monkeypox 2022 – what is this, symptoms, diagnostics, treatment of disease – Monkeypox risk

Key facts about monkeypox

• Monkeypox virus is mainly transmitted to humans from wild animals., such as rodents and primates. Its secondary distribution by human-to-human transmission is limited..
• Monkeypox is a rare viral zoonotic disease., which occurs, primarily, in remote areas of Central and West Africa, located near tropical rainforests.
• There is no specific treatment or vaccine for monkeypox., however, prior vaccination against smallpox also provides highly effective prevention of monkeypox.

Monkeypox virus belongs to the genus Orthopoxvirus in the Poxviridae family..

Monkeypox is a rare viral zoonotic disease. (ie. disease, transmitted to humans from animals), whose symptoms in humans are similar to those, observed in the past in patients with smallpox, however less serious. After the eradication of smallpox in 1980 year and the subsequent cessation of the use of vaccines against smallpox, monkeypox came out on top in terms of human pathogenicity among other orthopoxviruses. Cases of monkeypox still occur sporadically in parts of Africa, where tropical rainforests predominate.

Monkeypox outbreaks

Monkeypox among humans was first identified in 1970 year in the Democratic Republic of the Congo (at the time known as Zaire) in a 9-year-old boy in the area, where smallpox was eradicated in 1968 year. Since then, most cases have been reported in rural areas of the tropical rainforests of the Congo Basin and West Africa., especially in the Democratic Republic of the Congo, where the disease is considered endemic. IN 1996-1997 gg. the Democratic Republic of the Congo has experienced a major outbreak of the disease.

spring 2003 confirmed cases of monkeypox infection were reported in the Midwestern region of the United States of America. This was the first reported case of the disease outside the African continent.. It was found, that the majority of cases had contact with domesticated prairie dogs, who have been infected with rodents, imported from Africa.

Sporadic cases of monkeypox have been reported in many countries in western and central Africa., and as awareness of the disease grows, so does the number of diagnosed cases. FROM 1970 g. cases of human infection with monkeypox have been reported in 10 African countries: Democratic Republic of the Congo, Republic of the Congo, Cameroon, Central African Republic, Nigeria, Ivory Coast, Liberia, Sierra Leone, Gabon and South Sudan. IN 2017 g. Nigeria hosted the last known outbreak of the disease, the first in 40 yo case in this country.

Monkeypox transmission

Infection in index cases occurs as a result of direct contact with blood, biological fluids, as well as affected skin or mucous membranes of infected animals. In Africa, human infections have been documented from handling infected monkeys, gambian rats and squirrels, while rodents are the likely reservoir of the virus. One possible risk factor is eating meat from infected animals without proper heat treatment..

secondary transmission, or person-to-person transmission, occurs as a result of close contact with infected secretions from the respiratory tract, skin lesions of an infected person or with objects, contaminated biological fluids or materials from lesions of a sick person.

Transmission of infection occurs mainly by airborne droplets with prolonged personal contact., what puts the family members of the person with the acute illness at greatest risk of infection. Transmission may also occur by inoculation or through the placenta. (congenital monkeypox). To date, there is no evidence of, that human-to-human transmission alone is sufficient to maintain monkeypox infection in the human population.

Recent animal studies using the monkeypox model in prairie dogs and humans have identified two different monophyletic groups of the virus – the Congo Basin and West Africa, at the same time it is established, that the first group is more virulent.

Signs and symptoms of monkeypox

Incubation period (time period from infection to onset of symptoms) monkeypox usually ranges from 6 to 16 days, but may vary in range from 5 to 21 day.

The infection can be divided into two periods:

• invasion period (0-5 days), which is characterized by fever, Strong headache, Lymphadenopathy (hyperadenosis), backache, myalgia (myalgia) and severe asthenia (weakness);
• skin rash period (through 1-3 days after the onset of fever), when different stages of rashes appear, which often first appear on the face and then spread to other parts of the body. Most often they appear on the face. (in 95% cases), as well as on the palms and soles ( in 75% cases). Rashes go through several stages of development - from maculopapules (flat-based skin lesions) to vesicles (small fluid-filled blisters) and pustules, which are about 10 days are covered with crusts. It may take up to three weeks for the crusts to completely disappear..

The number of skin lesions varies from a few to several thousand.. They appear on the membranes of the mucous membranes of the oral cavity (in 70% cases), genitals (30%), as well as on the conjunctiva (century) (20%) and corneas (eyeball).

Some patients develop severe lymphadenopathy before the rash appears. (hyperadenosis), which distinguishes monkeypox from other similar diseases.

Monkeypox is usually a self-limiting disease., whose symptoms persist from 14 to 21 day. Severe cases are most common among children and are related to the degree of exposure to the virus., the patient's health status and severity of complications.

People, living in or near forested areas, may be indirectly or weakly affected by infected animals, which can lead to the development of subclinical (asymptomatic) infection.

Mortality varies widely depending on the epidemic, but in documented cases was less than 10%. Most deaths occur among young children. Generally, younger age groups may be more susceptible to monkeypox disease.

Monkeypox Diagnosis

In clinical differential diagnosis, the possibility of other diseases should be considered, accompanied by rashes, such as smallpox (even though, that the disease has been completely eradicated), enable vetryanaya, kor, bacterial skin infections, scabies, syphilis and drug allergy. Lymphadenopathy at the prodromal stage of the disease can serve as a clinical sign, differentiating monkeypox from smallpox.

The final diagnosis can only be made based on the results of laboratory diagnostics in specialized institutions., where this requires the performance of a number of specific tests to detect the virus. If monkeypox is suspected, health care workers should properly sample the patient (cm. below) and, respecting the proper conditions, transport samples to the laboratory, capable of diagnosing.

It is best to take samples of affected areas of the body - smears of exudate or crust. They should be kept dry, sterile test tubes (and not in a special environment for transporting viral materials), placed in the refrigerator. Blood or serum samples can be used, however, their analysis often does not provide a definitive conclusion due to the short duration of viremia and the suboptimal timing of sampling..

For the interpretation of the result, it is very important, that information about the patient be provided along with the sample, including:

• and) approximate date, when the temperature rose;
• b) date of onset of rash;
• c) sample date;
• d) current stage of the disease (rash development stage);
• e) patient's age.

monkeypox – treatment and vaccination

There are no specific treatments or vaccines for monkeypox, however, outbreaks of the disease are manageable. Smallpox vaccination has been effective in preventing monkeypox in the past. 85%, however, with the eradication of smallpox worldwide, this vaccine is no longer available to the general population. Nonetheless, a history of smallpox vaccination may contribute to a less severe course of the disease.

Natural carriers of the monkeypox virus

Monkeypox infection found in many animal species in Africa, such as striped squirrels, tree squirrels, gambian rats, striped mice, selevinia and primates. The natural history of the virus remains unclear, and further research is needed to determine the exact reservoir of monkeypox virus and its maintenance mechanism in nature..

It is believed, that in the US the virus has been transmitted from African animals to some susceptible non-African animal species (like a prairie dog) as a result of the residence of these animals in the common area.

Monkeypox prevention

Reducing the risk of infection in humans

During outbreaks of monkeypox, close contact with other patients is the most significant risk factor for infection with monkeypox virus. In the absence of specific treatment and vaccines, the only way to reduce human infections is to raise awareness of risk factors and educate the public about measures to take., that can be taken to limit exposure to the virus. Surveillance measures and rapid detection of new cases are essential for outbreak control.

When conducting health education among the population, special attention should be paid to the following risk factors:

• Reducing the risk of animal-to-human transmission. Efforts to prevent transmission in endemic areas should be directed, At first, to exclude any contact with rodents and primates and, Secondly, to limit direct contact with blood and meat, including the need for thorough heat treatment of animal products before consumption. When handling sick animals or their infected tissues, gloves and other appropriate protective clothing must also be worn during the slaughter of animals.
• Reducing the risk of human-to-human transmission. Avoid close physical contact with people, monkeypox infected. When caring for sick people, wear gloves and use protective equipment.. Hands should be washed regularly after caring for sick people or after visiting such people.. Patients are advised to isolate or at home, or in a medical facility.

Monkeypox control in healthcare settings

Medical profession, caring for patients with suspected or confirmed monkeypox virus infection or handling specimens, taken from these patients., should take standard infection control precautions.

Medical workers and people, having contact with monkeypox patients or specimens taken from them, contact national health authorities to consider vaccinating them against smallpox. However, people with weakened immune systems should not be vaccinated against smallpox using older vaccines..

Sample Handling, taken from humans and animals suspected of being infected with monkeypox virus, must be carried out by specially trained personnel in properly equipped laboratories. When transporting specimens taken from patients, they should be placed in a safe container and follow the rules for handling infectious materials.

Prevent further spread of monkeypox through the animal trade
Restricting or banning the movement of small African mammals or monkeys could be effective in curbing the spread of the virus outside of Africa.

Captive animals should not be vaccinated against smallpox. However, potentially infected animals must be isolated from other animals and immediately quarantined.. Any animals, who may have had contact with an infected animal, should be quarantined and monitored for symptoms of monkeypox within 30 days.

WHO response to monkeypox

WHO assists Member States in surveillance, preparedness and outbreak control in countries, smallpox monkeys.