Monkeypox what is known about the prospects for a new pandemic

(ORDO NEWS) — More than a hundred cases have already been registered on the planet, suspiciously resembling monkeypox, a relative of smallpox. Until 2022, patients with monkeypox were mainly infected from animals, and among people it quickly faded, being poorly transmitted by airborne droplets.

But in May 2022, the situation could change. A dozen countries on different continents showed a simultaneous outbreak of infections.

Many try to reassure the population by stressing the fact that vaccination against smallpox also protects against the new one. But the reality is far from simple, and the WHO has already held an emergency meeting of experts this Friday to discuss the disease.

She’s not actually a monkey!

Now monkeypox has entered Australia, Great Britain, Germany, the Netherlands, Spain, Portugal, the USA, Sweden, Italy, Israel, France, Belgium and Canada.

It turns out already 13 countries, and we cannot be sure that by the time this text is published, there will be no more of them. Information of this kind comes almost every hour, even faster than with the spread of the coronavirus a couple of years ago.

Contrary to the name, monkeys are not the only ones who suffer from this disease (although it was in them that it was first identified back in 1958). But who exactly is not yet very clear, because field biology in Africa is not as well developed as we would like.

The main reservoirs of monkeypox are the Democratic Republic of the Congo (the Congolese lineage of this virus circulates there) and West Africa (and here the West African line).

It is assumed that the main carrier both there and there are rodents, but what exactly is unknown. Both monkeys and humans contract the virus mainly from other animals. Africans still eat the meat of wild animals killed in the hunt, and with it the virus enters humans.

Until 2022, it was believed that the virus did not really know how to spread from person to person by airborne droplets. This seemed to confirm that the longest chains of infection from person to person had no more than six human links.

That is, the basic reproductive number R – the number of people that one patient can infect – was less than one for long periods of time. Even a few Africans who ate dangerous game could only infect two or three other people, those only one or two, and so on.

True, the authors of one scientific work, using simulations, counted in monkeypox R even higher than two. However, as is easy to see from her text , she relied on not entirely realistic assumptions.

And in the end, R is an important, but not decisive thing: we recall that the R of most influenza strains is below two. And yet the flu is constantly circulating in the human population.

In Africa, they stopped vaccinating against smallpox back in the 1980s: if monkeypox really had an R higher than influenza, then it would have become a mass disease of the Black Continent and the world as a whole a long time ago.

However, in practice, until the 2020s, about a couple of thousand Africans a year fell ill with it, which is difficult to attribute to diseases with the contagiousness of influenza. From this it is quite obvious that this disease has not known a truly effective spread (R> 1 over long periods of time) among people to this day.

Looks like something has changed dramatically in 2022. Either monkeypox mutated and learned to spread effectively from person to person by airborne droplets, or spread in some way that allows you to do without airborne transmission.

The British The Independent writes about one of these ways – sexual contact between men. This is the case in most of the cases detected in Britain and the Pyrenees (Spain still leads in the number of cases, in the region of three dozen).

Such contacts are accompanied by the exchange of physiological fluids. Obviously, similar contacts can occur in heterosexual couples.

However, so far, according to the Daily Mail , the British medical authorities are concentrating on this route of transmission. If new cases continue in this environment, smallpox vaccination will be offered to its participants (we will explain below why this is far from a panacea).

However, it is far from certain that everything is explained simply by quick and random same-sex relationships within the same “sex network”, as representatives of the British authorities say.

The problem with the current situation is that cases of the new disease are being reported almost simultaneously all over the planet, from Canada to Australia. The incubation period for smallpox is ten days. It turns out that about a hundred people became infected with it about a dozen days ago.

But this virus does not normally circulate among people (at least outside of Africa, where it has a natural reservoir). So, the infection happened at one point. At what point in particular can people from 11 countries separated by great distances be infected with one disease atypical for humanity at almost one moment in time?

If we discard the conspiracy theories about the secret world swingers congress, then the simplest and most obvious assumption is that this could happen at a major international hub airport. It’s not so convenient to exchange bodily fluids at the airport – anyone who has tried something like this knows about it.

The meat of Gambian rats (a typical reservoir of monkeypox) is also not fed at hub airports. It turns out that it is difficult to exclude that the transmission took place by airborne droplets, and to many people at the same time.

But very dangerous

Monkeypox has two genetically distinct lines. Now West African is spreading in the Western world – with a mortality rate of no more than 1%. That’s roughly the death rate of the coronavirus.

The 4-11% mortality figures circulating in the media are incorrect: those who cite them either do not know or forget that such mortality has so far been shown only by outbreaks in the Democratic Republic of the Congo, where this virus belongs to a different, more dangerous line of smallpox monkey virus.

However, the African smallpox line also had a mortality rate of only 1%, but it was nevertheless very much feared. This is because most people perceive the risks of infectious diseases more “on emotions” than on reason.

What does not leave obvious marks on the patient (coronavirus) is considered a mild illness (although in fact it still leaves them , they are just not visible at first glance), and what leaves visible marks is considered severe.

Smallpox and its new African variety too leaves lesions, pockmarks, and a crust on the skin that then falls off, leaving scars. In the case of severe and moderate course – life.

How to know that you are sick?

If you are just in Africa and for some reason ate the meat of wild animals or stay in Europe-USA-Canada and participated in the exchange of biological fluids with unfamiliar people, then you should think about whether you picked up something similar.

The clinical picture here is very similar to the old smallpox: about ten days elapse between infection and pronounced symptoms. By this time, skin itching, fever, fatigue, pockmarks and crusts may begin to appear.

But there are also differences from classical smallpox – crusts often appear on the palms of the hands, and also – lymph nodes swell (and are easily felt with fingers).

What to do in this case? We would recommend contacting the medical authorities. From such smallpox there are formally antiviral drugs.

You won’t get them yourself, they’re slow-moving goods, like tecovirimat . But the medical authorities may have something similar in storerooms in case of a biological attack (however, these reserves are not particularly large).

True, you should not rely too much on tecovirimat. After all, it has never been tested on a large sample of people specifically in relation to monkeypox.

Yes, it has positive animal test results, but still animal and human immunity differ significantly. To understand whether it helps with a new disease, a full-fledged epidemic is needed, which has not yet happened.

From the onset of symptoms to the end of the disease should take from two to four weeks. We say “should” because in modern society there are many people with not the best immunity, who did not live long in past centuries and therefore met extremely rarely. It is not known how long the disease can last for them.

Will our vaccination against smallpox also protect against monkeypox?

The Western media even give a figure: allegedly, the vaccine against the “old” smallpox protects against a new disease with a probability of 85%. This figure, however, was not the first to be named by them, but by the American medical authorities (however , without reference to any scientific work or clinical trials).

True, there is one scientific work from the last century, which names similar figures. But only its authors themselves did not conduct any clinical research, and in their assessments they relied on data of not the best quality (and even not collected by them).

A more significant question is: how do we even know that the smallpox vaccine is effective against monkeypox? The entire sample of victims of the latter known to world medicine is a matter of hundreds of cases. After all, most cases do not have a normal medical description at all: in Africa this is difficult.

On such a small sample, it is simply impossible to reliably determine how effective this or that vaccine is against a virus that was never the target of its creators. Observations “by eye” can give only the most approximate idea of ​​the issue.

Yes, logic suggests that, due to the relatedness of viruses and the similarity of symptoms, antibodies to one can bind the other. But we all know that Pfizer, once very effective against the Wuhan coronavirus, is rather weakly protective against the “omicron”. A similar situation cannot be ruled out in the world of smallpox vaccines.

The problem is also different: this vaccine, even against the very natural smallpox, quite reliably protected only in the first six months or a year after vaccination. And even then it protected not from the disease itself, but only from the lethal outcome that it causes.

Recall that during the smallpox epidemic in Yugoslavia in the 1970s, even people who were revaccinated three times became infected with smallpox. True, they did not die, but among those who did not have time to be revaccinated and received the initial vaccination more than six months ago, the mortality rate was quite decent.

Although, of course, it is somewhat lower than that of those who have not been vaccinated even once in their lives. In any case, you can be sure: the round scar on your left shoulder is not able to protect you even from the usual smallpox, and there is no question of a new one.

Another complication with the “old smallpox vaccine protects against new” idea is that the smallpox vaccine is not honey and sugar at all.

This means that, unlike new vaccines, where there is simply no live virus, the smallpox vaccine leads to death in one to three cases per million vaccinated. Its live virus multiplies in immunocompromised organisms to the point of killing the vaccinated.

It seems that any reasonable person, choosing between such a risk and monkeypox – if it suddenly turns into a pandemic, will still choose the vaccine. Fortunately, without it, the mortality rate will not be 1–3, but 10,000 people per million cases.

But from the experience of the coronavirus pandemic, it is known that tens of percent of the population are not ready to inject themselves even with Sputnik, which is incomparably safer than the smallpox vaccine. Accordingly, in the case of a smallpox epidemic, there will be even more anti-vaccinators than there were during the coronavirus.

This is sad, because there is simply no way to defeat a viral infection other than vaccination and revaccination. Even China and North Korea could not cope with the coronavirus quarantine.

There is nothing to say about other countries. In addition, as we have already noted , smallpox is completely asymptomatic and also has its own superspreaders. And stopping asymptomatic quarantine is much more difficult than ordinary patients.

What would you do in an ideal world

The only way to combat such diseases is well known from the history of smallpox is to prepare doses of smallpox vaccine in advance for the entire population of threatened countries. And at the very first outbreaks, start mass smallpox vaccination in the region where there is an outbreak.

In the case of Africa, it would be highly desirable to organize a mass vaccination campaign against smallpox even before outbreaks. The presence of a natural reservoir of the disease there (animals that it can infect) simply leaves no other reasonable way out.

But to do this really effectively and without unnecessary risks, it is worth creating smallpox vaccines on a new technological platform.

It’s worth being alert – not panicking

It’s too early to start getting too nervous. The fact is that there remains a significant chance that the spread of monkeypox in Europe is a simple consequence of sexual or other non-airborne transmission.

And if the latter type of transmission works here, it still does not allow one sick person to infect more than one healthy person. In this case, a new smallpox can be crushed by isolation of the sick pretty soon.

This version is supported by the fact that smallpox actually mutates much more slowly than the coronavirus, and therefore it is more difficult for it to gain the ability to spread effectively from person to person through the air.

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