“Monkeypox cannot be similar to the Corona virus”

It’s been a long time since we’ve heard about this, but this summer monkeypox It has been in the news again after the outbreak of a new disease that was decreed in Africa which occurred Global Health Organization To announce International health emergencyIn Europe, the risk of infection is low, and the European Union has not seen the need to impose border controls to contain the virus. Experts explain that it is very difficult for the disease to turn into a pandemic like the Covid epidemic, and they have made it very clear that there is no reason to worry or think about situations like the ones we will see in 2020. Oriol MitjaResearcher and physician at the German Trias Hospital in Badalona, ​​who says efforts should focus on the surveillance system, among other issues.

—What exactly is monkeypox and where are we now?
Monkeypox is a viral zoonotic disease, a virus that is usually transmitted from animals to humans. It used to occur in Africa, but caused outbreaks that were limited to twenty or forty people, and its transmission was eliminated. The virus adapted, and in 2022 it caused a global outbreak, infecting more than 90,000 people. The disease was primarily sexually transmitted, and the disease was mild or moderate, with ulcers in the mouth, genitals, and anal area. Thanks to vaccination and other measures, this outbreak was controlled, and now the situation is different: a different type of the virus is circulating in East and Central Africa, especially in the Democratic Republic of the Congo, and it is spreading.

—How did it spread?
– Basically through direct contact, which is no longer just sexual contact; that is, touching someone else’s skin and then touching the mucous membranes of the face, like your lips or eyes. This outbreak in the Democratic Republic of the Congo has affected 30,000 people in the past two years. 75% of them were children under 15, and there were about 1,200 deaths, most of them children who had other predisposing factors, like malnutrition. Transmission remained local, but at the beginning of the year, the new variant of variola virus 1 began to cause new transmission, also through sex, among sex workers in a mining town very close to the eastern borders with Burundi, Uganda, Bangladesh and Tanzania. Some of them crossed the border, and cases were subsequently detected in other African countries.

—The new strain is slightly more deadly, with a mortality rate of around 3%, but it has been confirmed that there is no cause for concern at the moment in Europe.
– The previous variant, category 2, has a case fatality rate of 0.1%. Out of 90,000 cases in the previous outbreak, there were just over 140 deaths worldwide. In category 1, on the other hand, out of 30,000 cases, about 1,200 people have already died. It has a higher case fatality rate because in addition to affecting the skin, the virus has also spread in some children to the lungs, digestive system and sometimes the brain.

—Authorities and experts urge people not to suffer: the EU has not asked for border controls, and it is repeated that there is very little chance of it ending in a pandemic.
– Yes, that’s true. It is necessary to finalize the mode of transmission and which population groups are most at risk. But the greatest risk at the moment still lies in the remote and poor areas of the DRC. As long as this focus is active, there will always be a risk that a case will arrive here and find the right chain of transmission to spread.

—If it spreads?
– In the worst case, if it does end up spreading, it will spread much more slowly than the coronavirus, which is transmitted through the respiratory system. With one sneeze you can spread it to many people. And here, specifically, you have to touch that person through direct contact or have sexual intercourse with them. The infection is one-on-one, and you have a lot of time to put up barriers to stop the spread. You identify the case and you can isolate them or quarantine them or vaccinate them, if you see that there is a community that is more affected. In 2022, there were certain communities of people who had a lot of sexual contacts, and they were vaccinated and the transmission stopped.

—Also, the cases recorded in the country are of the old type.
— This is very important. The surveillance system must be strong enough so that doctors are alert to identify cases. The detection of clade 1 must be more evident because patients have more widespread lesions. In contrast, in clade 2, the old outbreak, these lesions are hidden inside the vagina or the anus. It is necessary to implement techniques to differentiate between them. Today, PCRs are non-specific. They only tell you if you have the virus, but we are interested in knowing if it is clade 1, because that would be a warning sign that a more serious outbreak is coming. Therefore, a new type of PCR must be run that is able to differentiate between them. There are some doctors who advocate its analysis in all cases and others only when they come from the DRC. It will depend to some extent on availability, so far it has only been analyzed in cases where it is suspected that clade 1 has become endemic. Cases have continued in our country and will continue sporadically, without great severity.

—What should be done with vaccination?
-The indication made in 2022 was for populations with a high number of sexual contacts, especially men who have sex with men and sex workers, and on the other hand, exposed health care workers. At that time, the coverage was not 100%, and also of the people who were vaccinated, many of them received only one dose, which gives an efficacy of 50% to 60%. Two doses 80%. An attempt was made, first, to increase the vaccination coverage of the most at risk people. Second, those who received only one vaccine, let them get the second vaccine. Third, to make sure that health workers are updated with vaccines. Fourth, to wear them for travelers who go to high-risk areas.

—I understand that given the current data, no further action is necessary at this time.
-Exactly. It is important to protect those who leave, but there are a few people who put themselves at risk. It would have to be someone who goes to work in a rural area or to do humanitarian aid. The most likely entry would be through an adult, and adults usually spread it sexually. It would be strange if the entry into our country was for a child, because they have less international mobility.

—Why have these recent cases in the DRC affected so many children?
— They get a lot of infections when there is direct contact: scabies, lice, yaws, smallpox. In these countries, children often sleep together, play together… They have a lot of direct contact. Adults tend to stay more apart and wear more clothes. That’s the factor that makes the effect bigger. Then there’s gravity. When people are immunocompromised, their defenses are lower and they’re more susceptible to getting seriously ill. Immunosuppression in children in Africa happens mainly when they come from another illness, which makes their defenses lower.

—What prevention should we do collectively? How can we detect symptoms?
– These are signs similar to chickenpox, where spots start out, then turn into blisters, which end up crusting over. In chickenpox, you can find all the lesions in different stages: you have blisters that have burst, others that are crusted over, others that have already healed. However, in this virus, they all go together. And since people are now vaccinated against chickenpox, it should be suspected if someone has similar signs. They are usually accompanied by fever, swollen glands, muscle pain, headache, fatigue… But these other symptoms are non-specific, and can be confused with the flu or Covid.

—How does the disease progress from transmission to the appearance of the first symptoms?
– The person is exposed to the patient, and after about seven days fever and fatigue appear. After two or three days, lesions resembling chickenpox appear, affecting the face, head, neck, arms and legs, and to a lesser extent the trunk and back. They eventually progress to crusts, which eventually dry up and fall off.

—How do you see the vaccination situation in Africa? Is it similar to Covid in terms of vaccine shortages?
– In Africa, today, no vaccine has arrived yet. I am in contact with the manufacturer, Bavarian Nordic, and in June they received authorization from the Democratic Republic of Congo to allow the vaccine to be distributed. They have now placed a first order for 200,000 vaccines, which are expected to arrive in October. Then there are an estimated 10 million vaccines that will be needed to cover people at risk. This is where the mechanisms that ask rich countries to donate part of their vaccines come into play. But there is a difficulty: when the WHO activates this measure, rich countries could have an endless backlog of vaccines. There will be countries that want to have a lot of stock in case of a future outbreak, and this would make them shy away from donating. It is difficult to solve because the same measure both encourages and discourages donations.

—The situation with monkeypox has nothing to do with the situation we went through with Covid, but can any of the lessons learned from it be transferred?
– Systems, administrations and academics are better prepared and some lessons have been learned. Starting with communication, which is more comfortable, with a more proactive assessment of risks: pointing out uncertainties and waiting for appropriate decisions to be made. In this case, given that there was a previous outbreak in 2022, we already had diagnostic and vaccination tools ready, it is a giant step. When Covid arrived, we did not have these tools, and now we are in a very privileged position. The transmission of smallpox is slower and our preparation for diagnostic and preventive tools such as the vaccine is higher. So, everything is more appropriate and cannot be compared to what it was with the coronavirus.