Spread to 19 countries, mRNA monkeypox vaccine has been launched, why are we still panic about monkeypox epidemic?

Guided reading

Monkeypox is rampant and has spread to 19 countries around the world. Recently, China Biotechnology stated that it will restart the production of vaccinia vaccine if necessary.

Yesterday, Moderna has also urgently launched the development of a monkeypox vaccine. The scientific community is also very concerned about monkeypox. On the same day, British scholars published an article in the Lancet sub-issue, retrospecting the clinical data of 7 monkeypox patients from 2018 to 2021, in order to provide information on the current monkeypox epidemic prevention and control. scientific basis.

Monkeypox and historical smallpox belong to the same genus of Orthopoxvirus. WHO data shows that the smallpox vaccine is 85% effective against monkeypox virus, and the symptoms of monkeypox virus infection are similar to those of smallpox, but the clinical symptoms of monkeypox are mild, and the incubation period is usually 6 to 13 days, and may be as long as 21 days. .

So, is the monkeypox virus a threat to us today? Will it create a new "monkeypox pandemic"? Are we overly concerned about monkeypox?

In the era of the new crown epidemic, the turmoil of unknown children with hepatitis has not yet passed, and "monkeypox" has broken into our lives again. So, what exactly is the legendary monkeypox? Is it related to the "human pox" smallpox in human history? Can those drugs that treat smallpox be used directly to treat monkeypox?

Can monkeypox be treated with medication and how can it be prevented?

An article published in The Lancet Infectious Diseases recently reviewed clinical data and laboratory results from seven monkeypox-infected individuals in the UK between 2018 and 2021.

The study reported patients' response to treatment with two different antiviral drugs, brincidofovir and tecovirimat. The two drugs have previously been primarily used to treat smallpox and have demonstrated some efficacy against monkeypox in animals.

Of the patients studied, 3 patients received bricincidofovir (200 mg orally once a week), and all developed liver enzyme elevations that led to treatment discontinuation. One patient received tecavivir (200 mg, twice a day, orally for 2 weeks) with no adverse reactions, viral shedding and shorter duration of onset (10 days of hospitalization). The other patient developed a mild recurrence 6 weeks after discharge.

Studies have shown that tecavivir may be able to shorten the duration of monkeypox symptoms in humans and shorten the time that patients are contagious, but it has not been confirmed that this is a treatment effect of tecavivir. Brincidofovir has severe side effects, and there is currently no evidence to support its ability to treat monkeypox in humans.

The paper also notes that human monkeypox poses unique challenges, as well as for well-resourced healthcare systems. Prospective studies of antiviral drugs for this disease are urgently needed.

It is worth mentioning that on May 24, mRNA vaccine research and development company Moderna announced that it will use its mRNA vaccine research and development platform to carry out research and development of monkeypox mRNA vaccine.

Previously, Moderna started the research and development of new coronavirus mRNA the day after the release of the new coronavirus gene sequence, and quickly developed a new crown vaccine. CEO Stéphane Bancel says Moderna has invested heavily in the next new outbreak, which could cut the time to develop a new vaccine in half (just 20 days). ).

The Ins and Outs of Monkeypox

In an era when people are afraid of infectious diseases, what is the "sacred" of monkeypox that was born out of nowhere? Let's break it down with the help of a Nature article about what monkeypox is, where it came from, and what scientists are saying about monkeypox.

In 1958, researchers first identified monkeypox virus, a virus transmitted by wild rodents, in laboratory monkeys. Unlike the rapidly evolving RNA virus SARS-CoV-2, monkeypox is a DNA double-stranded virus. The DNA virus structure is relatively stable, and it will repair itself when it finds a mutation, which means that the possibility of monkeypox virus mutation is very small, and the spread will not suddenly become stronger.

Most monkeypox outbreaks in the past have occurred in places such as Central and West Africa, and even cases outside Africa have been limited to a few with a history of travel to Africa or associated with imported infected animals.

In 2003, a monkeypox outbreak was reported in the United States, when a group of rodents from Ghana transmitted the virus to pet prairie dogs in Illinois, infecting more than 70 people.

The Democratic Republic of Congo has been battling monkeypox in recent decades. In 2017, Nigeria experienced an outbreak of monkeypox that has not been seen in 40 years, and it has not yet ended.

But in the last week, 15 countries that have never had a monkeypox virus have reported confirmed and suspected cases of monkeypox.

This rare viral disease, rarely found outside Africa, first appeared in different countries in Europe, America and Australia, and has independent chains of transmission in different populations around the world, which has made people nervous.

On May 21, the World Health Organization issued a monkeypox outbreak warning. More cases are likely to be detected in the future as surveillance is stepped up. WHO believes that the current focus of the response is how to protect susceptible populations and prevent further spread of the virus.

Is monkeypox virus mutating?

Anne Rimoin, an epidemiologist at the University of California, Los Angeles, said in the article in Nature that she had studied the monkeypox outbreak in the Republic of Congo for more than a decade and was surprised that the disease was hiding in the African continent. How the virus spread to countries.

Chains of monkeypox transmission in Africa

The number of cases outside Africa now exceeds all cases in those regions since 1970. This speed of transmission has made scientists have to maintain a high degree of vigilance.

So how scary is monkeypox?

In fact, the symptoms of monkeypox are similar to those of smallpox, but the clinical reaction is milder. The initial symptoms include fever, headache, swollen lymph nodes, muscle aches, severe fatigue, etc.; Secondary infection, bronchitis, sepsis, etc.

Although the symptoms may seem dire, most people recover within a few weeks without treatment.

Jay Hooper, a virologist at the U.S. Army Medical Research Institute of Infectious Diseases at Fort Detrick, Maryland, made it clear that monkeypox is not like the new coronavirus.

First of all, it is not easily transmitted from person to person, it is transmitted through body fluids, close contact, such as saliva when coughing. The new crown has recently been confirmed to be transmitted through the air. It can be said that the number of people infected with monkeypox is insignificant compared with the new crown, and it is a lot shorter.

Second, WHO data shows that the smallpox vaccine is 85% effective against monkeypox virus. Hooper believes that people now have treatments and vaccines to curb the spread of monkeypox, and there is no need to panic. But we need to take precautions before they happen, and scientists still need to prepare for the worst.

On May 19, researchers in Portugal uploaded the first genomic report of the local monkeypox virus. From this preliminary genetic analysis, the researchers found that the monkeypox virus circulating this time was related to a strain found in West Africa. Compared with the strain in Central Africa, the strain causes milder symptoms and a lower mortality rate, which is only 1% in rural Africa, where medical resources are scarce.

Gustavo Palacios, a virologist at the Icahn School of Medicine at Mount Sinai in New York City, stressed that the content of the report has yet to be perfected, and scientists need to do more work before drawing firm conclusions. a lot of work.

Everyone can't let their guard down, because we don't yet know how different this strain is from the West African strain, and whether the cases in various countries are related.

How will China fight monkeypox in the future?

The international community attaches great importance to the monkeypox epidemic. So, more than 40 years after the smallpox vaccine has been stopped, how can my country prevent the infection of monkeypox?

As a precaution against bioterrorism, countries such as the United States have maintained a supply of a smallpox vaccine and have an antiviral treatment. For health care workers who have been in close contact with sick people, they use "ring vaccination" to control transmission, which is a vaccination of close contacts with monkeypox to cut off transmission.

Based on the data so far, Andrea McCollum, head of the poxvirus team at the U.S. Centers for Disease Control and Prevention in Atlanta, believes that containment strategies other than ring vaccination may not be needed for the current outbreak, saying: " Even in areas where monkeypox occurs every day, it remains a relatively rare infection."

Professor Zhang Zuofeng, an infectious disease expert at the University of California, pointed out that China stopped vaccinating the entire population in 1982. Nearly 50% of the Chinese population has been vaccinated against smallpox. Considering that the initial transmission index (R0) of the virus is less than 1, it means that there are new cases. , and it is difficult to cause a large-scale epidemic.

But once an outbreak is detected, we should urgently vaccinate people under the age of 40. This requires us to have sufficient vaccine reserves for emergencies. On May 22, Sinopharm Group China Bio said that after the eradication of smallpox, they have kept the "vaccinia" vaccine in safe storage and are always ready to use it again.

In a virus-ridden world, planning ahead is not a bad thing. We all want to see the monkeypox epidemic under control as soon as possible and stop spreading.

References

1. https://www.nature.com/articles/d41586-022-01421-8

2. https://mp.weixin.qq.com/s/Rjg77IUOJVNt7lMkn_oICw

Author: Angie Lee

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