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Monkeypox: all the questions you ask yourself about this disease and their answers

The WHO has declared the recent outbreak of monkeypox a public health emergency of international concern. Why? Know its symptoms and how to prevent contagion.

Since July 23, monkeypox is already a public health emergency of international concern (ESPII), according to the World Health Organization (WHO). The previous declaration occurred in January 2020 with covid-19. Just over two months have passed since the UK National Health Security Agency (UKHSA) identified the first cases of the current outbreak in the country, with no history of recent travel to endemic areas and no known contact with an imported case. weeks before. Today, there are already more than 20,000 confirmed infections in 75 countries, eight people have died and Spain is the European region with the most infected people (close to 4,300 in the Health bulletin).July 29). What is known about this disease? Below, we will tell you what symptoms it causes, how it is spread, what ways there are to cure it, and what you have to do if you have it, live with someone infected, are in close contact, or want to prevent it.

What is monkeypox

Monkeypox , also called monkeypox , is a viral zoonotic disease , that is, it can pass from animals to humans. In fact, it is called monkeypox because the virus that causes it was discovered in 1958 in colonies of monkeys used for research in a Danish laboratory. It was not until 1970 that the first human case was reported: a 9-month-old baby in the Democratic Republic of the Congo.

Monkeypox virus (MPXV) belongs to the genus Orthopoxvirus , of the family Poxvirida. And there are two strains: the one from West Africa and the one from Central Africa, with higher mortality. The current outbreak is of the milder West African strain . In two months, of the nearly 20,000 cases registered in 75 countries (most of them in Europe and the US), three deaths have been reported in Nigeria, two in the Central African Republic, two in Spain and one in Brazil.

The Working Group on Vaccinations of the Spanish Epidemiology Society (SEE) has prepared a guide on the disease where it explains that MPXV is very similar in symptoms to the smallpox virus already eradicated in the 1980s, but it has two differences : it is less contagious and less serious . However, since it is being transmitted outside its usual endemic area (Central and West Africa), it is necessary to “exercise strict epidemiological control to avoid extensive transmission of the virus.”

Hence the WHO statement. For most of the members of its International Health Regulations (IHR) Emergency Committee, this outbreak meets the criteria to consider it an emergency (ESPII): extraordinary event that arises suddenly; constitutes a public health risk for other States; and may require an immediate coordinated international response. Therefore, it gives a series of temporary recommendations to avoid expansion.

How do you spread monkeypox?

The animal reservoir of the virus is unknown, but it is known that rodents and primates in endemic areas can transmit it.

Monkeypox virus is transmitted from human to human through direct contact with infected skin , bodily fluids, or respiratory droplets from an infected person with whom sexual intercourse occurs or through other situations of sustained and prolonged physical contact.

Therefore, a pregnant woman can transmit it to her child through the placenta or the father to his baby by doing the kangaroo method . However, for now, 98% of infections are concentrated in the group of men who have sex with other men, reports the WHO.

It can also occur by contact with contaminated objects such as bedding, bandages, dishes, etc.

What are your symptoms?

The incubation period of the monkeypox virus is 6 to 13 days, although it can range from 5 to 21 days. It usually presents with a combination of symptoms, which last between two and four weeks:

  • Fever
  • headache
  • Asthenia (tiredness), exhaustion
  • Shaking chills
  • Back pain, myalgia (muscle pain)
  • Swollen lymph nodes (lymphadenopathy)

Between one and five days after the onset of fever, the characteristic lesions of this disease begin to develop on the skin . The first are enanthema , lesions on the mucous membranes of the mouth. A skin rash then develops, concentrating on the face (95% of cases) and the palms of the hands and soles of the feet. Lesions (flat or slightly raised, filled with clear or yellowish fluid) vary in size and evolve from macules, papules, vesicles, pustules to crusts, which dry and fall off. The most representative of this outbreak are skin lesions in the anogenital or perineal region, as well as inguinal adenopathies .

Is monkeypox deadly?

Monkeypox is usually a self-limiting disease (benign that heals without treatment). So much so that epidemiologists acknowledge that the cases of the current outbreak are being mild and ” they are barely generating hospital admissions “, around 10%, according to the latest WHO data. It must be taken into account that the lethality rate of the strain of this virus is 1%, when in the Central African lineage it reaches 10%. Of course, injuries to the skin and mucous membranes are very annoying.

But, as they remember from the Spanish Society of Pediatric Infectious Diseases (SEIP), it can be serious in children, pregnant women and immunocompromised people . Complications in severe cases include secondary bacterial infections such as bronchopneumonia, sepsis, encephalitis, and corneal infection with consequent loss of vision.

How is it diagnosed?

Early detection is essential to prevent the spread of the virus. And again, individual responsibility is key. Therefore, see your doctor if:

  • you have a vesicular rash anywhere on your body and any of the other symptoms listed.
  • in the 21 days before the onset of symptoms: you are a close contact of a confirmed or investigational case; you have had risky sexual relations; or you have traveled to endemic areas.

A laboratory test will confirm the suspected or probable case.

What should I do if I am infected?

Contagion of monkeypox can occur from the time the infected person begins to present symptoms. But the risk is higher when lesions appear on the oral mucosa . There is no danger when these are already healed and a new layer of skin is formed.

Therefore, if you are infected and you are not in the hospital:

  • Stay in your room isolated from other people (including pets) until all skin lesions have disappeared.
  • wear a mask , especially if you cough, sneeze…
  • do not leave home. If you need medical attention, wear a mask and do not use public transport .
  • Avoid, above all, close contact with immunosuppressed people .

What if I am a close contact?

In any case under investigation, according to the Health protocol , the search and identification of possible close contacts begins.

What is close contact in monkeypox? The person who has been with a confirmed or probable case from the moment the first symptoms appeared or in the event of debuting with a rash, from the day before its appearance, when there has been direct and prolonged physical contact. The official text states that “in the absence of physical contact, but with a history of exposure at less than 1 meter, over a prolonged period, without protection, with a confirmed or probable case, an individualized risk assessment must be carried out on a case-by-case basis.” ”.

If this is your case, you will be informed of the symptoms of MPX and you will have to take your temperature once a day for 21 days after exposure . You will not have to quarantine, but you must take extreme precautions: reduce your social interactions and wear a mask .

If you have a fever or another compatible symptom, you should immediately self-isolate at home and contact the person responsible for your follow-up, who will tell you what to do.

How to prevent monkeypox if you are cohabiting

Anyone who has physical contact with someone with symptoms or an animal infected with the monkeypox virus can contract the disease. Therefore, if you live with an infected person, keep these guidelines in mind:

  1. Try to spend as little time as possible with the infected. Avoid skin-to-skin contact .
  2. Wash your hands frequently or use hydroalcoholic gels , especially if you have been in contact with the infected person, have touched their clothes or any surface that could have infected.
  3. Wash your clothes , bedding, towels, etc. separately, with hot water (60ºC) and detergent (no need for bleach). Avoid shaking it when putting it in the washing machine.
  4. Do not share dishes and eating utensils ; wash them with soap and water. If not, how about disposables?
  5. Contaminated surfaces and objects must be cleaned and disinfected . If you use domestic bleach, the dilution would be 1:50 since, normally, it is at an initial concentration of 5%.

How it heals

Treatment of monkeypox is symptomatic , although treatment with antivirals (Cidofovir, Tecovirimat) or post- exposure prophylaxis with vaccines may be considered for close contacts. In these cases, the vaccine should be administered within four days of exposure to prevent the onset of symptoms. And if it is placed between 4 and 14 days, it can modify the severity of the disease.

Do I have to get vaccinated against smallpox?

In Spain, the smallpox vaccine was stopped in 1979. At that time, it was administered to 20-month-old babies, so people who are now under 45 years of age are not protected against this already eradicated disease.

Research to date has shown that the smallpox vaccine can protect people against monkeypox because the two viruses are similar, and that antibodies produced against the smallpox virus also protect against monkeypox .

However, at this time, vaccination against monkeypox is not recommended for the general population, as the risk is considered low. And that there is a smallpox vaccine (MVA-BN, also known as Imvamune, Imvanex or Jynneos) that was approved in 2019 for use in the prevention of monkeypox.

As detailed from the SEIP, it is not authorized in children, but there are several pediatric studies of other vaccines using MVA that demonstrate a safe profile of side effects. In addition, it is not contraindicated in pregnant women, nor during lactation, nor in immunosuppressed patients, although the data is limited.

The use of this third generation vaccine, according to the Spanish Epidemiology Society, is safe . Its side effects are similar to those of other vaccines, as it can cause headaches, nausea, muscle pain, asthenia, or pain in the area of ​​the puncture . In addition, it does not cause significant skin reactions due to the lack of replication in human cells, nor does it leave a scar, since scarification is not performed.

On the other hand, the World Health Organization and other organizations, as the Spanish Public Health Commission points out in its recommendations , do advise:

  • pre-exposure vaccination, for health and laboratory professionals (who have a high risk of exposure) and people under 45 who engage in high-risk sexual practices.
  • post-exposure vaccination, for health workers and for close contacts of cases with high risk of severe disease and confirmed cases.

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