Smallpox: The four basic questions that scientists have

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Scientists around the world are trying to understand the latest outbreak of monkey pox, as more than 400 more confirmed cases have been detected in at least 20 non-African countries and the disease is showing a trend of further international spread. Never before has monkey pox been so prevalent outside Africa.

This is a matter of concern to the scientific community, as the virus has “hit” different populations in different countries, with no apparent link between distant groups of cases, indicating multiple local transmission of the disease below the health level. “radar”.

“We need to act quickly and decisively, but there is still a lot to learn,” Anne Remon, an epidemiologist at the University of California, Los Angeles (UCLA), who studies monkey pox in the Republic, told Nature. Congo for over a decade.

There are four main scientific questions that need to be answered:

– How did the current outbreak start?

Researchers have analyzed the viral genome collected from patients with smallpox in various countries (USA, France, Germany, Belgium, Portugal, etc.). The bottom line so far is that all genomes bear a close resemblance to the less deadly West African strain of the virus (less than 1% of all cases in poor rural populations, up to 10% of the deadliest Central African strain).

Although more data is needed to confirm the scientists’ suspicions, because the samples that have been genetically analyzed so far are almost identical, it seems that the current international outbreak that spread outside Africa started from a single incident. The simplest explanation, according to virologist Bernie Moss of the US National Institute of Allergy and Infectious Diseases, is that a non-African (as yet undetected) who had visited Africa became infected with the avian pox virus through contact. of an infected animal or human carrier of the virus.

But alternative explanations cannot be ruled out, according to virologist Gustavo Palacio of Mount Icahn Medical School in Mount Sinai, New York. It is possible that the virus was already circulating invisibly outside Africa among humans or animals, having been extracted from the “black” continent during a previous local outbreak on it. This hypothesis, however, is less likely, because the disease usually causes visible rashes on the body, so it would probably have been perceived by doctors in the past.

– Can a genetic mutation explain the latest outbreak?

Understanding whether there is a genetic basis for the new unprecedented international outbreak of the disease outside Africa is considered incredibly difficult, according to computer biologist Eliot Lefkovic of the University of Alabama. Scientists are still struggling to determine exactly which genes are responsible for the greater lethality and transmissibility of the Central African strain compared to that of the West. Although more than 17 years have passed, they have not reached a definitive conclusion.

This is partly because the genomes of this virus contain many mysteries. In addition, the monkey pox virus genome is huge compared to that of many other viruses – e.g. at least six times that of the SARS-CoV-2 coronavirus. “So it’s six times harder to analyze,” said University of East Carolina virologist Rachel Roper.

Another difficulty, according to Palathios, is that little effort has been made to date for genomic surveillance in Africa, where monkey pox has been a public health problem for years, with the result that virologists are now somewhat blinded, with few sequences. older genomes at their disposal to compare them with recent ones. African virologists, according to Dr. Ifendagio Antifa of the Nigerian Centers for Disease Control, have always struggled to find funding for monkey pox studies, but only now, when the problem is directly related to other continents, are global health authorities showing interest.

Also, to understand the evolution of the virus, it will be useful to genetically analyze the virus in animals, which it also infects, especially rodents. But so far no “reservoir” of the virus has been discovered in the animal kingdom of Africa.

– Is it possible to bring the current outbreak under control?

Some countries have begun to supply smallpox vaccines, which are also considered quite effective against monkeypox because the two viruses are related. Unlike coronavirus vaccines, which take up to two weeks after administration to produce adequate antibodies and provide maximum protection, smallpox vaccines are believed to protect against monkeypox infection if given within a single period of time. four days after a person was exposed to the virus due to the long incubation period, according to the US Centers for Disease Control and Prevention (CDC).

If the vaccination strategy is adopted, it will most likely be primarily about close contact with people who are already infected, as well as some health care providers who come into contact with patients with monkey pox. Groups considered to be at high risk for infection may also be vaccinated.

But even if a “brake” is placed on transmitting the virus to humans, virologists are concerned that the virus could be transmitted to animals again, which in turn could increase the likelihood that the virus will infect humans again. The European CDC considers this to be “unlikely”, but European health authorities recommend isolating and – or even euthanizing – pets belonging to humans who became ill with monkey pox in order to prevent “human-animal-human” transmission chain. The fact that animals do not have the same visible symptoms as humans when infected with avian pox is a cause for extreme concern that such a route of transmission will be detected with a long delay when it is too late.

– Does the virus spread differently in this outbreak compared to the previous ones?

Monkey pox virus is spread through close contact with rashes, body fluids and respiratory droplets from infected humans or animals. New cases of sexually transmitted diseases do not mean that the virus has become more contagious or that it is a sexually transmitted disease. It’s just that the virus seems to be spreading more easily through close contact, according to Remoin.

Unlike coronavirus, which does not stay on surfaces for long, according to Roper, smallpox viruses can survive for a long time outside the body, making various items, such as clothes, knobs and bedding, possible. transmission route.

Although there have been several cases of men having sex with other men, according to Remoin, the most likely cause of the virus spreading to this group is that the virus accidentally penetrated this community, where it then spread through various close contacts.

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