U.S. health officials said that as of March 3, at least 22 monkeypox cases had been found in 11 states. After gene sequencing and analysis of recent monkeypox cases, two different monkeypox virus strains were found, indicating that the virus may have spread in the United States for a long time without being found.
According to NBC's report on the 3rd, US federal health officials said that most of the current cases belong to the same virus strain as the European wave of cases, but different virus strains were detected in two samples, which are similar to the sequencing of the virus gene of a patient who had monkeypox symptoms after returning from Nigeria in 2021.
This means that as early as before the outbreak of monkeypox in the United States, the virus may have "secretly spread" in the territory, but the degree of spread is not large, or it is misdiagnosed as other diseases.
The Centers for Disease Control and Prevention (CDC) warned that there may still be some undetected monkeypox cases in the United States, so those areas where there is no confirmed case may also be spreading at the community level. The government still needs to analyze more patients to determine how long monkeypox has spread in the country.
So far, there have been at least 22 monkeypox cases in the United States, of which 14 patients had entry-exit records within 21 days before the onset of symptoms.
At least two outbreaks are occurring at the same time
According to the US Centers for Disease Control and prevention, three of the newly completed six (2 from 2021 and 4 from 2022) genome sequencing results of monkeypox virus in the United States are significantly different from those involved in the current large-scale epidemic in Europe.
The genome sequencing results of nearly 40 monkeypox viruses from Portugal, France, Belgium, Germany and other European countries published in may show that this round of monkeypox epidemic points to the same source - these virus samples are similar to each other, which is closely related to the monkeypox virus found in Britain and other places in 2018-1019. They are both West African strains of monkeypox virus with mild symptoms and low mortality.
As of June 4, Beijing time, according to the data from the Centers for Disease Control and prevention of the United States, since the first monkeypox case in Europe was found in the United Kingdom in early May, there have been 909 confirmed cases of monkeypox worldwide, including 72 suspected cases. About 40 countries have reported confirmed cases. Britain is the country with the largest number of confirmed cases, with 225 confirmed cases, followed by 186 cases in Spain. Twenty seven cases have been reported in 11 states of the United States.
Most of the confirmed cases were infected by homosexuals, bisexuals and other men who had sex with men. Considering that monkeypox was previously a tropical zoonotic infectious disease, which mainly occurred in the DRC, Nigeria and other countries and regions in Africa, and there were few cases reported outside Africa, the trend of monkeypox epidemic was extraordinary, and there were many doubts.
On June 3, on the basis of the previously published four 2022 monkeypox virus genome sequences, the Centers for Disease Control and prevention of the United States released the latest four 2022 virus genome sequences and two virus genome sequences introduced in 2021. The two cases found in July and November 2021 were patients who went to Nigeria and returned to Texas and Maryland respectively.
Inger Damon, director of the Department of high consequence pathogens and pathology of the Centers for Disease Control and prevention of the United States, accepted the US medical website www.statnews Com said that the genomes of the three newly detected monkeypox viruses are obviously interrelated and have a common ancestor, but their differences are also greater than those of other viruses sequenced before.
In these three cases, the geographical range of monkeypox virus infection was also surprising - one in Nigeria, one elsewhere in West Africa, and the third in the Middle East or East Africa. Damon acknowledged that the relevant virus strain has obviously spread widely (different from the outbreak strain in Europe), which also indicates that the outbreak of monkeypox may take longer than people realize outside those countries that treat monkeypox as an endemic virus.
"We believe that this also means that at some recent time points, the virus may have spread from Nigeria many times, and additional transmission events may have occurred worldwide." Damon said, "this does raise a question, that is, whether there are host and human infections in a wider area? I think it is necessary to further understand whether the Middle East and East Africa are potential areas for the virus to be introduced."
However, Damon said that the genome sequences of the three different viruses are unlikely to indicate that there was undetected transmission in the United States after the monkeypox case was found in Texas last July. "At present, we have no evidence to support this. These people's diseases are indeed related to their travel events."
When asked whether he thought the spread of monkeypox could be stopped, Damon of the Centers for Disease Control and Prevention said, "we are trying to understand what is happening and consider what public health tools can be used to prevent further spread, including research on vaccines and related treatments," she said, "I think that only through close monitoring and observation of what is happening can we know whether it is controllable."
Damon said that the new research results show that doctors and nurses around the world should consider the possibility of monkeypox when facing patients with unusual ulcers or possibly sexually transmitted infections.
The expanding monkeypox epidemic has brought great challenges to the communication and transmission of public health departments. They believe that it is necessary to give necessary reminders to the people at greatest risk - men who have sex with men, but also to avoid further stigmatizing a group that is often condemned by the society.
Previously, the research team from Italy said that according to the information currently available, most of the confirmed symptoms are perianal and genital lesions, and a few skin lesions have synchronous evolution patterns.
June has come. Every June is the "Pride Month" of global minorities (gay, bisexual, gender neutral, transgender, etc.), and usually a series of parades and celebrations are held all over the world. Against this background, health officials around the world are trying to raise awareness of the growing monkeypox epidemic.
Nobody wants to screw it up
On June 2 local time, Maria van kerkhove, head of the Department of emerging diseases and zoonoses of the World Health Organization's health emergencies project, accepted www.statnews In an exclusive interview with www.monkeypox.com, he gave relevant answers to a series of questions that the public are most concerned about about the monkeypox epidemic - the risk of the epidemic and the challenges to deal with it.
Q: "How dangerous or not is the monkeypox epidemic?"
Maria van kokhoff: "our concern is that, first of all, so far, we do not know the degree of infection. This is not an explosive epidemic like the COVID-19 we have seen, but it is absolutely different. The reported cases span 40 countries - this range is quite wide, which indicates that more cases have been omitted."
"At the same time, we have seen some transmission patterns that we have never seen before. Obviously, monkeypox has spread in its non endemic countries for several months. We don't know exactly how it started. When we try to explain this to a wider audience, we realize that we know very little about this particular virus. At the same time, we should also ensure that we target those at greatest risk and ensure that they get the right information. Considering the mistakes made at the beginning of the emergence of HIV, no one wants to screw it up. "
"Based on the information we have seen in non endemic countries, we believe that further transmission can be prevented. Monkeypox virus is different from coronavirus. In terms of transmission, when someone has symptoms, there is real close physical contact. Therefore, we use phrases such as skin contact and mouth to skin, which is different from the way we describe respiratory diseases."
"At present, it seems that most cases occur in MSM (male male behavior) In the group. There were some females in the cases, but we did not see the expansion of the number as in the MSM population. Fortunately, we have not seen the virus spread among pregnant women, vulnerable groups, children and other high-risk groups. But if the virus spreads to vulnerable people - people with underlying diseases, children, pregnant women - then we may see a change in the severity of the virus, which is also our concern. "
Q: "The European health agency warned that if monkeypox virus spills from people to animals, it will become a local epidemic. How do you view this warning?"
Maria van Kirchhoff: "In the past few years, the global health organization has learned a lot from the way it communicates with the public. First, we must be accurate. Second, we must talk about the possibility. At present, we do not know much about monkeypox virus. We do not know the R0 of the virus - on average, how many people will be infected by an infected person. We also have very limited information about the epidemiology of monkeypox. Who is the most vulnerable ？ Why does the virus spread? How to spread? What is the ratio between animal infectious disease spillover and human to human transmission? How does communication happen? This is one of the things that needs to be improved. "
"Another thing we don't know much about is mortality. The proportion people talk about is 1% to 10%, which depends on the evolutionary branch of monkeypox virus. But this is a rough mortality, which is calculated according to the discovered cases, as well as missed cases and unconfirmed cases, which shows that the rough mortality is at the high end of the real mortality. However, 3% to 6% is not low."
Q: "Will we know more about monkeypox in the coming months?"
Maria van kokhoff: "yes. We have encountered a spreading and persistent problem of zoonotic diseases. Monkeypox may have been transmitted from person to person in several countries in West and Central Africa for several years. Although who has tried to draw people's attention to this and to promote people's attention to the diagnosis, treatment and vaccine of this disease, little attention has been paid to this problem."
"We need the current situation to move the agenda forward. I think it is heartbreaking in itself - we are concerned about Africa because it is now affecting countries outside the continent."