Monkeypox: confirmation of community transmission of the disease

On June 3, the US Centers for Disease Control and Prevention (CDC) published a full review about the outbreak of monkey pox in that country and also reported that, as of June 2, approximately 800 cases of monkeypox have been reported in 28 countries.

The main conclusion is that the appearance of cases of the infection in multiple places, with no clear relationship between them, indicates that the disease has reached a level of community transmission. Today we will see what this concept of public health consists of.

Community spread

When an infectious disease appears and the first cases In a community, the first thing epidemiologists do is determine if these cases are directly related to the geographic area where the epidemic originated (initial focus).

Let us remember how, at the beginning of the COVID-19 pandemic in Peru, the first patients came from a country that already had the infection. [casos importados]. Very soon, cases began to appear in people who had not been to foreign countries or had any contact with an imported case. They had been infected somewhere in the city, without being able to specify where and from whom.

That is community transmission. According to the CDC, is defined as the spread of the virus in a certain geographical area, without being able to determine the true origin of the infection. It’s important to understand, says the CDC, that each health department determines community spread differently, based on local conditions.

“By reaching the level of community transmission, monkeypox has become an infection that can be acquired by anyone.”

For reference, and as they have done last week with monkeypox, the CDC determined that COVID-19 had reached the level of community transmission on January 30, 2020.

Having reached the level of community transmission, the monkey pox it has become an infection that can be acquired by anyone, anywhere.

US cases

As of May 31, the CDC identified 17 cases of monkey pox in the US Most of them (16) were diagnosed in people who identify as gay, bisexual, or men who have sex with men (MSM).

The institution clarifies that “the high proportion of initial cases diagnosed in this outbreak in people who identify as gay, bisexual, or other MSM could simply reflect an early introduction of monkeypox into interconnected social networks”.

He adds that “this finding may also reflect verification bias due to the strong and established relationships between some MSM and their physicians in well-organized STD clinics, which have extensive knowledge of infectious diseases, including rare conditions”.

Lastly, he warns thatinfections are not limited to certain geographic areas or population groups, as close physical contact with infected people can spread monkeypox to anyone, regardless of gender or sexual orientation”.

Clinical features

The report says that cases in the US typically start with a fever 5 to 13 days after infection, which is accompanied by enlarged lymph nodes, malaise, headache and muscle aches.

One to four days after the onset of symptoms, the patient develops a skin rash that, beginning in the trunk, advances to the extremities (centrifugal distribution). The skin lesions include a kind of blisters (vesicles) with well-circumscribed edges, which can quickly fill with pus (pustules), which turn into scabs in a few days. Some cases are unusualand they present with lesions in the genital region and without fever or other symptoms, so they can be confused with sexually transmitted diseases (genital herpes or syphilis).

A person is considered contagious from the start of the illness until all skin lesions have crusted over, and a new layer of healthy skin has formed under the crust. Person-to-person transmission occurs through direct contact with infected body fluids or lesions and through respiratory secretions, requiring prolonged interaction. Infection can also occur through contact with contaminated clothing or bedding (fomites).

Genetic sequencing analysis of the virus was done in the first case, detected in Massachusetts, which showed similarity to published genomes from the current outbreak in Europe, which in turn are related to the 2017 and 2018 monkeypox outbreak in Nigeria.

For early diagnosis purposes, it is very important, dear reader, to know that a suspected case is defined as a person who develops a skin rash 21 days after contact with one or more people who have had a similar-looking rash, or who traveled to a country with confirmed cases of monkeypox or where the virus monkey pox it is endemic.

Corollary

This report is important, since it has been found that there are outbreaks of monkeypox in countries where there is no endemic disease and that patients with no travel history to a country with endemic monkeypoxreveals person-to-person community spread, meaning the virus is circulating in the US and other countries.