Monkey pox, a contagious and potentially fatal disease that is sweeping through more and more African countries is causing worldwide concern. As the Central African Republic announced it was dealing with a new, much more aggressive strain that has been around for some time in Congo, the World Health Organization is closing ranks and considering declaring an international emergency.
Monkeypox raises concern at WHO. Photo source: archive
Tedros Adhanom Ghebreyesus stated in this regard that he is considering convening an emergency committee on international health regulations. Several doctors and epidemiologists explained to us how close the danger is to us, how worried we should be and what are the risks of this disease appearing in Romania.
War and poverty, the environment conducive to the development of the virus
“Monkey pox is transmitted very specifically. It is transmitted by touch, through prolonged and intense physical contact. Not through the air. You don’t get sick if you meet, for example, a sick person and talk to them. The virus is transmitted at the skin level: mycoses, wounds, lesions… And there must be a long contact”, said Dr. Mihai Negrea, epidemiologist and expert in health policies, for “Adevărul”.
“We are also talking about a prolonged contact with objects contaminated by a sick person or with the fluids resulting from a sick person. So it can’t be transmitted that way through accidental short-term contact“, the epidemiologist Emilian Popovici, vice-president of the Romanian Society of Epidemiology, explained for “Adevărul” “And this shows that the risk of epidemic manifestations of proportions in which a large number of illnesses appear in a short time, is extremely reduced to excluded”, experts believe.
Sporadic cases in Europe and Romania can appear at any time, they say, because the world is in constant motion, we live in a globalized world, people travel, mobility is extremely high. “Some come, others leave… the chances of some cases of illness in Europe and Romania exist, but without thinking about an epidemicthousand”.
Why are things different in Africa? The answer is simple, Dr. Negrea believes. He explained that the virus broke out in African countries due to war, armed conflicts, poverty and lack of hygiene.
“The virus has emerged and is multiplying in conflict zones where people live in precarious conditions. There are already 450 deaths in Congo. But we are talking about people living in refugee camps. There is also the war in Sudan, Congo is also in civil war. The population lives in improper conditions, they sleep over a pile, they sleep communally in spaces that are very tight. We are talking about a very large number of displaced people, living on the edge of subsistence, in refugee camps, sheltering and sleeping in tents, sleeping on top of each other. This is how the virus is transmitted.”
As for the mortality rate in these areas, let’s not forget that we are talking about underdeveloped states, which have not set up a highly developed health system, where emedical services are almost non-existent. “They don’t have hospitals, they don’t have medicine, they don’t have conditions. There are people there who have never been to a doctor.”
Refugees are generally the ones who walk viruses from one place to another and bring with them eradicated diseases to the civilized world. “Global polio for example. Before the war in Afghanistan and Pakistan, only these two countries still had cases of poliomyelitis. With the war, when people began to leave massively from those areas, the disease spread. Now we have 40 countries where poliomyelitis is registered”.
As the situation worsens on the African continent, the WHO has declared that it will activate the technical committee of experts and, following consultations, will decide whether or not to declare an international alert. “It is a normal measure for any type of infectious pathology. Some protocol is being followed”explains Dr. Mihai Negrea.
There are vaccines, but not for everyone
Until two years ago, monkeypox was only transmitted between animals. There were also sporadic cases of transmission from monkeys to humans, but people who ate infected game meat mostly got sick. In 2022, cases of human-to-human transmission began to appear, and this was due to a mutation suffered by the virus. This is why in the summer of 2022 the European Commission approved the human smallpox vaccine, Imvanex, to be marketed and used for monkeypox as well. “Human smallpox is an eradicated disease. In our country, at least, there is no vaccine available to the population. However, in the event that cases of human smallpox occur, immunization can be resumed. There is a strategic reserve. More precisely, the active substances are preserved, and if there is a need to start production, it is very easy to start“, explains Dr. Negrea. “On May 8, 1980, smallpox was eradicated worldwide. Therefore, people born after this date 79 are not vaccinated. The others, however, already have an active immunization, even if we are not talking about this strain”, stated Dr. Gindrovel Dumitra, coordinator of the Vaccinology Group within the National Society of Family Medicine.
However, there are also vaccines against monkey pox, continues the idea of Dr. Emilian Popovici. “There are currently two vaccines that reduce the risk or severity of monkeypox infection, so they can prevent illness or reduce the severity of the disease: JYNNEOS and ACAM2000. Vaccines can be given either before or after a person is exposed to the virus, but vaccination before exposure is recommended for the best protection. If a person is exposed to mpox, vaccination within 4 days of first exposure to mpox will give the best chance of avoiding the disease. JYNNEOS is the preferred vaccine for use in the US and Australia based on its safety profile and because it is easier to administer. Where JYNNEOS is not available, ACAM2000 may be considered. JYNNEOS is available in the UK and Europe under the name IMVANEX As with any vaccine, vaccination with JYNNEOS or ACAM2000 should only be done on specialist medical advice and where there is an epidemiological context suggestive of this affection”.
In Romania, a vaccination plan against monkey pox was even adopted. The vaccine is administered by medical personnel, in hospitals with infectious diseases departments, as a post-exposure prophylaxis measure, to prevent the appearance and spread of the disease, in the following two situations: direct contacts of confirmed cases of the disease, in the first 4-14 days after exposure and to medical personnel if accidentally exposed to the virus.
The vaccine is administered in two doses, 28 days apart, with the note that people born before 1980 vaccinated against monkeypox will receive a single dose. The vaccine is not administered to pregnant women, children, adolescents under the age of 18. Mass vaccination is not necessary according to the recommendations of health experts.
Dr. Mihai Negrea recommends vigilance, not panic. “We should worry, but not to the point where we panic. We just have to be concerned, watch, treat if necessary, but it’s not something that should scare us. For better or for worse, we live in Europe, we have a higher standard of living than African states, we have spacious homes, access to medical services, we are more educated in terms of health. And let’s not forget: monkeypox is not so easily transmitted.” The doctor advises us to sit still and calls for calm. If we were faced with human pox or monkey pox the situation would be under control. “There is no need to do research for the vaccine, it already exists.”
Serious situation in Africa
Authorities in Central Africa said the infections had spread to the country’s capital, Bangui, after initially being confined to rural areas. The Minister of Health said that some families hide infected relatives because of the stigma, thus increasing the risk to others. Cases of the highly contagious disease have also recently been detected in Rwanda and Burundi, while a new strain has spread to the Democratic Republic of Congo. The official stated that at the moment the risk of transmission between individuals is very high, because the capital Bangui is densely populated.
According to the medical charity Médecins Sans Frontières Congo recorded more than 12,300 suspected cases and 479 deaths in the first half of this year. Experts say the new strain there has an estimated fatality rate of 10 percent. Neighboring Burundi recently confirmed three new cases, while Rwanda detected two. South Africa has recorded 20 cases, including two deaths.
Monkey pox, symptoms
Monkeypox presents with mild symptoms, and most infected patients recover within a few weeks without the need for treatment. Studies have shown that the incubation period for monkeypox is generally between 6 and 13 days, and the symptoms that may appear are as follows: a vesicular rash, which may cause itching (itching) or lesions on any part of the body (including around the genitals and anus), fever, sore throat, enlarged lymph nodes, back pain, muscle pain and sores in the mouth and eyes. The disease can be more severe in the case of young children, pregnant women or people with chronic diseases, whose body does not produce an adequate immune reaction.
What do you do if you got sick?
If a person suspects that they have been infected with this virus, having specific symptoms, they should contact their doctor and provide information about recent travel and vaccination history. It is recommended that people traveling to countries where the virus is endemic avoid contact with sick animals and the consumption of game.
How can you protect yourself?
It is necessary to observe adequate hand hygiene, using soap and water or an alcohol-based disinfectant. In the case of infected people, isolation is recommended, and people who come into contact with it, must use appropriate protective measures, such as a mask and gloves. People who have symptoms and suspect monkeypox infection should see their doctor. It is also important to identify the people who came into contact with the infected patient, in order to prevent the spread of the virus and the effective management of diagnosed cases.
How monkey pox came about
In 1970, the first case of monkeypox infection in humans was detected in the Democratic Republic of the Congo, where most cases of monkeypox in humans have been recorded so far. Later, cases spread to other states in Central and West Africa, but Europe was not an endemic risk area. But illnesses have also been recorded here. Romania was no exception. In 2022 we had 41 sick people.
