Pestilence on the Move: Monkeypox May Spread Before Symptoms Appear, a Study Suggests. From the Start of the Global Monkeypox Outbreak, Researchers Have Hoped That People Could Only Spread the Virus Once They Developed Symptoms. Not True!

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According to NBC New York, two monkeypox-related deaths were reported in New York City on Friday, the first in the five boroughs. Aside from stating that the victims were "immune compromised" and had "underlying health conditions," little information was released, with officials instead offering a short word of condolence.

A study published Wednesday in The BMJ by the UK's Health Security Agency reveals that pre-symptomatic transmission is conceivable, and may even be prevalent — a discovery that could make it impossible to completely remove new cases or prevent future outbreaks.

From May 6 to August 1, researchers investigated over 2,700 monkeypox patients in the United Kingdom. Thirteen of those cases were linked to the people who were infected, according to the study. Ten pairs demonstrated pre-symptomatic transmission, which means the first patient passed the virus to the second before the first became ill or acquired lesions.

Researchers calculated that 53% of monkeypox infections could spread pre-symptomatically using models. According to the experts, the virus can be spread up to four days before symptoms appear.

Monkeypox symptoms can include fever, chills, swollen lymph nodes, headaches, muscle aches, back pain, and exhaustion, in addition to painful lesions.

The research is the first to show that poxviruses, which include monkeypox and smallpox, can spread in this way. Previous study revealed that monkeypox might be transmitted asymptomatically and pre-symptomatically, but only symptomatic transmission had been documented.

"There is still work to be done to understand pre-symptomatic and asymptomatic infections and what that can indicate for future policies and management of the monkeypox outbreak," Dr. Nachi Arunachalam, the Health Security Agency's monkeypox incident director, said in a statement.

According to Dr. Esther Freeman, director of global health dermatology at Massachusetts General Hospital and Harvard Medical School, 53% of pre-symptomatic transmission may be the upper limit. Because monkeypox lesions aren't always easy to spot, some people may wrongly claim that they're symptom-free, she said in an editorial published alongside the findings on Wednesday. The lesions begin as lumps that mimic ingrown hairs and progress to fluid-filled blisters that resemble chickenpox, syphilis, or herpes.

"We see a significant number of patients with fewer than five lesions." "I believe it is conceivable to miss it," Freeman admitted. Nonetheless, the study from the United Kingdom "raises the possibility that there may be more pre-symptomatic transmission going on than we believed," she added.

The findings also suggest that simply separating persons who develop symptoms will not prevent some occurrences. According to Freeman, the research supports expanding vaccination eligibility in the United States, providing that more doses become available and high-risk individuals in other nations can also be vaccinated.

"The fact that there can be pre-symptomatic transmission makes our chances of entirely eliminating this virus less likely," Freeman added.

However, the present outbreak appears to be coming to an end. Since their high on August 7, average daily cases in the United States have dropped 93%. On Oct. 26, the United States recorded 30 daily instances on average. Cases have also decreased in the United Kingdom and the European Union since July.

Several mysteries remain.
Monkeypox has been acting strangely during the last few months. The virus spreads mostly through close sexual contact, with the majority of cases happening among men who have sex with men. People were exposed during previous epidemics by contact with infected wildlife, the interchange of respiratory droplets in household or health care settings, or contact with contaminated things such as clothing or bedding.

Many studies have discovered the virus in sperm since the current outbreak began in May, and New York state recently categorized monkeypox as a sexually transmitted infection to increase access to testing, treatment, and immunization.

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"There's been a lot of discussion about the potential for truly sexual transmission versus what we call transmission during sex," said Dr. Wafaa El-Sadr, a Columbia University professor of epidemiology and medicine. "Until we have conclusive confirmation, we would always advise individuals to think sexual transmission is possible."

Scientists also need to learn more about how frequently patients get symptoms in the first place. In October, French researchers discovered 11 asymptomatic cases of monkeypox, as well as two persons who tested positive before developing symptoms. In total, those patients accounted for around 6% of the monkeypox cases in the research. Researchers in Belgium discovered three asymptomatic cases among four persons who tested positive for monkeypox a month earlier.

"It's extremely possible that the individual, even if they don't have signs of those lesions, has been shedding the virus without even recognizing it," El-Sadr added.

To be successful, the monkeypox vaccination must be given before symptoms appear, ideally within four days of virus contact. The United States is currently providing vaccines to males who have sex with men, transgender and nonbinary people who have several sex partners or have recently been diagnosed with sexually transmitted diseases, as well as people who have had sex at bathhouses, sex clubs, or sex parties. The United Kingdom has identical vaccination guidelines, but it additionally vaccinates health care personnel who care for monkeypox patients.

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El-Sadr believes the United States' vaccine policy will be sufficient to halt the country's outbreak, however some believe complete eradication of the virus is doubtful.

With this new discovery of pre-symptomatic spread, Freeman believes it may be hard to reach zero cases. Monkeypox may spread before symptoms occur, according to a new study.

From the beginning of the global monkeypox pandemic, researchers hoped that people could only transfer the virus once they exhibited symptoms, but this was not the case.