Author丨Wei Xiao
Editor丨Xu Xu
Picture source丨Tuchong
Although new cases of monkeypox continue to increase around the world, The World Health Organization said on June 25 that has recently spread in more than 50 countries and regions. The monkeypox epidemic does not constitute a "public health emergency of international concern" for the time being.
Previously, on June 23, the WHO Emergency Committee held a meeting on the monkeypox epidemic. The meeting pointed out that since May this year, 47 countries have reported a total of 3,040 cases of monkeypox to WHO, with countries in the WHO European Region reporting the most cases. Monkeypox outbreaks are currently spreading in many countries where no cases have been reported. Most cases of monkeypox are male and belong to non-heterosexual groups in urban areas.
Following the outbreak in non-endemic areas such as Europe and the Americas in May, the monkeypox epidemic has now appeared in Asia. On June 24, the first case of monkeypox appeared in Taiwan Province of my country. According to reports, the case is a young man in his 20s from southern Taiwan.
Although it has not been designated as a "public health emergency of international concern" for the time being, WHO Director General Tedros Adhanom Ghebreyesus also pointed out on the 25th that monkeypox is obviously an evolving health threat, and WHO will convene again as appropriate. The meeting assessed the epidemic situation. Tedros urged countries to strengthen epidemic surveillance, improve diagnosis, community engagement and risk communication, as well as the appropriate use of public health measures such as treatments, vaccines, case tracking and isolation.
On June 14, the official website of the National Health Commission released the "Guidelines for the Diagnosis and Treatment of Monkey Pox (2022) Edition", requiring the improvement of medical institutions' ability to diagnose and treat monkey pox. Then on June 22, China Centers for Disease Control and Prevention issued a "Monkeypox Health Tip" pointing out that the number of cases and scope of the monkeypox epidemic in this round of monkeypox epidemic has increased rapidly around the world, making it the highest in the history of non-endemic areas. The Chinese Center for Disease Control and Prevention also reminded that if an imported case of monkeypox is found, there is a certain risk of infection mainly among its contacts, and there is no risk of infection for the general population.
In this regard, the team of Professor Lu Hongzhou, a well-known domestic infectious disease expert and president of Shenzhen Third People's Hospital, , believes that important knowledge about monkeypox should be popularized to promote global public health prevention and control. In June 2022, "Zoonoses" published the research paper "The Novel Monkeypox Outbreak: What Should We Know and Reflect On?" with Professor Lu Hongzhou as the corresponding author of and . The paper points out that monkeypox is caused by a relatively large DNA virus that is better at detecting and repairing mutations than the RNA virus , which means that the monkeypox virus is unlikely to suddenly mutate into a virus that can easily spread from person to person. thus causing a global pandemic.
Whether monkeypox can be sexually transmitted is worthy of discussion
"Public Health Emergency of International Concern" is the highest level public health emergency in the world that can be declared by the WHO. At the end of January 2020, the WHO declared that the COVID-19 epidemic constituted a "public health emergency of international concern".
On May 13, 2022, the UK first reported local monkeypox cases. Since then, monkeypox cases have been discovered in Europe, America, Asia, Oceania and Africa (non-endemic countries). According to the latest data released by the WHO, monkeypox epidemics are spreading in more than 50 countries and regions around the world, with a total of more than 3,000 monkeypox cases reported.
As a close relative of smallpox , monkeypox is a zoonotic disease that was once prevalent in Africa. It is worth noting that compared with the strains circulating in Africa from 2018 to 2019, the monkeypox virus that broke out in 2022 has nearly 50 genetic mutations , and some mutations make the virus more easily spread.
Lu Hongzhou's team pointed out in the paper that the main epidemic areas of monkeypox are in central and western Africa, usually close to tropical rainforests, including tree squirrels, Gambian kangaroos, dormice, and various animal species including non-human primates. have been identified as susceptible to monkeypox virus.Monkeypox can be transmitted through humans, animals or humans. The main infection routes for humans are as follows: direct contact with the blood, body fluids or damaged skin and mucous membranes of infected animals; direct contact with the damaged skin of an infected person, or being infected by other animals within 21 days. Contaminated objects or close contact with their respiratory secretions. Mother-to-child vertical transmission or close contact during the perinatal period may cause congenital monkeypox.
In addition, Lu Hongzhou’s team also pointed out that the issue of whether monkeypox can be transmitted through sexual transmission deserves further exploration.
Previously, the Chinese Center for Disease Control and Prevention pointed out in a reminder that the cases are mainly young and middle-aged men; most are gay men, and the spread of the epidemic is closely related to sexual activities; the vast majority of cases have not traveled to areas where monkeypox is endemic (i.e., central Africa) Traveling to 11 countries in the west that have reported cases of monkeypox before 2022); the clinical manifestations are relatively mild and atypical, the rashes are mainly distributed in the genital area, the number is obviously small, there are only a few or even one rash, and no further spread is seen .
However, the Chinese Center for Disease Control and Prevention also pointed out that it is not yet certain whether will be transmitted through semen or vaginal secretions.
Monkeypox virus is unlikely to become a global pandemic
Monkeypox is usually a self-limiting disease (a disease that, after the disease develops to a certain extent, can be controlled by the body's regulation and gradually recovers. Generally speaking, In the absence of serious other complications (with or without symptomatic treatment), symptoms may last 2 to 4 weeks. is different from chickenpox . The rash of monkeypox is more concentrated on the face and limbs rather than the trunk. In more than 70% of cases, rash appears on the face, palms, soles of the feet and oral mucosa.
There is currently no specific drug treatment for monkeypox. Symptomatic treatment and optimized nursing care are mainly used to reduce symptoms, control and prevent complications; For severe cases, antiviral drugs can be considered for treatment. There are two drugs currently approved for the treatment of monkeypox: brincidofovir and tecovirimat.
Lu Hongzhou’s team pointed out that in terms of vaccination, most of the smallpox vaccines currently preserved in many countries around the world are replicating tissue culture vaccines, which can protect about 85% of monkeypox and reduce the severity of symptoms. The attenuated smallpox vaccine Jynneos (MVA-BN) approved by the US FDA in 2019 is a non-replicating monkeypox vaccine and can be used to prevent smallpox and monkeypox in adults. However, at present, this vaccine is only recommended for high-risk groups and close contacts, and its effectiveness in blocking and preventing outbreaks has yet to be evaluated.
Lu Hongzhou's team also pointed out that the eradication of smallpox and the cessation of vaccination paved the way for monkeypox to gain clinical "advantage". Furthermore, because most cases of monkeypox occur in rural Africa, suspected underreporting may result in the potential threat of this pathogen being underestimated.
But unlike the new coronavirus, monkeypox virus is spread through close contact with body fluids, such as saliva produced by coughing. This means that people with monkeypox are likely to infect far fewer close contacts than those with COVID-19.
Additionally, monkeypox is caused by a relatively large DNA virus that is better at detecting and repairing mutations than RNA viruses, meaning it is unlikely that the monkeypox virus suddenly mutated into a virus that spreads easily from person to person, causing Global pandemic virus.
In the paper, Lu Hongzhou's team also emphasized that the current global population has generally low immunity to the pox virus , and the main confirmed cases of this epidemic are men who have sex with men. They should be alert to the increased risk of monkeypox infection and increased infection with HIV infection. disease severity.
As more and more countries relax prevention and control measures against the new crown epidemic, global travel and trade are gradually recovering. The outbreak of monkeypox has brought a warning: In an interconnected world, the risk of disease transmission is also global. problems that need to be faced together.
At the State Council Joint Prevention and Control Mechanism press conference held on June 9, Xu Wenbo, director of the Institute of Virology of the Chinese Center for Disease Control and Prevention, said that the Chinese Center for Disease Control and Prevention conducted a study on the sensitivity and specificity of monkeypox virus in Sierra Leone, Africa. It has been verified that my country has the ability to detect the monkeypox virus gene through real-time fluorescence PCR on clinical specimens of suspected imported cases, and can detect potential imported monkeypox cases in a timely manner.
The "Guidelines for the Diagnosis and Treatment of Monkey Pox (2022)" issued by the National Health Commission also requires careful organization of training related to the diagnosis and treatment of monkey pox, and effectively improve the "four morning" capabilities. Once suspected or confirmed cases of monkey pox are discovered, they should be followed in a timely manner. Report relevant requirements, and make every effort to organize medical treatment work to effectively protect the life safety and health of the people.
Editor of this issue Li Yutong Intern Li Kailin
