The monkey’s smallpox seems to have exploded out of nowhere over the past two weeks, spreading across Europe, America and other regions. But the warning signs seem to have been ignored.
According to experts, an unusual and long-lasting outbreak in Nigeria should have served as a warning that it was only a matter of time before this orthopoxvirus started towards the center of the infectious disease stage.
After decades without cases, Nigeria experienced a major smallpox outbreak from 2017 that continues to this day. Earlier this year, the outbreak spread beyond Nigeria’s borders eight times, with infected people traveling to the United States, the United Kingdom, Israel and Singapore.
announcement
Chikwe Ihekweazu, the former director general of the Nigerian Centers for Disease Control, said his country sought help to try to decipher what was happening with the monkey’s smallpox. But the requests were not well received.
As such, some critical questions about the smallpox of the monkey, including the actual death of the West African virus, which is now circulating, as well as how many people, on average, each infected person transmits, are unclear.
announcement
“So far there has been little interest in supporting this work, unfortunately,” said Ihekweazu, who was recently appointed head of the World Health Organization’s new pandemic and epidemic intelligence center with its in Berlin. “He never received the interest needed to answer some of these questions.”
Nigeria has detected 558 suspected cases, 241 of them confirmed, since the current outbreak began in 2017.
Nigerian CDC
“When we saw this suddenly arise in Nigeria in 2017, we were literally all very surprised,” he told STAT. “In a way, it’s like a surprise around the world right now, because it’s a similar scenario. Suddenly, out of nowhere, we had a lot of cases in the Niger Delta part of Nigeria in the south. “
An additional investigation revealed cases across the country, Ihekweazu said. “So interesting that a virus that we hadn’t seen in about 40 years then in Nigeria suddenly appears and appears in several places at once.”
The Nigerian CDC tried, so far without success, to find out how people were being infected with the virus. Some small mammals are thought to be the host species of the virus, but efforts to find the virus in the wild have failed so far.
The rest of the world seems to be catching up quickly with Nigeria. More than 300 suspected cases have been detected since the UK reported in mid-May that it had diagnosed cases of monkeypox in people who had not traveled to any of the West or Central African countries where the virus is endemic. . Of the cases outside Africa, 219 have been confirmed, the European Center for Disease Prevention and Control said on Wednesday.
Ihekweazu said before the Covid-19 pandemic that he was trying to raise awareness about the problem that smallpox could cause. In 2019, the London-based Chatham House think tank convened a meeting to discuss the risks, said David Heymann, a professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine, who chaired the meeting. Among them was the possibility of sexually transmitted smallpox from the monkey because some people who contracted the virus developed lesions in their genitals or genital area.
The current outbreak appears to have erupted when the virus began to be transmitted among men who have sex with men.
The virus is not transmitted by sex per se; there is no evidence, for example, that it passes through semen or vaginal fluid. But skin-to-skin contact experienced during sex can lead to transmission, if one of the couples has monkeypox injuries.
Anne Rimoin, an infectious disease epidemiologist at the University of California, Los Angeles, who has studied monkeypox since 2002, agreed with Ihekweazu that people studying poxviruses knew that the spread of monkeypox was a possibility. . The eradication of the smallpox in 1980 and the cessation of the use of the smallpox vaccine – which offers some protection against smallpox – created an ecological vacuum that experts feared another poxvirus could fill.
“There have been a million exercises on the table and stuff, watching the spread of monkeypox, smallpox, other poxviruses. This is not a completely unexpected situation here,” Rimoin said. “All the time we knew, as the population’s immunity decreased and potentially individual immunity decreased for those who were vaccinated, we could see cases of smallpox or other poxviruses spreading.”
As of 2018, there have been sporadic cases in which infected travelers to Nigeria have carried the virus to countries where monkeypox is not found. Ihekweazu said each export put recipient countries on high alert to try to prevent domestic spread, with cases handled in high-containment facilities while they were infectious. But help to prevent the virus from spreading to its source did not follow.
“So you basically withdraw the army as long as a single case is exported. But there’s no interest in working together with the country where the cases come from to try to understand a little bit more,” he said.
He suggested that after the Covid pandemic, the world might be more open to understanding the need to cut out incoming infectious diseases. “It was all pre-Covid. So … hopefully people’s general sense of these things has changed a little bit and we’re paying a little more attention.”