Viruses

Monkeypox Outbreaks: What Do You Need to Know? Do You Need to Worry?

Author Chandana Balasubramanian , 15-May-2022

 

Cynomolgus monkey, a known reservoir of the Monkeypox virus

Cynomolgus monkey, a known reservoir of the Monkeypox virus

Monkeypox cases have been reported in 19 countries, including several in Europe, Australia, the United States, and even the United Arab Emirates in the Middle East. What’s concerning is that, for the first time, more monkeypox cases have been reported in countries where it does not usually occur (non-endemic regions).  Also, the monkeypox cases have been detected in men who did not have contact with anyone who had recently traveled to West or Central Africa — the regions endemic to monkeypox [1].

What do these outbreaks mean? Is this a public health crisis? Is Monkeypox contagious? What do you need to do to protect yourself? Here’s all the information you need.

What is Monkeypox?

Monkeypox is an infectious disease caused by the monkeypox virus. The virus belongs to the same family as the smallpox virus. Monkeypox got its name after it was first detected in lab monkeys in 1958. The first human case of monkeypox was not discovered until 1970 in the Democratic Republic of Congo [2]. The virus belongs to the Orthopoxvirus genus of the Poxviridae family and is an enveloped double-stranded DNA virus. Other members of poxviridae include smallpox (variola), cowpox, buffalopox, and aracatuba [2].

 

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 compared to the rash of smallpox, also an Orthopoxvirus. Image courtesy of CDC/Dr. Brian W.J.Mahy

How Do You Get Monkeypox? (How Does it Spread?)

Monkeypox is not highly contagious — the virus is not airborne and cannot be aerosolized. The monkeypox virus can spread from person to person through prolonged contact with an infected person. Or it can spread through droplets from the nose and mouth and even broken skin. It is not known to be a sexually-transmitted disease, but since sexual activity involves close contact with another individual, there is a risk of transmission through body fluids [3].

Contrary to its name, it’s rare to get a monkeypox infection from monkeys. The usual suspects are often rodents like rats and squirrels through bites or scratches. Another method of transmission is through close contact with contaminated materials like hospital bedding [3].

You can also get monkeypox by eating undercooked or raw meat from a contaminated animal or contact with products like fur made from infected animals [4].

 

Notable Outbreaks

During the single year of 1967, almost eleven thousand cases occurred in West and Central Africa.  The most unusual disease 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 imported from Ghana. Fortunately, all patients recovered without sequelae. By coincidence, the iconic outbreak of SARS was also reported – perhaps, as in the current COVID-19 pandemic, distracting media attention from events surrounding other diseases.  From 2018 to 2019, five Nigerian travelers were found to have monkeypox – in Israel, Singapore, and London. 

 

A Recent Rise in Cases

The viruses of monkeypox and smallpox are biologically similar. Indeed an attack of one will immunize the patient against the other. Thus, human monkeypox cases were low when smallpox vaccination was widely used in Africa, while a resurgence of human monkeypox infections has followed the discontinuation of immunization. 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, 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

 

 

Symptoms of Monkeypox Infection

According to the CDC, monkeypox symptoms usually appear within 7-14 days after a person is first infected (incubation period) but can range anywhere from 5-21 days.  Monkeypox symptoms start with:

  • Fever 
  • Headache
  • Muscle pain and backache
  • Swollen lymph nodes
  • Chills 
  • Extreme tiredness 

 

A characteristic rash develops after a few days (1-3). The rash often starts on the face and spreads to the rest of the body. In the beginning, the rash looks like small, raised spots, but eventually, the spots turn into blisters filled with fluid.  Monkeypox rashes are sometimes confused with chickenpox, but the two diseases are different and caused by different viruses. 

Difference Between Monkeypox and Chickenpox Rashes

Symptoms of monkeypox can be similar to that of chickenpox. The best way to know for sure is through tests. However, here are a few of the differences to keep in mind: 

  • While a monkeypox rash first appears on the face and spreads to the rest of the body, chickenpox rashes can start on the chest, back, and face and then spread. 
  • Monkeypox symptoms include swollen lymph nodes (lymphadenopathy), while chickenpox does not have this as a symptom.
  • Monkeypox can last 2-4 weeks, while chickenpox usually lasts a week. 
  • Deaths from chickenpox are very rare, but monkeypox has a 3-6% case fatality rate [5].

Is Monkeypox Fatal? 

According to WHO (World Health Organization), the death rate in individuals infected with monkeypox is 3-6%. This metric is also known as the case fatality rate [6].  

Diagnosis of the Virus

Monkeypox symptoms can be confused with that of chickenpox and smallpox, but a distinguishing feature of monkeypox is the presence of swelling in the lymph nodes. Differential diagnosis must include other rash-related illnesses like scabies, skin infections, and syphilis. The most common diagnostic tool is a physical examination by trained physicians and the PCR (polymerase chain reaction). However, for this test to provide accurate results, samples from skin lesions or fluid from the rash vesicles or pustules work best. PCR blood tests for monkeypox, and antigen and antibody tests are usually inconclusive, according to WHO

Can Monkeypox be Treated? 

Monkeypox often goes away on its own within 2-4 weeks so treatment for monkeypox usually focuses on alleviating symptoms. There are no therapies specifically designed to treat monkeypox but outbreaks can be controlled with drugs (antivirals) and vaccines developed for smallpox [7]. 

How to Prevent Monkeypox?

According to WHO, observational studies show that the smallpox vaccine is 85% effective in preventing monkeypox. So, even if infected, vaccinated individuals may experience a milder illness.  However, the original smallpox vaccine is unavailable to the general public in many parts of the globe. Many countries have a vaccine stockpile from previous eradication efforts that can be used in case of a larger outbreak or epidemic [8].

 

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References

[1]  “Multi-country monkeypox outbreak in non-endemic countries,” Who.int. [Online] [Accessed: 26-May-2022].

[2]   H. Adler et al., “Clinical features and management of human monkeypox: a retrospective observational study in the UK,” Lancet Infect. Dis., 2022.

[3]   “Monkeypox,” Cdc.gov, 20-May-2022. [Online] [Accessed: 26-May-2022].

[4]  “Monkeypox,” nhs.uk. [Online][Accessed: 26-May-2022].

[5]   Z. Jezek, M. Szczeniowski, K. M. Paluku, M. Mutombo, and B. Grab, “Human monkeypox: confusion with chickenpox,” Acta Trop., vol. 45, no. 4, pp. 297–307, 1988.

[6]  “Monkeypox,” Who.int. [Online][Accessed: 26-May-2022].

[7]   “Monkeypox,” Cleveland Clinic. [Online][Accessed: 26-May-2022].

[8]    P. Joi, “How the smallpox vaccine stockpile could stop monkeypox in its tracks,” Gavi.org, 24-May-2022. [Online][Accessed: 26-May-2022].

  1. Sklenovská and M. Van Ranst, “Emergence of Monkeypox as the most important Orthopoxvirus infection in humans,” Front. Public Health, vol. 6, p. 241, 2018.
Author
Chandana Balasubramanian

Chandana Balasubramanian is an experienced healthcare executive who writes on the intersection of healthcare and technology. She is the President of Global Insight Advisory Network, and has a Masters degree in Biomedical Engineering from the University of Wisconsin-Madison, USA.

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