Emerging Threat: Smallpox Monkey Outbreak in Thailand Exacerbated by HIV Co-Infection

Key points:

– The number of smallpox monkey cases in Thailand has been increasing, with hundreds of patients being co-infected with HIV.
– The World Health Organization (WHO) is studying the use of a drug to treat smallpox, and Thailand has been given this drug for use.
– As of August 8, 2023, there have been 189 reported cases of smallpox monkey in Thailand, with 161 Thai nationals and 28 foreigners affected.
– The disease has spread to 19 provinces in Thailand, with the highest number of cases in Bangkok, Nonthaburi, and Chonburi.
– Most of the patients are men who have sex with men, and 43% of smallpox cases are also HIV-infected.
– There have been 152 deaths globally from smallpox outbreaks since May 2022, and Thailand has reported its first death from smallpox.
– The deceased patient had severe symptoms and complications, including pneumonia and encephalitis.
– Smallpox infection and HIV infection can be more severe in patients with low immunity, and deaths may be caused by a combination of both infections.
– Many smallpox cases in Thailand are linked to unsafe sexual behavior and dating applications, making it difficult to trace close contacts.
– Risk factors for smallpox transmission include having sex with an infected stranger, close contact, and indirect contact.
– There is currently no specific treatment for smallpox, but some seriously ill patients have received a drug called Tecovirimat from the WHO. The effectiveness of the drug is being monitored.

Key points:

situationthe smallpox monkeyThat has increased from about 1 year ago, there were more than 20 patients, but during June-July 2023 we met hundreds of patients and co-infected with HIV, althoughthe smallpox monkeyIt can be treated according to the symptoms and can be cured on its own. But the relationship that doesn’t know me, doesn’t know you is the reason why I can’t follow the touch. As a result, the number of sick people increased and there was the first death in Thailand and also HIV infection. Recent symptoms and treatmentthe smallpox monkey the World Health Organization (WHO) is studying the use of one drug in the treatment and Thailand is one of the countries that has been given this drug to use

Smallpox gets worse, joins HIV infection

a diseasethe smallpox monkeyIt is an emerging infectious disease in Thailand. Found in Thailand since last year, from July 2022 to April 2023, only met more than 20 cases, but in May, met more than 20 monthly, June met almost 50 cases, July met hundred. As for the month of August It is expected that it will be in the hundreds as well.

As of August 8, 2023, a total of 189 cases were reported in Thailand, of which 161 were Thai nationals and 28 were foreigners.

According to documents from the Department of Disease Control, it was reported that between January 1 and August 15, 2023, there were 217 patients, 30 foreigners, 187 Thais, with an average age of 20-64 years, among which 1 case died. , 34 years old, untreated HIV infection

Infections were reported in 19 provinces, with three provinces in the red level: Bangkok (136 cases), Nonthaburi (14 cases), Chonburi (9 cases).

Orange has 3 provinces: Samut Prakan, 9 cases, Phuket, 8 cases, Pathum Thani, 7 cases.

There are 13 provinces in yellow: Samut Sakhon, Lopburi, Maha Sarakham, Khon Kaen, Phayao, 2 each, Nakhon Ratchasima, Kalasin, Chachoengsao, Suphan Buri, Nakhon Nayok, Chiang Rai, Ayutthaya, 1 each, and Rayong 3.

Infected people tend to spread more. In the first phase, patients were found in and around Bangkok before spreading to other provinces. Most of the patients were men who had sex with men. and 82 HIV-infected cases (43%)

In the beginning, there will be many foreigners. But in later infections Almost 100 percent of those infected are Thai people, and recently infected foreigners have been infected in Thailand. It is not an infection from abroad.

Sophon Iamsirithavrn Deputy Director General of the Department of Disease Control (Khor.) said that the smallpox epidemic situation has increased. reflecting the continued risky behavior Almost half of all new cases of smallpox are HIV-infected.

This group of patients is already immunized. It is often associated with other opportunistic infections, causing severe symptoms that lead to death.

“The current situation is worrying. in risk groups who have unsafe sex As for people who do not have dangerous sexual behaviours, they should not worry too much. The most infected areas are Bangkok, perimeter, tourist provinces. which is a province where there are people with very dangerous behaviours,” said Dr Sophon.

infected with HIV-smallpox, the first death of a monkey

Globally, 152 deaths from smallpox outbreaks have been reported since the outbreak began in Europe and other countries since May 2022.

In Thailand, in mid-August 2023, the Department of Disease Control received a report of the death of a smallpox patient from the Bamrasnadura Institute of Infectious Diseases. therefore a team was sent to investigate and control the disease The Epidemiology Division and the Disease Prevention and Control Office 6, Chonburi, went to investigate the disease together with the Chonburi Provincial Public Health Office and relevant agencies in the area.

The deceased was a 34-year-old man with a history of fever, headache, itching, and rashes and blisters on the skin in different parts of the body since July 3, 2023, and was admitted to a private hospital in Chonburi province. On July 11, 2023, doctors suspected smallpox. Therefore, samples were sent to confirm the genetic material of the smallpox virus. and at the same time detect HIV and syphilis infections

Later, the patient had a sore throat, a fungal infection was found. which is an opportunistic infection of HIV Smallpox lesions spread across the body on the skin. After four weeks of treatment, the doctor allowed him to go home. Later, on August 9, the patient experienced fatigue and difficulty in breathing. So the relatives brought the patient to be treated at Bamrasnadura Institute of Infectious Diseases.

A smallpox rash was found spreading over the body. and extensive tissue necrosis in the nose and throat Complications of infection in the limbs having pneumonia and symptoms of encephalitis A CD4 count of 16 cells/mL indicates severe immunodeficiency. Doctors have also prescribed smallpox antivirals and antibiotics. Later, the patient’s condition deteriorated and he died on the night of August 11, 2023.

Chakrarath Pittayawonganon, MD Director of the Epidemiology Division, Department of Disease Control, Ministry of Public Health.Explain that cases of smallpox infection and IHV infection can be divided into two groups:

1. Infected with HIV but receiving antiretroviral drugs able to control the level of immunity to be within normal limits When infected with smallpox, the symptoms of smallpox are pustules, which are similar to abscesses small distributed throughout the body

2. HIV patients with opportunistic infections very low body immunity Risk of complications such as pneumonia, fungal or bacterial encephalitis when infected with smallpox makes the pustules become larger, clustered, with a large number of abscesses

“Deaths can be caused by HIV. However, due to the nature of the smallpox infection, the symptoms expressed are greater than in non-HIV-infected or HIV-infected but manageable patients. So, it was not possible to clearly determine from which infection he died,” said Dr Chakrarath.

You don’t know me – you can’t follow the tangent.

From the investigation of smallpox patients in Thailand Most of them have sexual behavior that comes from dating through dating applications. Therefore, there is a risk that he could be infected by having sex with someone you do not know.

when one is found to be infected He was unable to trace close contacts with the patient because when the activity is completed The user account has already been cancelled. This makes it more difficult to investigate the disease, or some cases have sex like One Night Stand.

“Some people change their sex partners every day without knowing each other’s names. Many people hide their true identity while using the program. which is a concern that the smallpox infection is starting to look like an AIDS trend. starting with a group of people Then it spread to other groups,” said Dr Chakrarath.

Risk factors – smallpox symptoms

Major risk factors for infection and transmission Has sex with an unknown stranger who is infected with smallpox. The risk is divided into 3 levels:

1. Close contact, such as having sexual activity even wearing a condom Can get infected because the patient’s pustules can touch the skin causing infection

2. close contact, such as sharing a bed sharing a bathroom Being close to each other or just holding hands The risk will be reduced.

and 3. indirect contact, such as the patient going to sleep in a hotel Then the staff came to clean the room. A general feast that is not so close that they nestle together. eat together at the table

consecutively

Those at risk can be examined.

Initial symptoms on their own A rash/blister on the genitals, anus, mouth, or body and had a history of close contact, intimate contact, or sex with suspected smallpox or smallpox patients wen Self-observation within 21 days after contact with the patient, if symptoms include fever, headache, aches, swollen lymph nodes, rash, or blisters or pustules in the genital area, anus, or around the hands, feet, chest, face, or mouth area. to be examined in a health facility or hospital immediately by reporting symptoms and risk history for diagnosis

A specific drug for treating smallpox

There is currently no specific treatment for smallpox, so symptomatic treatment is used. However, 100 people in Thailand have received an antiviral drug called Tecovirimat (or TPOXX) from the World Health Organization (WHO) to treat patients who are seriously ill with smallpox which could cause complications. And the effectiveness of this drug must be measured at the same time.

It is currently being used and stored at the Bamrasnadura Institute of Infectious Diseases. The criterion for smallpox patients to receive the drug was HIV infection with low immunity levels. There are complications from opportunistic diseases. People with pneumonia What kind of oral drug is this drug, 1 patient will only take it 2 times, however, data is still being collected for actual use in Thailand. Including information about the side effects of taking the drug.

“Patients with smallpox are not at risk. Symptomatic treatment may be used. The disease will take about 2-4 weeks to heal and then it will disappear on its own,” said Dr Chakrarath.

Contact – smallpox prevention

Smallpox is a sexually transmitted disease. And direct contact without having to have sex, such as touching the skin around the pustules then entering the body through the skin which may have broken skin or a wound

In addition, smallpox disease began to be detected among males who have sex with men. that despite being protected with a condom But it cannot prevent smallpox infection. Because abscesses occur on the body If you come into contact, you can become infected.

And if you have sex in a bisexual sexual orientation, the infection will spread among women. and the risk spreads to other groups as well

Smallpox is preventable.

by abstaining from sex with strangers Do not touch skin-to-skin with people who have rashes, blisters or pimples It is recommended to wash your hands often. Do not share personal property with others.

If people have questions or need advice on how to act, they can ask for information on the Disease Control Department’s helpline, call 1422.

#Dont #dont #monkey #rash #caused #HIV #hit