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By Dr. Stephen A. Berger


Cynomolgus monkey, a known reservoir of the Monkeypox virus
Cynomolgus monkey, a known reservoir of the Monkeypox virus



Monkeypox, as the name implies, is a disease of monkeys (unlike chickenpox – which has no relation to chickens). Although the condition is reported in a group of eleven African countries, the virus was first discovered in a laboratory in Denmark in 1958, when it was first isolated from cynomolgus monkeys.

The signs and symptoms are similar to those of smallpox. Following a three-day prodrome of fever, headache, myalgia, and back pain, patients develop a papular rash in the face, extremities, and genitals. The rash then spreads outward to involve the face, with lesions evolving into umbilicated pustules. 

Unlike smallpox, death from monkeypox is relatively uncommon – five-to-ten percent.

Palms of a monkeypox patient
This 1997 image was created during an investigation into an outbreak in the Democratic Republic of the Congo (DRC) and depicts the palms of a monkeypox case-patient. It is important to note how similar this maculopapular rash appears to be when compared to the rash of smallpox, also an Orthopoxvirus. Image courtesy of CDC/Dr. Brian W.J.Mahy


During the single year of 1967, almost eleven thousand cases occurred in West and Central Africa. 

The most unusual outbreak of monkeypox occurred in 2003 when 81 humans in the American Midwest were infected through contact with infected prairie dogs – themselves infected by rodents that had been imported from Ghana. Fortunately, all patients recovered without sequelae. By coincidence, the iconic outbreak of SARS was also reported at this time – perhaps, as in the current COVID-19 pandemic, distracting media attention from events surrounding other diseases. 

During 2018 to 2019, five Nigerian travelers were found to have monkeypox – in Israel, Singapore, and London. 



The viruses of monkeypox and smallpox are biologically similar. Indeed an attack of one will immunize the patient against the other. Thus, rates of monkeypox were low during the period that smallpox vaccination was widely used in Africa, while the discontinuation of vaccination has been followed by a resurgence of monkeypox cases. 

These developments are well illustrated by an ongoing outbreak of monkeypox that has persisted well into the COVID-19 pandemic. From January 1 to September 13, a total of 4,494 cases of monkeypox (171 fatal) were reported in the Democratic Republic of Congo.


Monkeypox cases in the Democratic Republic of Congo
Cases in the Democratic Republic of Congo, 1970 – 2019


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