New year, new virus? Monkeypox has become the new fear in the town. What is it? How does it spread? How can we avoid it? These and many more questions are arising in every person’s mind.
With the recent pandemic of the corona, people have hardly resumed their normal activities. Many lost their loved ones, while others suffered from physical and mental illnesses. In short, the effects of the last outbreak have not even vanished yet and we start hearing about a new virus and fearing the arrival of a new epidemic.
Let’s know more about the monkeypox disease and debunk some of the myths related to this virus.
What is Monkeypox?
It is a zoonotic viral disease caused by the monkeypox virus. This virus belongs to the same virus family as the smallpox virus, Poxviridae family, and Orthopoxvirus genus and so presents with a disease similar to smallpox. There have been two strains identified of this virus:
- Strain from Central Africa
- Strain from West Africa
These areas are endemic to monkeypox disease. The latter strain is responsible for the recent outbreaks in various countries that have been reported including the United States, Canada, the UK, etc.
How Does the Monkeypox Virus Spread?
Monkeypox virus spreads by close contact; direct skin contact with an infected person, bite/scratch of an animal, or by coming in contact with materials contaminated with the virus.
Among humans, it can spread if you come in direct contact with infected sores, and respiratory droplets during prolonged face-to-face contact (because the droplets travel only a few feet distance).
Travel history is also significant in this disease. Traveling to a monkeypox endemic area is usually positive when a case arrives in a non-endemic area. In 2003, cases were reported in the United States, and the source was found to be prairie dogs and other rodents that were imported from Africa, a monkeypox endemic area.
Another thing that has been observed in the newly reported cases is that this disease is more common in gay or bisexual men. The disease is not an STD; however, it can spread through close and intimate contact.
When was the First Monkeypox Case Reported?
Monkeypox was first discovered in 1958 in monkeys and hence the disease was named after them. The first case in humans was reported in 1970 in Congo. Ever since then, it has been reported in several countries including Central and Western African countries including Liberia, Congo, Nigeria, etc. These countries have been labeled endemic to monkeypox disease. Traveling to these endemic areas can lead to new cases in non-endemic areas.
Who is Vulnerable To Getting Monkeypox Disease?
Some specific populations are at extreme risk of developing monkeypox, which include:
- Immunocompromised patients – such as HIV, leukemia, any generalized malignancy, an autoimmune disease with immunodeficiency as an accompanying factor
- Immunosuppressed patients – such as diabetic, transplant recipients, taking high dose steroids, recipients of stem cell transplant
- Pediatric population – children who are 8 years old or younger
- Geriatric patients with compromised immunity
- Pregnant women
- Breastfeeding women
- People with one or more co-morbidities – such as those having skin infections, gastroenteritis with vomiting, diarrhea, dehydration – etc
What is the Incubation Period of the Monkeypox Virus?
The incubation period of the monkeypox virus is usually 1 to 2 weeks but it can cause illness as early as 5 days or as late as 3 weeks as well.
What are the Signs and Symptoms of Monkeypox?
The signs and symptoms are:
- Fever and chills
- Generalized body pain including headache and backache
- Exhausted feelings
- Lymph nodes swellings
After the appearance of fever, a rash starts to appear within 1-3 days or even after that. It generally starts on the face and then continues to appear on the body; palms, hands, arms, feet, legs, trunk, and so on. The lesion starts and proceeds in the following manner before it falls off.
In gay or bisexual men with monkeypox disease, the rash first appeared on genitals and was even misreported as herpes.
The disease stays for around 2 to 4 weeks and resolves completely. It has a generally mild course and does not cause severe disease. However, in some cases when the disease is severe, it can cause death as well. But the mortality rate is very low.
The disease course is quite similar to the smallpox virus. The only difference is in lymphadenopathy (swellings of the lymph nodes) which does not occur in smallpox disease.
What Investigations can help in the Diagnosis of Monkeypox?
For confirmation of the disease, health officials usually require proof of viral DNA. The recommended sample for lab testing is usually taken from a skin lesion, either the skin of the lesion itself or the material/exudate arising from the lesion.
The sample is then used for Polymerase Chain Reaction (PCR) for analysis.
What is the Treatment of Monkeypox?
Generally, monkeypox is a mild self-limiting ailment and does not require much treatment. However, some risk factors lead to worse disease progression including
- Vaccination status
- Previous health condition
- Simultaneous diseases and co-morbidities
For this disease, there is no fixed treatment regimen; however, the following treatment options are available.
- Tecovirimat is an antiviral medicine that may prove beneficial against monkeypox. It is FDA approved drug and can be used orally or in injectable form.
- Cidofovir, an antiviral drug, is also in trials for being used again in the monkeypox outbreak. Originally it is used against Cytomegalo viral retinitis in AIDS patients.
- Vaccinia Immune Globulin Intravenous (VIGIV), was approved by the FDA for the treatment of a monkeypox outbreak. Otherwise, it is a drug for treating the complications of the vaccinia vaccine.
In June 2021, a new drug, Brincidofovir has been approved by FDA for the treatment of smallpox disease in humans. However, it is also being investigated as a treatment option for monkeypox which belongs to the same genus and family of the smallpox virus.
What are the Precautionary Measures to Prevent Monkeypox?
To prevent this disease, certain measures can be taken;
- Avoid contact with infected animals or patients, even if the infection is only suspected, especially in monkeypox endemic areas.
- Isolate the infected patient to avoid transmission of the monkeypox virus. Special care should be taken by immunocompromised people to avoid contracting the infection.
- For healthcare workers, it is advised that they use PPE while taking care of the patient to avoid exposure.
- Practice good hand hygiene for handling the patient or the materials that could potentially be contaminated by the infected person.
Is There Any Vaccine Available for Monkeypox?
Imvamune or Imvanex, sold by the brand name Jynneos, is a live attenuated vaccine developed for monkeypox which has been approved by Food and Drug Administration (FDA). This vaccine is given to people who are older than 18. Vaccines that are available for smallpox have also been used for preventing the monkeypox virus.
Can Monkeypox Cause Covid like Epidemic?
Monkeypox cases in non-endemic areas are usually not of great concern because they get explained by travel to endemic areas. However, in recent cases, some cases arrived in non-endemic areas with no travel history of the infected people, which was alarming. But health officials all around the world state that it is unlikely that the monkeypox virus creates a Covid like global epidemic because of the following reasons:
- It is not a novel virus. It has already been present for around 50 years.
- It is less infectious than coronavirus. C-Vid can spread more easily through respiratory droplets however monkeypox virus can transmit only through prolonged close contact with the infected person.
- It poses less serious complications and is a less deadly virus than C-virus.
- It can be prevented by a vaccine. This vaccine is already being used by healthcare workers in endemic areas.
Monkeypox is a viral zoonotic disease, first identified in laboratory monkeys. It can be transmitted by prolonged close contact with infected people and generally takes 1 to 2 weeks for disease manifestation. The virus belongs to the same family as the smallpox viruses and presents a similar clinical picture.
The sign and symptoms include fever, body aches, lymphadenopathy, and maculopapular rash that first starts from the face. The treatment is generally symptomatic, but antivirals can be given in severe cases. The vaccine is also available and precautionary measures can be taken to avoid contracting the disease from infected patients.
- What to Know About Monkeypox Amid U.S. Cases [Internet]. WebMD. 2022 [cited 2 June 2022]. Available from: https://www.webmd.com/a-to-z-guides/news/20220524/what-to-know-monkeypox-us-cases
- Multi-country monkeypox outbreak in non-endemic countries [Internet]. Who.int. 2022 [cited 2 June 2022]. Available from: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385
- Monkeypox cases are rising—here’s what we know so far [Internet]. Science. 2022 [cited 2 June 2022]. Available from: https://www.nationalgeographic.com/science/article/monkeypox-cases-are-risingheres-what-we-know-so-far
- Le Page M. Monkeypox: Key questions answered. New Scientist. 2022;254(3388):8-9.
- Monkeypox: An unfamiliar virus spreading fast — sound familiar? – Harvard Health [Internet]. Harvard Health. 2022 [cited 2 June 2022]. Available from: https://www.health.harvard.edu/blog/monkeypox-an-unfamiliar-virus-spreading-fast-sound-familiar-202205252752
- [Internet]. 2022 [cited 2 June 2022]. Available from: https://www.cdc.gov/mmwr/volumes/71/wr/mm7122e1.htm
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