Not Monkeying Around

Human cells under a microscope.
Human cells under a microscope. Photo credit to @NCI on Unsplash.

Monkeypox is a rare disease caused by infection with the monkeypox virus. The monkeypox virus (which is unrelated to the chickenpox virus) is a member of the same family of viruses as the variola virus, otherwise known as smallpox. The symptoms of both diseases are comparable. Monkeypox spreads in different ways. The virus can spread from person-to-person through direct contact with infectious rash, scabs or bodily fluids typically exchanged through kissing, cuddling, or sex. It is also possible for people to get monkeypox from an infected animal, whether by being scratched or bitten by the creature or by consuming meat or using goods derived from it.

Monkeypox spreads from the start of symptoms until the rash area is replaced by new skin. Typically, it lasts 2 to 4 weeks. People who do not have monkeypox symptoms cannot spread the virus to others. At this time, it is not known if monkeypox can spread through semen or vaginal fluids.

In 1958, two instances of a pox-like illness occurred among colonies of monkeys kept for research. Despite the name “monkeypox,” the virus’ origin remains unknown. The virus may be harbored by African rodents and non-human primates (such as monkeys) and transmitted to people.

The first recorded instance of monkeypox in a person occurred in 1970. Monkeypox had previously been reported among humans in several central and western African nations. Prior to the 2022 outbreak, monkeypox was most frequently reported among people living outside of Africa, mostly as a result of international travel to countries where the disease is common through imported animals.

The first monkeypox outbreak outside of Africa occurred in the United States in 2003, when it was linked to contact with pet prairie dogs infected with the disease. The pets had been housed with Gambian pouched rats and dormice that had been imported into the country from Ghana. This led to over 70 cases of monkeypox in the U.S.

Monkeypox has also been reported in travelers from Nigeria to Israel in September 2018, to the United Kingdom in September 2018, December 2019, May 2021 and May 2022, to Singapore in May 2019, and to the United States of America in July and November 2021.

In May 2022, multiple cases of monkeypox were identified in several non-endemic countries. The CDC is collaborating with state and local health authorities to identify individuals who may have come into contact with people who have monkeypox, so they can keep an eye on their well-being.

As of the end of July 2022, the CDC has reported 20,000 cases confirmed in 71 countries that have not historically reported monkeypox. The United Sates accounts for over 4,600 of the cases. With high travel destinations like New York and California leading the US in confirmed cases at the time of this article.

Lymphadenopathy (swollen lymph nodes) is a distinctive feature of monkeypox compared to other diseases that may initially appear similar (chickenpox, measles, smallpox). Other symptoms of monkeypox include fever, headache, muscle aches, chills, exhaustion, respiratory symptoms (e.g. sore throat, nasal congestion, or cough), and/or a rash that can look like pimples or blisters. This rash can appear on the face, inside the mouth, and on other parts of the body, like the hands, feet, chest, genitals, or anus. The rash goes through different stages before healing completely. The illness typically lasts 2-4 weeks. Sometimes, people get a rash first, followed by other symptoms. Others only experience a rash.

Symptoms from monkeypox usually last 2 to 4 weeks. Complications of monkeypox can include secondary infections, bronchopneumonia, sepsis, encephalitis, and infection of the cornea with ensuing loss of vision. The extent to which asymptomatic infection may occur is unknown. The World Health Organization (WHO) lists the fatality ratio historically from 0 to 11 % in the general population and has been higher among young children. In recent times, the case fatality ratio has been around 3 to 6%.

There are no definitive treatments for monkeypox, however, there are medications that have the potential to aid convalescence in severe cases. The majority of monkeypox cases are treated with over-the-counter medicines to ease symptoms. However, more severe cases can be treated with an antiviral medication called Tecovirimat or TPOXX, which is kept in the US government’s stockpile.

Another medication called Brincidofovir or CMX001, has similarly been approved for the treatment of smallpox, and the CDC is currently creating a protocol to use it for monkeypox but can be more toxic to individuals taking the medication.

If under the care of a clinic, patients should be given fluids and nourishment to keep their nutritional status stable. Bacterial infections should be treated as needed if they develop.

Several observational research have confirmed that smallpox vaccination is about 85% effective in preventing monkeypox in monkeys. As a result, past smallpox immunization might cause less illness.

The newest vaccine, which is based on a modified attenuated vaccinia virus (Ankara strain), was authorized in 2019 for the monkeypox prevention. This is a two-dose vaccination that is presently restricted. Due to cross-protection offered by the immune response against orthopoxviruses, smallpox and monkeypox vaccines are made in forms that can be used for both prevention and response.

During human monkeypox outbreaks, close contact with infected persons is the most significant risk factor for monkeypox virus infection. Health workers and household members are at a greater risk of infection. Health workers caring for patients with suspected or confirmed monkeypox virus infection, or handling specimens from them, should implement standard infection control precautions. If possible, persons previously vaccinated against smallpox should be selected to care for the patient.

Since the CDC identified the first case of monkeypox in an individual living in Massachusetts on May 18, it has been informing the public and health-care providers about what they need to know and do. CDC has been in contact with hundreds of organizations, community health centers, provider networks, and stakeholders in the LGBTQI+ community to give regular updates on the situation and recommendations for prevention.

Further information on this outbreak can be found here.

Photo courtesy of Unsplash.

Written by Editorial Team

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