Hello World : WHO ; Drug resistance for HIV

 

Overview HIV

Antiretroviral therapy (ART), which has helped tens of millions of individuals living with HIV/AIDS, has seen an unparalleled rise in use over the past ten years. Out of an estimated 37.7 million persons living with HIV, 27.5 million were receiving ART globally as of the end of 2020.

The evolution of HIV treatment resistance, whose levels have gradually risen in recent years, has coincided with growing usage of HIV medications.

HIV genetic mutations that affect a treatment's capacity to stop the virus from replicating are what lead to HIV drug resistance. Due to the advent of drug-resistant viruses, all antiretroviral medications, even those from more recent pharmacological classes, run the danger of going partially or completely inactive. HIV drug resistance puts the effectiveness of HIV medications in jeopardy if it is not prevented, leading to a rise in HIV infections and HIV-related morbidity and mortality.

Size of the issue

HIV medication resistance monitoring gives nations data they can utilize to improve patient and population-level treatment outcomes. WHO recommends that nations regularly carry out surveys on HIV drug resistance in various populations, including adults, kids, and teenagers.

The implementation of nationally representative surveys in low- and middle-income countries, as well as the formulation of national action plans to prevent, monitor, and address HIV drug resistance, have advanced significantly, according to the WHO's Report on HIV Drug Resistance 2021. As of 2021, national action plans had been created in 64% of the nations with a high prevalence of HIV. 34 nations intend to carry out HIV drug resistance surveys during the next two years. Between 2004 and 2021, 66 countries implemented surveys of HIV drug resistance using WHO-recommended standard procedures.

HIV medication resistance during pretreatment

Some individuals already exhibit drug resistance before starting treatment. This resistance may be developed during prior treatments or transmitted at the time of infection, as in the case of women who use antiretroviral medication to stop HIV from being passed from mother to child.

In order to make the best choice of first-line regimens, WHO advises monitoring HIV medication resistance in adults starting or restarting ART as well as in treatment-naive newborns starting ART.

When initiating HIV treatment, up to 10% of individuals may have medication resistance to the NNRTI drug class. People who have previously taken antiretroviral medications are up to three times more likely to develop pretreatment NNRTI resistance. Children under the age of 18 months who have just been diagnosed with HIV have a high prevalence of drug-resistant HIV. According to surveys done in ten sub-Saharan African nations between 2012 and 2020, over half of babies with newly discovered HIV already had NNRTI-resistant virus.

The urgency of accelerating the switch to the dolutegravir-based treatments advised by the WHO is highlighted by the global incidence of NNRTI resistance in both adults and newborns.

acquired medication resistance to HIV

The purpose of HIV treatment, viral load suppression, is to avoid the development of HIV medication resistance. HIV that has developed treatment resistance is less likely to spread when viral load reduction is attained and maintained. Adults using ART generally had high levels of viral load suppression in 14 nationally representative studies conducted between 2015 and 2020. For people taking first-line ART, the combined outcomes for viral load suppression in Africa were 94% (95% CI 92-96%), and for those receiving second-line ART, they were 84% (95% CI 79-88%). For individuals getting first-line ART in the Americas, the pooled results for viral load suppression were 81% (95% CI 75-87%) and for those receiving second-line ART, they were 70% (95% CI 67-72%).

Some HIV drug resistance is anticipated to develop despite therapy with powerful medications and even when adherence to treatment is encouraged. For the best choice and management of ART regimens, surveillance of acquired HIV drug resistance in people undergoing ART offers valuable information. Resistance to routinely used NNRTIs varied from 50% to 97% among populations that failed NNRTI-based ART.

The high rates of HIV medication resistance to NNRTIs among those who experience treatment failure highlight the need for expanded viral load testing, improved adherence counseling, and rapid therapy switching.

Fortunately, nations are implementing dolutegravir-containing regimens for both adults and children very quickly. It has been demonstrated that dolutegravir-based ART is associated with very high levels of viral load suppression and that patients who fail it do not develop as much acquired resistance. Global statistics on the establishment of HIV resistance to dolutegravir are currently scarce.

According to WHO, nations should regularly monitor the development of HIV medication resistance in adults, kids, and teenagers using ART using either a viral load laboratory-based method or an ART clinic-based method. Depending on the availability of deidentified demographic data and the extent of national viral load testing coverage, a particular strategy may be employed.

Pre-exposure medication for the prevention of HIV

Many people who are at high risk of being exposed to HIV take medications every day to lower their risk of contracting the illness. Oral pre-exposure prophylaxis (PrEP) is advised by the WHO as an alternative HIV preventive option.

People using PrEP are less likely to contract HIV, especially those who take their meds as prescribed. However, medication resistance frequently develops among those who contract HIV despite using PrEP. Due to overlapping antiretroviral medication resistance profiles used for both PrEP and treatment, this may result in fewer alternatives for HIV treatment.

WHO advises that countries carry out nationally representative surveys to track the levels of HIV drug resistance among those beginning treatment, those receiving treatment, and those using PrEP who contract HIV in order to monitor the ongoing efficacy of HIV medications used for both treatment and prevention.

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Dioxins and their effects on human health (WHO : World Health Organization) with I'm World

  

Background

Environmental contaminants include dioxins. They are part of the "dirty dozen," a collection of hazardous substances known as persistent organic pollutants (POPs). Because of their potential to be extremely hazardous, dioxins are a problem. They have an impact on a variety of organs and systems, according to experiments.

Due to their chemical stability and capacity to be absorbed by adipose tissue, where they are then retained in the body, dioxins have a lengthy half-life once they enter the body. They have a 7 to 11-year half-life in the human body. Dioxins frequently build up in the food chain after entering the environment. The concentration of dioxins increases with an animal's position in the food chain.

Tetrachlorodibenzo- 2,3,7,8-dioxin is the chemical name for dioxin (TCDD). The family of chemically and structurally related polychlorinated dibenzo para dioxins (PCDDs) and polychlorinated dibenzofurans is frequently referred to as "dioxins" (PCDFs). The name "dioxins" also refers to a number of PCBs that have hazardous qualities comparable to those of dioxins. There are 419 different types of dioxin-related chemicals known, but only around 30 of them are thought to be harmful in any noticeable way, with TCDD being the most toxic.

sources of contamination with dioxin

Dioxins can also be produced naturally, such as during volcanic eruptions and forest fires, but they are primarily byproducts of industrial operations. Dioxins are undesirable by-products of numerous manufacturing processes, such as smelting, chlorine bleaching of paper pulp, and the production of various herbicides and insecticides. Uncontrolled waste incinerators (solid waste and hospital waste) are frequently the worst offenders when it comes to the release of dioxin into the environment because of incomplete combustion. There is technology that enables reduced dioxin emissions during regulated waste incineration.

Although dioxins are formed locally, their circulation in the environment is worldwide. Environmental sources around the world contain dioxins. The largest concentrations of these substances can be found in certain soils, sediments, and food—particularly dairy, meat, fish, and shellfish. Plants, water, and air all have extremely low quantities.

There are vast collections of used industrial oils containing PCBs, many of which include high concentrations of PCDFs. The wrong handling and long-term storage of this chemical could cause dioxin to leak into the environment and contaminate human and animal food supplies. Waste containing PCBs is difficult to get rid of without contaminating the environment and people. Such materials need to be handled as hazardous trash, and the best way to get rid of them is through burning at high temperatures in specialized facilities.

incidences of dioxin contamination

Many nations keep an eye out for dioxins in their food supply. This has helped to prevent larger-scale effects by allowing for the early detection of contamination. In many cases, contaminated animal feed is the source of dioxin contamination. For instance, cases of elevated dioxin levels in milk or animal feed have been linked to clay, fat, or citrus pulp pellets used in the manufacturing of the animal feed.

There have been more substantial instances of dioxin contamination, with wider ramifications in numerous nations.

When testing of pork contained levels of dioxins up to 200 times the acceptable limit, Ireland ordered the recall of large quantities of swine meat and pork products in late 2008. One of the biggest food recalls due to chemical contamination resulted from this. Ireland's risk analyses revealed no issues with regard to public health. The contaminated feed was the source of the contamination.

Belgian chicken and eggs were found to contain significant amounts of dioxins in 1999. Dioxin-contaminated animal-based foods (poultry, eggs, and pork) were later found in a number of other nations. Animal feed contaminated with improperly disposed of PCB-based waste industrial oil was found to be the root of the problem.

At a chemical factory in Seveso, Italy, a catastrophic accident in 1976 resulted in the emission of significant amounts of dioxins. A 15 square kilometer area containing 37 000 people was eventually poisoned by a cloud of poisonous chemicals, including TCDD.

The long-term human health repercussions of this tragedy are still being investigated extensively in the impacted population.

As a contaminant in some batches of the herbicide Agent Orange, which was employed as a defoliant during the Vietnam War, TCDD has also been thoroughly investigated for potential health consequences. Diabetes and a possible link to some types of cancer are still being researched.

Although all nations may be impacted, the majority of contamination cases have been documented in industrialized nations due to stronger regulatory oversight, appropriate food contamination monitoring, increased public knowledge of the risk, and the ability to detect dioxin issues.

There have also been a few instances of deliberate human poisoning documented. The most noteworthy occurrence occurred in 2004 when Viktor Yushchenko, the president of the Ukraine, had chloracne that left his face disfigured.

Dioxins' effects on human health

Short-term exposure of people to high amounts of dioxins may cause liver dysfunction as well as skin lesions like chloracne and uneven skin discoloration. The immune system, the developing brain system, the endocrine system, and reproductive systems have all been shown to be compromised by long-term exposure.

Dioxin-exposed animals have developed a variety of cancers as a result of chronic exposure. The International Agency for Research on Cancer (IARC) of the WHO reviewed TCDD in 1997 and 2012. IARC designated TCDD as a "known human carcinogen" based on epidemiological and animal research. The risk of developing cancer would be minimal at levels of exposure below TCDD since it has no effect on genetic material.

Because dioxins are everywhere, everyone has some background exposure to them and a certain amount of them in their bodies, which results in the so-called "body burden." On average, it is not anticipated that current background exposure would have an impact on human health. However, efforts must be made to lower the present background exposure because of the high hazardous potential of this family of chemicals.

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Hallo World : understand the AIDS/HIV virus (The human immunodeficiency virus) with I'm World

 The human immunodeficiency virus (HIV) preys on the immune system and erodes people's resistance to a variety of illnesses and cancers that healthy immune systems are better able to combat. Infected individuals eventually lose their immunological capacity as the virus kills and damages immune cells. CD4 cell count is commonly used to assess immune function.

Depending on the individual, acquired immunodeficiency syndrome (AIDS), the most advanced stage of HIV infection, might take many years to manifest. The emergence of certain tumors, infections, or other serious long-term clinical symptoms is what defines AIDS.

Depending on the stage of infection, the symptoms of HIV change. Although those who have HIV are typically most contagious in the first few months after becoming infected, many don't become aware of their condition until much later. People may suffer no symptoms in the first several weeks following first infection or flu-like symptoms, such as fever, headache, rash, or sore throat.

They may also have other signs and symptoms like swollen lymph nodes, weight loss, fever, diarrhea, and cough as the virus gradually weakens the immune system. In addition, they run the risk of contracting life-threatening conditions such as Kaposi's sarcoma and lymphomas, as well as cryptococcal meningitis, severe bacterial infections, and tuberculosis (TB).

Blood, breast milk, semen, and vaginal secretions are just a few of the bodily fluids from infected people that can spread HIV. During pregnancy and delivery, a mother's HIV infection might pass to her kid. Normal daily interactions like kissing, hugging, shaking hands, or sharing of personal items, food, or water do not cause an infection in a person.

It is crucial to remember that HIV-positive individuals who are on ART and have their viral load lowered do not transfer the virus to their sexual partners. Therefore, early access to ART and encouragement to continue treatment are essential not just to improve the health of those living with HIV but also to stop the spread of HIV.

Risk Elements

Individuals are more likely to get HIV if they engage in the following behaviors and conditions:

sharing contaminated needles, syringes, and other injecting equipment and drug solutions when injecting drugs; engaging in condom-free anal or vaginal sex; having another STI like syphilis, herpes, chlamydia, gonorrhoea, and bacterial vaginosis; using harmful alcohol and drug use during sexual activity; receiving unsafe injections, blood transfusions, and medical procedures that involve unsterile instruments;

Diagnostic

Rapid diagnostic assays with immediate findings can be used to diagnose HIV. This makes it much easier to correlate early diagnosis with care and therapy. Self-tests for HIV are another option for people. A confirmatory test must be performed by a certified and trained health or community worker in a community center or clinic because no one test can fully diagnose HIV positivity. Using WHO prequalified assays within a nationally accepted testing strategy and methodology, HIV infection can be found with high accuracy.

The majority of commonly used HIV diagnostic tests look for antibodies that an individual produces as part of their immunological response to combat HIV. People typically produce anti-HIV antibodies within 28 days after infection. People go through a period of time known as the "window period" during which they may have no symptoms of HIV infection and no high enough levels of HIV antibodies have been developed to be detected by routine tests, but they are also at risk of spreading the virus to others. After becoming infected and going without treatment and viral suppression, a person may pass HIV to a partner with whom they engage in sexual activity or drug use, or in the case of pregnant women, to their unborn child while they are nursing.

Prior to beginning lifelong therapy after receiving a positive diagnosis, individuals should be retested to rule out any possible testing or reporting error. When there are doubts regarding the veracity of an HIV patient's diagnosis or when they discontinue medication and care and need to be re-engaged, it is crucial to encourage them in continuing their treatment and to offer counseling messages and services.

While testing for teenagers and adults has become quick and easy, this is not the situation for infants born to mothers who are HIV-positive. Rapid antibody testing is insufficient for detecting HIV infection in children under the age of 18 months; virological testing must be done as early as at birth or at 6 weeks of age. It is now possible to run this test at the point of care and have results the same day, which will hasten the proper linkage to therapy and care.

Treatment

Antiretroviral (ARV) medication combinations can be used in treatment plans to control HIV illness. Antiretroviral therapy (ART) as it is practiced now slows viral replication while allowing an individual's immune system to recover, strengthen, and restore the ability to combat opportunistic infections, some malignancies, and HIV infection.

Since 2016, WHO has advocated Treat All, which calls for all HIV-positive individuals—including children, adolescents, adults, pregnant women, and nursing mothers—to get lifelong ART, regardless of their clinical status or CD4 cell level.

By June 2022, 189 nations had already enacted this suggestion, providing care for 99% of all HIV-positive individuals worldwide. In addition to the Treat All plan, WHO advises a prompt ART introduction for all HIV-positive individuals, including providing ART to those who are prepared to begin treatment the same day as their diagnosis. Nearly two-thirds of the 97 nations that reported adopting this strategy by June 2022 said it had been implemented nationally.

In 2021, 28.7 million HIV-positive individuals received ART globally. In 2021, there was 75% [66-85%] global ART coverage. To scale up treatment, though, additional work is required, especially for kids and teenagers. By the end of 2021, only 52% [42-65%] of youngsters (0-14 years old) were receiving ART.

The HIV response continues to struggle with advanced HIV illness. People who have advanced immune suppression continue to seek medical attention or re-seek it, which increases their risk of contracting opportunistic infections. To lower illness and mortality, WHO is assisting nations in implementing the advanced HIV disease package of care.

Prevention

By reducing their exposure to risk factors, individuals can lower their risk of contracting HIV. The following are important HIV preventive strategies that are frequently combined:

The use of male and female condoms; 

HIV prevention, testing, and counseling; 

voluntary medical male circumcision (VMMC); 

the use of antiretroviral drugs (ARVs) for prevention (oral PrEP and long-acting products), the dapivirine vaginal ring, and injectable long-acting cabotegravir; 

harm reduction for people who inject drugs and use drugs; and the abolition of mother-to-child transmission (MTCT) of HIV.

An essential feature of HIV prevention is expanding access to testing and promoting linkage to ART because HIV cannot be transmitted if a person's sexual partner is virally suppressed on ART.

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Indonesia has confirmed that monkeypox is present (Cacar Monyet), according to the RI Ministry of Health.

  

Kemenkes RI has confirmed that one Indonesian citizen has confirmed having the MONKEYPOX, also known as CACAR MONYET. The person in question is a 27-year-old woman named Pasien who had recently returned from a trip to another country before being arrested.

According to the report, the patient started experiencing symptoms of monkeypox on August 11, 2022, moved into the sole residence of the Kemenkes military on August 18, and had a positive PCR result on August 19.

Dr. Syahril, a juru bicara of the Kementerian Kesehatan RI, stated that the pasien were not sick and were adequately isolated from the outside world. Ia also encourages the populace to maintain their composure in the face of alarmingly high tular and cacar fatality rates relative to Covid-19.

According to a graph, there are currently 39,718 confirmed cases of cacar monyet worldwide, although just 12 people have died, or little under 0.001% of all cases. Additionally, Covid-19's method of transmission for monkeypox is not as straightforward as penularannya via erat-contained droplets.

Gejala cacar monyet is similar to gejala cacar air but is more ring-shaped. Demam, sakit kepala, nyeri otot, and kelelahan continued the gejala. The primary difference between gejala cacar air and cacar monyet is that cacar monyet results in pembengkakan on kelenjar getah bening (limfadenopati), but cacar air does not.

There won't be a tambahan infection or a berat komorbid that can affect the monkeypox's condition, so it will go away on its own and last for 2 to 4 weeks.

As a form of kewaspadaan, Kemenkes has been conducting intense pemantauan in every part of Indonesia, including the udara, laut, and darat. To encourage greater awareness of monkeypox, the Pemerintah has also given instructions to every Indonesian Dinas Kesehatan, every sakit home, and Puskesmas.

A crucial point to keep in mind in the context of pencegahan is the constant practice of a healthy lifestyle (PHBS) as well as the advancement of healthy lifestyle practices such rajin mencuci tangan, drinking alcohol, and using maskers.

Public Information and Communication Agency, Kemenkes RI (Republic of indonesia)

More Information Here.

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Hallo World : WHO launches appeal to respond to urgent health needs in the greater Horn of Africa

 

Millions of lives are in peril, including children. US$ 123.7 million is needed for the health agency’s response until December 2022.

People's lives and health are in danger in the wider Horn of Africa as a result of an unprecedented food crisis. The World Health Organization is today launching a fundraising request for US$ 123.7 million in order to carry out critical, life-saving work.

More than 37.5 million people in the seven countries of the region—Djibouti, Ethiopia, Kenya, Somalia, South Sudan, Sudan, and Uganda—are categorized as being in IPC phase 3, a stage of crisis where people must sell their possessions to buy food for themselves and their families and where malnutrition is rampant. Over 80 million people are estimated to live in food insecurity in these seven countries.

This area has developed into a hunger hotspot due to violence, climatic changes, and the COVID-19 epidemic, with severe effects on the health and lives of its residents.

Dr. Tedros Adhanom Ghebreyesus, Director-General of WHO, stated that hunger "is a direct threat to the health and survival of millions of people in the wider Horn of Africa, but it also weakens the body's defenses and opens the door to disease." In order to address this dual challenge, treat malnourished people, and protect them from infectious diseases, the WHO is looking to the international community for assistance.

The money will be used to take immediate action to save lives, such as strengthening national disease detection and response capabilities, acquiring and ensuring the supply of life-saving medications and equipment, identifying and filling gaps in health care infrastructure, and treating ill and severely malnourished children.

The issue is getting worse as it is anticipated that the upcoming rainy season will fail. Already, there have been instances of preventable infant and maternal fatalities. As violence, especially gender-based violence, is on the rise, there is a greater risk of trauma and injuries. Measles outbreaks are occurring in 6 of the 7 countries, despite low vaccination rates. Countries are battling cholera and meningitis outbreaks at the same time because of deteriorating hygienic conditions, a lack of clean water, and people leaving their homes on foot to obtain food, water, and pasture for their animals.

As more individuals are compelled to flee their countries, the estimated 4.2 million refugees and asylum seekers in the region are anticipated to grow. Communities find it more difficult to receive health care while traveling, a service that is already in short supply as a result of years of underinvestment and violence.

"It's important to make sure everyone has enough to eat. Making sure kids have access to clean water is essential. Access to basic healthcare services is particularly crucial under these circumstances, according to Dr. Michael Ryan, the executive director of the WHO's Health Emergencies Programme. For people caught up in these terrible conditions, services like therapeutic feeding programs, primary healthcare, immunization, safe deliveries, and mother and child services can mean the difference between life and death.

The World Health Organization has already issued $16.5 million from its Contingency Fund for Emergencies to guarantee that people have access to healthcare, to treat malnourished children who are sick, and to stop, identify, and contain infectious disease epidemics.

WHO expresses gratitude to its contributors for making it possible to carry out this vital job.

More Information Here.

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Hallo World : Monkeypox Virus (WHO)

 

 Introduction

While clinically less severe than smallpox, monkeypox is a viral zoonosis (a virus that spreads from animals to people). It has symptoms that are comparable to those of smallpox. Monkeypox has replaced smallpox as the most significant orthopoxvirus for public health since smallpox was eradicated in 1980 and smallpox vaccinations were subsequently discontinued. Primarily affecting central and west Africa, monkeypox has been spreading into cities and is frequently seen close to tropical rainforests. Numerous rodent species and non-human primates serve as hosts for animals.

The pathogen

The Orthopoxvirus genus of the Poxviridae family contains the enclosed double-stranded DNA virus known as the monkeypox virus. The central African (Congo Basin) clade and the west African clade are two separate genetic clades of the monkeypox virus. In the past, the Congo Basin clade was thought to be more contagious and to produce more severe illness. The only nation where both viral clades have been discovered is Cameroon, which serves as the geographic boundary between the two groups.

Natural host of monkeypox virus

The monkeypox virus has been found to be susceptible to several animal species. This comprises non-human primates, dormice, rope and tree squirrels, Gambian pouched rats, and other species. There is still uncertainty about the monkeypox virus's natural history, and further research is required to pinpoint the precise reservoir or reservoirs and understand how the virus circulates in the wild.

Outbreaks

In the Democratic Republic of the Congo, where smallpox had been eradicated in 1968, a 9-month-old boy was the first person to be diagnosed with human monkeypox. Since then, human cases have progressively been recorded from central and west Africa, with the majority of cases coming from the rural, rain forest parts of the Congo Basin, mainly in the Democratic Republic of the Congo.

Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Cote d'Ivoire, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan are the 11 African nations where human cases of monkeypox have been documented since 1970. Unknown is the true cost of monkeypox. For instance, an epidemic with a lower case fatality ratio and a higher attack rate than typical was reported in the Democratic Republic of the Congo in 1996–1997. Monkeypox and chickenpox outbreaks that occurred simultaneously in this instance could be explained by real or apparent modifications in the dynamics of transmission produced by the varicella virus, which is not an orthopoxvirus. Nigeria has had a significant outbreak since 2017, with more than 500 suspected cases and more than 200 confirmed instances and a about 3% case fatality ratio. Cases are still being reported today.

Given that it affects the rest of the world in addition to countries in west and central Africa, monkeypox is a disease of worldwide public health significance. The first monkeypox outbreak outside of Africa occurred in the United States of America in 2003, and contact with pet prairie dogs that had the disease was to blame. These pets had been kept with dormice and pouched rats from Ghana that were imported from the Gambia. Over 70 cases of monkeypox were brought on by this outbreak in the US. Travelers from Nigeria to Israel in September 2018, the UK in September 2018, December 2019, May 2021, and May 2022, Singapore in May 2019, and the United States of America in July and November 2021 have also been reported to have monkeypox. Monkeypox cases were found in a number of non-endemic nations in May 2022. Studies are being conducted right now to learn more about the epidemiology, sources of illness, and patterns of transmission.

Transmission

Direct contact with blood, body fluids, or lesions on the skin or mucous membrane of diseased animals can result in animal-to-human (zoonotic) transmission. Numerous animals, including rope squirrels, tree squirrels, Gambian pouched rats, dormice, various species of monkeys, and others have been reported throughout Africa to have the monkeypox virus. Although rodents are most likely, the natural monkeypox reservoir has not yet been found. A potential risk factor is consuming undercooked meat and other animal products from infected animals. Living in or close to forests can expose people to diseased animals indirectly or at a low level.

Close contact with respiratory secretions, skin sores on an infected person, or recently contaminated objects can cause human-to-human transmission. Health professionals, family members, and other close contacts of current patients are more at risk because droplet respiratory particles typically require extended face-to-face contact. The number of person-to-person infections in a community's longest documented chain of transmission has increased from 6 to 9 in recent years. This might be an indication of a general decline in immunity brought on by the end of smallpox vaccination campaigns. Congenital monkeypox can result through transmission through the placenta, which can also happen during intimate contact during labor and after delivery. Although close physical contact is a known risk factor for transmission, it is not known at this time whether monkeypox can particularly spread through sexual intercourse. Studies are required to comprehend this risk better. 

Signs and symptoms

Monkeypox typically takes 6 to 13 days to incubate, although it can take anything from 5 to 21 days for symptoms to appear.

There are two phases to the infection:

1. the 0–5-day invasion period is marked by fever, severe headache, lymphadenopathy (swelling of the lymph nodes), back pain, myalgia (muscle aches), and severe asthenia (lack of energy). Compared to other diseases that may initially seem similar, monkeypox has a specific characteristic called lymphadenopathy (chickenpox, measles, smallpox).

2. After a fever first appears, the skin eruption often starts one to three days later. Instead of the trunk, the rash is more frequently found on the face and limbs. In 95% of cases, it affects the face, and in 75% of cases, it affects the palms of the hands and the bottoms of the feet. Along with the cornea, oral mucous membranes, genitalia, and conjunctivae are all also impacted in 70% of instances. The progression of the rash goes from macules (flat, firm lesions) to papules (slightly raised, firm lesions), vesicles (clear fluid-filled lesions), pustules (yellowish fluid-filled lesions), and crusts that dry up and break off. Lesions can range in number from a few to several thousand. Lesions may combine in severe situations, causing big chunks of skin to flake off.

Typically, monkeypox is a self-limiting illness with symptoms that last between two and four weeks. Children are more likely to experience severe cases, which are connected to the level of viral exposure, the patient's condition, and the type of problems. The results could be worse if immunological deficits were present. Although smallpox immunization proved protective in the past, people under the age of 40 to 50 (depending on the country) may now be more susceptible to monkeypox due to the worldwide discontinuation of smallpox vaccine campaigns after the illness was eradicated. Monkeypox complications can include secondary infections, bronchopneumonia, sepsis, encephalitis, and corneal infections with subsequent vision loss. It is unknown how widespread an asymptomatic infection might be.

In the general population, the case fatality ratio of monkeypox has traditionally fluctuated from 0 to 11%; it has been higher in young children. The case fatality rate has recently been in the range of 3-6%.

Diagnosis

Other rash disorders, such as chickenpox, measles, bacterial skin infections, scabies, syphilis, and medication-associated allergies, must be taken into account when making a clinical differential diagnosis. During the prodromal stage of the illness, lymphadenopathy can be used as a clinical feature to differentiate monkeypox from chickenpox or smallpox.

Health professionals should get the right sample and arrange for it to be delivered safely to a lab with the right equipment if monkeypox is detected. The kind of laboratory test used and the type and quality of the specimen used determine whether monkeypox is confirmed. As a result, specimens should be sent and handled in line with local, state, and federal regulations. Given its precision and sensitivity, polymerase chain reaction (PCR) is the primary laboratory test. The best diagnostic samples for monkeypox come from skin lesions, such as dry crusts and the liquid that comes from vesicles and pustules. Biopsy is a possibility when it is possible. Lesion samples need to be kept cool and dry in sterile tubes without viral transport media. Because viremia typically lasts for a short time after symptoms start, PCR blood tests are typically inconclusive and shouldn't be routinely obtained from patients.

Antigen and antibody detection techniques do not offer proof of monkeypox-specific infection because orthopoxviruses are serologically cross-reactive. Therefore, in cases where resources are scarce, serology and antigen detection procedures are not advised for diagnosis or case inquiry. Furthermore, recent or distant immunization with a vaccinia-based vaccine (for example, anyone immunized prior to the eradication of smallpox, or more recently due to heightened risk, such as orthopoxvirus laboratory employees) may result in false positive results.

The following patient data must be included with the specimens in order to interpret test results: a) age; b) date of onset of fever; c) date of specimen collection; d) date of current condition of the patient (stage of rash); and e) date of beginning of rash.

Therapeutics

In order to treat monkeypox symptoms effectively, handle complications, and avoid long-term effects, clinical care must be properly optimized. Fluids and food should be provided to patients in order to maintain a healthy nutritional condition. As necessary, secondary bacterial infections should be treated. Based on information from both animal and human research, the European Medicines Agency (EMA) granted tecovirimat, an antiviral drug originally created to treat smallpox, a license to treat monkeypox in 2022. It is still not readily accessible.

If tecovirimat is utilized for patient treatment, it is ideal to monitor it in a clinical research setting with prospective data gathering.

Vaccination

Numerous observational studies have shown that the smallpox vaccine is around 85% effective at preventing monkeypox. There may be a milder sickness as a result of previous smallpox vaccination. A scar on the upper arm is typically present as proof of previous smallpox immunization. The first-generation (original) smallpox vaccines are no longer accessible to the general population. Some laboratory or healthcare employees may have had a more current smallpox vaccination to safeguard them from orthopoxvirus exposure at work. In 2019, a brand-newer vaccine based on the Ankara strain of the modified attenuated vaccinia virus was authorized for the prevention of monkeypox. This two-dose vaccine is still only partially available. Because the vaccinia virus provides cross-protection for the immune response to orthopoxviruses, formulations of the smallpox and monkeypox vaccines are based on this virus.

Prevention

The primary preventative method for monkeypox involves increasing public knowledge of risk factors and teaching individuals about the steps they may take to lessen virus exposure. A scientific evaluation of the viability and suitability of vaccination for the prevention and control of monkeypox is now being conducted. Some nations have policies in place or are creating them to provide vaccines to people who may be at risk, including laboratory staff, members of quick reaction teams, and healthcare professionals.

More Information Here.

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Hallo World : Stories from the Field: COVID-19 Response Special Series - Mongolia (WHO : World Health Organization)

 Mobile health clinics in Mongolia provide primary healthcare to underserved populations.

Due to its size, Mongolia has a difficult time reaching out to rural and underserved communities, including nomadic peoples, migratory workers, and unregistered residents. It is demonstrating to be a low-cost efficient strategy to eliminate imbalances and ensuring that everyone, everywhere can receive the health services they need. This is done through the use of mobile health technologies using a primary health care approach.

Find out how Mongolia is contributing to the creation of a more equitable and healthy world.

This is a developing story that will be updated as more data comes in from the field. Please return often to see any updates.

Norov Bayarjargal, a local herder in the southernmost village of Mongolia known as Dersene-Us, appears in front of a temporary mobile health clinic. He is in the Gobi Desert. Aside from the two yurts next to him and the sporadic herds that graze the area, nothing but desert and sky can be seen for kilometers in the distance. The sub-provincial health center's mobile health team, which visits herder communities in their homes, just held a session with Norov.

The mobile health team examines herders and their families for communicable and non-communicable diseases, as well as for blood sugar and cholesterol levels. They also provide women with ultrasounds. Through this service, Norov was given a diagnosis of gallbladder and renal issues a month ago. He was then referred to the closest neighborhood (sub-province or soum) health center, where a doctor gave him the necessary medications.

"I obtained prompt treatment and an early diagnosis as a result of the mobile health screening. My diet of salt and animal fat should be reduced, according to the medical authorities. Regardless of my financial situation, I need to choose a healthy lifestyle because I know that health is wealth", stated Norov.

Due to its size, Mongolia faces numerous difficulties in providing health care to its residents, particularly those who reside in underserved and distant rural areas, as well as vulnerable and nomadic groups, migrants, and unregistered individuals.

The government ran an effort known as M-Health, or "Expanding Use of Mobile Health Technology in Primary Care Toward Universal Health Coverage in Mongolia," from 2016 to 2020. Through the UHC Partnership, the Korea Foundation for International Health Care, and the Community Chest of Korea, it received support from WHO.

Primary health care practitioners are also observing the difference that the M-Health project is making to the lives of distant communities.

The quality and accessibility of preventative health exams among locals have improved over the past two years as a result of the M-Health project. 90% of the population have access to preventive health exams as of 2019. Dr. Chuluuntsetsetseg Erdenechuluun, Director of the Mandakh Soum Health Center, Dornogobi Province, stated that the majority of remote herders reside 130 kilometers from the soum [sub-province] health center and that health workers primarily reached them through mobile health service delivery.

One of the 115 nations and regions to whom the UHC Partnership provides assistance and technical know-how to advance UHC is Mongolia. The European Union (EU), the Grand Duchy of Luxembourg, Irish Aid, the Government of Japan, the French Ministry for Europe and Foreign Affairs, the United Kingdom - Foreign, Commonwealth & Development Office, and Belgium are among the organizations that have contributed to the Partnership's funding.

More Information Here.

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