"Monkeypox" has been reported one after another, mainly in Europe and the United States.
More than 2000 people have been confirmed infected.
It has not been confirmed in Japan, but it may come in in the future.
WHO = The World Health Organization will determine on the 23rd of this month whether it will be a "public health emergency of international concern".
Is monkeypox an infectious disease that requires the same vigilance as the new corona?
How should we respond?
I have summarized what I have learned.
(As of June 21)
“Abnormal behavior not seen in the past” WHO To consider whether it corresponds to an emergency
"It's clear that the virus is behaving abnormally like never before. It's affecting more countries and needs a coordinated response," WHO Secretary-General Tedros said at a press conference on the 14th of this month. Was shown.
He then announced that he would meet an urgent committee on the 23rd of this month, revealing that the spread of the infection would be considered as a "public health emergency of international concern." Did.
"Public health emergency of international concern" is a procedure stipulated in the "International Health Regulations" and is "recognized to pose a public health risk to other countries and is urgently internationally coordinated." Is issued when something is needed.
In English, it is called "Public Health Emergency of International Concern", which is called PHEIC (fake) by its acronym, and has been issued six times in the past.
This time, WHO will bring together experts from each country to discuss whether monkeypox is subject to PHEIC.
Monkeypox was an infectious disease that was sporadically seen in Central Africa and other countries, but there are concerns that it will become established in Europe and elsewhere.
What is the status of infection in each country?
The number of confirmed cases of monkeypox has increased, and according to WHO, 2103 cases were confirmed in 42 countries between January 1st and June 15th, 2022.
In Nigeria, one person died.
By region, the number of people confirmed to be infected is high in European countries.
The major countries are the United Kingdom with 524, Spain with 313, Germany with 263, Portugal with 241 and Canada with 159, France with 125, the Netherlands with 80 and the United States with 72.
(WHO has so far tabulated the countries of the Midwestern Africa where monkeypox infections have been occasionally seen, and the Western countries where infections have been found one after another since May, but it was announced on the 17th of this month. 64 people from 6 countries in Africa are counted as infected.)
As a result of genetic analysis of the virus, it is said that the virus of the West African strain, which is relatively low in pathogenicity, is spreading. I am.
Monkeypox with a characteristic rash In this infection
Monkeypox is a disease caused by infection with the "monkeypox virus," which is similar to the smallpox virus.
According to websites such as the National Institute of Infectious Diseases and WHO, the incubation period of monkeypox virus is usually 7 to 14 days, and after the incubation period, fever, headache, lymphadenopathy, myalgia, etc. are 1 day. It lasts for 5 days, and then a rash appears.
The rash typically begins on the face and spreads throughout the body.
It gradually swells and becomes blisters (blisters), scabs, scabs, and heals within 2 to 4 weeks after the onset.
In most cases, it is mild and recovers spontaneously, but it can cause complications such as pneumonia and sepsis, and it is said that the younger you are, the more severe it may be.
According to WHO, this spread of infection is characterized by cases where the rash is limited to a part of the genitals and the area around the anus, and cases where the rash appears before fever.
Origin of the "monkeypox" name and previous infections
Monkeypox was named after it was first discovered in 1958 in cynomolgus monkeys at a facility where primates from around the world were gathered to produce the polio vaccine.
However, the natural host that normally carries the virus is thought to be a reservoir, not a monkey.
WHO is currently considering changing the name "monkeypox".
Human transmission was first identified in the Republic of the Congo in 1970, and has since spread sporadically in the rainforest regions of Central and West Africa.
In 2003, the virus was introduced into the United States through small animals imported as pets from Africa, infecting 71 people.
In Africa, monkeypox infections are still frequent.
From January 2022 to June 8, more than 1,500 people, including suspected cases, have been reported and 72 have died in eight countries, including the Democratic Republic of the Congo and Nigeria.
It is said that different strains of virus are spreading in West Africa such as Nigeria and Central Africa such as the Democratic Republic of the Congo.
Monkeypox found in Central Africa is more likely to become more severe, with case fatality rates ranging from a few percent to 10%.
In recent years, all cases confirmed outside Africa have a pattern of onset of returnees from Nigeria, and several cases have been confirmed annually.
No one has died outside Africa.
The infection route is
Monkeypox is generally transmitted by being bitten by infected animals such as mice and squirrels, or by touching blood, body fluids, or rashes.
It has also been pointed out that anyone can be infected by contact with the infected person's rash, body fluids, scabs, bedding or clothing used by the patient, or by being exposed to flying shots at a short distance. increase.
Regarding the spread of the infection, WHO and the ECDC = European Centers for Disease Control and Prevention have stated that anyone can be infected by close contact, and the patients confirmed in the follow-up survey so far. For many, there was sexual contact between men.
Some experts have suggested that the infection may have spread through large-scale events held across Europe, and countries are wary of more such events in the coming summer. I'm calling.
On the other hand, it is said that patients who are considered to be so-called "community-acquired infections" whose infection route cannot be identified and female patients have been confirmed, and that they should be cautious without considering it as a disease of a specific group of people.
The WHO states that anyone who has had close contact with a person with monkeypox is at risk of getting infected, "no one should be unfairly treated because of the disease."
WHO encourages people with symptoms to be tested, avoid close contact with others, and seek medical attention.
The ECDC said it was "very unlikely" and pointed out that if human-to-human transmission continues, it could eventually spread from human to animal and spread among animals and become established in Europe.
Nahoko Shindo, a senior advisor at WHO, told an interview at an academic conference held in Yokohama on the 18th of this month, saying, "As far as we know, most of the spread of infection is sexual contact between men. It remains among those who have gone, but it is completely unknown how widespread the base of the infection is, but it is not as widespread as the new coronavirus. Direct physical contact is the main infection. It will be a route and will not spread in places like the venue for lectures. "
Smallpox vaccine is highly effective
For monkeypox, the smallpox vaccine that was once inoculated is highly effective, and according to WHO, the effect of preventing monkeypox infection is up to 85%.
However, smallpox was eradicated from the earth in 1980 as a result of active vaccination.
The last vaccination in Japan was in 1976, and the children in their late 40s and above, who were children at that time, may have been vaccinated and have immunity to monkeypox.
Smallpox vaccines are highly effective in Japan and have small side reactions, and are stockpiled nationally as part of counterterrorism measures.
Although the development of drugs for monkeypox is underway, there is no treatment like a silver bullet so far, and each country is responding with symptomatic treatment.
Vaccination movements in Europe and the United States
In Western countries, there are a series of movements to purchase new vaccines for smallpox as a countermeasure against monkeypox infection.
In some countries, such as Canada, vaccinations have begun on healthcare workers and those who have come into contact with patients.
However, it is becoming an issue that few people want to be vaccinated even if they are in contact with patients.
In a report released by the British health authorities on June 2, 69% of health care workers who were asked to get vaccinated wanted to get vaccinated, compared to only 14% of those who came into contact with the patient. It is said that he did not wish to be vaccinated.
"In order to achieve the goal of eradication, rapid detection of patients and tracking of transmission routes are essential. We should also consider measures other than vaccines, such as regular tests."
No reports of infection in Japan
According to the Ministry of Health, Labor and Welfare, no monkeypox infections have been reported in Japan since 2003, when the data was started.
Monkeypox is designated as "Class 4 infectious disease", which is the same as rabies under the Infectious Diseases Control Law, and the doctor who diagnosed it must report the outbreak to the health center.
The Ministry of Health, Labor and Welfare will contact prefectures on May 20th and June 1st to report any suspicious patients and request that they be hospitalized at designated medical institutions.
In addition, since monkeypox can be inspected by PCR from the liquid contained in the blisters in the same way as the new coronavirus, the inspection system is available not only at the National Institute of Infectious Diseases but also at the local health laboratories of each local government. Is being maintained.
From now on, preventive measures
We spoke with Professor Shigeru Morikawa of Okayama University of Science, a former director of the Department of Veterinary Sciences at the National Institute of Infectious Diseases, who has been studying monkeypox, about the latest infection status and countermeasures.
Q: How would you rate the current infection status?
A: I think it is certain that the number of infected people will continue to increase and reach 3,000.
However, the pace of increase has not changed much since the beginning when it was about 200 to 300 people, and the speed has not exceeded expectations.
Q: The focus is on what WHO considers to be a "Public Health Emergency of International Concern (PHEIC)".
A: Looking at the current situation, I don't think I've reached the level of putting it out.
In order for WHO to issue PHEIC, 1 there is a risk of serious public health damage, 2) the spread of infection is unpredictable, 3) there is a risk of spreading internationally, and 4 internationally. It is said that two or more of the four factors that need to restrict traffic and distribution must be met.
Regarding 1, there were no deaths (due to the spread of this infection), and WHO has a moderate risk assessment.
So far, it can be said that no serious public health situation has arisen, so this is not the case.
As for 2, the prediction of the spread of infection is not applicable because it has been made to some extent.
3 is true because the spread of the infection has spread to about 40 countries, but 4 international traffic restrictions are not recommended by WHO and are not true.
However, the situation may change in the future if the infection route changes, for example, if an infection occurs through blood transfusion.
Q: How far has the research progressed?
A: Detailed information on the gene sequence of monkeypox virus has come out.
It was only known that the virus that was spreading was from West Africa, but according to the analysis of genetic information, it seems that this virus may have spread from one patient to various places such as Europe and the United States. ..
On the other hand, there are rather negative views as to whether the monkeypox virus has become more susceptible to infection due to gene mutations.
Q: What will be the focus in the future?
A: I am most concerned about the spread of monkeypox to animals other than Africa.
WHO urges monkeypox patients not to come into contact with pets kept at home because the monkeypox virus also infects a variety of animals.
There are now infected people in Europe, the North American continent, and several other regions, but if we completely block human-to-human transmission, it should converge.
However, if the infection spreads among wild animals, it will be difficult to completely eliminate it and it will become a resident country, so we are cautious.
Q: Is there a risk of influx into Japan?
A: Of course, there is a risk that infected people during the incubation period will enter Japan and develop the disease.
It is possible that the acceptance of tourists from overseas will resume, and infected people will come from overseas and develop the disease.
Q: What kind of measures should be taken?
A: If an infected person appears in Japan, it will be necessary to carry out an inspection including those who have close contact.
At medical institutions, I think that monkeypox should be suspected by people who have fever or rash from overseas.