Who is most at risk from smallpox?

As the number of global cases of monkey smallpox exceeds 1,300, we have a clearer picture of how the infection affects individuals. It is usually manageable: in infected people, after sexual intercourse, small, painful bumps or blisters appear in the genital area, which are accompanied by fever and swelling of the lymph nodes. Rash is most common on the hands, feet, and face.

Although smallpox is known to leave scars that cause cosmetic problems, a less viral version of the virus is rare in West Africa. As of June 2, none of the participants in the current epidemic in non-endemic countries have died.

In addition, infection is relatively easy to avoid. The virus is most often transmitted through monkey smallpox, so avoiding other people’s rashes is a strong prevention strategy.

Smallpox infection in monkeys can be prevented and not particularly fatal, making it easy to eliminate the risk of the pathogen. But we should not do that, and the important reason is that these infections can be fatal.

Kovid-19 found that a mild infection in one person could result in the death of another. Minorities are at greater risk due to preconditions – and as the epidemic progresses, smallpox may find more vulnerable people. This turns it into a contagious pathogen and deserves to be shared and treated well. It will also help determine who is more likely to be affected as the epidemic continues to spread.

The risk of monkey smallpox is higher in people with weakened immune systems, pregnant women or those with certain skin diseases.

Our best understanding of the range of smallpox problems comes from Nigeria, where health workers have identified more than 550 cases of smallpox since the start of the epidemic in 2017.

Skin rashes caused by monkey smallpox infection in most people can be very severe, and in some cases may require hospitalization to control discomfort and blisters. But what makes monkey smallpox dangerous is when the virus spreads beyond the skin, said Andrea McCollum, an epidemiologist with the Poxvirus and Rabies Department at the Centers for Disease Control.

In cases where the monkey smallpox infection was fatal, patients suffered from severe infections of the brain, blood, or lungs. These complications can be caused by the direct viral effects of bacterial infections on the organs, which are often referred to as “secondary” infections, which are helped by the inflammatory effects of the virus.

Dimi Ogoina, an infectious disease doctor at Niger Delta University in Bayelsa and co-author of a report describing the results among Nigerian patients hospitalized between 2017 and 2018, said the problems could be among people with immunosuppression.

Nine people have died of monkey disease since the outbreak began in Nigeria, he explained via email. Ohina said four of the dead were living without HIV control, one was a newborn, the other had kidney disease and was taking immunosuppressive drugs. In addition, a pregnant woman with a monkey disease had a miscarriage at 26 weeks’ gestation.

Stuart Isaacs, a virologist at the University of Pennsylvania who studied a family of monkeys with the smallpox virus, said it was unclear why some immunocompromised states were increasing the risk of monkeys being infected.

Using animal models, the researchers sought to identify specific types of immunocompromised states that increased the risk of poxvirus. These experiments showed that CD4 T cells (depleted by untreated HIV infection) and antibody-producing B cells play a key role in controlling the primary infection. However, little is known about the man at the moment, said Brett Petersen, a CDC doctor and medical epidemiologist.

So far, the agency’s treatment recommendations indicate that people with a wide range of immunocompromised conditions are currently at risk for serious diseases (including HIV, various cancers, organ transplants, some stem cell transplants, and some autoimmune diseases). under the age of eight.

In addition, people with pre-existing skin conditions, such as eczema (atopic dermatitis), are at greater risk, McCollum said, as people spread the infection from one part of the body to another as they scratch, as well as pregnant women who are more likely to spread the virus. can lead to their pregnancy and miscarriage.

Risk factors for monkey smallpox infection coincide with the main risk factors for immunodeficiency: Uncontrolled HIV

In the current global epidemic, monkeys’ smallpox seems to be spreading through sexual intercourse. The same type of contact that puts people at risk for ape disease also puts them at risk for uncontrolled HIV infection. Thus, uncontrolled HIV infection raises concerns not only that monkeys may be infected with smallpox, but also that it may suffer the worst consequences.

“This is what worries me the most,” said Gregg Gonsalves, an epidemiologist at Yale University’s School of Public Health and an HIV and global health activist. On average, 13 percent of Americans living with HIV are unaware of their diagnosis and treatment, but that proportion is as high as 20 percent in some southern states and even higher in a few plains and western states. “If one-fifth of the HIV-positive community doesn’t know their status, it means they are at risk,” Gonsalves said.

If people avoid sexual intercourse while they are sick or use precautions such as condoms or toothpaste, they can prevent the spread of sexually transmitted diseases. Although many sexually active people use these precautions, people who are sexually stigmatized, such as closed gay or bisexual men, do so. For these groups, homophobia and other stigmas often prevent them from being tested for sexually transmitted infections, including HIV.

This means that untreated people with HIV are at higher risk for monkey smallpox infection and the serious consequences of both. In many parts of the United States, homophobia is a proportional barrier to life-saving treatment for black men – contributing to an increase in HIV infection and black American mortality.

The more the disease spreads, the more likely it is that the number of people with weakened immune systems will eventually increase. That should prompt us to take immediate action, regardless of where it spreads, Ohio said.

“Unless global measures are taken to better understand the virus and disease everywhere and to develop innovative countermeasures to address the monkey smallpox challenge, there is a serious threat,” Ohina wrote. Then we saw a big change in who was infected with the virus and how much damage it caused.

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