Monkeypox Mutation Alert

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    In this video, Roger Seheult, MD of MedCram discusses new information regarding the mutations being found in Monkeypox and possible causes for this. With the recent rise in cases,  Spain currently leads in the number of new cases reported, and there has been renewed interest in what has been happening in Africa. This has been specifically directed toward the genome of Monkeypox. He reviews an article from the Atlantic that discusses the events in the health community in Nigeria over the past five years. Per the article, it appears that five years ago, Monkeypox made a so-called “leap” in its evolution that went relatively unnoticed by the world. 

    Monkeypox variants

    Currently, there are two variants of Monkeypox. The Congo Basin variant has a 10% mortality associated with it, whereas the West African (and the current strain in the outbreaks) has a 1% mortality.  In West Africa,  there have not been any deaths reported in the current outbreak. However, in the Democratic Republic of Congo,  where the more virulent strain is present, there have been 1200 cases with 58 deaths according to the most recent statistics.

    Monkeypox transmission

    Nigeria’s last case of Monkeypox occurred in 1978 and they had no further cases of it, until a resurgence in 2017. Since 2017 and until 2022, there have been 500 cases documented. It was found that these cases were spread primarily during sexual contact of men who have sex with men. Given the potential for the spread of Monkeypox through certain behaviors,  in this case, men having sex with men, precautions should be taken. However, it is unclear if using condoms would provide adequate protection. Unlike HIV, Monkeypox spreads through transmission of open sores and this can occur even with the contact with infected clothing or sheets.

    Monkeypox is a DNA virus

    Monkeypox itself is a DNA virus. Typically DNA viruses have fewer mutations and lower mutation rates compared to RNA viruses. The expected normal mutation rate in the DNA can be 1-2 base pairs per year in the genome. However, when scientists reviewed the mutation rate in the 500 cases that occurred from 2017 to 2022, they noted the mutation rates had skyrocketed to about 47 base pairs per year. The question arose about what was causing the sudden increase in these mutation rates. 

    Monkeypox mutations

    What the scientists reported is that within the innate immune system, there is a protein in the host that has the ability to purposely insert mutations into the genome of the virus itself.  A paper in Plos discusses a set of enzymes called Apobec3 that are part of the innate immune system and help introduce mutations into viral genomes. They do this by changing out some of the nucleotides in the DNA molecule.  These mutations that result may simply be the result of “battle scars” that the virus is obtaining as it goes through a reservoir of either animals or humans. It is unclear at this time whether the mutations confer any possible advantages to the virus. Furthermore, it is also unclear what the virus is infecting that is allowing it to accumulate so many of these mutations.

    Monkeypox vaccines

    So how can you protect yourself against Monkeypox? Well, Monkeypox is very closely related to Smallpox. Scientists are able to use the Smallpox vaccine against Monkeypox. There are currently two vaccines (ACAM2000 and Jynneos) which are both live vaccines that carry the vaccinia virus or (Cowpox). Cowpox is also similar to Smallpox and Monkeypox. The difference between the two is that the ACAM2000 vaccine has a live virus that can replicate and can create a “pox” mark at the site of injection and itself can cause infections. The new vaccine Jynneos contains a non-replicating virus and can’t be transmitted among people. There is no “pox” mark created by this route. ACAM2000 vaccine conveniently only requires one injection whereas the Jynneos requires 2 doses.

    LINKS / REFERENCES:

    Monkeypox tracker (BNO) | https://bnonews.com/monkeypox/

    We Should Have Seen Monkeypox Coming (Atlantic) | https://www.theatlantic.com/science/a…

    U.S. Monkeypox 2022: Situation Summary (CDC) | https://www.cdc.gov/poxvirus/monkeypo…

    Genetic data indicate at least two separate monkeypox outbreaks underway, suggesting wider spread (STAT) | https://www.statnews.com/2022/06/03/g…

    Footprint of the host restriction factors APOBEC3 on the genome of human viruses (PLOS) | https://journals.plos.org/plospathoge…

    /journal.ppat.1008718

    Nov 3, 2021 ACIP Meeting – Orthopoxviruses Vaccines (CDC) | https://youtu.be/4SCUOppgtxE

    Monkeypox Explained Clearly (MedCram) | https://youtu.be/lWEj4J9cu7Y

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