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Monkeypox Spreading

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    Posted: March 18 2018 at 7:06am

Health authorities issue warning on monkeypox outbreak

Pandemic fears arise as smallpox relative spreads. Andrew Masterson reports.  News Biology 19 March 2018

Labelling it a “concern for global health security”, the US Centres for Disease Control and Prevention (CDC) have sounded the alarm about a surge in cases of a sometimes-fatal close relative of smallpox called monkeypox.

In its Morbidity and Mortality Weekly Report, the CDC notes a “recent apparent increase in human monkeypox cases across a wide geographic area”, and calls for urgent public health action and international collaboration to head off the threat of a pandemic.

Monkeypox is described by the World Health Organisation as being similar to smallpox. Primary infection is caused by contact with the bodily fluids of sick animals, but cases of human-to-human transmission have also been documented.

The disease presents in two phases. After an incubation period of up to three weeks, victims experience up to five days of intense fever, headache and muscle pain. This is followed by a rash, typically on the face, palms and soles of the feet, and sometimes across the entire body. The rash period lasts for around three weeks, after which recovery or death occurs.

Monkeypox is fatal in about 10% of cases.

The CDC warning targets several countries in Africa, many of which had not until recently reported a single case in decades. The Democratic Republic of Congo is experiencing more than 1000 cases a year, with, since 2016, additional cases reported in the Central African Republic (19), Liberia (two), Nigeria (more than 80), Republic of the Congo (88) and Sierra Leone (one).

There has also been an outbreak among captive chimpanzees in Cameroon.

Altogether, the CDC says, there have been monkeypox cases reported in more countries during the past decade than in the preceding 40 years. Describing the disease as an “emerging zoonosis”, the organisation flags multiple concerns, including the fact that many of the countries affected lack the knowledge, experience and facilities to respond quickly to outbreaks, thus increasing the likelihood that the virus will continue to spread.

In calling for an increase in resources to tackle the disease – a call echoed by WHO, which this year identified monkeypox as a developing threat – the CDC draws comparisons with smallpox.

While closely related, the two viruses differ in one crucial aspect. Smallpox is an entirely human disease, a crucial factor in its vaccine-led eradication. Monkeypox, however, is zoonotic – meaning that it exists outside humans in one or more animal species that serve as reservoirs.

These reservoirs have not been identified, meaning attempts at a smallpox-style eradication will be much harder, if not impossible. (A similar problem besets Ebola researchers. During the 2013 to 2016 West African outbreak, which killed over 11,000 people, the animal species reservoir was never conclusively identified. The search continues today, with candidates ranging from bats to snakes.)

There is, however, some good news. Although there is no specific treatment available for monkeypox, the smallpox vaccination offers cross-protection, meaning that, in theory at least, large-scale prevention is possible.


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Monkeypox outbreak baffles experts

23 March 2018 • 11:52am

A rise in the number of cases of a rare virus across Africa is baffling experts.

Monkeypox, which is closely related to smallpox, has spread throughout west and central Africa over the last 10 years, with six countries reporting cases, compared to just two countries 20 years ago.

Nigeria, whose last reported case was in 1978, is experiencing a particularly virulent outbreak with 89 people infected and six deaths since 2017. 

Monkeypox starts with a high fever before turning into a painful rash with open sores. One in 10 people who catch the disease die, with those with suppressed immune systems particularly at risk. If the disease infects the eye it can lead to scarring of the cornea and, in some cases, blindness.

But scientists are still unsure what is behind the rise in the number of cases, said Andrea McCollum, epidemiologist at the US Centers for Disease Control and Prevention and an expert in pox viruses.

She said it could be due to better detection and surveillance of outbreaks in west Africa.

“Another component could be from changes in terms of the environment or ecology of the animal reservoir,” she said.

"One of the problems is that there are no experts in these countries because there has been a lapse in the number of cases over the last 30 to 40 years. A lot of the experts from the smallpox era are just not around any more," she added. 

Monkeypox was first observed in the 1960s in monkeys brought to Europe from Africa, with the first human case diagnosed in the Democratic Republic of the Congo (DRC) in 1970. However, scientists are still unsure if the disease is actually transmitted by monkeys - rats or other rodents maybe the culprits, said Dr McCollum.

As well as improving countries’ ability to detect the disease another priority is development of a vaccine, with researchers from CDC and Kinshasa University currently trialling a smallpox vaccine in the DRC.

“We know it performs well in the laboratory and in animals but we don’t know if it performs well in an area like the DRC where people are exposed to the naturally occurring virus,” she said.

An outbreak of monkeypox in the US in 2003, which infected 47 people, was traced to the import of small animals from Africa.

Dr McCollum said the movement of bushmeat out of Africa was also a potential driver for outbreaks in other parts of the world.

“There’s a lot of illegal movement of animal product out of Africa to all regions of the world. It’s astounding,” she said.

According to figures from the UK Department for Environment, Food and Rural Affairs (Defra) 6,900kg of bushmeat from west Africa was seized by border officials in 2015-16, compared to 6,200kg in 2014-15.

The majority of this meat is brought in by individuals for family occasions or as a taste of home, Defra said.

It is important to understand what animal is spreading the disease, said Dr McCollum, as the consumption of bushmeat is common in west and central Africa.

“These communities, particularly in central Africa, that live in the bush are dependent on wild animals for protein sources. Their backyard is the forest and they hunt these animals. We’re trying to put out scientifically accurate communication about the risk,” she said.

But she acknowledged this was difficult. “People tell us if they don’t hunt their family will suffer,” she said.


Monkeypox | Key facts

  • Monkeypox is a rare disease affecting people in the tropical rainforests of central and west Africa
  • It is similar to smallpox although not as deadly
  • The virus is transmitted from various wild animals such as the rope squirrel or sooty mangabey but can also be spread between humans
  • The disease is not highly infectious and only those who have been in close contact with a patient, such as a health care worker or family member, are at risk
  • The disease begins with a fever and then a rash spreads over the body, mainly to the palms of the hands and soles of the feet. It also affects the eyes and can lead to blindness
  • Most people recover within three weeks but up to 10 per cent of those affected die
  • There is no treatment or vaccine available although a smallpox vaccine is currently being trialled

Source and map of current spread:

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