The second alert came in late 2017, when Nigerian health authorities confirmed the country’s first case in nearly 40 years: an 11-year-old boy was taken to hospital with injuries to his face and extremities – a suspected case of chickenpox.
“Compared to chickenpox, his presentation was very unusual,” Dimie Ogoina, the doctor who treated the boy, said in an email. The child’s lesions, including some on the inside of the nose, were larger than those found in chickenpox, and doctors knew right away that they were dealing with more than an isolated case. Two relatives said they had experienced similar symptoms. Ogoina and his colleagues at the Niger Delta University Teaching Hospital diagnosed monkeypox and alerted health authorities.
Their report, published two years later, concluded that the virus was spreading from person to person, not just from animals to humans. It appears to be spreading in a potentially dangerous new way — through sexual contact.most Compared to previous monkeypox outbreaks in the region, which mainly affected children, young men were among those infected.
In its report on the 2017 outbreak in Nigeria, the World Health Organization stated: “The nature of human-to-human contact leading to transmission needs to be studied; some suspected sexual transmission may be a route.”
But the wider health community has barely noticed. In the eight months since Ogoina’s report was published, the novel coronavirus has overshadowed nearly every other global health problem as it circles the globe.
A case in Nigeria in 2017 was thought to be the source of the current outbreak, and it wasn’t until this spring that monkeypox spread to dozens of other Western countries, including the United States, of great interest.By then, the neglect of the world had left two clades or types Virus, smoldering: The West African version Ogoina met in Nigeria is now replicating globally, The mortality rate is less than 1%, and the more severe Congo Basin version, with a mortality rate of about 10%. In the United States, there have been more than 10,760 confirmed cases, mostly among gay and bisexual men, and no monkeypox-related deaths.
“We should listen to people like Dimie Ogoina saying, ‘This is spreading, and it seems to be spreading to a large extent through sexual transmission,'” said Michael Worobey, chair of the University’s Department of Ecology and Evolutionary Biology. University of Arizona, where he is now collaborating with Ogoina on monkeypox research. “We should eradicate it where it spreads before it emerges.”
Worobey, who has fought wildfires in British Columbia, said the same approach is needed to stop infectious diseases.
When lightning strikes, he said, “We get there and put out the fire when a tree burns, not a thousand acres. What we’re doing here is make it a thousand acres on every continent, not everywhere It’s all a tree.”
Columbia University epidemiologist W. Ian Lipkin, Arguing that the monkeypox outbreak does not represent a public health failure, but rather an example of the “grand challenge” of predicting which of a hundred global outbreaks poses the greatest threat.
“It’s a fire hose,” he said of the myriad viruses and pathogens. “How do you decide where to look?”
In a statement, the WHO defended its record on monkeypox, saying it “has been working hand-in-hand with relevant ministries, research institutes and communities for decades, even before the first human case was detected. Monkeypox has been studied.” In Nigeria in 2017, the agency supported the country’s CDC in its response, the WHO said. Given the increasing risk of monkeypox, the agency also advocates for the development of additional treatments, vaccines and clinical trials, the statement said.
‘An important warning sign’
Monkeypox virus, which can exist in the environment for hundreds or even thousands of years, was first discovered in 1958 and named after the Danish laboratory monkey. The first human case was It was not reported in Congo until 1970.
By 1980, a study in the Bulletin of the World Health Organization recorded 47 cases spread over the past decade in Central and West Africa. Although monkeypox has been found in laboratory and zoo animals, the paper’s authors write that “no animal cases have been identified in nature; the source of human monkeypox infection remains unknown.” Of the 47 cases, they noted, there were “Human-to-human transmission” may have occurred in 4 cases.
That same year, global health leaders announced the eradication of smallpox, and Congo stopped vaccinating its population for the disease, which is from the same family of viruses as monkeypox but is more severe.
In 1987, researchers used computer models to predict that a lack of vaccination against smallpox, which protects people from a similar virus, would lead to more cases of monkeypox. But they concluded that it “seems highly unlikely” that monkeypox reaches the point of permanent transmission in humans.
Rimoin’s findings suggest less uncertainty: She and her colleagues reported 760 confirmed cases in Congo between 2005 and 2007, mostly in children born after smallpox vaccination was stopped in 1980.
So far, the virus has only invaded one place Enter the United States — A 2003 outbreak affected 71 confirmed and suspected patients in six states, most of them in Wisconsin. The cases were spread to people through pet marmots kept near infected small mammals imported from Ghana.
However, in 2003, it was unclear whether the virus was only transmitted by animals.Although all infected people interacted Along with the animals, the two also reported exposure to lesions or eye fluid from another patient.Compared to the current outbreak, the spread of the virus is In 2003, there was still more than a month before it died.
DNA viruses such as monkeypox have a much larger genetic blueprint than RNA viruses such as SARS-CoV-2, and generally evolve more slowly. However, according to evolutionary biologist Trevor Bedford of the Fred Hutchinson Cancer Center, monkeypox mutations occur much faster than expected—about once a month, rather than once a year.
Viruses are opportunistic, just need to Find the right environment to thrive.
“With HIV, it’s almost certain that these viruses spread from chimpanzees and gorillas to humans, possibly over thousands of years,” Worobey said. “But it wasn’t until the late 1800s and early 1900s that steamships were used on the Congo River, on the railways, on the roads and on the cities. And in the cities, things like prostitution really helped spread the STI.”
“You have a virus that couldn’t survive in humans for thousands of years, and now it can,” he added.
Several factors in recent decades appear to have provided monkeypox with an opportunity to exploit.
The first could be the successful eradication of smallpox, one of only two diseases that humans have wiped from the face of the earth (the other being the animal disease rinderpest).
In addition, repeated civil wars in Congo, deforestation for logging and agriculture, and the slaughter of animals for meat have increased human contact with animals that transmit the virus. But these trends, and their impact on monkeypox transmission, have failed to elicit a significant response from health authorities.
“It’s easier to avoid trouble than to get out of trouble, oh my God, have we not heeded the warnings,” Rimoin said. “What’s happening in Nigeria should be a major warning sign.”
Instead, she said, “everyone globally is pressing the snooze button for pathogens that clearly have the potential to take off.”
Researchers suspect that the current outbreak started in Nigeria because a mutational pattern in virus samples taken from patients in 2017 has persisted and expanded to this day.These mutations are different from those Found in the animal version of the virus. They show the markers that encounter antiviral human proteins as part of an immune response.
While some viruses have spread from animals to people, they have never caused sustained outbreaks, Bedford said. Any human-to-human transmission is a concern. “This puts evolutionary pressure on the virus to spread better between humans,” he said.
The success of monkeypox depends not only on human behavior, but also on where the mutation carries the virus. Most mutations alter the genetic characteristics of monkeypox, but not its function.This allows health officials to trace the virus and identify infected people, such as in Nigeria since 2017 and from other countries this spring.
In the worst case, the mutation could make the virus more deadly or more contagious. In the best-case scenario, accumulating mutations at 10 times the normal rate could lead to changes that threaten the survival of the virus.
“But don’t hold your breath to stop this outbreak,” Worobey said. “It’s not going to be a process that’s going to happen anytime soon.”
Scientists are most concerned that monkeypox may Based on the United States and other countries, join the virus such as HIV and flu. Finding reliable animal hosts in the U.S. or elsewhere increases the likelihood.
“I think it’s certainly possible,” Rimoin said.
Back in 2010, she and her colleagues warned that American ground squirrels were highly susceptible to the virus. “If monkeypox spreads in wildlife reservoirs outside Africa, the public health setback will be difficult to reverse,” they wrote.