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Published June 24, 2022 | Version v1
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Monkeypox Virus Outbreaks and Poxvirus Infections: Transmission Routes and Epidemiological Characteristics

  • 1. Medical Microbiology Laboratory, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Türkiye.
  • 2. Department of Medical Microbiology, Gulhane Medical Faculty, University of Health Sciences, Ankara, Türkiye.

Description

Özet

İnsanlık tarihinde ortak mücadele ile ulaşılan bir başarı öyküsü olan çiçek virusunun eradikasyonu büyük bir tehdidi ortadan kaldırırken, etkenin (variola virus) zoonotik orijinli olmaması en önemli avantajdı. Dünya genelinde çiçek enfeksiyonlarının artık görülmüyor olması ve kapsamlı aşılama programlarının sonlandırılması küresel ortopoksvirus bağışıklığının her geçen gün azalmasına yol açmıştır. Dünya genelinde bağışık olmayan (poksviruslar için) bireylerin ve immünyetmezlikli (genel) hasta sayılarının giderek artıyor olması yeni riskleri de beraberinde getirmektedir. Çiçek hastalığına göre insanlarda daha hafif enfeksiyonlara neden olduğu bilinen maymun çiçeği virusunun (monkeypox virus, MPXV) pandemi potansiyeli olan 10 enfeksiyöz etkenden biri olarak görülmesi ve yayılım alanının genişleyebileceğine dair öngörüler, virüsün 2022 yılında neden olduğu salgının ardından dünya gündemine yerleşmesi ile gerçeklik kazanmıştır. Son birkaç yıl içerisinde yeni geliştirilen antiviral ilaçların ve aşıların onay alması, bazı ülkelerin bu değişime hazırlık yaptığını göstermektedir. Sağlık otoritelerince, MPXV enfeksiyonlarının insanlar arasında yayılım hızının düşük olduğu ve yeni bir pandemi riskinin söz konusu olmadığı ilan edilmiş olsa da, enfeksiyonun bulaş ve yayılma paternindeki değişikliklerin virüsü Afrika kıtasının dışına taşıması gerçeği, virüsün evcil hayvanlar aracılığı ile doğal yaşamdaki potansiyel rezervuar hayvanlara aktarılması ile kıta dışında yeni endemisite bölgelerinin oluşabileceğini göstermekte ve endişe kaynağı olmaya devam etmektedir. MPXV enfeksiyonlarının, bağışıklığı baskılanmış popülasyonlarda uzun bulaş zincirleri ile aktarılma olasılığı ise bir diğer önemli risk olarak değerlendirilmektedir. Artan vakaların büyüyen bir salgına dönüşme riski ve potansiyel biyogüvenlik tehditleri, koruyucu aşı ve tedavide kullanılacak antiviral ilaçların üretim, saklanma ve erişilebilirliği ile ilgili kaygıları da gündeme getirmiştir. Son MPXV salgınında gözlemlenen olağandışı insandan insana bulaş hızı, virüsün endemik bölgelerle bağlantılı olmaksızın çok sayıda ülkeye yayılımı ve diğer halk sağlığı riskleri dikkate alındığında, MPXV ve diğer poksvirus ilişkili insan ve hayvan enfeksiyonlarının izlenmesi, risk altındaki popülasyonun ve sağlık çalışanlarının bilgilendirilmesi ve diğer önleyici faaliyetlerin önemi açıkça görülmektedir.

Abstract

While the eradication of smallpox virus, which is a success story achieved through a common struggle in human history, eliminated a major threat, the most important advantage was that the agent (variola virus) was not of zoonotic origin. The absence of smallpox infections around the world and the termination of extensive vaccination programs have led to a decrease in global orthopoxvirus immunity day by day. The increasing number of non-immune (for poxviruses) individuals and immunocompromised (general) patients around the world brings along new risks. The predictions that monkeypox virus (MPXV), which is known to cause milder infections in humans compared to smallpox, is seen as one of the 10 infectious agents with pandemic potential, and its spread area may expand, became a reality with the virus placed on the world agenda with the last epidemic in 2022. The approval of newly developed antiviral drugs and vaccines in the last few years shows that some countries are preparing for this change. Although it has been declared by the health authorities that MPXV infections have a low rate of spread among humans and that there is no risk of a new pandemic, the fact that changes in the transmission and spread pattern of the infection carried the virus out of the African continent indicates that new endemic areas may be occur outside the continent, via transmission of the virus from domestic animals to potential reservoir animals in the wild life, continues to be a cause for concern. The spreading possibility of MPXV infections by long transmission chains in immunocompromised populations is considered as another important risk. The risk of increasing cases turning into a growing epidemic and potential biosecurity threats have also raised concerns about the production, storage, and accessibility of preventive vaccines and antiviral drugs to be used in treatment. Considering the unusual rate of human-to-human transmission observed in the recent MPXV outbreak, the spreading of the virus to multiple countries unrelated to endemic areas, and other public health risks; the importance of monitoring MPXV and other poxvirus-related human and animal infections, informing the population at risk and health care workers, and other preventive activities is clearly apparent.

Notes

Maymun Çiçeği Virusu Salgınları ve Poksvirus Enfeksiyonları: Bulaşma Yolları ve Epidemiyolojik Özellikler

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