Chickenpox: symptoms, diagnosis, treatments, vaccines

The current monkeypox outbreak has now become a major health threat, since the high alert on Saturday by the head of the World Health Organization to try to contain it. Here is an overview of the symptoms of the disease, which now accounts for more than 16,000 cases worldwide, diagnostic methods, treatments and vaccines.

Symptoms

Fever, headache, sharp muscle aches, unusual tiredness, swollen and painful lymph nodes in the jaw, neck, or groin may occur in the first period. In a second period, skin and mucosal lesions may appear all over the body.

In the current smallpox outbreak, the genital, anal and oral areas are most often affected, with lesions sometimes appearing before lymph node involvement, fever, malaise and pain associated with the lesions, the WHO said two days ago..

From one patient to another, the symptoms are, however, variable. After a few days or weeks, the pimples turn into scabs, which eventually fall off and the lesions heal. The patient is contagious until complete healing.

Diagnosis

Monkeypox is suspected if there is possible exposure to the virus within three weeks of contact with a confirmed or probable case, return from travel to a country in Africa where the virus is endemic, or the existence of multiple sexual partners. In the current wave, of which Europe is the epicenter, the vast majority of patients so far are relatively young men who have sex with men, living mainly in cities, according to the WHO.

Diagnosis can be difficult because cases do not necessarily show the usual symptoms of the disease and can resemble certain sexually transmitted infections, several health officials have warned. The physician performing the physical examination will rule out other rash illnesses such as chickenpox, hand-foot-mouth syndrome, shingles, measles, bacterial skin infections, scabies, syphilis, herpes, allergic skin reactions.

Confirmation of the diagnosis of monkeypox may require analysis, in particular by PCR testing. Skin sampling (biopsy or swab swabbing multiple vesicles) and/or nasopharyngeal if the person has a rash in the mouth or throat is preferable. While waiting to take a test and know the results, you should isolate yourself. Once the infection is confirmed, the recommended isolation is approximately three weeks. It is not known whether the virus can be transmitted through semen and, if so, for how long. As a precaution, the European Center for Disease Control recommends using a condom 12 weeks after recovery.

treatments

The disease usually heals on its own after two to three weeks, sometimes four. Usually, only symptomatic treatment is needed, for example, to stop a fever or relieve itching. In some cases, the lesions are very painful, as reported by several testimonies, and may require analgesics or even hospitalization. It is advisable not to scratch the lesions so as not to re-inoculate the virus or leave scars, and to cover them to limit these risks.

A vial of the antiviral drug tecovirimat used as a treatment for smallpox on July 19, 2022 in New York City (AFP - Yuki IWAMURA)
A vial of the antiviral drug tecovirimat used as a treatment for smallpox on July 19, 2022 in New York City (AFP – Yuki IWAMURA)

In some people, the disease may be complicated by superinfection of skin lesions or by respiratory, digestive, ophthalmologic, or neurological disorders. If necessary, certain antiviral drugs such as tecovirimat, designed in particular against smallpox, can be used.

Severe cases most often concern children, pregnant women, immunocompromised patients. No deaths have been reported so far in Europe or the United States.

vaccines

A third-generation smallpox vaccine from the Danish company Bavarian Nordic (Imvanex or Jynneos, a live vaccine that does not replicate in the human body) can be given to adults, including caregivers, after risky contact, but also as a preventive measure. If given within four days of exposure, it can have a significant protective effect, according to the European Center for Disease Control. The European Commission on Monday approved the extension of one such smallpox vaccine.

In some countries (United States, United Kingdom, Canada, France), preventive vaccination may be offered to groups most exposed to the virus, including men who have sex with men. In New York, thousands of people have already been vaccinated. Vaccination is performed with two doses, spaced at least 28 days apart. For people vaccinated against smallpox in childhood, one dose is sufficient. For the immunocompromised, one third is recommended.

These vaccines do not provide immediate or full protection, health authorities urge people to remain cautious after injection.

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