Monkeypox is not a new disease, and in some African countries it is endemic. However, the international outbreak which began in May 2022, has prompted the World Health Organization (WHO) to declare a global health emergency. Here are some of the important things to know about monkeypox.
What is Monkeypox?
Monkeypox got its name in 1958, when it was detected in several laboratory apes. It is a zoonotic viral disease, which means it can be transmitted from animals to humans. It can also pass from human to human.
Human monkeypox was first identified in 1970 in the Democratic Republic of the Congo (DRC) in a 9-month-old boy, in a region where smallpox (a close relative) had been eliminated in 1968.
Symptoms are similar to those seen, in the past, in smallpox patients, but it is clinically less severe (smallpox was eradicated worldwide in 1980). In 2003, the first Monkeypox outbreak outside Africa was reported in the United States and was linked to contact with infected pet prairie dogs.
Despite the name, most of the animals susceptible to contracting the disease, and then infecting people, are rodents, such as Gambian giant rats, dormice, or tree squirrels.
Where is it typically found?
Monkeypox is most found in the rain forests of central and western Africa, where animals that can carry the virus are native, and the disease is endemic. In these countries, it is increasingly appearing in urban areas.
On occasion, it can also be found elsewhere, in people who could have been infected after visiting these countries.
What are the symptoms?
Symptoms usually include fever, severe headache, muscle aches, back pain, low energy, swollen lymph nodes, and skin rashes or lesions.
The rash usually begins on the first or third day of the onset of fever. The lesions may be flat or slightly raised, filled with clear or yellowish fluid, then crust over, dry up, and fall off.
The number of lesions varies, from a few to several thousand. The rash tends to appear on the face, the palms of the hands, and the soles of the feet. They can also be found in the mouth, genitals, and eyes.
Can people die from monkeypox?
In most cases, the symptoms of Monkeypox go away on their own within a few weeks but, in between three and six per cent of cases reported in countries where it is endemic, it can lead to medical complications and even death. New-born babies, children, and people with immune system deficiencies may be at risk of more severe symptoms and death from the disease.
In severe cases, symptoms include skin infections, pneumonia, confusion, and eye infections that can lead to vision loss.
Many of the fatal cases are children or people who may have other health conditions.
How is monkeypox transmitted from animals to humans?
The virus can be spread to people when they come into physical contact with infected animals, which include rodents and primates.
The risk of contracting it from animals can be reduced by avoiding unprotected contact with wild animals, especially those that are sick or dead (including contact with their flesh and blood).
It is crucial to stress that any food containing meat or animal parts should be cooked, especially in countries where Monkeypox is endemic.
How is it spread from person to person?
The virus is spread through physical contact with someone who has symptoms. Rashes, body fluids (such as fluids, pus, or blood from skin lesions), and scabs are particularly infectious.
Ulcers, lesions or sores can also be infectious since the virus can be spread through saliva. Contact with objects that have been in contact with the infected person – such as clothing, bedding, towels – or objects such as eating utensils can also represent a source of infection.
People who have the disease are contagious while they have symptoms (usually within the first two to four weeks). It is not clear whether or not people who are asymptomatic can transmit the disease.
Who is at risk of getting it?
Anyone who comes into physical contact with someone with symptoms or an infected animal, is at increased risk of infection.
Those who live with infected people have a high risk of infection. Health workers, by the very nature of their job, are at risk of exposure.
Children are often more likely to have severe symptoms than teens and adults.
The virus can also be transmitted from a pregnant woman to the foetus through the placenta, or through contact of an infected parent with the child, during or after delivery, through skin-to-skin contact.
How can I protect myself and others?
You can reduce the risk of contagion by limiting contact with people who suspect they have the disease, or are confirmed cases.
Those who live with infected people should encourage them to self-isolate and, if possible, cover any breaks in the skin (for example, by wearing clothing over the rash).
It is important to wear a face mask when in close proximity to the infected person, especially if they are coughing or have mouth sores, and when touching the clothing or bedding of an infected person. Avoid skin-to-skin contact by wearing disposable gloves.
Wash your hands frequently with soap and water or use an alcohol-based hand sanitizer, especially after coming into contact with the infected person, with their clothing (including sheets and towels), or touching other items or surfaces (such as utensils or dishes) that may have come into contact with rashes or respiratory secretions.
Clean and disinfect any contaminated surfaces and dispose of contaminated waste (such as dressings) properly, and wash the infected person’s clothing, towels, sheets, and eating utensils with warm water and detergent.
What should I do if I suspect that I have been infected?
If you think your symptoms might be related to Monkeypox, or if you have had close contact with someone who has these symptoms, or suspects that there is a possibility of being infected, notify your doctor immediately.
If possible, isolate yourself and avoid close contact with other people. Wash your hands frequently and follow the steps listed above to protect others from contagion. Your doctor, or other health professional, should take a sample for testing so you can get the right care.
Symptoms usually last two to four weeks and go away on their own without treatment.
Is there a vaccine?
There are several vaccines, developed for the prevention of smallpox that also provide some protection.
A smallpox vaccine (MVA-BN, also known as Imvamune, Imvanex, or Jynneos) was recently developed and approved in 2019 for use in preventing Monkeypox but it is not yet widely available.
The World Health Organization (WHO) is working with the manufacturer of the vaccine to improve access to it. People who have been vaccinated against smallpox in the past, will also have some protection.
Is there any treatment?
Symptoms often go away on their own without the need for treatment. It is important to care for the rash by letting it dry if possible or cover it with a moist bandage if necessary to protect the area.
Avoid touching any eye or mouth sores. Mouthwashes and eye drops can be used as long as products containing cortisone are avoided.
For severe cases, an antiviral agent known as tecovirimat, that was developed for smallpox, was licensed by the European Medicines Agency (EMA) for Monkeypox in 2022, based on data in animal and human studies. It is not yet widely available.
What do we know about the current outbreak?
In May 2022, cases were reported in more than 10 countries in non-endemic areas. Additional cases are being investigated. You can find the latest information on case numbers from the WHO here.
As of May 2022, there is no clear link between reported cases and travel from endemic countries, and no link to infected animals.
Studies are also underway in affected countries to determine the source of infection for each identified case and to provide medical care and limit further spread.
The WHO is working with all affected countries to improve surveillance and provide guidance on how to stop the spread and how to care for those who are infected.
Is there a risk that it will turn into a bigger outbreak?
Monkeypox is generally not considered highly contagious because it requires close physical contact with someone who is contagious (for example, skin-to-skin). The risk to the public is low.
However, the WHO is responding to this outbreak as a high priority to prevent further spread; for many years Monkeypox has been considered a priority pathogen. Identifying how the virus is spreading and protecting more people from becoming infected is a priority for the UN agency
Raising awareness of this new situation will help stop further transmission.
Is monkeypox a sexually transmitted infection?
The condition can be spread from one person to another through close physical contact, including sexual contact. However, it is currently unknown whether it can be spread through sexual transmission (for example, through semen or vaginal fluids). However, direct skin-to-skin contact with lesions during sexual activities can spread the virus.
Rashes can sometimes appear on the genitals and in the mouth, which probably contributes to transmission during sexual contact. Therefore, mouth-to-skin contact could cause transmission when there are lesions in one of these parts.
The rashes can also resemble some sexually transmitted diseases, such as herpes and syphilis. This may explain why several of the cases in the current outbreak have been identified among men seeking care at sexual health clinics.
The risk of becoming infected is not limited to sexually active people or men who have sex with men. Anyone who has close physical contact with someone who is contagious is at risk.
WHO response to stigmatizing messages circulating online?
Messages that stigmatize certain groups of people around this outbreak have been circulating: the WHO has made it clear that this is unacceptable.
Anyone who has close physical contact of any kind with someone with Monkeypox is at risk, regardless of who they are, what they do, who they choose to have sex with, or any other factor.
The WHO points out that it is inadmissible to stigmatize people because of a disease.
Anyone who has been infected, or who is helping care for people who are unwell, should be supported: stigma is likely to only make things worse and slow efforts to end the outbreak.
HL7 FHIR, the Future of Health Information Exchange?
Health Level 7 International is an association that calls itself a non profit organization, ANSI-accredited standards developing organization devoted to creating a thorough structure and standards set for the exchange, incorporation, sharing, and retrieval of digital health data that endorses clinical practice and the management, delivery, and evaluation of health services.
A next-generation standards framework developed by HL7, FHIR is described as such on the HL7 website. The best aspects of HL7’s v2, v3, and CDA product lines are combined in FHIR, which also makes use of the most recent web standards and places a strong emphasis on implementation.
Do you wonder what’s the difference between HL7 and FHIR? The core development technologies are the fundamental distinction between HL7 and FHIR. FHIR depends on open web technologies like JSON and RDF data formats as well as RESTful web services. FHIR reduces the learning curve for developers because they are already familiar with these technologies, allowing them to start working more immediately.
FHIR is essentially an effective mechanism for healthcare professionals to communicate data about patients in a range of settings, including in-patient, ambulatory, acute, long-term, community, allied health, etc. The implementation of FHIR through its Resources is the aspect of it that matters the most to providers. The resources are comparable to “paper ‘forms’ indicating various types of medical and administrative data that can be gathered and shared,” as stated on their website. Each Resource or “form” is assigned a template by FHIR.
Data was locked in proprietary structures for many years. Providers, payers, and patients frequently had to revert to outdated, time-consuming techniques to transmit information, such as faxing chart notes or physically transferring paper-based records. Or systems had to transmit whole papers to answer a doctor’s demand for specific health information. Doctors have to search through entire paperwork to find a single piece of information, which drains them and takes lots of time. Luckily, each Resource can be provided using FHIR without the whole clinical record. This enables a quicker and significantly more effective interchange of health information.
Sharing data is made easier, implementation is greatly simplified, and mobile apps are support FHIR better. Additionally, it provides crucial use cases that are advantageous to patients, payers, and providers.
To expedite decision-making, physicians can exchange patient data more effectively among teams. Medical data can be added to claims data by insurance companies to enhance risk assessment, reduce costs, and enhance outcomes. Additionally, patients can have more influence over their health by getting access to medical data via user-friendly apps that operate on smartphones, tablets, and wearables.
Although FHIR differs from earlier standards in numerous ways, there are two fundamental distinctions that make it so remarkable:
Security: TLS/SSL encryption is necessary for any production health data exchanged over FHIR. This makes it significantly safer than earlier HL7 standards.
Resources: FHIR makes use of uniform data components and formats, also referred to as “Resources.” The lowest feasible transactional unit in FHIR is a Resource, which provides significant data through a known identity.
FHIR can be used in a wide range of situations, such as mobile apps, cloud communications, data sharing based on electronic health records, server communication in large institutional healthcare providers, and more. Open source, cost-free, scalable, and adaptable summarize FHIR.
Time to address mental health issues in the workplace
With an estimated 12 billion workdays lost annually due to depression and anxiety, costing the global economy nearly $1 trillion, more action is needed to tackle mental health issues at work, the World Health Organization (WHO) and the International Labour Organization (ILO) said on Wednesday. The UN agencies have launched two publications which aim to prevent negative work situations and cultures while also offering mental health protection and support for employees.
Performance and productivity affected
“It’s time to focus on the detrimental effect work can have on our mental health,” said Tedros Adhanom Ghebreyesus, Director-General at WHO, which has issued global guidelines on the issue.
“The well-being of the individual is reason enough to act, but poor mental health can also have a debilitating impact on a person’s performance and productivity.”
The WHO guidelines contain actions to tackle risks to mental health at work such as heavy workloads, negative behaviours, and other factors that can create distress.
For the first time, the UN health agency recommends manager training, to build their capacity to prevent stressful work environments and respond to workers’ needs.
A workplace taboo
WHO’s World Mental Health Report, published in June, revealed that of one billion people estimated to be living with a mental disorder in 2019, 15 per cent of working-age adults experienced a mental disorder.
The workplace amplifies wider societal issues that negatively affect mental health, including discrimination and inequality, the agency said.
Bullying and psychological violence, also known as “mobbing,” is a key complaint of workplace harassment that has a negative impact on mental health. However, discussing or disclosing mental health remains a taboo in work settings globally.
The guidelines also recommend better ways to accommodate the needs of workers with mental health conditions and proposes interventions that support their return to work.
They also outline measures to ease entry into the jobs market, for those workers with severe mental health conditions.
Importantly, the guidelines call for interventions for the protection of health, humanitarian, and emergency workers.
The objective is to support the prevention of mental health risks, protect and promote mental health at work, and support those with mental health conditions, so they can participate and thrive at work.
“As people spend a large proportion of their lives in work – a safe and healthy working environment is critical,” said, Guy Ryder, the ILO Director-General.
“We need to invest to build a culture of prevention around mental health at work, reshape the work environment to stop stigma and social exclusion, and ensure employees with mental health conditions feel protected and supported.”
Lack of national programmes
However, only 35 per cent of countries reported having national programmes for work-related mental health promotion and prevention.
The crisis exposed how unprepared governments were for its impact on mental health, as well as a chronic global shortage of mental health resources.
In 2020, governments worldwide spent an average of just two per cent of health budgets on mental health, with lower-middle income countries allocating less than one per cent.
A good night’s sleep is a tonic to remember
BY ANTHONY KING
Everyone suffers restless nights from time to time. Chewing over failures or worries at the end of the day undermines rest, especially deep sleep. ‘A ruffled mind makes a restless pillow,’ wrote author Charlotte Brontë.
A good night’s sleep serves as a tonic. What’s more, it is long recognised that shuteye gives learning and memory a boost. More recently, scientists revealed that the early phase of deep slow-wave sleep is especially important.
‘When you learn something in the evening, that information becomes reactivated during sleep,’ said Dr Bjoern Rasch, who took part in the Horizon-funded MemoSleep project and is a professor at the University of Fribourg.
The Swiss researcher added that ‘Ruminations and negative thoughts increase our awakenings during sleep, make us wake earlier than we want and make us sleep less deeply.’
But there is good news too. Positive thoughts can also be reactivated in brain circuits and, in the process, improve sleep, according to Dr Rasch. He organized an experiment around the whole idea.
His test was a small boon to students in his university who received 50 Swiss francs (EUR 52) for every night they spent snoozing in a comfortable four-bed sleeping laboratory.
The students were connected to an electroencephalogram that monitored their brain waves. They also had their muscles monitored to record when they fell into slumber and what sleep-state they were in.
Some relaxation strategies allow people to fall asleep faster, but don’t change the quality of sleep afterwards, according to Dr Rasch. He played hypnotic tapes with imagery such as a fish swimming in deep water, and with words suggestive of safety and relaxation, for the students.
‘The subjects spent more time in the deeper slow-wave sleep stage after listening to the hypnotic tape,’ said Dr Rasch. ‘We would explain this by an increased reactivation of relaxing and reassuring thoughts during sleep, heard previously during the hypnosis tape.’
In future studies, Dr Rasch hopes to help patients who suffer from insomnia.
‘It could not only help them fall asleep but could actually make their sleep more restful,’ he said. Furthermore, this could aid people with psychological illnesses, such as post-traumatic stress disorder, who sleep poorly.
Seahorses and learning
The seahorse-shaped part of the brain called the hippocampus (from the Greek word for seahorse) is especially important for learning and memory. Scientists often use rodents to investigate their hippocampus in learning and sleep.
Rats, for example, are masters at remembering paths through mazes to find foods. The hippocampus is key to this recall.
Dr Juan Ramirez-Villegas uses rodents to probe how mammalian brains store memories – work that could eventually contribute to fighting human illnesses such as Alzheimer’s.
As part of the Horizon-funded DREAM project, he discovered that another part of the brain – the brainstem – plays a crucial role along with the hippocampus and becomes active beforehand.
‘It seems like the brainstem is setting up some scenery so that the hippocampus can reactivate memories across different stages of sleep,’ said Dr Ramirez-Villegas, who is a postdoctoral fellow at the Institute of Science and Technology Austria.
He has attached electrodes to record activity in the brains of rats as they navigate a maze and afterwards as they sleep. Sleeping allows the brain to replay daytime events and etch them as long-term memories.
‘It is very striking that the cells fire in the same order during sleep that they did during learning, but they are more compressed in time during sleep,’ said Dr Ramirez-Villegas.
How we remember
The discovery was surprising because it suggests that the brainstem has an overlooked function in stimulating and changing memory formation. This seems to be true for rodents as much as for primates and, as a result, is likely to be a basic mechanism of the brains of mammals, including people.
The research, while crucial to understanding the basic operation of the brain, could have clinical benefits too. ‘We are untangling the basic principles of memory processes, but we can also use these to ameliorate the effects of memory-related illnesses,’ said Dr Ramirez-Villegas.
The research in this article was funded via the EU’s European Research Council and the Marie Skłodowska-Curie Actions (MSCA). This article was originally published in Horizon, the EU Research and Innovation Magazine.
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