Science

Monkeypox: symptoms, diagnosis, treatment, vaccines

The current outbreak of monkeypox has now become a major health threat as the head of the World Health Organization provoked a maximum warning on Saturday to try to contain it. Here’s an overview of the symptoms of the disease, which now accounts for over 16,000 cases worldwide, diagnostics, treatments, and vaccines.

Symptoms

In the first period, there may be fever, headache, acute muscle pain, unusual fatigue, swollen and sore lymph nodes in the jaw, neck, or groin. In the second period, lesions of the skin and mucous membranes throughout the body may appear.

The WHO reported two days ago that in the current outbreak of monkeypox, the genitals, anal and oral regions are more likely to be affected, with lesions sometimes appearing before lymph node involvement, fever, malaise and pain associated with the lesions.

However, symptoms vary from one patient to another. After a few days or weeks, the pimples turn into scabs, which eventually fall off and the lesions heal. The patient is contagious until complete recovery.

Diagnostics

Monkeypox is suspected when there is possible exposure to the virus within three weeks of exposure to a confirmed or probable case, when returning from a trip to an African country where the virus is endemic, or when having multiple sexual partners. In the current wave, with Europe as its epicenter, the vast majority of patients so far have been men who have sex with men, relatively young people living mostly in cities, according to the WHO.

Diagnosis can be difficult because cases don’t necessarily show the usual symptoms of the disease and may resemble some sexually transmitted infections, several health authorities warn. The doctor performing the physical examination will rule out other rashes such as chickenpox, hand-foot-mouth syndrome, shingles, measles, bacterial skin infections, scabies, syphilis, herpes, skin reactions from allergies.

Testing, such as PCR, may be required to confirm the diagnosis of monkeypox. Skin sampling (biopsy or smear by rubbing several vesicles) and/or nasopharynx is preferred if the person has a rash in the mouth or throat. While waiting to take the test and receive the results, you must self-isolate. Once infection is confirmed, isolation is recommended for approximately three weeks. It is not known whether the virus can be transmitted through semen, and if so, for how long. As a precautionary measure, the European Center for Disease Control recommends using a condom 12 weeks after recovery.

Treatment

The disease usually resolves spontaneously, after two to three weeks, sometimes after four. As a rule, only treatment of symptoms is necessary, for example, to stop a fever or soothe itching. In some cases, the lesions are very painful, as reported in several reviews, which may require painkillers or even hospitalization. It is advisable not to scratch the lesions so as not to re-introduce the virus and leave scars, and to cover them to limit these risks.

A bottle of the antiviral drug tecovirimat used to treat monkeypox on July 19, 2022 in New York City (AFP – Yuki IWAMURA)

In some people, the disease may be complicated by superinfection of skin lesions or respiratory, digestive, ophthalmic, or neurological disorders. If necessary, some antiviral drugs, such as tecovirimat, which are intended, in particular, against smallpox, can be used.

Severe cases often affect children, pregnant women, immunodeficiencies. To date, no deaths have been reported in either Europe or the United States.

Vaccine

The third-generation smallpox vaccine from the Danish company Bavarian Nordic (Imvanex or Jynneos, a live vaccine that does not replicate in humans) can be given to adults, including caregivers, after risky exposure and also as a preventive measure. According to the European Center for Disease Control, if given within four days of exposure, it can have a significant protective effect. The European Commission on Monday approved the extension of one of these vaccines to monkeypox.

In some countries (USA, UK, Canada, France), preventive vaccination may be offered to groups most at risk of contracting the virus, including men who have sex with men. Thousands of people have already been vaccinated in New York. Vaccination is carried out in two doses with an interval of at least 28 days. For people vaccinated against smallpox in childhood, one dose is sufficient. For weakened immunity, a third is recommended.

These vaccines do not provide immediate or complete protection, health authorities urge people to be careful after they are injected.

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