Antigen fast test: will monkeypox, neglected by the world, become the next super infectious disease?

The COVID-19 has not completely disappeared, and there is another virus, monkeypox virus, which has caused people's concern again.

Monkeypox is a rare infectious disease caused by monkeypox virus, which mainly occurs in some African countries, but at least 12 countries outside Africa have also experienced infectious cases recently.

Antigen fast test: will monkeypox, neglected by the world, become the next super infectious disease?

Monkeypox virus is a double stranded DNA virus that can infect cells and then replicate in the cytoplasm. Source: British health and safety agency / scientific picture library

The first case occurred in the UK on May 7. The patient has recently been to Nigeria, where he is estimated to have contracted the virus and became ill after returning to the UK.

On the evening of June 25 local time in France, the health agency of the French island region announced that a child was infected with monkeypox virus, which was the first case of monkeypox in children found in France. It is reported that the patient is a primary school student. His condition has been controlled and there is no risk of deterioration. According to statistics, France has so far confirmed more than 300 monkeypox cases.

Monkeypox spreads to different groups in different countries in a short time, which makes scientists, governments and health personnel more alert, especially many confirmed cases have not been to areas with high incidence of infection.

Epidemiologists are investigating the spread of monkeypox and warning that there may be more confirmed cases, and many people are beginning to worry about whether the virus will spread on a large scale. However, Raul Rivas Gonzalez, a microbiologist at the University of Salamanca in Spain, published an article on the knowledge sharing website the conversation, saying that we don't need to worry too much now.

However, some scientists hold a negative attitude. They believe that monkeypox virus is being ignored by the world.

A virus that has existed for 60 years

Monkeypox virus was first discovered and confirmed in 1958. At that time, monkeys used in laboratory research developed blisters similar to smallpox. The first human case occurred in the Democratic Republic of Congo in 1970. Since then, scientists have studied monkeypox virus and closely monitored monkeypox infection cases.

There are mainly two ways of infection, from animals to humans and from human to human.

Zoonotic infectious diseases from animals to humans can be infected by direct contact with the blood, body fluids, mucous membranes and skin wounds of infected animals. Eating raw or undercooked meat of infected animals is also one of the risk factors, and being bitten or scratched by infected animals can also infect diseases.

Human to human transmission can be infected through close contact with droplets and respiratory secretions of infected persons, skin wounds, or objects newly infected with the virus. The virus enters the human body through the respiratory tract, mucous membranes and skin wounds.

The rash develops through different stages, and eventually scabs become dry and fall off

Monkeypox virus is a relatively large DNA virus. Compared with coronavirus or influenza virus and other RNA viruses, monkeypox virus has a slower mutation speed and a better detection and repair mutation system, that is to say, monkeypox virus is less likely to mutate or mutate rapidly, resulting in a higher infection rate or high variability in humans.

This also means that once cured, patients will have long-term immunity to the virus. Now it has been described that the two gene differentiation branches of monkeypox virus are West Africa branch and Central Africa branch, which are geographically separated and have clear specificity in epidemiology and clinic.

DNA sequences show that the current outbreak is a mild virus spreading in West Africa, which is closely related to monkeypox virus that appeared in the UK, Singapore and Israel in 2018 and 2019.

Last month, monkeypox cases broke out in Portugal, Spain, Britain and other countries. The world responded quickly and distributed vaccines in some countries. In fact, monkeypox virus has continued to erupt in parts of central and West Africa for many years. To the dismay of local African researchers, similar resources have not been provided in their countries. For a long time, local researchers have been warning that monkeypox virus may spread in new ways.

So far, there have been more than 3000 confirmed cases of monkeypox in countries outside central and West Africa, but no deaths have been reported. However, in Africa, health officials have reported more than 70 deaths suspected of being caused by monkeypox. "This number is likely to be underestimated because of limited testing and monitoring capabilities," said Dimi ogona, an infectious disease doctor at Niger Delta university in amasoma, Nigeria

Rarely noticed, may spread through sexual behavior

Before this year, only a few monkeypox cases were observed outside Africa, and these cases were related to animals imported from the African continent or tourists. The largest outbreak occurred in the United States in 2003. The epidemic originated from imported animals and sickened more than 70 people.

Meanwhile, some African countries have been dealing with monkeypox outbreaks since scientists discovered the first human case in the Democratic Republic of the Congo (DRC) in 1970. Although researchers still don't know which animals naturally carry the virus, they know that the virus circulates in many kinds of rodents and can be transmitted from animals to humans. A major outbreak began in Nigeria in 2017, with more than 200 confirmed and 500 suspected monkeypox cases. In the past decade, there have been thousands of suspected cases and hundreds of suspected deaths in the Democratic Republic of the Congo. In Central Africa, monkeypox virus strains infected with human beings are more toxic, with a mortality rate of about 10%.

For adesola yinka ogunleye, an epidemiologist at the Nigerian Center for Disease Control in Abuja, the current global outbreak brings a sense of deja vu.

Before the outbreak in Nigeria in 2017, the virus seemed to be limited to rural areas, where hunters would come into contact with animals. The symptoms are fever and unique pustular "acne" on the face, hands and feet. After 2017, more epidemiologists warned that the virus was spreading in an unfamiliar way: it appeared in urban environments, and infected people sometimes had genital lesions, indicating that the virus may be transmitted through sexual contact, and now it is spreading in western cities.

"The world is paying the price for not responding adequately in 2017."

Meanwhile, researchers have been warning that monkeypox cases in sub Saharan Africa have been rising for years. In part, this is because countries have stopped vaccinating people against smallpox.

Smallpox is caused by a mutant virus, which is closely related to the virus that causes monkeypox. Smallpox was eradicated in 1980, and vaccination was stopped, which means that the proportion of the population vulnerable to smallpox has been increasing (see the following figure, "rise of monkeypox cases in Africa").

Source: E. M. Bunge et al. PLoS neg Trop. Dis. https://doi.org/10.1371/journal.pntd.0010141 (2022).

Since then, some countries have maintained national stocks of smallpox vaccine, because health officials have been worried that laboratories that keep samples of the mutated virus may accidentally release the virus or "weaponize" the virus. Recognizing that so far many cases have occurred among men who have sex with men (MSM), Canadian and British authorities have gone further and begun to provide vaccines to their MSM communities.

Some health officials in sub Saharan Africa are worried that they will continue to be left behind by the "big countries" based on their experience of vaccine inequality during the covid-19 pandemic. Although the number of cases is on the rise, only 18.4% of people in Africa have been vaccinated against coronavirus sars-cov-2, compared with 74.8% in high-income countries in other regions.

The member countries of the World Health Organization (who) have promised to provide the agency with more than 31million doses of smallpox vaccine for smallpox emergencies, but these vaccines have never been distributed to Africa to prevent monkeypox. Rosamund Lewis, who's technical director for monkeypox, said that part of the reason was that the vaccine pledged by the agency was "first generation" vaccine. These vaccines may have serious side effects and are not recommended for monkeypox, because the lethality of monkeypox is lower than that of smallpox.

She also mentioned "regulatory issues" because some member states only licensed these vaccines for the prevention and treatment of smallpox, not monkeypox. Although these vaccines are safe and effective for smallpox infected people, their tests for monkeypox are still incomplete.

Rosamund Lewis also stressed when talking about solving the problem of monkeypox in Africa: "who has been coordinating with African countries with monkeypox outbreaks to improve monitoring and diagnosis."

In recent weeks, who has recognized that monkeypox has received unequal attention worldwide.

On June 17, the agency announced that it would no longer report monkeypox cases and deaths in sub Saharan Africa and other regions of the world respectively. After researchers released a proposal to change the name of monkeypox virus strain, the director general of who stood up to support this change and promised to "publish the new name as soon as possible".

However, oyewale tomori, an independent virologist in Ibadan, Nigeria, believes that even if sub Saharan African countries purchase vaccines, monkeypox cannot be eradicated by vaccination alone. He reminded that vaccination would be effective only when health officials knew the local epidemic situation of the pathogen. He suggested supporting the research of animal repositories investigating monkeypox, so that health officials could formulate more precise measures to curb the spread of the virus. "If you don't solve the fundamental problem, you will eventually use all the vaccines on monkeypox instead of dealing with the root cause of the problem."

Ogoina also believes that isolated solutions only solve problems for developed countries and ignore developing countries, which will lead us to experience the same cycle again. He warns that pathogens that broke out in the past continue to reappear.

"It's just a matter of time."

No matter what decision the World Health Organization will make, it is hoped that the existing infection cases can be effectively controlled, and there is no need to take broader and stricter anti epidemic blockade measures.