So far in May, the United Kingdom, Spain, Portugal, Italy and the United States have all reported several cases of monkeypox that have triggered the alarms.
1. What is monkeypox?
It is a zoonosis (disease transmitted between vertebrate animals and man) produced by a DNA virus. Although it produces symptoms and has a presentation similar to those of smallpox, a disease eradicated since 1980, it has less severity, transmissibility and mortality.
It is endemic mainly in Central and West Africa., and in recent years there has been a clear increase in both its frequency and its distribution. Sporadic major cases have been reported, especially in the UK. There are two variants: the West African variant and the Central African variant.
2. How is it spread?
transmission is believed to be produced through saliva or respiratory excretions, or by contact with exudate from the lesion or crusting material. It is also considering the possibility of contagion during sexual intercourse and that viral excretion through feces may represent another source of exposurealthough more data is needed on this.
Sustained person-to-person transmission is limited and much less efficient than animal-to-person transmission.
3. What symptoms do they produce?
The incubation period of the disease (time from infection to the onset of symptoms) is usually 7 to 14 days, although it can vary between 5 and 21 days.
The picture begins with symptoms similar to those of a influenza table (fever, headache, muscle aches, back pain, chills and exhaustion), which is associated with significant swollen glands. Later appears a rash, which often begins on the face and then spreads to other parts of the body, particularly the hands and feet. These lesions will go through different stages before forming a coast and finally falling off. The course of the disease usually lasts 2 to 4 weeks..
Monkeypox does not appear to be contagious during its incubation period, but only after symptoms appear and the possibility of contagion persists until the scabs fall off.
4. How is it diagnosed?
To reach the diagnosis, samples can be taken from skin lesions, crusts and the oropharynx. Molecular techniques are used by PCR for its diagnosis.
5. How serious is it?
The most frequent complications are bacterial superinfection of lesions, keratitis, bronchopneumonia, corneal superinfection or encephalitis.
Mortality reported in outbreaks in Africa varies from 1 to 10%. The cases identified in the United Kingdom are of the West African variant, which has a mortality of approximately 1%, compared to the Central African variant, which has a higher mortality (10%).
The highest mortality rates occur in children, young people and immunosuppressed. A more severe course of infection has been observed in people not vaccinated against smallpox.
6. Do you have treatment?
There is no specific antiviral treatment. Some antivirals have been used experimentally. The treatment administered is supportive, to control symptoms and to prevent bacterial superinfections.
7. What isolation measures should be applied to a suspected case?
As it is a new virus in Spain, protocols for its specific management are currently being prepared.
According to the definition of the United Kingdom Health Security Agency (UKHSA) and recently provisionally adopted by the CCAES and the Spanish autonomous communities, monkeypox should be suspected in subjects with vesicular exanthema without an explainable cause in any part of the body associated with at least one of the classic symptoms of monkeypox infection (acute illness with fever, severe headache, muscle and joint pain, back pain, lymphadenopathy) since March 15, 2022.
It must also meet other requirements: have an epidemiological link with a confirmed or probable case of monkeypox in the 21 days prior to the onset of symptoms; o be a man who has sex with men (MSM); or have been traveling in West or Central Africa in the 21 days prior to the onset of symptoms.
At the present time, and with the information available, the epidemiological evolution of monkeypox is unknown. For this reason, anyone who has doubts that they may be affected is advised to wear a mask and keep the injured covers.
In addition, it is advisable to contact the reference health center or the local public health authorities to make the most appropriate chest diagnostic decisions in each case.
(Article published in The Conversation)
*Marta Díaz Menéndez is coordinator of the Reference Unit for Imported Pathology and International Health. (La Paz-Carlos III University Hospital, Madrid), Madrid Health Service. And José Ramón Arribas is head of the Internal Medicine Section and coordinator of the High-Level Isolation Unit of the La Paz University Hospital, Madrid Health Service.
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