MPOX IRIS Syndrome - high mortality of unvaccinated immuncompromised humans and HIV patients

 

Credits: NHIAD byCC BY 2.0 Licence

During the MPOX outbreak at 2022 the Case fatality rate (CFR) was below 0.1%.

Now with the Clade 1b the case fatality rate of MPOX has significant increased to 3-4% among all MPOX cases at Africa. ECDC has now warned within a bulletin to healthcare workers about the high risk of death by MPOX infection at immunecompromised and HIV infected patients - especially those which are starting an antiviral therapy against HIV and developing an IRIS Syndrom when the immunsystem of these patients starts to restore its immuncompetence after starting its antiviral therapy.

A 15% mortality rate was described among individuals with advanced HIV-related disease characterised by CD4 cell counts below 200 cells per mm3 [43]. An immune reconstitution inflammatory syndrome (IRIS) to mpox was suspected in 21 (25%) out of 85 people who were initiated or re-initiated on antiretroviral therapy (ART), of whom 57% died. ECDC

More than 57% mortality at the Clade 2 infected population was oberserved. From my point of view this Case fatality rate will rise at the patient subpopulation in case of Clade 1b infection up to nearly 90% if the immunsystem restarts during an MPOX Infection.

While Clade 2 normally has less than 20 skin lessions, the new clase 1b is able to develope more than 100 skin lessions which are able to occur at the palm of the hands and feets - very painful and combined with pruritus in the deeper parts of the skin. Scrathing effects can lead to bacterial superinfections resulting in more severe disease course.

Beyond severe infections of the eye - called MPXROD - even pneuomonia, encephalitis and genital ulcer - especially at immuncompromised inviduals were observed at the clase 1b MPOX cases.

High risk if severe disease also excist at childs below age of 10 and pregnant woman.

Sexual transmission of MPOX virus has been described up to 12 weeks after infection.

Animal to human is further a concern about transmission of the highly contagious MPOX Virus.

Further information is available at ECDC - Link

MPXROD - MPOX related Ocular Disorder

Beteiligung der Augen bei Affenpocken ist wie bei den Variola Pocken in der Lage das Sehvermögen zu zerstören 
Quelle des Bildzitates: CDC/USA abgebildet ist ein echter Pockenbefall des Gesichtes
wie er auch bei den Affenpocken möglich ist

MPOX related ocular disorder of the human eye are difficult to treat and able to lead to severe pain or even to the loss of the eye.

A view on the scientific literature on medical database is pointing out that MPXROD is often correlated with severe systemic disease of the MPOX illness in general - which is able to lead to death of infected patients.

Typical affection of the eye in the course of an MPOX disease are:

• Eyelid affections with affection the conjunctiva or even of the cornea (Conjunctivitis versus Keratitis)
• MPOX conjunctivitis is often correlated with poor prognosis or a severe systemic infection
• Keratitis in case of MPOX affection is a really dangerous situation which is able to develop a corneal ulcer of the eye and propably a total loss of the eye if not treated adequately or the treatment fails.
• Scleritis is very painful and even can lead to necrosis and severe inflammation of the eye with consequtive loss of the eye.
• Normally rare phlyctanes of the conjunctiva has been observed in the case of MPOX affection. This special form of conjunctivitis needs special treatment strategies.
• Uveitis and secondary glaucoma are further complications of MPXROD spectrum diseases of the human eye. They can lead to cystoid macula edema and secondary visual loss by destruction of the retina structure - similar to observed cases of choroiditis and retinitis or chorioretinitic affection of the back of the eye.
• Papillitis or retrobulbarneuritis, a dangerous affection of the optic nerve is even possible and able to lead to blindness if the disease did not respond to therapy.

Unvaccinated MPOX patients are developing significant more MPOX related ocular disorder than vaccinated. Around 3-4% of the Clade 1 MPOX patients at the democratic republic of Congo are developing a keratitis, and up to 27% of the clade 1 patients at the DRC are developing a difficult to treat conjunctivis. The unvaccinated patients has a significant higher risk to develop devasting scars of the cornea and/or the conjunctiva and eyelid or in worst case a corneal perforation as result of an ulcus - combined with heavy pain, loss of visual function and loss of quality of life.

Patients and healthcareworkes should be aware not to autoinocculate pox material into the own eye by rubbing with a contaminated hand or finger for example a healthy eye. Such an inoculation of the MPOX Virus to the eyes is able to destroy even the visual function of the last eye.

A restoration of vision when the cornea has already developed massive scars is difficult and risky. The best way to protect an affection of the eye by MPOX is vaccination. If there is already a Conjunctivis or keratitis an offlabel use of Trifluridin 1% every 2 hours is possible and after reepitheliasation of the cornea it can be reduced to every 4 hours for the next 7 days. The therapy should last until all ocular and perioculare affections by MPOX has disappeared.

Despite such a treatment the risk of corneal ulcer remains - even when the MPXROD has dissappeared and scars of the cornea are visible.

Even more than 6 (!!!) weeks after onset MPOX an MPXROD has been observed, even like viral shedding combined with the occurence of a keratitis.

Human to human transmission should be avoided by using protective equipment in every healthcare setting of MPOX patients.

Affenpocken - aktuelle Daten aus Afrika

 

Source: CDC Africa

Anzahl der Gesamtfälle in Afrika: 37 583
Gesamtzahl der Todesopfer: 1451
Case Fatality Rate (CFR) - Letalität: 3.9%

aus 15 Mitgliedsstaaten der afrikanischen Union

Stand für die Zeit von Januar bis Juli 2024 in Afrika:

Gesamtzahl der Erkrankungen: 14 250
Todesopfer: 456
CFR - Letalität: 3.2%
in 10 Mitgliedsstaaten der afrikanischen Union

Quelle des Bildzitates - CDC USA

Weltweit sind laut Angaben der US Gesundheitsbehörde bislang fast 100000 Menschen an Affenpocken erkrankt. Während in Zentralafrika die tödlichere Variante der Clade 1 sich ausbreitet ist in den USA die Clade 2 die derzeit häufiger anzutreffende Variante.

Laut Medienberichten wie Reuters erfolgt nach einer Mutation des MPOX Virus in Afrika die Übertragung vornehmlich inzwischen schon bei einfachen Kontakten über Kinder.

Ausbrüche von Affenpocken sind auch für Gesundheitseinrichtungen beschrieben, wo durch infizierte Patienten es zu Infektionsketten beim medizinischen Personal und anderen Patienten gekommen ist.

Übertragungen werden auch von Virus kontaminierten Tieren auf den Menschen berichtet.

Die WHO dürfte daher morgen vorraussichtlich für die Affenpocken den internationalen Notstand ausrufen.

Gestern veröffentlichte die WHO ein Update zur weltweiten Ausbreitung der Affenpocken, wonach in bereits 26 Ländern mehr als 99000 Menschen erkrankt sind: https://www.who.int/publications/m/item/multi-country-outbreak-of-mpox--external-situation-report-35--12-august-2024

MPOX Outbreak at Africa - Current Data Status

 

Source: CDC Africa

Total Cases: 37 583
Total Death: 1451
Case Fatality Rate (CFR): 3.9%
15 African Union Member States (AU MS)

January-July 2024

Total Cases:14 250
Total Death: 456
CFR: 3.2%
10 AU MS

Quelle des Bildzitates - CDC USA

Following Media Reports like Reuters the transmission of the virus occurs by simply contacts with infected or virus contaminated humans or animals. Increasing transmission and infections between children and at healthcare settinngs has been observed after mutation of the clade 1 of the MPOX Virus.

WHO presumably declares tomorrow the global emergency status.

Yesterday WHO current data Report to monkey pox pointed Out that more than 99000 humans at 26 countries already hast been infected: https://www.who.int/publications/m/item/multi-country-outbreak-of-mpox--external-situation-report-35--12-august-2024