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Researchers are concerned about the outbreak management of monkeypox as the virus evolves. Historically, the first human cases of monkeypox were observed in the 1970s. Now, in peer-reviewed

research, the authors say there have been 42 substitutions to the virus within three to four years, which is "an unexpectedly large number". In March 2022, there was an

international epidemic of human monkeypox, which was overshadowed by Covid. Monkeypox has been "spreading widely across Europe and, subsequently, the globe", the authors note. It

is estimated that the monkeypox virus has been circulating in humans since 2016, which means its viral management requires immediate updating. As the virus is no longer just a zoonotic

disease, the monkeypox virus is diverging into new lineages as the result of continued interactions with the human immune system. The study authors said: "These observations of

sustained MPXV [monkeypox] transmission present a fundamental shift to the perceived paradigm of MPXV epidemiology as a zoonosis. "[It] highlights the need for revising public health

messaging around MPXV as well as outbreak management and control." The World Health Organisation (WHO) says monkeypox is an infectious disease that can cause a "painful rash,

enlarged lymph nodes, and fever". Anybody can become infected if they've touched, kissed, or had sexual intercourse with an infected person. Even touching contaminated sheets and

clothes could lead to an infection with monkeypox. Symptoms of monkeypox include: * Rash * Fever * Sore throat * Headache * Muscle aches * Back pain * Low energy * Swollen lymph nodes * Skin

lesions of the palms of hands and soles of feet, face, mouth and throat, groin and Genital areas and anus. The WHO confirmed there was a global outbreak of monkeypox in 2022 to 2023.

"The global outbreak of monkeypox was declared a public health emergency of international concern on 23 of July 2022," said the WHO. "Surveillance, diagnostics, risk

communication and community engagement remain central to stopping the outbreak and eliminating human-to-human transmission of monkeypox in all contexts." The study was published in the

American Association for the Advancement of Science on November 2, 2023.