Monkeypox (Ampox). Prevention and Public Health

 

Professor Dr. Kamal Al-Saad

College of Veterinary Medicine / University of Basra

8/11/2024

It is a viral disease that may be considered rare and is transmitted from animals to humans. The disease results in smallpox-like lesions on the skin. It is closely related to smallpox, but it is not as deadly as smallpox. It was first discovered in 1958 in monkeys used for research.

 

The disease is endemic in central and western Africa near tropical rainforests, and the occurrence and spread of the disease may be linked to travel to those areas. The World Health Organization has declared the latest outbreak of monkeypox in Africa a “public health emergency of international concern”, a category used in the past for the outbreak of Ebola, Covid-19, and the rise in monkeypox cases in Europe in 2022.

 

The causative agent.

The virus that causes it belongs to the poxvirus DNA family, as one of the members of this family is the main cause of smallpox, which caused the death of at least 500,000 people in the past until the disease was eradicated by vaccination in the eighties, but this virus is much less dangerous than the human smallpox virus, despite the increase in the spread of the disease now.

There are two main strains of the virus.

The first type, clade I, is caused by the West African strain and is characterized by a low mortality rate of 1%, which is now widespread, especially in England.

 

The second type, clade II, is caused by the Central African strain and is characterized by a mortality rate of more than 10%.

 

Methods of transmission of infection.

1- Transmission from animals to humans. The main carrier is still not precisely known, and it is believed and likely that rodents, squirrels and hedgehogs are the carriers. The disease is transmitted through small wounds in the skin by biting or scratching.

2- The disease may also be transmitted through contact and friction with wild animals such as monkeys or eating their meat that is not cooked well

1. Direct contact with patients infected with monkeypox
2. Touching blisters or skin scales of an infected person with Monkeypox
3. Through objects contaminated with the virus, such as bedding and clothing.
4. Coughing or sneezing of a person infected with monkeypox

 

Disease prevalence and outbreaks

1- In the fall of 2003, confirmed cases of monkeypox were reported in the United States of America (71 cases, including 37 confirmed cases and no deaths)

2- In 2005, an outbreak of monkeypox broke out in Unity State, Sudan (49 cases and no deaths), and sporadic cases were reported in other parts of the African continent

3- In 2009, two cases of infection among refugees arriving from the Democratic Republic of the Congo

4- The Democratic Republic of the Congo in particular: 2000 cases were recorded between 2011 and 2014.

5- Between August and September 2016: 26 cases and two deaths in the context of another outbreak of the disease in the Central African Republic.

6- Nigeria: The outbreak began in September 2017 and has continued across multiple countries as of June 2019

7- 2018, 2021: Cases were recorded in the United Kingdom

8- 2019: Case in Singapore (Nigerian man)

9- In 2022-2023, outbreaks of the disease were detected by clade IIb and clade I MPXV strains in refugee camps in Sudan as an indication of the evolution of the causative virus

 

Current epidemiological situation of the disease

• The first case was detected in Britain on May 7 for a traveler from Nigeria.
• Then the number of cases increased further.
• It was noted that most of the initial infected cases were in men who had homosexual relations, but this is an unusual and unknown pattern for monkeypox. It is a venereal disease that may result from contact during intercourse.
• It is believed that the current outbreak of the disease may differ due to the possibility of the virus undergoing an evolution process.
• From The spread of the disease is expected to expand further due to the re-permission of travel significantly after the Corona period, in addition to the possibility of genetic mutations of the causative virus.
• It should be noted that accurate knowledge of the disease is still very limited and is based only on the number of diagnosed cases.
• The Democratic Republic of the Congo is witnessing a severe outbreak, with more than 14,000 infections and 524 deaths recorded since the beginning of 2024.

It was noted that children under the age of 15 currently constitute more than 70% of monkeypox cases and 85% of deaths in the Congo, which may be attributed to immune differences and malnutrition.

 

Symptoms of the disease .

The symptoms of monkeypox are similar to those of human smallpox, but they are less severe, less deadly, and less contagious.

• The incubation period of the disease is relatively long, ranging from 5-21 days, so an infected person may transmit the infection unintentionally, and it is possible for anyone in close contact with a person infected with monkeypox to be infected with the virus. The disease is characterized by a high degree of probability of environmental conditions, and therefore contaminated surfaces play an important role in its spread.
• In most cases, clinical symptoms are mild and may disappear spontaneously and the patient recovers within weeks, but some infections are more severe and sometimes fatal.

 

Symptoms of the disease

• Symptoms begin with a rise in body temperature with chills
• Headache
• Feeling tired and exhausted
• Body aches
• Swollen lymph nodes
• This is followed, within a few days, by the appearance of skin lesions specific to the disease, which are characterized by the appearance of
• Rash, papules, vesicles, blisters and scars
• The rash begins as flat red spots that turn into blisters, then fill with pus, then begin to peel off, forming scars
• Skin lesions begin on the face and then spread to all parts of the body
• There may be swelling in the anus or rectum or pain during urination sometimes.

 

Diagnosis.

1- Clinical signs

Monkeypox is usually diagnosed by taking a sample from a skin lesion and examining it for the genetic material of the virus (DNA). The Anility m monkey pox assay has been licensed

 

It is a continuous and random molecular analyzer with a result time of less than 115 minutes, eliminating mixing procedures and improving laboratory workflow.

 

• Severity of the disease:
• Most cases are mild, sometimes resembling chickenpox, and resolve spontaneously within a few weeks (14-21 days).
• Monkeypox can sometimes be more severe, and has been reported to cause deaths in West Africa with complications
• The mortality rate in cases resulting from monkeypox outbreaks usually ranges between 1 and 10%, with most deaths occurring in younger groups (the risk of death reaches 10-11% in the Congo Basin countries).
• In general, the recovery rate from monkeypox is good to excellent, with most patients recovering. The recovery rate may be lower in immunocompromised patients, and patients with other problems such as malnutrition or lung disease.

 

Countries endemic with monkeypox

• In Africa Cameroon Central African Republic Democratic Republic of the Congo Gabon South Sudan Ivory Coast Liberia Nigeria Republic of the Congo Sierra Leone and Ghana
• Number of monkeypox cases in the world recorded as of January, 2022,
• One case of monkeypox in Morocco
• 4 cases of monkeypox in Lebanon
• 3 cases of monkeypox in Saudi Arabia
• 133 cases of monkeypox in Palestine
• 16 cases of monkeypox in the Emirates
• 2 ​​cases of monkeypox in Qatar.
• Sporadic cases were also recorded in Egypt, Jordan, Iraq, Tunisia and Yemen.
• The United States of America recorded the highest number of monkeypox cases worldwide, which is 35,000

4,298 cases of monkeypox in Spain

2,595 cases of monkeypox in Germany

2,546 cases of monkeypox in Britain

1,955 cases of monkeypox in France

879 cases of monkeypox in the Netherlands

497 cases of monkeypox in Italy

 

Treatment methods

Antivirals:

1. Tecovirimat
2. Cidofovir or Brincidofovir

 

Supportive health care:

• Antipyretics
• Fluid balance
• Oxygenation
• VIG immunoglobulin).

 

Disease control methods

• Procedures followed in Corona control methods, including washing hands with soap and disinfecting surfaces
• Avoid contact with animals, especially rodents and monkeys
• Isolate infected people, treat clinical symptoms, and track contacts
• Educate doctors and veterinarians about the symptoms of the disease, methods of diagnosing it, and how to avoid infection
• Imposing restrictions on animal trade, and restricting the transfer of small African mammals and monkeys or imposing a ban on their transfer may contribute effectively to slowing the spread of the virus outside Africa.
• Euthanasia of infected or contact animals.
• Quarantine for at least 6 weeks.
• Vaccination with smallpox vaccine (Smallpox vaccine) or other vaccines currently permitted
• “Vaccinating high-priority people”
• Use of environmentally friendly disinfectants
• Use of chlorine Sodium hypochlorite 0.5% (bleach)