Monkey pox, a smallpox like disease, has emerged from Africa and is infecting people on all the inhabited continents.
”As a result
of aggressive worldwide vaccinations, the similar, lethal viral disease, smallpox,
stopped afflicting humans in 1975. In
the 1980s, nations of the world stopped vaccinating people, and that left
mankind susceptible to smallpox like diseases.
One of them,
monkeypox, has been “endemic in ten countries in west and central Africa” for a
few decades. The number of people who have
become infected has steadily increased as people in those countries “more and
more move into the forest to find food and build homes.” In 2022 there were
more than 1000 known cases in the Democratic Republic of the Congo alone.
In the wild,
the illness is chiefly spread by squirrels, rats, and shrews. (We only know of one case in a monkey.) Several pharmaceutical firms have developed
and produce smallpox vaccines. Experts
believe they will also prevent monkeypox.
Monkeypox is
not airborne. It is mainly spread by
contact, so it shouldn’t be that hard to control. So far reported cases seem to be “concentrated
in men who have sex with men.
There are currently two known strains of the virus. The West African strain kills one percent of the people it infects and the Congo Basin Strain is “ten times more lethal.”
Addendum march 13, 2022.
Since May 2022, when the multinational mpox (formerly known as monkeypox) clade IIb virus outbreak was first reported, more than 30,000 cases and 38 deaths have been identified in the United States. In one study, gay, bisexual, and other men who have sex with men make up the majority of cases in the current mpox outbreak. Anyone, regardless of sexual orientation or gender identity, who has been in close, personal contact with someone who has mpox is at risk.
For most patients with intact immune systems, monkeypox is a self-limited illness that does not require anti-viral treatment to clear the disease.
For those who do require intervention, a 14-day course of oral tecovirimat, (FDA-approved for the treatment of human smallpox disease caused by Variola virus in adults and children.) usually leads to resolution of the disease. Tecovirimat is a virostatic agent that targets a major envelope protein conserved across orthopoxviruses (VP37 in monkeypox virus). Experiments performed during drug development and independent studies have demonstrated induction of resistance following tecovirimat exposure.
Tecovirimat is sold under the brand name Tpoxx. As of August 2022, Tpoxx is available in the US only through the Strategic National Stockpile as a Centers for Disease Control and Prevention investigational new drug.
Source of
information;
“Global Outbreak Puts Spotlight On Neglected Virus” by John Cohen. SCIENCE June 3, 2022 page 1032 and 1033
https://emergency.cdc.gov/han/2022/han00481.asp
Aug 15, 2024 The director of the World Health Organization
determined that the upsurge of mpox in the Democratic Republic of the Congo
(DRC) and a growing number of countries in Africa constitutes a public health
emergency of international concern (PHEIC). "The emergence of a new clade (1b) of mpox and its rapid
spread mainly through sexual networks is concerning. In the past
month, over 100 laboratory-confirmed cases of clade 1b have been reported in
four countries neighboring the DRC that have not reported mpox before: Burundi,
Kenya, Rwanda and Uganda.
https://www.who.int/
98% of the infected persons were gay
or bisexual men, 75% were White, and 41% had human immunodeficiency virus
infection;
Transmission was suspected to have
occurred through sexual activity in 95% of the persons with infection. The median incubation period was 7 days
(range, 3 to 20). Monkeypox virus DNA was usually detected in the seminal fluid.
In this case series, the median age was 38 years.
A sexual history was recorded in 75 percent of
the people.
The median number of sex partners in the previous
3 months was 5 partners. 103 (20%) had
attended large gatherings (>30 persons), such as Pride events..
95% of the persons presented with a rash (with
64% having <10 lesions),
73% had anogenital lesions, and
41% had mucosal lesions (with 54
having a single genital lesion).
Common systemic features preceding
the rash included fever (62%), lethargy (41%), myalgia (31%), and headache
(27%); lymphadenopathy was also common (reported in 56%).
Most cases were mild and self-limited, and there
were no deaths. In persons for
whom follow up PCR data was available, all tested lesions were negative 21 days
after symptom onset.
70 (13%) of those infected were hospitalized; the reasons for hospitalization were pain management, mostly for severe anorectal pain (21 persons); soft-tissue superinfection (18); pharyngitis limiting oral intake (5); eye lesions (2); acute kidney injury (2); myocarditis (2); and infection-control purposes (13).
https://emergency.cdc.gov/han/2022/han00481.asp
https://www.nejm.org/doi/full/10.1056/NEJM
oa2207323?query=featured_home
From: NEJM September 7, 2023 Mpox by Mridula Nadamuni, M.D., and Lindsey
Baden, M.D.
More than 80,000 cases of Mpox have been diagnosed
to date worldwide. The virus is enveloped, double-stranded DNA. It usually causes a characteristic vesiculopustular
rash.
The animal reservoir of mpox is not currently
known, though various rodent species, including Gambian pouched rats, have been
suggested. Monkeys are considered intermediate hosts. Close contact with wildlife and livestock is a major risk for disease transmission.
Human-to-human
spread of the virus typically occurs from direct contact with mpox rash, scabs,
or bodily fluids or prolonged contact with respiratory secretions from a person
with mpox. Contact with fabrics and surfaces that come in contact with the
virus may also spread the infection. The risk of spreading the infection
continues until the rash has fully healed and new skin has formed (typically 2
to 4 weeks).
Mpox
is not currently classified as a sexually transmitted infection though close
contact sustained during sexual activity can promote its spread.. The majority
of patients reported to have mpox in the 2022 outbreak were men who had sex
with men (MSM).
In addition to the characteristic rash, patients may have
headache, fevers, myalgia, lethargy, persistent cough, lymphadenopathy, or sore
throat. The
mean incubation period is 13 days. The prodrome phase is characterized by
fever, headache, and fatigue, as well as lymphadenopathy, which distinguishes
mpox from chickenpox.
In the
eruptive phase, skin lesions appear simultaneously in a centrifugal
distribution, including the palms and soles. Over 14 to 28 days, the lesions,
which are firm and umbilicated with well-defined borders, will progress through
several stages: macules, papules, vesicles, and finally pustules. Healing
lesions can sometimes leave permanent scars.
People with immune-compromising conditions, such as HIV, are at higher
risk for contracting the disease.
Currently, two vaccines have been approved by the Food and
Drug Administration (FDA) for the prevention of mpox and smallpox:
a nonreplicating modified vaccinia virus vaccine (JYNNEOS,
Bavarian Nordic) and
a live vaccinia virus vaccine (ACAM2000, Emergent
BioSolutions).
Persons who have had close contact with someone diagnosed
with mpox, especially sexual contact, should consider vaccination.
Tecovirimat was approved by the FDA in 2018 for use against smallpox and has in vitro evidence for activity in the treatment of mpox with severe symptoms. The drug inhibits the orthopoxvirus protein p37, blocking viral cell-to-cell transmission.
Mpox
Update: September 7, 2023
taken directly from N Engl J Med 2023; Mridula
Nadamuni, M.D., and Lindsey Baden, M.D.
Mpox virus (MPXV; previously known as monkeypox virus) is an orthopoxvirus of the family Poxviridae, subfamily Chordopoxvirinae, which also includes the molluscum contagiosum, vaccinia, and variola (smallpox) viruses. The Poxviridae viruses are enveloped, double-stranded DNA viruses. Patients infected with these viruses present with a characteristic vesiculopustular rash. Vaccines administered during global smallpox eradication programs are thought to have provided protection against mpox as well and kept the virus limited to small outbreaks in specific geographic regions in Africa. Routine vaccination against smallpox was discontinued after the disease was declared to be eradicated following a global campaign by the World Health Organization in the 1970s and 1980s.
Mpox has three phases: incubation, prodrome, and eruptive.
The mean incubation period is 13 days. The prodrome phase is characterized by fever, headache, and fatigue, as well as lymphadenopathy, which distinguishes mpox from chickenpox.
In the eruptive phase, skin lesions appear simultaneously in a centrifugal distribution, including the palms and soles. Over 14 to 28 days, the lesions, which are firm and umbilicated with well-defined borders, will progress through several stages: macules, papules, vesicles, and finally pustules. Healing lesions can sometimes leave permanent scars.
Currently two vaccines have been approved by the Food and Drug Administration (FDA) for the prevention of mpox and smallpox: a nonreplicating modified vaccinia virus vaccine (JYNNEOS, Bavarian Nordic) and a live vaccinia virus vaccine (ACAM2000, Emergent BioSolutions). Persons who have had close contact with someone diagnosed with mpox, especially sexual contact, should consider vaccination.
JYNNEOS contains vaccinia virus (modified vaccinia Ankara, or MVA), a weakened relative of the mpox and smallpox viruses that cannot replicate in mammalian cells or cause infection. Two doses are given 28 days apart. It is unknown how long the protective effects last. JYNNEOS may be concurrently administered with other vaccines. Because it is a nonreplicating vaccine, pregnancy, breast-feeding, and immunocompromising conditions, such as HIV, are not considered contraindications.
ACAM2000 is an FDA-approved vaccine that uses a weakened, live vaccinia for the prevention of smallpox and mpox. As with a traditional smallpox vaccine, a sore may form at the site of injection. Because ACAM2000 is a live-virus vaccine, it is not recommended for persons with immuno compromising conditions, such as HIV, or autoimmune skin conditions, such as psoriasis or severe atopy. Other live-virus vaccines, such as the measles–mumps–rubella (MMR) and varicella vaccines, should be deferred for at least 28 days after administration of ACAM2000.
Past vaccination against smallpox does confer a protective effect against mpox. However, the immunity wanes over time, and disease outbreaks have occurred among persons previously vaccinated against smallpox.
Tecovirimat is an antiviral drug that was approved by the FDA in 2018 for use against smallpox and has in vitro evidence for activity in the treatment of mpox. Tecovirimat should be prescribed only for people with severe symptoms, to avoid the development of resistance. Tecovirimat inhibits the orthopoxvirus protein p37, blocking viral cell-to-cell transmission.
Brincidofovir is an antiviral drug approved for use against smallpox. It is a prodrug of cidofovir, which is commonly used to treat cytomegalovirus. Brincidofovir inhibits viral DNA polymerase. It is currently used off label for the treatment of mpox.
Vaccinia immune globulin is available and may be considered for use in severe cases, but data on its efficacy are limited.
Brincidofovir inhibits viral DNA polymerase.
It is currently used off label for the treatment of mpox and is approved for use against smallpox.
For much of mankind’s history people knew that people who develop smallpox and survive don’t get it again. That’s why some in ancient China and Africa tried to prevent the lethal form of the disease by blowing crusts of a fresh scab up the nose of an uninfected person. They hoped the illness they were causing would be mild, or at worst it wouldn’t be deadly.
George Washington developed smallpox in 1751 when he accompanied a cousin who had T.B. and was sailing to Barbados in the hope that someone there could cure him. His cousin died of T.B. and Washington’s face was permanently scarred.
In 1796 Edward Jenner a British doc proved there was a safer way to prevent the disease. He heard that milkmaids who were infected by cowpox didn’t’ develop small pox, and he checked it out. He took material from the pussy scabs on a young woman’s hand and “inserted it into small incisions he made in a boy’s skin.” Much as cats and tigers are members of the same species, the viruses that cause cowpox and small pox are related. Each can cause pustular lesions. People who develop cowpox sometimes run a fever and are sick for a week, but the illness is mild and when a person recovers (or is vaccinated) their body is protected from the oft lethal disease
Jenner submitted his findings to the Royal Society and it was rejected so he self published and became famous. Thomas Jefferson and James Madison read about his findings and in 1813 Congress passed the Vaccine act.
In1853 and 1867 the British Parliament made vaccination with modified cowpox compulsory.
After widespread vaccination contained the illness, people in the U.S. stopped vaccinating. In the19th century there were outbreaks, and states attempted to enforce existing vaccination laws or pass new ones. The disease finally disappeared from North America in 1952 and from Europe in 1953. As recently as 1967 (according to the CDC) 10 to 15 million people in Africa, Asia, Indonesia, and Brazil were contracting Smallpox each year. That year 2 million died, many were scarred for life, and the World Health Organization started a program of worldwide vaccinations. They hoped to eliminate the terrible disease and seem to have succeeded. The bug’s last known “natural” victim was infected in 1977.5
https://www.cdc.gov/smallpox/history/history.html
https://www.bbc.com/news/uk-england-birmingham-45101091
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