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Monkeypox Can Be Contained—but Time Is Running Out

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Anne Rimon who has witnessed the rise of monkeypox in parts of West and Central Africa for the past 20 years has watched the current outbreak with a sense of certainty.

“There’s always been this existential threat to what can happen with poxviruses,” said Limoyne a professor of epidemiology at the UCLA Fielding School of Public Health. “If it gets into a population it’s in It can spread efficiently and we could see extended chains of transmission giving this virus a runway that it didn’t have before. ”

Rimoin and colleagues listed these warning signs in a paper back in 2010 but public health officials have largely ignored them. Now Europe and North America are facing outbreaks that are rare in these regions. Latest statistics show confirmed infections Over 1400 people from 31 countries.

While monkeypox typically spreads from animals to humans in relatively isolated incidents genome sequencing has shown that it has spread between humans repeatedly over the past five years. In fact the current case transmission appears to involve at least two separate outbreaks. been known as These likely started sometime in 2017 when cases suddenly spiked in Nigeria before spreading globally sometime earlier this year although the exact time frame is unclear.

Several countries including the U.K. U.S and Canada have adopted a containment strategy called ring vaccination which involves tracing close contacts of infected people asking them to self-isolate and providing them with a drug called Imvanex. Smallpox vaccine which is produced by Pharmaceutical company Bavaria Nordic. The UK has ordered 20,000 doses of Imvanex while Germany has signed contracts for 40,000 doses.

Computer models suggest that this strategy should prove effective. Because monkeypox is generally relatively low contagious research conducted by the nonprofit research group RTI International predicts that a combination of contact tracing and ring vaccination can May reduce the likelihood of a new case by 78% to 89%.

But is this strategy really enough? Thankfully the virus has not yet caused any deaths but scientists fear a sense of complacency with some arguing that more needs to be done by health authorities to prevent monkeypox from developing into a recurring public health problem.

One problem with the models for example is that they do not account for vaccine hesitancy. According to a report published in May only 15 of 107 community contacts in the UK and 169 of 245 healthcare workers opted to receive the monkeypox vaccine following possible exposure to monkeypox.

Donal Bisanzio a senior epidemiologist at RTI International who is modeling the outbreak said there needs to be clearer information and education for frontline healthcare workers when it comes to the importance of being protected and dealing with suspected cases quickly.

“We need to make sure everyone knows how to handle these cases in case they pop up in the clinic,” he said. “There is no rapid test for monkeypox. You need to send a sample to a laboratory and if it is a suspected case people are advised to self-isolate if confirmed Conduct contact tracing and provide vaccinations. ”

Rimoin said there is an urgent need to develop faster diagnostic tests and provide healthcare workers across the country with slides and photos so they can quickly identify suspected cases. Communicate with and serve subpopulations that are particularly vulnerable to the virus Vaccines are also important she said. Current data suggest that this includes health care workers and men who have sex with men (MSM).

“Our concern is that when it comes to cases we’re just seeing the tip of the iceberg,” said John Brownstein a professor of medicine at Harvard Medical School. “We don’t know how deeply ingrained this virus is in certain communities and whether It has moved beyond a containment strategy and is more of a mitigation strategy. ”

When it comes to predicting what might happen the problem lies in many unknowns. Brownstein noted that we still don’t know how transmissible the current strain is whether it’s transmitted by means other than sexual contact and whether it can be spread by asymptomatic people. he Some of these fundamental questions are still weeks away from being resolved while bigger questions such as how the virus affects people who are immunocompromised and the possible long-term consequences of infection remain unknown.

“Predicting future risks is challenging because data are so sparse right now,” Brownstein said. “We’re building some picture of the transmission mechanism. But it’s not complete. Are those current outbreaks dying? Or are they just bubbling up up? ”

The scientists also warned that governments should avoid focusing too much on the current situation as monkeypox poses a more long-term risk. If we fail to eradicate the virus and it continues to spread it could eventually spread to immunocompromised people Rimoin said.

While monkeypox virus is more stable and less prone to forming new variants than RNA viruses such as SARS-CoV-2 if it infects immunocompromised people it may have the opportunity to acquire mutations that could make it more transmissible or virulent. This is because people are Weakened immune systems—such as organ transplants or cancer patients taking immunosuppressants—work to clear the infection giving the virus time to adapt to the body.

Another risk is the spread of monkeypox from humans to other species thus establishing itself in animal populations in North America and Europe as it has already happened in parts of Africa where it is endemic. This would make it nearly impossible to eradicate in the Western world.

When monkeypox briefly entered the United States in 2003 it infected prairie dogs. “We know that ground squirrels are highly susceptible to this virus and have a wide variety of hosts,” Rimoin said. “If monkeypox can build up in wildlife reservoirs Outside of Africa it will be a very complex situation. ”

To determine exactly how widespread the current outbreak is the UK has opted to make monkeypox a notifiable infectious disease meaning all health professionals and laboratories who detect a suspected case must alert the UK Health Security Agency (UKHSA).

“I think UKHSA is doing the right thing because they’ve broadened their surveillance network,” said David Heymann an infectious disease epidemiologist at the London School of Hygiene and Tropical Medicine who has been working for many years. Research on monkeypox in sub-Saharan Africa. .

“They’ll start to determine if it’s also present in other populations. It’s very early days and we don’t know which groups are really at risk or beyond MSM. We expect there may be others.”

There are other challenges ahead. Because the virus has been linked to the MSM community — even though it is thought to be able to spread through all sexual networks — scientists say health officials must communicate clearly with the public to avoid Monkeypox is stigmatized. If a vaccine starts rolling out in a targeted fashion to select subpopulations and the disease builds stigma it could dampen the contact-tracing efforts that epidemiologists fear may have taken place.

“People are concerned about wanting to self-identify out of fear of stigma,” Brownstein said. “There are concerns that this virus like others may be unfairly linked to certain subgroups.”

There are also questions about the capacity of health care systems which have been exhausted and stretched to their limits by the demands of Covid-19 and their ability to intensify responses to monkeypox.

“The public health infrastructure is barely capable of dealing with one virus let alone two,” Brownstein said. “But there’s a lot of people working really hard on case identification contact tracing tests. It’s definitely a stretch there may be Exhausted but I don’t think public health is indifferent to it. ”

While scientists believe there is still room for optimism — we’ll see in the coming weeks and months whether the rate of new cases begins to decline — the ongoing outbreak is taken seriously before the virus becomes too entrenched in society. epidemic is crucial.

“I think when we think about having a poxvirus that can spread relatively efficiently in humans the risk is actually pretty high,” Rimoin said. “If it builds up we could end up in a situation where we have to keep throwing resources at it It has been extended to fight poxviruses that are spreading around the world. “

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