The US authorities have decided to declare monkeypox a public health emergency. This was announced on August 4 by the Minister of Health of the country Javier Becerra.
“We are ready to take our response to the virus to the next level and urge every American to take monkeypox seriously,” he said during a telephone briefing, adding that more than 6,600 cases have been identified in the United States.
Earlier, the state of emergency has already been introduced in some states. In European countries, the state of emergency has not yet been introduced, but as of August 2, the number of cases here was already about 16 thousand people.
“The majority of infections were in people aged 31 to 40 years (41%) and men (99.1%),” the European Center for Disease Prevention and Control (ECDC) said in a statement.
In the majority of cases, the patients had a rash (94.8%) and systemic symptoms such as fever, fatigue, muscle pain, chills or headache (65%). According to the department, 399 people (5.6%) were hospitalized, while three patients were admitted to intensive care units, two of them died. In addition, 41 patients were a health worker, although the infections are not associated with professional activities.
Head of the World Health Organization (WHO) Tedros Adhanom Gebreisus has called the monkeypox outbreak an international public health emergency, but the organization has yet to recommend mass vaccination.
“WHO recommends targeted vaccination for those who have been in contact with a patient with monkeypox, as well as for those who are at high risk of infection, including healthcare workers, certain laboratory workers and those with multiple sexual partners,” he said at a briefing in late July. .
The head of the WHO also said that there are no data on the effectiveness of existing vaccines against monkeypox, although some of them have already received approval in several countries.
So far, deaths from this disease are rare and, according to the chief researcher of the Research Center for Epidemiology and Microbiology named after V.I. N.F.Gamalei Anatoly Altsteinthey do not talk about the strengthening of the virus and the increased danger to humans. Nor does he see the need for monkeypox vaccination.
“In countries where there are hundreds and thousands of cases, of course, it can be carried out among specific groups of people. But there is no need to massively vaccinate against monkeypox, ”he said.
According to him, this is a self-liquidating disease and after some time it will disappear, it is only necessary to identify and isolate the sick in time and monitor those with whom they contacted.
So far, one case of monkeypox has been diagnosed in Russia, the patient has already been discharged from the hospital and, according to the head of Rospotrebnadzor Anna Popovathe risks of the spread of the disease in our country are low. Nevertheless, tests for detection in Russia have been developed, sent to the regions, and the relevant services are familiar with the necessary measures in case of detection.
Candidate of Medical Sciences, Immunologist Nikolai Kryuchkov notes that monkeypox spreads much more slowly than, for example, COVID-19.
“This is due to the low infectivity, which, in turn, is due to the routes and certain conditions of transmission. For example, we need a longer close contact between people. In this case, an airborne or contact route is possible, but it does not occur instantly. It is much more difficult to get infected than COVID-19, which is a big plus.
In addition, the infection is relatively moderately lethal, especially in developed countries. In Africa, the West African variant has a mortality rate of 2 to 4 percent in population studies. There are no exact comprehensive statistics on this in Africa.
In the current outbreak, there are 5-6 deaths out of about 25,000 detected cases in the world. Most likely, the final lethality will be noticeably lower than 0.5%.
“SP”: – Why is it still dangerous if the United States has already declared an emergency?
The virus evolves as it spreads. It evolves only by getting inside the target cells of the host and multiplying in them, the so-called replication process. In this case, the replication process of the virus always occurs with small errors. This means that different viruses can mutate at different rates. In most cases, mutations do not lead to phenotypic changes, that is, they do not affect vital activity. Quite often, they lead to negative changes that impair the ability of a particular strain to spread. In a small percentage of cases, these mutations lead to positive changes for the virus.
This virus, compared to coronaviruses and a number of others, is relatively low mutating. Another thing is that since the outbreak in the world, the rate of mutation, according to data a month ago, has increased at least 5 times, and most likely even 7-8 times. Most likely, they will continue to grow, although not so much. This is due to how many people become infected over a period of time.
The most dangerous mutation that the virus is aiming for – other things being equal, if there are evolutionary reserves, and monkeypox has them – is an increase in infectivity.
Now the problem does not look so serious. Back in March 2020, I told many people, don’t look at the situation from today’s positions, look from the perspective of six months or a year – how the situation will develop, because the measures taken actually have a time lag of several months. The measures taken do not affect the current situation, but the future, which is more serious.
Of course, the situation with coronavirus is more clear, with monkeypox, everything is not so clear, there are risks. At some point, by infecting a large number of people, a mutation appears that dramatically makes the virus more infectious. For example, a two-fold or even more increase in contagiousness. And this will immediately change the behavior of the virus, the characteristics of the infection, it will spread much faster. It becomes possible to infect even more people, its evolution continues, and it can acquire the properties of infecting even more people. This is an unstable process that does not need to apply templates for stable.
The most unstable process is now the coronavirus, we understand that the risk of another unstable process is not very attractive for both specialists and society as a whole. Control measures are needed to determine the moment when an abrupt transformation of the infection occurs.
There is nothing good in this infection, it must be controlled and at the moment it can be controlled much easier than coronavirus. We are talking about information, timely isolation, but in many countries we have groups of people who lead a very specific way of life. I don’t mean marginal
“SP”: – So who is at risk? In early August, information appeared about two cases in teenagers in Germany who became infected in early July.
– This is in Germany, and in the world, children have already been in this outbreak. It is believed that in the original cohort these were people from the so-called MSM group, i.e. men who have sex with men. These are risky sexual relationships, behavioral patterns, the frequency of sexual relationships and the change of partners, unprotected sex, and so on. There are features that probably contribute to the transfer. Monkeypox is not a classic sexually transmitted infection, but during the sexual route there is a long and persistent traumatic contact of the mucous membranes and skin, respectively, the risk of transmission of this infection increases dramatically.
The MSM group is of great importance, the percentage of infections there is abnormally high among all cases, but we do not know for sure whether this group was nuclear. Even if this is the case, as the circles on the water diverge, more and more distant groups are involved. I hope it will not come to a pandemic, but no one is completely protected – neither children nor adults.
“SP”: – We were all vaccinated against smallpox in childhood, many were ill. How effective is this protection?
“There is significant protection in people who have been vaccinated against smallpox. We had a mass program until the 1980s, this disease has been eradicated. Those who have received this vaccine and now do not have severe immunodeficiency are more protected. This is at the level of the population group, and not at the level of each person, since everyone has their own characteristics, immunity.
Vaccination is needed in certain specific groups, which is already recommended by WHO, and post-exposure prophylaxis is very important. If a person suspects that he has been in contact with a person who has monkeypox or even suspicious signs, he should come to the clinic and be vaccinated against smallpox with the vaccines currently available. If in the first five days he managed to do this, then the probability is extremely high that the disease will not develop in him. If in the first 10-12 days, then the disease is likely to develop, but it will be mild.
We need stocks of this vaccine in order, firstly, to vaccinate risk groups, and secondly, to do post-exposure prophylaxis. Russia had and still has time to do it quickly.
“SP”: – What is the likelihood of the spread of monkeypox in Russia? Maybe we should limit the travel of Russians to countries where monkeypox is spreading? Strengthen border controls?
– Russia has already received a head start in connection with the restriction of air traffic, primarily with Europe and the United States, where this outbreak has fully materialized. Sanctions and anti-sanctions played their role. Now this smallpox is already in other countries.
Close from all countries, including the most developed? I think it will be quite strange. Getting to Russia is inevitable, it is important to work out a mechanism for how to quickly receive information about the possible presence of a disease in a person, his environment and quickly take measures for their temporary isolation and treatment.
I think in August we will officially know that there is confirmation of the transmission of the infection within the country. Most likely, this is already happening, we just do not know about all cases.
Border control, even for the coronavirus, has been canceled, but it makes sense. The question is more complex, whether monkeypox can be effectively weeded out only by body temperature, for example. Rather, no, but some of the people who are in the active period can. This is not a panacea, but half of the people can be “cut off”. Is it being done now? As far as I understand, no.
Lockdowns do not need to be introduced, unlike covid. And there it was necessary, but we didn’t do it and got what we got – in 2021, super-mortality
It is impossible to guarantee non-importation, and it is important that the relevant institutions in the state and the people themselves react actively. Beds, isolation algorithms, provision of medicines, vaccinations must be ready