As the world continues to battle COVID-19 and many countries look at ways to recover from the pandemic, a new virus is making headlines worldwide.
The monkeypox virus is now thought to be nearing 100 cases in 12 countries, and more are expected as surveillance is stepped up. The first case of this current outbreak was detected in the United Kingdom on May 7, and so far, infections have been confirmed in nine European countries: the UK, Spain, Portugal, Germany, Belgium, France, the Netherlands, Italy and Sweden, as well as the United States, Canada and Australia.
Although the first case detected in the UK was linked to travel to Nigeria – which reports about 3,000 monkeypox cases a year – subsequent cases have not been tracked back to Africa, puzzling many scientists and doctors.
What is unusual about the current outbreak is that cases are being diagnosed in countries where monkeypox is a rare occurrence, and the fact that many cases being identified are not linked to Western and Central Africa makes this outbreak unprecedented.
What is monkeypox?
Monkeypox is caused by a virus endemic to tropical parts of Africa. Despite its name, monkeypox is rarely spread through infected monkeys, but is more common in rodents such as squirrels, rats and mice. The virus is known as zoonotic – meaning it is spread to humans through infected animals via blood, infected fluids or lesions on the animal.
Human-to-human transmission can result from close contact with respiratory secretions, skin lesions of an infected person or recently contaminated objects. Transmission via droplet respiratory particles usually requires prolonged face-to-face contact, which puts health workers, household members and other close contacts of active cases at greater risk. Whether the virus can be spread via the airborne route is currently under investigation, though currently there is no evidence to support this.
Although first identified in laboratory monkeys in 1958, monkeypox was first identified in a human in 1970 and is a disease usually confined to parts of Africa, being most common in rural parts of the Democratic Republic of the Congo, though outbreaks have been reported in Gabon, Cote d’Ivoire, Liberia, Nigeria, Benin, Cameroon, Sierra Leone and South Sudan. The first outbreak outside of Africa occurred in 2003 affecting people in the US; it was linked to infected pet prairie dogs that had been imported from Ghana and housed with infected rodents. Since then, there have been small numbers reported across the globe, linked to travel.
Initial symptoms of monkeypox include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion. A rash can develop, often beginning on the face, then spreading to other parts of the body including the genitals. The rash changes and goes through different stages – initially it can be a fluid-filled blistering rash that resembles chickenpox or syphilis, before finally forming a scab that later falls off. Most people recover from monkeypox in a few weeks without treatment.
The diagnosis is usually a clinical one, meaning the signs and symptoms are enough for clinicians to make the diagnosis without the need for tests. However, if monkeypox is suspected, clinicians should take a sample of fluid from one of the lesions and send it to the lab for a polymerase chain reaction (PCR) test in order to confirm the diagnosis. Blood tests are not thought to be as accurate and should not be used routinely.
The monkeypox virus is part of a family of viruses known as “DNA viruses”. Unlike the SARS-CoV-2 virus that causes COVID-19, which is an RNA virus, DNA viruses mutate at a much lower rate as they are better at identifying errors in their genetic makeup and correcting them during the replication process. This is important as it will help scientists better understand why the current outbreak of monkeypox is happening – has the virus itself changed or is it just in the right place at the right time? It is too early to be sure. The current strain is thought to be related to a strain usually found in West Africa, which is associated with mild symptoms and a low death rate, around one percent.
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Who is being infected?
This outbreak certainly feels different to previous outbreaks outside of Africa.
Aside from the initial cases, many of the people infected have no links to travel or to anyone from Africa. Unusually, the virus has been detected in a disproportionate number of men who have sex with men. Monkeypox is not known to be a sexually transmitted virus, but sexual contact would constitute as close contact, one of the main routes by which the virus is known to spread.
It may be that members of the LGBTQ community are better at getting sexual health checks, so the virus is simply being picked up more here than in the heterosexual community. Whatever the reason, it remains important that nobody who is infected is stigmatised, both for their wellbeing and to help continue to monitor cases and outbreaks.
Increased travel after a period of travel restrictions during the COVID pandemic may also be a factor.
What is concerning is that the cases being found across Europe and the world are not linked, meaning there is a missing piece to the puzzle in how this virus is being spread.
The monkeypox virus is part of the same family the smallpox virus comes from. Older generations will have been vaccinated against smallpox, eradicating the disease and offering them some protection against monkeypox. It may be that with most younger generations not being vaccinated against smallpox, the monkeypox virus has been able to spread more easily.
Is there any treatment or a vaccine available for monkeypox?
For the vast majority of people, signs and symptoms of monkeypox will resolve on their own, without any treatment. Rest, plenty of fluids and good nutrition are all that are usually required.
The risk of serious illness may be greater in pregnant women, children and those with weaker immune systems.
Currently, there is no specific vaccine available for monkeypox, however, the smallpox vaccine has been shown to offer 85 percent protection against monkeypox. At the present time, the original (first-generation) smallpox vaccines are no longer available to the general public. Scientific studies are now under way to assess the feasibility and appropriateness of vaccination for the prevention and control of monkeypox. Some countries have, or are developing, policies to offer vaccines to people who may be at risk such as laboratory personnel, rapid response teams and health workers.
An antiviral agent known as tecovirimat that was developed for smallpox was licensed by the European Medical Association (EMA) for monkeypox in 2022 based on data in animal and human studies. It is not yet widely available.
Understanding how this current outbreak is spreading will be key to breaking the chain of transmission and getting numbers under control. Going forward, our relationship with animals needs to be evaluated. Zoonotic spread of viruses will continue to cause concern while we encroach on the environments of wild animals, and handle them as part of science, the food and the pet trade.
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How worried should we be?
Most scientists agree that this current outbreak of monkeypox, though important to understand, is unlikely to cause another pandemic akin to SARS-CoV-2.
This is not a new virus, we have known about it for many years and have a good understanding of its structure and replication process. We already have a good vaccine available in the form of the smallpox vaccine and treatment options, should we need them. The virus spreads more slowly than the COVID virus and most people exhibit symptoms, including a distinctive rash which is easier to recognise than some of the vague symptoms COVID causes. This means we can identify those who are infected and vaccinate or isolate their close contacts if needed.
There is, however, some concern that as summer approaches and large gatherings such as festivals and conventions become more common, close contact is likely to occur and the virus may spread.
But even with the virus exhibiting some new behaviour and the distinct likelihood that more cases will be identified over the coming weeks and months, there is no reason to panic.
The World Health Organization has started holding daily emergency meetings on the infection and continues to monitor the situation globally. There is much more to be understood about this current outbreak and although this is not another COVID, more research and subsequent prevention strategies need to be put in place to prevent the virus from getting a foothold.
MILWAUKEE (AP) — Whooping cough is at its highest level in a decade for this time of year, U.S. health officials reported Thursday.
There have been 18,506 cases of whooping cough reported so far, the Centers for Disease Control and Prevention said. That’s the most at this point in the year since 2014, when cases topped 21,800.
The increase is not unexpected — whooping cough peaks every three to five years, health experts said. And the numbers indicate a return to levels before the coronavirus pandemic, when whooping cough and other contagious illnesses plummeted.
Still, the tally has some state health officials concerned, including those in Wisconsin, where there have been about 1,000 cases so far this year, compared to a total of 51 last year.
Nationwide, CDC has reported that kindergarten vaccination rates dipped last year and vaccine exemptions are at an all-time high. Thursday, it released state figures, showing that about 86% of kindergartners in Wisconsin got the whooping cough vaccine, compared to more than 92% nationally.
Whooping cough, also called pertussis, usually starts out like a cold, with a runny nose and other common symptoms, before turning into a prolonged cough. It is treated with antibiotics. Whooping cough used to be very common until a vaccine was introduced in the 1950s, which is now part of routine childhood vaccinations. It is in a shot along with tetanus and diphtheria vaccines. The combo shot is recommended for adults every 10 years.
“They used to call it the 100-day cough because it literally lasts for 100 days,” said Joyce Knestrick, a family nurse practitioner in Wheeling, West Virginia.
Whooping cough is usually seen mostly in infants and young children, who can develop serious complications. That’s why the vaccine is recommended during pregnancy, to pass along protection to the newborn, and for those who spend a lot of time with infants.
But public health workers say outbreaks this year are hitting older kids and teens. In Pennsylvania, most outbreaks have been in middle school, high school and college settings, an official said. Nearly all the cases in Douglas County, Nebraska, are schoolkids and teens, said Justin Frederick, deputy director of the health department.
That includes his own teenage daughter.
“It’s a horrible disease. She still wakes up — after being treated with her antibiotics — in a panic because she’s coughing so much she can’t breathe,” he said.
It’s important to get tested and treated with antibiotics early, said Dr. Kris Bryant, who specializes in pediatric infectious diseases at Norton Children’s in Louisville, Kentucky. People exposed to the bacteria can also take antibiotics to stop the spread.
“Pertussis is worth preventing,” Bryant said. “The good news is that we have safe and effective vaccines.”
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AP data journalist Kasturi Pananjady contributed to this report.
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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
How a sperm and egg fuse together has long been a mystery.
New research by scientists in Austria provides tantalizing clues, showing fertilization works like a lock and key across the animal kingdom, from fish to people.
“We discovered this mechanism that’s really fundamental across all vertebrates as far as we can tell,” said co-author Andrea Pauli at the Research Institute of Molecular Pathology in Vienna.
The team found that three proteins on the sperm join to form a sort of key that unlocks the egg, allowing the sperm to attach. Their findings, drawn from studies in zebrafish, mice, and human cells, show how this process has persisted over millions of years of evolution. Results were published Thursday in the journal Cell.
Scientists had previously known about two proteins, one on the surface of the sperm and another on the egg’s membrane. Working with international collaborators, Pauli’s lab used Google DeepMind’s artificial intelligence tool AlphaFold — whose developers were awarded a Nobel Prize earlier this month — to help them identify a new protein that allows the first molecular connection between sperm and egg. They also demonstrated how it functions in living things.
It wasn’t previously known how the proteins “worked together as a team in order to allow sperm and egg to recognize each other,” Pauli said.
Scientists still don’t know how the sperm actually gets inside the egg after it attaches and hope to delve into that next.
Eventually, Pauli said, such work could help other scientists understand infertility better or develop new birth control methods.
The work provides targets for the development of male contraceptives in particular, said David Greenstein, a genetics and cell biology expert at the University of Minnesota who was not involved in the study.
The latest study “also underscores the importance of this year’s Nobel Prize in chemistry,” he said in an email.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.
The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.
The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.
The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.
“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.
When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.
“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.
“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.
The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.
Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.
The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.
“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.
They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.
“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”
This report by The Canadian Press was first published Oct. 17, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
