A study published in 'The Lancet' points to an antiviral as a possible treatment for monkeypox

Monkeypox is an endemic African disease, so the advanced world hasn't been overly concerned about it. Historically, hardly any cases had been registered outside that continent, so the infection does not have an official approved treatment and not much is known about its operation; for example, how long someone infected is contagious.

The "emerging threat" of zoonoses: what lies behind the spread of diseases like monkeypox

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Now, with outbreaks exploding in 14 European countries, interest in the first world is growing. A team of researchers from the United Kingdom has evaluated the treatment and response of seven infected with monkeypox in the British country between 2018 and 2021, in addition to the behavior of the virus, and draws some preliminary conclusions. The study, published in the journal The Lancet Infectious Diseasesexplains that the antiviral tecovirimat has the potential to mitigate both the duration of symptoms and the period in which a person is contagious, although he warns that more research is needed.

“Clinical trial data is lacking,” says Dr. Hugh Adler, of Liverpool University Hospital and lead author of the text. “As public health officials try to understand what is causing these 2022 monkeypox outbreaks in Europe and North America – which have affected patients who report they have neither traveled nor come into contact with known cases – our study offers some of the earliest insights into the use of antivirals to treat monkeypox. Although this latest outbreak has affected more patients than we have previously located in the UK, monkeypox has historically not been efficiently transmitted between people, and overall the risk to public health is low. expert.

Between five and 21 days contagious

What is known is that the disease is rare outside of Africa, which has an animal origin and that cases of infection between humans are rare. Monkeypox does not have an approved treatment, although the smallpox vaccine protects against infection, and the period in which an infected person can potentially infect others extends between 5 and 21 days. The usual symptoms are fever, skin rashes and swollen lymph nodes, which in more severe cases can include inflammation of the lungs or brain and bacterial infections. The mortality rate varies, the study adds, from 1% to 10% in the Congo Basin to 3% in Nigeria, with deaths occurring mostly in children or HIV carriers. The usual thing before a case is to isolate the patient in specialized hospitals.

The British study now adds as a possible treatment the antivirals brincidofovir and tecovirimat, which are used to treat smallpox in humans and have shown some efficacy against monkeypox in animals.

In the United Kingdom, they treated seven patients between 2018 and 2019: four of them became ill in West Africa and another three were infected from another human.

Of this group, three were treated with brincidofovir seven days after the first skin rashes, but "it was not found to have any convincing clinical benefit in treating monkeypox and liver abnormalities were seen," explains the study, which was published today. He asks if it had been administered earlier in the development of the disease or in different doses, the result would have been different. Despite everything, adds the text, the three patients recovered.

The next block of patients was registered in 2021, when a family became infected after a trip to Africa. In this case, the study highlights, the first two cases of contagion between humans in the home were observed. One of these three people was treated with tecovirimat and "experienced a shorter duration of symptoms and lower viral shedding from the upper respiratory tract than other cases in that same group," says the study, although it also admits that the authors cannot confirm the effectiveness of the antiviral with such a small cohort, so they call for further investigation.

The investigation recalls that all patients were hospitalized not because of the severity of the symptoms but to control possible infections. He also points out that none of them suffered from the more severe complications that can accompany monkeypox, such as pneumonia and sepsis, although one of them suffered a mild relapse six weeks after leaving the hospital and another developed an abscess that had to be drained.

Finally, the health workers briefly address how long an infected person is contagious. "In previous outbreaks of monkeypox, patients were considered infectious until all lesions crusted over," says Dr Catherine Houlihan, of the Health Security Agency and University College London, "but in these seven cases, Viral shedding for at least three weeks after infection. In any case, data on infectivity is limited and it is an important area to study in the future”, she closes.

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