It may be too late to prevent monkeypox from becoming an epidemic in the United States and Europe

We failed to beat an outbreak of monkeypox and may have missed the opportunity to prevent the disease from becoming epidemic – and a permanent threat – in the United States and Europe.

Monkeypox is spreading rapidly throughout the world, especially in the United States and Europe. With cases doubling every two weeks or so, there is an increased risk that monkeypox will become a perennial problem in countries where outbreaks were previously rare and small.

In other words, smallpox is close to becoming endemic in many new places. If it does, it can become very difficult to eradicate. Monkeypox, which causes fever, rash, and is fatal in very few cases, will become another disease that people have to worry about all the time.

For smallpox, there are two paths to endemicity. If the virus infects enough people quickly enough to bypass authorities’ efforts to trace transmission and vaccinate at-risk individuals, it could become epidemic in humans. “We’re really close to this,” James Lawler, an infectious disease expert at the University of Nebraska Medical Center, told The Daily Beast.

The good news with this type of endemicity is that it isn’t You have to be permanent. Reversing the course of human settlement is difficult, yes, but it is possible. Amish Adalja, a public health expert at the Johns Hopkins Center for Health Security, told the Daily Beast: “If the disease is only spreading between humans, it can be controlled — eventually — through vaccination and natural immunity.

But monkeypox was originally a “zoonotic” animal virus. It is prevalent in rodent and monkey species in West and Central Africa, where it is common in humans.

If smallpox finds a habitat for some animal species in North America or Europe – for example, squirrels, rats or prairie dogs – it will be impossible to eradicate locally. “It’s game over,” Lawler said. Smallpox will be all around us, perhaps forever, just waiting for opportunities to spread from animals to humans. Outbreaks will be frequent and large, just as they are now in West and Central Africa.

To be clear, smallpox is not endemic to humans or animals in the United States or Europe – yet. But the trends are not encouraging. “I share other scientists’ concerns about containment and the virus becoming endemic to our rodent community in the United States,” Stephanie James, head of the viral testing laboratory at Regis University in Colorado, told The Daily Beast.

Officials first noticed the current outbreak, which involves a relatively mild strain of smallpox in West Africa, after a British traveler returning from Nigeria was diagnosed in early May. Smallpox spread through close physical contact including sex, and soon accompanied travelers on planes to far and wide countries. Doctors diagnosed the first case of infection in the United States on May 27.

But now it is clear that the first diagnosed Smallpox cases in Europe and the United States were not the first true cases. On June 3, the US Centers for Disease Control and Prevention announced that it had found genetic evidence of US cases of smallpox that preceded the first cases in Europe from May.

The rapid spread of monkeypox in humans is a preventable tragedy. But it can still get worse.

Doctors may not have noticed or reported these previous infections, at first, due to the similarity between the symptoms of smallpox and those of some common sexually transmitted diseases such as herpes. Adalja explained that “the virus was masquerading as a sexually transmitted infection and was spreading in secret for several months.”

The virus had a big start, which helps explain why, months later, it is still ahead of ramping up efforts to contain it. There were 20,638 confirmed cases in 77 countries as of Wednesday, according to the Centers for Disease Control and Prevention. That’s up from less than 10,000 cases two weeks ago. The World Health Organization counted five smallpox-related deaths in non-endemic countries.

What is frustrating for epidemiologists is that, in theory, we have all the tools we need to quickly contain a smallpox outbreak. Thanks to COVID, health workers around the world are better than ever at contact tracing. Vaccines and treatments that work for smallpox also work for monkeypox. There is a proven strategy: diagnose cases, isolate and treat patients, and vaccinate their families, friends and co-workers.

and educating the public – especially the most at-risk groups including men who have sex with men.

But so far, the strategy is not working. Part of the problem, Lawler said, has to do with the virus itself. “The disease is different from monkeypox that we’ve seen in the past. I don’t think we know the cause — maybe a combination of viruses, hosts, and the environment.”

Mostly, this is our fault. Many doctors misdiagnose smallpox cases as herpes or some other STD. The World Health Organization and the Centers for Disease Control (CDC) have waited too long to define the smallpox outbreak as a public health emergency and to mobilize resources. The World Health Organization declared a state of emergency on July 23. The CDC is expected to do the same in the next few days.

Authorities are deploying more vaccines and treatments and boosting testing. However, clinics on the front line of public health in the United States need more of everything. More tests. More vaccines and treatments. More money to connect with the community. The US National Coalition of STD Managers recently surveyed a hundred clinics and found that half of them lacked the capacity to handle monkeypox outbreaks.

“We’re still going too slow,” Lawler warned. “We still rule out the possibility of the unexpected,” he added. Including the increased possibility of smallpox spreading to squirrels or mice.

The feds seem to be at a loss to deal with “reverse” transmission from humans to animals. To prevent endemicity in animals, you need to detect smallpox infection in a species, exclude infected animals, and then closely monitor the remaining populations to make sure all viruses are eliminated.

But it is not clear who should take the lead in the federal health institution. “The operational response to zoonoses is in this gray area,” Lawler said. The CDC maintains a website that describes symptoms of smallpox in pets and livestock and explains where to send samples for diagnosis. The Department of Agriculture’s Animal and Plant Health Inspection Service monitors diseases in animals. Especially cattle.

APHIS could not, or not, confirm that it tests animals for monkeypox. The agency referred The Daily Beast to the CDC, which did not respond to an email requesting comment. If there is a leading agency for detecting smallpox in animals, that agency doesn’t seem eager to take responsibility.

The rapid spread of monkeypox in humans is a preventable tragedy. But he can still get a file Many worst. With hard work and a little luck, human outbreaks can still be contained and eventually eradicated.

But if American or European rodents catch smallpox, the outbreak will escalate into something much worse. Newly endemic disease. One that is impossible to eliminate.

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