Tuesday 31 May 2022

 

           Monkeypox outbreak: What to know.

  • Since early May 2022, an increasing number of monkeypox cases have been identified in more than 20 countries, including the United States and the United Kingdom.
  • As a viral disease native to Africa, symptoms of monkeypox include skin lesions, fever, and body aches.
  • Some recent cases of monkeypox have involved men who have had sex with men, however, experts say the disease is not a sexually transmitted infection but can spread via direct contact during sex.
  • The World Health Organization said it is unlikely the outbreak will turn into a global pandemic, but warned that quick measures are crucial to stop the spread.

This is a developing story. We will provide updates as more information becomes available.

On the heels of the ongoing COVID-19 pandemic, a zoonotic virus seems to be spreading across the globe.

Since early May, MonkeypoxTrusted Source has been making headway across more than 20 countries, including the United Kingdom, Spain, Portugal, Australia, and the United States.

In the U.K., nearly 200 monkeypox cases have been confirmed since May 7. During a press conference on May 17Trusted Source, World Health Organization (WHO) officials said that these are mostly separate occurrences except for “a family cluster with two confirmed cases and one probable case[…].”

Recently, Canada and the U.S. joined these nations in tracking and tracing the virus.

As of May 19, Canada confirmed two monkeypox cases and said it was investigating more than a dozen suspected cases. The Massachusetts Department of Health also announced a single case in an individual who had recently been in Canada. Several of the Canadian cases have been linked to this person.

On May 18, Scott Pauley, press officer at the Centers for Disease ControlTrusted Source (CDC), told Medical News Today:

“The U.K. notified the U.S. of 8 people in the U.S. who might have been seated near the U.K. traveler when they flew from Nigeria to London [on May 3-4, 2022]. Of these, one is no longer in the U.S., and one was not a contact. The remaining six are being monitored by their respective state health departments. None of these six travel contacts have monkeypox symptoms and their risk of infection is very low.”

The WHO officials have been tracking monkeypox’s path through Europe and North America for several weeks. However, with the data available so far, they do not know long the virus has been spreading.

On May 30, the agency said during a public webinarTrusted Source that while it cannot rule out the risk, it is unlikely the outbreak will turn into a global pandemic.

Monkeypox is a zoonotic virus, which transmits disease from animals to humans. Cases typically occur near tropical rainforests, where animals that carry the virus live.

The monkeypox virus is a member of the orthopoxvirus family. It also has two distinct genetic strains or cladesTrusted Source: the Central African (Congo Basin) clade and the West African clade. The Congo Basin clade is known to spread more easily and cause more severe symptoms.

Monkeypox naturally occurs in Africa, especially in west and central African nations. Cases in the U.S. are rare and associated with international travel from places where the disease is more common.

Monkeypox symptoms and signsTrusted Source include headache, skin rash, fever, body aches, chills, swollen lymph nodes, and exhaustion. It produces symptoms similar to smallpox, but milder.

The time from infection to the onset of symptoms, which is referred to as the incubation period, can range from five to 21 days. The illness typically resolves within two to four weeks.

Severe cases are more common among people with underlying immune deficiencies and young children. In recent times, the case fatality ratioTrusted Source of monkeypox is around 3-6%.

Transmission of the monkeypox virus among humans is limited, but it can happen through close skin contact, air droplets, bodily fluids, and virus-contaminated objects.

Most of the recent cases of monkeypox in the U.K. and Canada have been reported among attendees of sexual health services at health clinics in men who have sex with men.

Regarding this trend, Dr. I. SocĂ© Fall, the regional emergencies director for the WHO’s Health Emergencies Program, cautioned:

“This is new information we need to investigate properly to understand better the dynamic of local transmission in the U.K. and some other countries.”

During a press conference on May 17, Dr. Fall acknowledged that public health officials still have much to learn about the monkeypox virus.

“But the most important thing is we really need to invest in understanding the development of monkeypox because we have so many unknowns in terms of the dynamics of transmission, the clinical features, the epidemiology. In terms of therapeutics and diagnostics also, we still have important gaps,” he said.

WHO experts believe that solutions for monkeypox calls must go beyond addressing the disease.

During the press conference, Dr. Michael RyanTrusted Source, executive director of the WHO’s Health Emergencies Program, said: “[G]etting answers isn’t just about getting answers about the virus. We’ve got to get answers about the hosts, we’ve got to get answers about human behavior and practice, and we’ve got to operate at all levels to try and ensure that human populations are protected.”

For more insight, Medical News Today spoke with Dr. Kartik Cherabuddi, clinical associate professor in infectious diseases and director of the Global Medicine and Antimicrobial Management Program at the University of Florida.

“Being aware of the rash of monkeypox which presents as vesicles is very important. Additional measures include vigilance in those who have traveled in the past 30 days to countries that have reported cases of monkeypox [and] who have contact with a person who is confirmed or suspected of monkeypox.”
— Dr. Kartik Cherabuddi

Dr. Cherabuddi mentioned that smallpox vaccinations offer some protection against monkeypox. He said the Democratic Republic of Congo is currently employing ring vaccinationTrusted Source for close contacts of confirmed cases.

The U.K. is also using ring vaccination, in addition to contact and source tracing, case searching, and local rash-illness surveillance, he added.

Smallpox and monkeypox vaccines

Dr. Cherabuddi believes that more cases will arise in the U.S., but it’s difficult to predict how many.

He said he was concerned that with fewer people in the U.S. having had smallpox vaccinations, this could be putting “a majority of the population below the age of 40-50 years at risk for infection[…]”

Dr. Ryan also noted that preventing the disease may not entirely rest on vaccines. He pointed out that “the protection offered by previous smallpox vaccination also has reduced[…]”

He said there might be a need to change agricultural, social, and food storage practices to prevent further outbreaks. Officials hope to help communities understand how the virus spreads so they can address it at its sources.

Dr. Cherabuddi told MNT that vaccines for monkeypox have also been approved for limited circulation.

“An approved vaccine for monkeypox—MVA-BN—is not widely available. Tecovirimat (TPOXX), as both oral and IV medication is approved in the U.S. for treating smallpox and oral form in Europe to treat cowpox, monkeypox, and smallpox. The FDA also approved brincidofovir (Tembexa) in 2021 to treat smallpox. These medications are not widely available,” he said.

History, cause, and treatment of smallpox.

Many people with smallpox recovered, but the mortality rate was high. About 30%Trusted Source of smallpox cases were fatal. In addition, the disease often left survivors with large areas of scarring and, sometimes, blindness.

Smallpox no longer affects humans because a smallpox vaccine became available. The smallpox vaccine was the first successful vaccine that doctors ever developed, and it represented a significant advancement for modern medicine.

In this article, we look at what smallpox was and who it affected. We also look at the symptoms and treatment of smallpox and explain whether it could come back.

What was smallpox?

Smallpox was a serious contagious disease that affected humans until the late 20th century. Experts do not know where it originated, but — based on the presence of smallpox-like rashes on some ancient Egyptian mummies — they estimate that it existed for about 3,000 yearsTrusted Source.

The variola virus caused smallpox. This virus is a member of the orthopoxvirus family, which also includes cowpox and monkeypox. Historians believe that the first written description of smallpox comes from 4th century China.

Human activities allowed the variola virus to spread to different countries and regions over the centuries. Trade gave it the opportunity to spread to Korea and Japan by the 6th century, while the growth of empires meant that it spread through the Middle East, North Africa, Spain, and Portugal.

The wars known as the Crusades brought smallpox to northern Europe in the 11th century. Colonialism and the slave trade then transported smallpox from Portugal to western Africa, and then across the Atlantic to the Caribbean, North America, and South America. Here, it decimated the populations of Indigenous peoples.

Smallpox was an epidemic, which means that it was a disease that spread quickly over a large geographical area. It was one of the most devastating diseases known to humans.

Monday 30 May 2022

 

       Monkeypox: Small study points to a promising antiviral.

  • In a new study, researchers describe seven cases of monkeypox that occurred in the United Kingdom between 2018 and 2021, the first cases of in-hospital and household transmission outside of Africa.
  • These monkeypox patients received two antiviral medications as treatment, one of which reduced the length of symptoms.
  • All patients made a full recovery following treatment.

The monkeypox virus, which is related to smallpox, is endemic to Central and West Africa. It can cause a range of symptoms including headache, skin lesions, fever, body aches, swollen lymph nodes, and fatigue.

Since the first report of monkeypox in 1970Trusted Source, cases of monkeypox in humans have rarely occurred outside of the African continent. However, since early May 2022, several cases have emerged in Europe, Australia, Canada, and the United States.

Although doctors can reliably identify and diagnose monkeypox, much remains unknown about the virus, including the dynamics of its transmission, the full range of symptoms it causes, and how best to treat it.

In a new clinical study that appears in The Lancet Infectious DiseasesTrusted Source, researchers describe the first cases of in-hospital and household transmission of monkeypox outside of Africa.

They detail the clinical features of the infection and its management, including the use of an antiviral drug that could reduce the length of the contagious period and time of recovery.

The report looks at seven cases of monkeypox occurring in the United Kingdom between 2018 and 2021. In three of these cases, the individuals acquired the virus in the U.K. These represent the first cases of in-hospital and household transmission of monkeypox outside ofAfrica. In the remainder of the cases, the individuals became infected with the virus in Nigeria.

Dr. Nick Price of Guy’s & St Thomas’ NHS Foundation Trust in London, U.K., senior author of the paper, explained the importance of sharing these data:

“Until now, monkeypox has been a rare, imported condition in the U.K. and the NHS [National Health Service] High Consequence Infectious Diseases Network has treated all seven of the U.K.’s confirmed cases until 2021. Outbreaks outside of Africa are unusual but in recent days, significant outbreaks have been reported in several European countries, including the U.K., and further afield globally. Clinical trial data is lacking and we are pleased to share some of our collective experience in managing this previously rare and sporadic condition.”                                               The symptoms described include fever, headache, night sweats, and skin lesions, with complications including deep tissue abscesses, pain, and low mood. However, none of the patients experienced severe complications from the infection, such as lung inflammation or sepsis.

In previous outbreaks, doctors considered patients no longer to be infectious when all their skin lesions had crusted. This study, however, found viral DNA in the respiratory tract of several patients for at least 3 weeks — indicating that they were still infectious after skin lesions had crusted.

This is an important finding, as most cases of monkeypox previously have occurred in parts of the world where PCR testing is not readily available, and so these data had not been available either.  

       Antiviral treatment

The study also trialed the use of two antiviral medicines — brincidofovir and tecovirimat — which doctors have traditionally used to treat smallpox. Tecovirimat is now approved for the treatment of monkeypox in the European Union and the U.S.

Sunday 29 May 2022

 

Through My Eyes: Male eating disorder

About 4 years ago, what may have appeared healthy to others was really my debilitating desire to be as small as possible.                                                                                                 There were many warning signs that my initial attempt to improve my health was turning into something much more sinister. However, I ignored these warning signs. I was too ashamed to admit to what was going on.                                                                                        Now, I want to change that by sharing my story. Namely, I was suffering from an eating disorder.                                                                                                                                            I have always felt unhappy about my body . As I was leaving college to go to university, I wanted to make a change. I was always the “token fat kid” growing up, being the biggest one among my peers. Although I never realized that it bothered me, I always thought my body didn’t look “how it should.”                                                                                                I had grown up with this story, but I didn’t want to be known just as the fat kid anymore. Why would anybody want to be reduced down to how their body looks?                                 So, I started to make changes slowly. I started to move a little more and improve my eating habits — nothing particularly drastic. On reflection, I wouldn’t say I had an eating disorder at this time. However, I definitely had a disordered attitude toward eating and my body. I felt compelled to eat in a way that changed my body and how it looked.                                         As I did this, I began to receive many compliments: “Connor, you’re looking so healthy!,” “You’re looking great!,” “Looking lean, Connor!,” and so on.                                  Truth be told, I began to crave this recognition. I struggled a lot in school, mainly due to learning difficulties that doctors only picked up not long before I went to university. Not only was I the token fat kid, but I was also the one who was intellectually always going to be behind. I never felt I got any credit, but here was something everybody could see and praise me for “achieving.;                                                                                                           I started going to the gym every other day. I would scour the internet for the next “Brutal Bodybuilder Muscle Building Blueprint” or other similar rubbish. I would do this for a week before panicking that I wasn’t looking more “manly” and jumping onto the next program. I did this for a year obsessively, not realizing that I had started going down a path I would later regret.                                                                                                                        I then started to go to the university boxing club. Yes, I wanted to make some new friends, but more importantly, I wanted to carry on this transformation. If people could see me and think, “Hey, look at the ex-fat kid doing the toughest sport around — go him!,” then I’d be satisfied.                                                                                                                            I attended a few times a week. After about 6 months, my coach asked me if I wanted to compete. “Amazing,” I thought to myself. “What an end to this fat kid story I’ve featured in for so long. An actual boxing match! Me! Connor, the fat kid whom everybody pointed out for being big and never gave any credit.”                                                                                       Sadly, from the moment I accepted this match, I changed. I had to lose some weight to meet a weight category requirement that was far below what is healthy for me. However, I was going to do it regardless. I craved the credit, and I was going to get it.                                 To say I was obsessed with food, weight, calories, and so on would be an understatement. I trained multiple times a day, measured every bit of food that I ate, and weighed myself morning and night. Eventually, I weighed myself at every possible opportunity. I started to become disinterested in all other hobbies and activities.   

           I had one thing on my mind: Losing weight

Fast forward a couple of months after starting this new regimen, and I had my boxing match. It was good, but the real fight started after the bout finished. Now that I had no requirement to meet a certain weight, I started to binge on food. Many around me thought it was funny and almost deserved. I had been “good” with my diet for so long that I deserved to indulge.                                                                                                                                           I remember having a panicked feeling the day after my first boxing match and the subsequent bingeing episode. I knew I would gain weight if I didn’t do something about the excess food I had eaten. So I went for a longer run than usual and restricted my food intake even further once I got back. I felt I had to “make up for” the binge.                                        This 1-day solution turned into an all-encompassing way of living. I tumbled to a point where I was restricting extremely all day, exercising compulsively through all the injuries I was picking up, and ending each night in pain from uncontrollable food binges.                      Sadly, none of these warning signs mattered. I had to lose weight and maintain this macho image — there was no choice. Anyway, my boxing club elected me as captain and signed me up for my second boxing match, so I felt, “something must be working, right?”                      Far from it. I was broken inside, unable to think of anything other than the food I was eating little of but craving so intensely. Despite this, I never thought that things could be any different. I was residing in the idea that this pain was my new way of living, even if it would slowly kill me.                                                                                                                                 Then, one day, on a freezing 4 a.m. run in Edinburgh — trying to burn off my “failure” of eating too much the night before — I broke down. I was injured, miserable, and a different person entirely. How did I get to the point where I was so obsessed with how I looked and how people saw me that I was going to such extreme lengths to lose weight?                     

Making a change

Thankfully, I spoke to my friend about what was happening. I didn’t have the words to call it an eating disorder, but I knew something wasn’t right.                                                            I was lucky enough to then speak with my general practitioner [primary care physician] and eventually work with a therapist. I had a great experience with my therapist and now consider myself fully recovered, but that was only possible because I reached out.                       Many men out there are suffering from an eating disorder. However, because of our cultural misunderstandings around how they affect people, many men go without treatment — their struggles unnoticed.                                                                                      These are not just insignificant issues that affect a small minority. Eating disorders are a debilitating experience, but it is possible to overcome them with the right help. Men do experience eating disorders, and I was one of them. By sharing my story, I hope that more people can realize this and intervene with their friends, family, or even themselves.                If you think a man in your life is suffering, please speak with them. And if it is you who is suffering, please reach out. It is a hard conversation, but it is always worth it.

Through My Eyes: Empowering my son to negotiate the 'autism cliff,' enter adult life

Like many parents with young autistic children, my focus suddenly changed when my son received the diagnosis of autism spectrum disorder (ASD). After a long and arduous diagnostic process, I shifted from wondering if he had autism to searching for the services he needed to learn, grow, and manage autism-related challenges. This included in-home therapy, school-based services, and nutritional therapies.                                                                  Because of the time invested in researching and implementing various treatments, and the effort invested in advocating for my son, I didn’t have the mental bandwidth to think too far into the future.                                                                                                                                But as he grew, I realized that even though he had experienced incredible progress throughout his journey, the challenges associated with autism would likely not end when he became a legal adult. This realization made planning for his future a new and urgent priority.   

Like many autistic students in the United States, my son’s educational journey from pre-school to high school graduation was mapped out with an Individualized Educational Program (IEP). An IEP is a legally binding document developed and instituted when a child meets the public school’s criteria for specialized education.    This document outlines the child’s needs and designs an educational program to meet those needs best, whether through speech and language therapy, occupational therapy, or the addition of support people like paraprofessionals to assist the child throughout the day.                                                               With an IEP in place, a child’s educational journey does not have to end at 18. Instead, the young person and their parents can decide to continue attending school up to age 21.              This 18–21 period is considered one of “transitions”— and is designed to shift the young person from educational-centered to adult-oriented learning. Much of this includes teaching independent living and job skills. In the United States, statistics suggest that 500,000 young adults with autism will transition into adulthood over the next 5 years. Unfortunately, many schools don’t have the resources to develop transitions programs that fully address the needs of autistic students entering the adult world.

Building a bridge over the ‘autism cliff’

When faced with a sudden reduction or loss of services, parents of autistic children must build a bridge over that gap. And they may not always have the information and resources needed to construct it, which leaves them unsure about what to do next.

Fortunately, my son’s experience has been different due to the charter school for autism he attends. His school, Lakeland STAR School/Academy, was created in 2018 by a group of dedicated parents, educational professionals, and community members and supported by generous donors. STAR serves diverse learners in grades 7–12 and has a transitions-focused curriculum.

However, because autism ratesTrusted Source continue to rise, the school has seen tremendous growth. As space to enroll new students became limited, a need for a separate transitions program emerged.

To address this need, Lakeland STAR is now developing a transitions center with the help of community-based organizations, including Aspirus Health, Lakeland Union High School (LUHS), the Howard Young Foundation (HYF), and the HYF Women’s Legacy Council.

Scheduled to open in the fall of 2022, the center will offer transitions-based education, including independent living skills, job skills training, and related services. The new center will help my son and other autistic young adults bridge the gap over the autism cliff and into the adult world.

Still, through my experiences, I’ve learned that transitioning is more than just transition programs. It also includes critical legal aspects of becoming an adult regarding healthcare and finances.

Depending on the level of support the young person needs, these legal aspects may include deciding whether to pursue legal guardianship, financial power of attorney (POA), or power of health (POH). In the U.S., a parent must complete these documents before the young adult’s 18th birthday.


Over the years, I’ve heard many parents and caregivers explain the incredible challenges of navigating finances and healthcare after their autistic child reaches adulthood. And this is especially true if there are no legal documents in place that allows parents to have some oversight in their child’s decision-making after they turn 18.

Legal documents may be necessary because autism often affects executive functioning, expressive and receptive language skills, and social skills — leading to unforeseen challenges in the adult world.

For example, executive functioning challenges may make it difficult for an autistic person to organize their finances and pay bills on time. This could lead to loss of housing or referrals to debt collection agencies.

Autistic individuals may also have a higher risk of exploitation and victimization from others due to social difficulties. Because of this, they could experience fraud or other financial abuse without essential legal safeguards in place.

Additionally, expressive and receptive language challenges could lead to miscommunication with authorities, resulting in unwarranted legal issues.

Challenges with healthcare can also occur. For instance, in the U.S., medical professionals cannot discuss an adult’s medical situation with parents or caregivers without guardianship or active power of attorney for healthcare. So, an autistic person may not have the support they need in a medical emergency.

Although autistic adults who need minimal support can often handle many aspects of adult life on their own, it’s not always easy to determine this by the time they turn 18. Therefore, it’s often in the child’s best interest to establish legal documents until support people can fully understand the young person’s abilities.

For some parents in the U.S., especially those who support an autistic child with significant verbal communication challenges, guardianship is the answer to this legal dilemma. However, obtaining this level of legal oversight can be a complicated process.

Often, you need a medical professional to declare that the autistic young person is unable to make their own decisions and then go through a detailed court process.

In addition, becoming your child’s guardian involves managing their finances and medical needs as a separate individual. Other parents have told me that managing guardianship is like a full-time job, but most consider it a labor of love.

Still, for many autistic adults, an active power of attorney for healthcare and finances is adequate because it allows some oversight on decisions yet leaves individuality and decision-making intact. These documents are drawn up by a lawyer and signed by the autistic person soon after reaching the age of 18.

In my son’s situation, although he needs minimal support, he was welcoming of the idea of giving his father and myself the ability to assist him financially and medically when required.

This acceptance of help may be partly due to his self-awareness — something that began evolving soon after I was transparent with him about his diagnosis at a young age. I believe this knowledge has helped him understand himself better and more easily identify areas in his life where he may need more assistance.  

Autistic individuals have many strengths that make employment or attending college more than possible. Still, research from 2017 suggests that about 38%Trusted Source of autistic adults are unemployed. In addition, estimates indicate that only 17%Trusted Source of autistic students graduating from high school attend a 4-year university.

Still, a transitions program can help increase employment and post-secondary attendance for autistic individuals.

In my son’s situation, his school has helped by searching out job experiences in the community. However, these job experiences are slightly different than a typical employment experience.

For example, the employer is aware their new employee has ASD and will make accommodations to support their needs. In other cases, a job mentor will accompany the autistic employee when they start their job and slowly withdraw support as needed.

Source - Medical News Today