What is M.Fox, and why has it spread faster?
Who gets the M.Fox vaccine shot? Photo source, Getty ImagesPhoto Explained, Many Countries Have Started Vaccination to Stop the Spread of Empox
The M.Fox virus, once called monkeypox, was first discovered in the late 1950s. However, there are several indications that the virus has undergone many mutations in the last three to four years, increasing human-to-human transmission.
There is something to be addressed about this disease first. This disease, once called monkeypox, has little to do with monkeys in practice.
"It was first discovered in a monkey in a laboratory in Denmark, and monkey-to-monkey infections and virus extraction have been done," said Sagan Prient, an anthropologist at Pennsylvania State University in the U.S. "But monkeys are not the early epicenter of this disease." "The first to develop this disease was probably an animal that could transmit it, but does not suffer or die from it in itself."
Freeland has been studying the virus in Nigeria for more than 15 years, and the COVID-19 pandemic broke out when he was just beginning a new research project. He said it's possible the virus came from a rodent, although it hasn't been proven yet. Meanwhile, the World Health Organization (WHO) announced in late 2022 that it was changing its name to Empox.
"For a long time, scientists thought primate diseases were the biggest threat to humans because they were genetically very similar to humans," Freeland said. "But looking at the spread of new diseases to humans, infectious diseases that come from rodents and bats are now becoming more and more important."
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Zoonotic infectious diseases are infectious diseases that are transmitted from animals to humans. Some of these are transmitted between humans after crossing the intersection of biological species.
In this respect, Empox and COVID-19 appear to be quite similar. However, the Empox virus came out much earlier than the coronavirus that caused the recent pandemic. However, the recent pace of the Empox spread has put health authorities around the world on edge. In August 2024, the African Centers for Disease Control and Prevention (Africa CDC) declared a public health emergency related to the new Empox mutation. This is because the mutation is increasing the number of confirmed cases and deaths in several countries, including the Democratic Republic of the Congo, Burundi, Central African Republic, and Rwanda. On the 14th (local time), the WHO also declared an International Public Health Emergency (PHEIC) for Empox.
Where did it come from?
Empox was first identified in 1958 in a laboratory in Copenhagen, Denmark. The disease was discovered in a monkey brought from Singapore about two months before the confirmation.The first confirmed case of human infection was a 9-month-old boy who was admitted to a hospital in the Democratic Republic of the Congo in 1970. Although the boy lived in a rainforest area that houses monkeys, doctors at the time were not able to confirm whether he had come into contact with the infected monkey or if he had contracted it through another route. The boy, who was hospitalized, later recovered, but sadly died of measles a few days later.
Empox Virus Microscope Photo Source, Getty Images
Photo description, Empox virus (pictured left) contains a brick-shaped protein and genetic material inside an oily outer shell
It is possible that the virus has not been identified, and other cases of human infection have existed. This is because when infected with the M.pox virus, lesions similar to those of smallpox infection (such as changes in tissue and body fluids caused by the disease, resulting in abnormalities in its function) appear. It is highly likely that even before 70 cases were reported in the United States in 2003, infection cases existed in several African countries.
Additionally, rodent prairie dogs were used as pets during the U.S. outbreak, along with Gambia opossums from Ghana. People who traveled mostly from African countries were also infected in other cases from the United Kingdom, Israel, and Singapore.
Cases of infection reported after May 2022 have come from the United States, the United Kingdom, Australia, mainland Europe, and Canada. While this has been of great concern to health officials and scientists in the region, these cases are actually very small compared to the number of infections in Africa, where the disease has already reached an endemic level.
Since January 2023, the Democratic Republic of the Congo has seen more than 19,000 infections and 900 deaths. The virus that caused the outbreak in the Democratic Republic of the Congo is a more virulent strain known as Clade I. The strain that caused the outbreak in the United States in 2022 is known as Clade II.
The U.S. Centers for Disease Control and Prevention said the risk to the U.S. from the M.Fox variant, which is prevalent in the Democratic Republic of Congo, is low, and people who have been vaccinated or have suffered from M.Fox in the past are immune to the Clade I virus. And no cases of the Clade I virus have been reported in the U.S. yet.
It is yet to be determined medically where exactly the M.Fox surge after 2022 began. Genetic analysis revealed that the variant of the virus belongs to the M.Fox family, which first appeared in West Africa. However, a clear link between the virus and African countries has yet to be confirmed. This is why some health experts say it may have spread among people in several countries outside of Africa for months without being detected.
According to genetic analysis studies that have not yet been reviewed by academia, the West African M.fox virus (Clade II) may have already acquired human-to-human transmission power as early as 2017.
Recently, a variant called "Clade Ib" appeared in the Democratic Republic of the Congo. It is a variant that is known to spread more easily through close contact. It appears to have first appeared in the area around Goma in northern Kivu, and is particularly prevalent among children under the age of 15. Academia estimates that the variant has spread as early as September 2023.
How does it spread?
Unlike the highly contagious COVID-19 virus, which is usually transmitted by small droplets from breathing, Empox is not easily transmitted. Transmission from person to person, or from animals to person requires close physical contact (usually for a long time).
"The cause could be contact with someone who has an infectious rash, such as lesions, scabs, and body fluids," said Madeleine Barron of the American Society of Microbiology (ASM). "The infection can also be caused by touching something that an infected person has touched."
According to a study published in the New England Journal of Medicine, 98 percent of infections in 16 countries between April and June 2022 occurred in men who had sex with men. However, the reason is unknown. Since a disease usually tends to spread around a group when it enters one group, this situation may be due to chance. There is also no evidence that men who have sex transmit Empox faster than others. There is also no evidence that transmission is better in men than in women.
"We don't know whether the virus can spread through sexual transmission pathways such as vaginal secretions or semen," Barron said, but "close contact seems to promote the spread."
Researchers have also discovered the Empox virus DNA from semen. However, this does not demonstrate how the Empox virus spreads. The Empox virus has a protein envelope and membrane surrounding it with genetic information. All of these components must be properly equipped and functioning in order to infect a cell. However, the virus may not have been able to cause infection because it was not viable on its own, even though viral DNA was detected in the semen.
How dangerous is it?
Compared to the mfox virus in central Africa, the West African virus usually causes mild levels of disease, resulting in fewer deaths. When infected with Clade I, the mortality rate is about 10%. With Clade II, 99.9% survive. According to the WHO, there were 99,176 confirmed cases of the Clade II virus between 2022 and June 2024, which resulted in 208 deaths.
But even if the mortality rate is relatively low, patients say the disease is very painful and debilitating.
"It's long, messy, and it's something I really want to avoid," Barron said. "In the beginning, you can feel flu-like symptoms such as fever and headache, but as the disease progresses, you can get multi-level rashes, lesions in the mouth, feet, and genitals, and pus."
Photo description, Empox lesions or blisters last for weeks, even leaving scars permanently
The incubation period for M.Fox is usually 6 to 14 days. However, symptoms may appear 5 to 21 days after infection, and may appear somewhat earlier or a little later than the normal incubation period. When infected, during the first few days, you feel headache, fever, muscle pain, and fatigue. One of the characteristics of the virus is lymph node swelling. After a few days of fever, skin rashes tend to appear.
And about three to four weeks after infection, the blisters appear and fall off. Even those who recovered during this process often leave scars. There is no specific treatment other than medications to treat symptoms yet. And like most other diseases, the likelihood of getting seriously ill or dying depends on factors such as age and immune level.
Empox is similar to a disease that was prevalent in the past. It is smallpox, which was thought to have been successfully vaccinated and eradicated worldwide. However, despite belonging to the same virus group as smallpox, Empox is a different virus.
Is it evolving?
M.Fox is a brick-shaped virus with double-stranded DNA. This means that the virus is relatively stable, making it less likely to mutate into a more virulent or contagious variant. On the other hand, the COVID-19 virus (Sars-CoV-2) contains a genetic material made of single-stranded RNA.
"RNA viruses mutate very quickly, and they happen so many times that they do," said Rodney Rodde, a professor at the University of Texas who has studied public health and virology. He also summarized his knowledge of M.Fox in a release published by the American Society of Microbiology with Barron in 2022. "Normally, DNA viruses don't mutate that quickly. With 50 mutations found, the mutation doesn't seem to affect the severity of the disease."
Collecting Empox Viruses From Humans Photo Source, Getty Images
Photo Explains: The Empox virus was mainly found in African countries, but began to spread worldwide in 2022
More than half of the mutations found between 2018 and 2022 were classified as "silent." Silent means not changing the proteins needed to infect cells and evade the immune system. Nevertheless, some scholars are nervous about the fact that many mutations occurred in the three to four years leading to the outbreak in 2022. Academia has found that there are two strains of the virus spreading in the United States. In other words, they come from different sources. There are also some indications that the virus may have circulated quietly for about 20 years without being detected outside of Africa.
However, the emergence of new Clade Ib variant M.fox infections in the Democratic Republic of the Congo means that the virus is rapidly evolving. This variant shows many changes from the past, including some mutations in the genetic code, which may have made it easier for the virus to spread from humans to humans.
Another study, which has not yet been officially published, also identified potential mutations that could alter the characteristics of the disease in future outbreaks. If this study is accurate, health authorities and scientists will have evidence that Empox is evolving into a more worrisome disease.
Why did it lead to a global health emergency?
The WHO declared an international public health emergency in connection with Empox in July 2022. However, it was later withdrawn in May 2023 due to progress in fighting the disease. However, with the increased risk of Empox, in August 2024, the African CDC declared a public health emergency due to the rapid spread of the new variant of the virus on the continent. On the 14th, the WHO also declared a new international public health emergency.
The reason the world is concerned about the current situation is related to smallpox.
We have been vaccinated against smallpox for about 200 years. Thanks to these efforts on a global level, humans declared the eradication of smallpox on May 8, 1980. Smallpox has made it the only human disease that humans have driven from Earth. Smallpox virus remains in safe laboratories today, but smallpox no longer presents itself as an infectious disease. However, we currently have no natural immunity to smallpox, of course, similar viruses. And with the end of the smallpox vaccination campaign in the mid-1980s, preventive activities against two other viruses decreased.
"At the time of smallpox eradication, there would have been some pretty strong herd immunity in place around the world," Rodde said. "There's some research out there that, based on the population in Nigeria, M.P.O. would have spread more strongly if we hadn't gotten vaccinated against smallpox. But since we stopped vaccinating against smallpox, antibodies have weakened. We can have some immunity from just looking at our parents, but it's going to be really weak."
How Effective Are Vaccines?
Fortunately, the smallpox vaccine is said to be up to 80% preventive against Empox. Not long ago, there was a movement to eliminate the smallpox vaccine stockpile worldwide, but now many countries are replenishing the vaccine. However, this is mainly true of wealthy countries. This is the saddest point regarding the recent Empox. We have known about this disease for more than 50 years. However, it wasn't until the disease spread to North America and Europe that governments outside of Africa became interested in it.
Data from the Africa Centers for Disease Control and Prevention shows that there have been 1267 confirmed cases of M.Fox across Africa since the beginning of 2022 (until May, when infections came from North America and Europe). And that has killed at least 285 people.
Photo Description: Infected prairie dogs bred with animals imported from Ghana are believed to be responsible for the 2003 M.Fox outbreak in the United States
"A lot of people have been pointing this out for decades," Laude said. "We don't seem to think about it when it doesn't really become our problem."
"In areas like Africa where Empox is a long-term problem, we still lack all the resources, diagnostics, vaccines, all the necessary elements to deal with this disease," Barron said. "If COVID-19 has taught us anything, it's that the world is narrow and the disease has no boundaries, so we have to work together to deal with it."
A 2020 UN report warned of a growing risk of new outbreaks of animal-to-human transmitted diseases due to human invasion of natural habitats and the effects of climate change. Freeland's conclusion, who has been studying the effects of human-to-animal interactions on health, is that better monitoring of all potential zoonotic diseases is needed.
"More investment is needed to understand the disease and to prevent the initial spread of animal-to-human transmission," Freiant said. "We also need to strengthen our capabilities and cooperation to help countries respond to these developments, and the efforts should not be limited to simply protecting the Western world."
Like COVID-19, Empox is a disease that has been transmitted from animal to human. With its relatively slow transmission and the availability of vaccines to prevent infection, Empox control seems possible. However, Empox may not be the end of these diseases. The world must stay vigilant and prepare for the next one.
*This article was first published on August 2, 2022. It was republished on May 20, 2024 and August 13, 2024, reflecting the latest research on the situation and evolution of the virus in the Democratic Republic of the Congo.
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