.
Management announced Wednesday that another 786,000 doses are now available.
Shots are provided in bulk, long queues have occurred in some localities and access has not been equitable in all regions and populations.
The other vaccine, ACAM2000, will not be used to treat immunocompromised people, such as those who are HIV-positive, and would possibly cause greater side effects. There are millions of doses available in U. S. stockpiles. But only one state has asked for this far away.
Khan said it would make sense to use ACAM2000 widely only “if it’s a primary epidemic with more people hospitalized and dying. “
A full cycle of Jynneos requires two injections, the hour at least a month after the first. But New York, Washington, D. C. and other major cities have postponed instant moves due to limited supply.
Although the CDC doses for comprehensive long-term protection, Glesby said it made sense to defer momentary doses in order to protect more people.
“We don’t know with this specific vaccine” what coverage is provided through the first dose, he said.
An antiviral called tecovirimat, sold under the TPOXX logo name, has been approved to treat smallpox and is now used to treat other people with monkeypox.
TPOXX can prevent an infection if given before or within 4 days of exposure, Khan said, and avoid serious illness if given up to two weeks after the user was exposed to the virus.
It has been tested on other healthy people for side effects, but it hasn’t been used before unlike other people affected by monkeypox, Glesby said. still ongoing, he said.
Since most people go untreated, a clinical trial with a placebo group will be needed to determine whether TPOXX can safely reduce symptoms, lead to a faster recovery or avoid complications, he said.
Still, Glesby said, thirty patients treated with TPOXX in his program well.
The disease was first known in a monkey, hence its call, but humans don’t contract it from monkeys, and the World Health Organization is looking to replace the call to avoid confusion.
Squirrels cordoned off in parts of Central and West Africa have been known as monkeypox carriers. They transmit the infection to other people who hunt or eat them, and then from each other, Khan said.
Monkeypox genes come in the form of DNA, which mutates as much as RNA-based viruses, such as the SARS-CoV-2 virus, which causes COVID-19.
Still, Khan said, in the past four years, the virus has undergone more changes than expected, most likely because it has quietly moved from one user to another in places like Nigeria, and only most of the transmissible variants survived.
The virus looks different in this global outbreak than in previous, more localized outbreaks, Glesby said, but “it remains to be seen whether this is due to genetic differences in the virus. “
Fortunately, circulating editing of monkeypox appears to be less lethal than a strain known to have the disease in Central Africa.
Monkeypox’s knowledge is hard to come by. ” I don’t think we have a very intelligent concept of the true extent of the disease and how temporarily it is spreading,” Khan said.
States generally collect information, but they lack an undeniable way to share it with the federal government.
Currently, no one tracks who is vaccinated or inflamed before or after vaccination, he and Glesby said.
“It’s hard to judge and say where the disease is now,” Khan said.
As with COVID-19, bureaucracy slowed down testing, vaccinations, and remedies in the first few weeks of the outbreak.
Most of the diseases seem to have been solved by now. Although monkeypox testing was initially concentrated at the CDC, advertising labs now offer tens of thousands of tests a day.
Doses of vaccines owned by the U. S. governmentthey have remained in Europe for weeks awaiting FDA approval, but are now available and more have been ordered.
Paperwork paralyzed the launch of the antiviral TPOXX, but since then the CDC has simplified the procedure and made the solution less difficult and faster.
The scenario is better, but the first repeated mistakes serve as a warning, Khan said.
“We want this to hold up in pandemics in the long term,” he said, adding that the government could take many other steps to be better prepared. “I’m worried about the next coronavirus, I’m worried about the next flu that can kill thousands and millions of people. “
Contact Karen Weintraub at kweintraub@usatoday. com.
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