On June 16, the number of confirmed cases of monkeypox in the world exceeded 2,000, reaching 2,027. Widespread human-to-human transmission of monkeypox virus among European communities has been demonstrated, but its route of transmission has been puzzling, and “bodily fluids,” “droplets,” “pathogens,” and even “sexual behavior” do not seem to be sufficient to explain the virus The reason it spread so fast. On June 16, a team of scholars from the Department of Respiratory Medicine at the University of Leicester, UK, published a newsletter in the top medical journal The Lancet (www.thelancet.com), stating that it is impossible to row monkeys. Poxvirus transmission by “aerosol”.

Image: A man receives a monkeypox vaccination in Montreal, Canada, on June 7

At the same time, the article calls on the UK Health and Safety Agency (UKHSA) to re-evaluate the definition of monkeypox cases in order to better investigate and detect possible monkeypox patients.

In the UK, monkeypox cases are increasing rapidly. Since the first case of monkeypox was detected on May 6, the number of confirmed cases of monkeypox in the UK has reached 524 as of June 16.

Currently, the UK Health and Safety Agency (UKHSA) defines a probable monkeypox case as, “an unexplained rash on any part of the body since 15 March 2022, combined with one or more typical symptoms of monkeypox infection Symptomatic and one of the following: Epidemiologically linked to a confirmed or probable case of monkeypox within the 21 days prior to the onset of symptoms; Travel history to West or Central Africa within the 21 days prior to the onset of symptoms; Be gay or bisexual or other men who have sex with men.

“However, many of the confirmed cases have neither travel history nor exposure to travel-related cases, nor exposure to cases in West or Central Africa, so we strongly urge the UK Health and Safety Authority to re-evaluate the monkeypox case definition.” the article said.

The article states that community spread of monkeypox has already begun. Monkeypox can easily be mistaken for other skin conditions commonly found in sexual health clinics or primary care (such as chickenpox, shingles, herpes simplex, syphilis chancre, gonorrhea, or infectious molluscum molluscum). A previous medical exercise in the United States showed that six of 13 simulated smallpox patients were misdiagnosed with West Nile virus and upper respiratory tract infections when they were discharged from the hospital. In February 2020, the case definition of new coronary pneumonia also included qualifications, that is, people who had previous contact with confirmed cases of new coronary pneumonia, or who had recently traveled to Wuhan, China or Lombardy, Italy.

The current case definition for monkeypox would have missed the case of a heterosexual patient with a typical vesicular-pustular rash but no travel history or contact with a confirmed infection.

In addition, the article further emphasizes the need for preventive control measures to control the spread of the virus, and urgent research to better understand the exact route of human-to-human transmission of monkeypox virus.

The current global literature on monkeypox virus transmission is severely lacking. The researchers searched PubMed for the keywords “monkeypox and transmission” and found only 224 manuscripts published between 1962 and 2022. There are more primitive human studies,” the authors said.

Of these papers, 15 studies involving human monkeypox investigated the transmission routes of monkeypox virus, the largest of which was in Zaire, Congo, between 1980 and 1984, in 2510 exposures of 214 monkeypox patients. research conducted by the authors. In this study, investigators reported cases of monkeypox infection without a rash.

A 2005 report showed little to no skin lesions in monkeypox breakthrough-infected individuals who had been vaccinated against smallpox. Prolonged shedding of viral DNA from the upper respiratory tract also occurred between 2018 and 2021 in monkeypox patients treated at specialized high-consequence infectious disease centers after skin lesions resolved. In the early days of the COVID-19 pandemic, it was believed that COVID-19 was transmitted by droplets from symptomatic patients, but now there is ample evidence that the virus can be transmitted by aerosols (remotely), with asymptomatic or pre-symptomatic patients accounting for the majority of the chain of transmission status.

While the assumption of asymptomatic and aerosol transmission may be premature for monkeypox virus, the possibility of this mode of transmission must be considered given the rapid spread of another outbreak around the world, the researchers said. .

“While the majority of cases in the current outbreak are among men who have sex with men (MSM), monkeypox has not historically been a sexually transmitted disease. Given the environment in which the virus is currently circulating (high close contact rates), each case The number of further transmissions may be artificially increased,” the researchers said.

If this happens, other vulnerable groups may be at the same risk of infection. Notably, while variola virus was found to decrease rapidly over time in urine, throat and conjunctival secretions, the amount of virus in crusts (dry pustules) did not.

In the early days of the pandemic, racial minorities were disproportionately affected by the virus, not because they were at an inherently higher risk of developing severe disease, but because of their relationship with vulnerable groups, researchers say. Patients are more exposed, so if the number of monkeypox cases continues to rise, these immunocompromised groups may also be at a higher risk of contracting monkeypox.

“In addition to ensuring that monkeypox case definitions do not overlook high-risk groups, it is also critical that these definitions do not further stigmatize or marginalize these specific groups. Our public health response to monkeypox must learn from these mistakes in order to rapidly identify key risk groups without placing blame in these communities,” the researchers said.

Finally, the researchers re-emphasized that while monkeypox is unlikely to cause as much harm to the public as Covid-19, the lessons learned from the recent Covid-19 outbreak must be applied. If the initial case definitions were less stringent and widespread community testing was implemented earlier, the early spread of the new coronavirus might have been mitigated.

Therefore, the investigators suggest that the possible case definition of monkeypox should be expanded to include individuals with unexplained vesicular-pustules anywhere on the body, with prodromal symptoms of fever, malaise, and enlarged lymph nodes, in order to reduce Community missed cases. While this may initially significantly increase the workload of the public health sector, “once the factors that make individuals contagious, where exposure may occur, and the incubation period of the virus are better understood, possible case definitions can be developed in the coming weeks and days. improved within a few months,” the researchers said.

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