China News Service, May 21. Recently, monkeypox cases have been found in many countries, which has attracted global attention.

On the 21st, the WeChat public account "Huashan Infection" of Huashan Hospital Affiliated to Fudan University published an article by Wang Xinyu, "A Rare Monkeypox Epidemic in Europe and America: Should We Be Worried?


  The article said that monkeypox, a disease that rarely occurs outside Central and West African countries, has become a hot topic in the news in less than half a month recently, with the United Kingdom, Spain, Portugal, the United States, Sweden, Italy and the United Kingdom. Cases have appeared in Canada.

This article introduces the background knowledge, epidemic status, preventive treatment and other aspects of monkeypox, and recommends relevant departments to prepare for possible imported cases.

  On 7 May 2022, the UK Health Security Agency (UKHSA) reported the first case of a patient who had recently travelled to Nigeria and was diagnosed with monkeypox after returning to the UK.

On May 14, two additional cases were identified in the UK, both residing in the same household but with no recent travel history and no contact with the case reported on May 7.

On May 16, UKHSA confirmed four more cases, with no recent travel history to endemic areas, and no contact with cases reported on May 7 and 14.

All cases reported on May 16 were men who self-identified as men who had sex with men (MSM).

On May 19, two more cases were identified, with no travel links and no links to other cases.

The two cases are in the South East and London.

On 20 May, UKHSA announced 11 new cases of monkeypox, bringing the total number of confirmed cases in the country to 20.

  The string of cases has been described by experts as "unusual" and "surprising".

"This outbreak is very rare," epidemiologist Susan Hopkins, chief medical adviser to the UK Health Security Agency (UKHSA), said in a statement.

  In addition, on May 18, Portugal reported five confirmed cases of monkeypox and more than 20 suspected cases.

All cases are young males and all are in Lisbon and the Tagus Valley.

Spain has also reported eight suspected cases.

  On May 19, Sweden and Italy said they had confirmed their first cases, the Italian case being a man who had reportedly traveled to the Canary Islands, and authorities in Italy said two other suspected cases were being monitored.

  On May 20, Spanish health authorities announced 24 new confirmed cases of monkeypox, mainly in the Madrid region, bringing the number of confirmed cases in the country to 31.

Portugal also recorded nine new cases, bringing the country's total to 23.

On the same day, health experts in Belgium announced two new cases of monkeypox in the country, and Germany also reported the first case of monkeypox.

The head of the WHO in Europe said he was concerned that infections in the region could accelerate as people gather for parties and festivals in the summer.

  Scientists at the U.S. Centers for Disease Control and Prevention (CDC) are working with the Massachusetts Department of Public Health to investigate a case of monkeypox in a Massachusetts resident who recently traveled by private transportation to Canada.

Testing in Massachusetts on the evening of May 17 found an orthopox virus infection, which the CDC laboratory confirmed as monkeypox.

Separately, New York City health officials said late on May 19 that they were investigating a possible monkeypox case.

Details about the patient were not provided.

  On May 19, health officials in Montreal, Canada, said they were investigating 17 suspected cases of monkeypox in the area, most of them in men between the ages of 30 and 50.

  On May 20, Australian authorities said they had identified a confirmed case of monkeypox infection in recently returned travellers from the UK, while another suspected case was still being tested.

  On May 20, the World Health Organization (WHO) reported cases of monkeypox in 11 previously non-endemic countries around the world, with approximately 80 confirmed cases and 50 suspected cases pending confirmation.

WHO is concerned about the further spread of monkeypox in non-endemic countries and will hold an emergency meeting to discuss monkeypox.

  Infectious disease and epidemiology experts fear the known cases are the tip of the iceberg, with most patients not linked to each other, suggesting it is spreading more widely.

Experts described the outbreak as "unusual" because human-to-human transmission of monkeypox was previously considered extremely rare.

  The WHO said the early cases were unusual for three reasons: All but one had no relevant travel history to areas endemic for monkeypox; most cases were detected in sexual health services and men who have sex with men, across multiple European countries Widespread distribution suggests that transmission may have been ongoing for some time.

  The WHO has warned that more cases are expected in more countries in the coming weeks.

Epidemic sounded the alarm

  As countries ramp up surveillance, more and more countries are reporting cases of the virus, which used to be rare outside of Central and West Africa.

These natively endemic countries include Sierra Leone, Liberia, Côte d'Ivoire, Nigeria, Cameroon, Gabon, Central African Republic, Republic of Congo, and Democratic Republic of Congo.

  Countries that have previously reported imported cases include the US, UK, Israel, Benin, South Sudan and Singapore.

  While infection patterns in this outbreak suggest the virus has been spreading undetected, it is unclear the extent of community transmission or whether the cases in the United States are linked to those in Europe.

Targeted testing of individuals with such clinical manifestations is beginning in affected EU/EEA countries.

Genome sequencing can help answer these questions.

  "This is the first time that a chain of transmission with no known epidemiological link to West and Central Africa has been reported in Europe," the European Centre for Disease Prevention and Control (ECDC) wrote in a report on Thursday.

  In the past, cases outside Africa, except for very few isolated cases, were usually imported infections without human-to-human transmission.

In 2003, a large monkeypox outbreak in the United States was reported for the first time outside of Africa, with 47 confirmed and suspected cases involving six states.

Several Gambian giant rats and squirrels tested positive for the virus at the time and eventually spread the virus to groundhogs sold as pets in multiple Midwestern states, according to the CDC website.

47 people contracted the disease through close contact with groundhogs.

Fortunately, all infected people recovered at that time, and no one spread the disease to others.

In other words, before this year's outbreak, there had never been so many cases of infection after no contact with animals.

Does monkeypox come from monkeys?

  Monkeypox virus is a close relative of smallpox virus, both are orthopoxviruses, and the genus orthopoxvirus also includes vaccinia virus, vaccinia virus, and several other poxviruses associated with animals.

Smallpox used to be a common infectious disease. In 1980, the World Health Organization announced that the world had eradicated smallpox. Soon after, the world stopped vaccinating against smallpox.

  Monkeypox is considered the most important orthopoxvirus infection in humans since the eradication of smallpox.

The monkeypox virus is believed to have been infecting humans in sub-Saharan Africa for thousands of years.

The virus was first isolated from pox fluid in 1958 during an outbreak of vesicular disease in cynomolgus monkeys used for polio vaccine-related research in Copenhagen, Denmark, hence the name.

  The name "monkeypox" comes from monkeys, but monkeys are not actually reservoir hosts for monkeypox virus.

Similar to humans, monkeys are just an accidental host for monkeypox virus.

In other words, the real source of monkeypox virus is not monkeys.

In nature, many animal species have been found to be infected with monkeypox virus.

Some evidence suggests that African native rodents, such as the Gambian giant rat (Cricetomys gambianus) and squirrels, may be reservoir hosts for the virus.

What are the symptoms of monkeypox infection?

  The incubation period (time from exposure to onset) of the disease is 5 to 21 days.

Infected people initially develop a mild flu-like illness -- headache, fever, rash, and swollen lymph nodes.

But after a few days, a rash develops, usually starting on the face.

The rash usually spreads to other parts of the body, mainly the extremities.

The lesions of monkeypox are similar to those of smallpox infection.

  The palms and soles of the feet are often affected.

Unlike other rashes, it usually consists of blisters that form on the palms.

Scarring lesions will form in the next stage of the disease and can last from two to six weeks.

For most people, monkeypox is a self-limiting disease that usually lasts two to four weeks with a full recovery.

Is monkeypox infection fatal?

  While most people recover from infection within a few weeks, there's no denying that the disease can be deadly.

Two phylogenetically distinct clades of monkeypox viruses were identified by genome sequencing: the Central African (Congo Basin) clades and the West African clades.

In general, the Central African monkeypox virus is associated with more severe disease, higher mortality, and more frequent human-to-human transmission.

Genetic differences between the viral genomes of these two clades may explain the differences in viral clearance and pathogenesis.

  The cases confirmed in Europe this time are caused by the West African branch of the virus, which is generally less dangerous than the Congo Basin branch.

In its report, the ECDC said the case fatality rate in the West African branch was 3.6%.

Differences in disease severity may also be influenced by route of transmission, host susceptibility, and amount of infecting virus.

How Humans Get Monkeypox

  Previous studies and data have shown that monkeypox is a zoonotic disease, and the virus is mainly transmitted to humans through the skin, respiratory tract, or wounds around the eyes or mucous membranes of the nose and mouth of infected animals.

It is thought to be spread by rodents such as mice and squirrels.

The disease can also be contracted by eating the meat of an infected animal that is not properly cooked.

  It is generally believed that the efficiency of human-to-human transmission of monkeypox virus is relatively low.

When it does occur, it is mainly transmitted through droplets, which can infect the mucous membranes of the eyes, nose and throat, and studies have shown that transmission requires prolonged face-to-face contact (for example, in the absence of personal protective equipment, within a 2m radius for more than 3 hours).

But it can also be spread through contact with lesions or bodily fluids, or through contact with clothing or linen contaminated with pus or other damaging substances.

  In September 2018, three patients in the UK were diagnosed with monkeypox, two of whom had travelled to Nigeria, and the third was a healthcare worker caring for one of the cases.

The cases of healthcare workers provide indisputable evidence of limited human-to-human transmission of monkeypox viruses belonging to the West African branch.

  Jay Hopper of the U.S. Army Medical Research Institute of Infectious Diseases believes that monkeypox is far less contagious among humans than smallpox.

In many cases, people don't spread the virus to anyone else.

Before this outbreak, an average monkeypox patient could transmit the virus to less than one person (R0<1).

So all previous outbreaks quickly disappeared.

Is monkeypox sexually transmitted?

  Previous knowledge tells us that monkeypox is not sexually transmitted, but it can be transmitted through close contact with bodily fluids, respiratory droplets and lesions — meaning it could theoretically be transmitted through sexual contact.

  Given the unusually high frequency of human-to-human transmission observed in this outbreak, and the possibility of community transmission without a history of travel to endemic areas, UKHSA epidemiologist Mateo Prochazka believes that transmission through close contact (e.g. The potential for further transmission of the virus during sexual contact is high.

The potential for transmission between individuals without close contact is considered low.

  However, cases may not be limited to this population.

Let alone jump to conclusions, not only to avoid stigma, but also to ensure that clinicians continue to pay attention to infections in other populations.

The WHO said scientists were sequencing the viruses from different cases to see if they were related.

The agency is expected to provide an update soon.

Is there a cure for monkeypox?

  History has proven that vaccination against smallpox protects against monkeypox.

Although a new vaccine (MVA-BN) and a new therapeutic drug (Tecovirimat) have been approved for monkeypox in some countries in recent years, these responses are not yet widely available, and around the world 40 (or under the age of 50) no longer benefit from the protection afforded by the previous smallpox vaccination program.

  In July 2018, the United States approved the use of Tecovirimat for the treatment of smallpox.

The drug protects nonhuman primates from a deadly monkeypox virus infection and may also be effective against this infection in humans.

Tecovirimat is a potent inhibitor of orthopoxvirus proteins that are required for the formation of infectious viral particles that are essential for transmission within infected hosts.

What should clinicians do

  Clinicians (especially dermatologists and infectious disease physicians) should treat monkeypox infection as a clinical syndrome of vesicular herpes for differential diagnosis, and should contact disease prevention and control or related institutions for sequencing identification.

Public health and community-based organizations should take steps to raise awareness about the possible spread of monkeypox in the community.

  Suspected cases should be isolated, tested and notified in a timely manner.

For positive cases, reverse and forward contact tracing should be initiated.

If smallpox vaccine is available, vaccination of high-risk close contacts should be considered after a risk-benefit assessment.

For severe cases, treatment with a registered antiviral drug, if available, may be considered.

  Health workers and other caregivers caring for patients with suspected or confirmed monkeypox should implement standard, contact, and droplet infection control precautions.

Samples collected from suspected monkeypox patients or from animals suspected of being infected with monkeypox virus should be handled safely by trained personnel in a properly equipped laboratory.

  Any illness during travel or after returning from an endemic area should be reported to health professionals, including information on all recent travel and immunization history.

Residents and travelers to endemic countries should avoid contact with sick animals (dead or alive) (rodents, marsupials, primates) that may carry monkeypox virus and should avoid eating or handling wild game ( bush meat).

The importance of hand hygiene with soap and water or alcohol-based sanitizer should be emphasized.

What is the source of the increasing number of cases?

  Back in 2010, reports suggested that monkeypox populations in the Democratic Republic of Congo had increased 14-fold since the 1980s.

The incidence has risen from less than 1 case/10,000 to about 14/10,000.

In the Democratic Republic of Congo, cases have ballooned into the thousands each year, recent research shows.

In 2020, there were nearly 4,600 suspected cases, according to a study published in February.

  Smallpox eradication can be indirectly blamed for this sharp rise, because the smallpox vaccine actually protects people well from monkeypox.

Studies have shown that the smallpox vaccine is about 85% effective against monkeypox.

But after the world eradicated smallpox, countries stopped vaccinating children.

The WHO found that in countries where monkeypox is found, middle-aged and young adults may be at greater risk of contracting monkeypox because these people were not vaccinated against smallpox as children.

  In a paper published in 2021, Australian scientists said the eradication of smallpox led to the end of routine smallpox vaccinations around the world, which may have contributed to an increase in human cases in Nigeria since 2017.

Professionals should be more vigilant

  To be honest, in a non-endemic area, there are so many confirmed cases of monkeypox of unknown origin in a short period of time. As an infectious disease professional, it is impossible not to worry.

  Scientists are closely watching the virus and the outbreak, particularly whether the virus has changed its route of transmission, as might happen in the current outbreak.

This new outbreak across Europe and the US could be a sign that the virus has changed -- if only a little -- and could increase its ability to spread among people.

  In my country, although there has never been a report of a confirmed case of monkeypox, infectious diseases have no national borders, and the risk of monkeypox virus importing into my country will continue to exist. Increase.

Since my country stopped vaccinating against smallpox (vaccinia) in the early 1980s, people under the age of 40 are generally not immune to smallpox and monkeypox.

While paying close attention to the international monkeypox epidemic, we should make preparations in advance, carry out popular science and publicity of monkeypox, strengthen the monitoring of cases with similar symptoms, and develop diagnostic methods and reagents, so as to detect imported cases in time and block spread and prevent monkeypox from spreading in my country.

At the same time, we should start to reserve effective vaccines and antiviral drugs to avoid being in a passive situation after a case occurs.

  For thousands of years, the development of human society has always been intertwined with the emergence, prevalence and control of various infectious diseases. Only by continuously understanding the epidemic law of infectious diseases can we try our best to protect human beings from infectious diseases. Protect human health and dignity.