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Monkeypox: What We Know (and What We Don’t)

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TCurrent monkeypox outbreaks began in Europe earlier this year with a few people and rarely involved travel to areas where the virus was endemic, such as West Africa and Central Africa. Instead, it is most often associated with sex between men. As the number of cases continues to grow, there is evidence that monkeypox may have spread longer than health authorities know in the United States. Currently, there are thousands of confirmed cases of the virus in countries where it is not endemic, and the World Health Organization is considering declaring monkeypox a global health emergency.

To find out more about the monkeypox virus and its current outbreak the scientist I spoke with Anne Rimoin, an epidemiologist at the University of California, Los Angeles. Limoin has been studying monkeypox, a less toxic relative of smallpox, in the Democratic Republic of the Congo (DRC) for 20 years. In 2010, she co-authored a study showing that the incidence has increased since the smallpox vaccination campaign was discontinued.

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Ann Limoan

Bader Howar

the scientist: As of June 19, more than 2,500 cases have been reported in more than 40 countries and one death has been reported. How serious should the public take this outbreak of monkeypox?

Ann Limoan: Looking at this worldwide distribution of monkeypox cases would suggest that it is likely to have spread undetected for some time. Also, when you see a virus spreading to a population, it usually doesn’t spread or behave unexpectedly, but you should take it seriously.

TS: How is this outbreak compared to what normally occurs in the western and central regions of Africa where the virus is endemic in terms of parameters such as number of cases and mode of infection?

AR: AR: We usually see [monkeypox] At least in the DRC where I work, it occurs in the majority of people in remote rural environments. [whom] I have come into contact with animals that are likely to be the source of the infection. That said, the number of human-to-human infectious events has increased over time, which is definitely something we should be aware of.But most of the work done in places like DRC [is] More about case identification [about] Case investigations and epidemiological investigations simply because of limited resources [there]..

TS: Does the current degree of outbreak suggest that monkeypox can become endemic in Europe and the United States?

AR: AR: We have always known that cases of monkeypox and other poxviruses can increase as herd immunity to poxviruses weakens. And it’s already enduring. The number of cases of poxvirus is increasing all over the world. One of the things we have traditionally been concerned about is whether monkeypox can actually settle in human or animal populations, and the more the virus continues to spread, the more likely it is that the scenario will occur. It will be higher.

TS: Does that mean that the monkeypox epidemic can look like COVID-19 in that it circulates over a long period of time rather than ending its outbreak?

AR: AR: COVID is a very different type of virus [in terms of spread] .. .. .. [so] There is nothing about the mechanism. [Regarding this monkeypox outbreak]There is no short-term end to this, [but] I don’t think anyone can predict that. This is mostly to choose your own adventure story. There we need to decide how seriously we are going to take it, and whether we want to prevent the poxvirus from circulating in populations of humans and animals outside the scope of endemic disease, and we If you are willing to endure the result. So it depends on the situation.

This is mostly to choose your own adventure story. So we have to decide how seriously we take it.

TS: Are we doing the right thing, if not, what should we do?

AR: AR: I don’t work for the Ministry of Health, the CDC, or any of these organizations, so I can’t comment specifically on what we’re doing.

What I say is that what we have to do is pretty easy. You need to identify the case. Case investigation is required. You need good contact tracing. It is necessary to carry out an appropriate diagnosis. How clinicians identify cases of monkeypox or suspected monkeypox, how to collect samples, [and] Where you need to send the sample exactly. [We need] The right system to handle these logistics. Good material is needed for the general public so that they can recognize if they may have been exposed to monkeypox. .. .. And if they think they have a rash that fits the explanation, what exactly should they do?

I think we need to understand epidemiology. We must be very humble about what we know and what we do not know. And what we know about this virus is mostly from studies done in local DRCs, and I remember it these days. .. .. In Nigeria, but that’s the first time since 2017. And all of this is in the resource shortage setting. We know something about this virus. We have a foundation, but we need to understand the epidemiology and all its implications in this new context.

TS: The majority of cases of current outbreaks are associated with men who have recently had sex with other men, and the spread of the virus is associated with social and sexual networks. Given that men having sex with other men are neither new nor unusual, do scientists know why this outbreak is happening now?

AR: AR: So, first of all, obviously, we don’t know exactly what happened. It’s like tuning to a TV series you’ve never seen before. I don’t know what kind of episode you are doing. We know it’s not episode 1. Is it two, five, or ten? Are we in Season 2? We really don’t know where we are in all this. Therefore, there is a lot of forensic epidemiology we have to do to really understand it. Look more carefully at what is happening. [in endemic regions] It is important, [along with] Where we know it is spreading. .. .. [and] Use gene sequencing data to more accurately reconstruct the circulating time. But it’s very likely that this has been going on for some time and we weren’t looking for it.

It’s like tuning to a TV series you’ve never seen before. I don’t know what kind of episode you are doing. We know it’s not episode 1. Is it two, five, or ten?

TS: Earlier we talked about the actions we should take, but what are the main questions that the scientific community needs to focus on in order to curb the spread of current outbreaks and prepare for future outbreaks? mosquito?

AR: AR: I think two important categories are to characterize the transmission mechanism [their] Possibility—that is, understanding human-to-human transmission routes, assessing the likelihood of presymptomatic and asymptomatic infections, defining the duration of infection, and assessing the stability of the virus on the surface. .. .. And we truly assess the potential for zoonotic diseases and spillback events. And the second category is to characterize clinical symptoms and disease severity. [as well as] Various risk groups.

See Predicting future zoonotic diseases.

TS: Media and public health agencies emphasize the need to direct education to their communities by emphasizing the fact that gay and bisexual men are at greatest risk in the current epidemic. It seems to be sandwiched between gay and bisexual men who don’t want to be stigmatized. What advice would you give to the media dealing with monkeypox?

AR: AR: I think it needs to be clarified that this virus, as we understand it, spreads most efficiently through close contact. This includes sexual contact. .. ..Especially skin-to-skin contact [usually through contact with lesions, scabs, or respiratory secretions].. It also spreads through parameters. .. .. ..It’s important to understand that these are sexual networks that are currently widespread, but that’s [also] It is important for people to understand this to understand that it has nothing to do with who is having sex with whom. Overall, it’s very important that this is not a blame for the population. And I think we need to double in that this has nothing to do with the currently infected person. It can affect people in close contact.

TS: What are we talking about the monkeypox virus and this outbreak that seems important to mention?

AR: AR: I think it’s very important to remind you that many of us who have been working on poxviruses warn about the need for control. [them] I really understand what’s happening on earth.And if you want to be able to prevent the worldwide spread of pathogens, to ensure that the appropriate disease monitoring and appropriate mechanisms are in place for the countries in which these types of viruses are present. Must be carefully addressed [are] Circulation, [and the ability] Perform the work that needs to be done. If not, we will always catch up. But that requires investment.

See “Virus Hunter”

Editor’s Note: This interview has been edited for brevity.

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