While we are still fighting the COVID-19 pandemic, another viral disease, monkeypox, is beginning to affect a large number of people worldwide. As of June 6, 2022, the Centers for Disease Control and Prevention (CDC) had reported 1,019 confirmed and suspected cases of monkeypox in over 29 countries.
Monkeypox was formerly found in the tropical rainforests of Africa. This disease was endemic in countries like Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Ghana, Ivory Coast, Liberia, Nigeria, and the Republic of the Congo, and Sierra Leone, and South Sudan.
Outside of these countries, monkeypox was initially exclusively diagnosed in travellers to these countries. But now, monkeypox has also been detected among people who have never been to these areas.
Recently, the WHO issued a warning for monkeypox. WHO’s epidemic and pandemic preparedness and prevention chief, Sylvie Briand, said, “We don’t know if we are just seeing the peak of the iceberg.”
So, is the World Health Organization suspecting that monkeypox might cause another pandemic like COVID-19? If that happens, what should we do?
After smallpox was eradicated in 1980, its vaccine was removed from the vaccination schedule. Previously, this vaccine offered immunity against a wide range of viruses in the Poxviridae family, including monkeypox. But now most of the world’s population is susceptible to monkeypox as they have not been vaccinated. The following blog will discuss the disease “monkeypox” in detail.
“Monkeypox” is a zoonotic disease caused by the Orthopoxvirus of the Poxviridae family. The presenting symptoms include acute onset of fever (> 38.5 ˚C), intense headache, lymphadenopathy (swelling of the lymph nodes), back pain, myalgia (muscle aches), chills, exhaustion, and intense asthenia (lack of energy), and skin eruptions.
The symptoms may take about 6 to 13 days to appear in a patient after exposure to the virus. Between the first and third days of fever, skin eruptions appear on the face, inside the mouth, and on other body parts such as the hands, feet, chest, genitals, or anus. It can take several weeks for the rash to disappear.
Even though this disease is self-limiting, severe cases can also be found in some patients. About 3%-6% of the infected patients may die due to complications of the disease.
Currently, not much is known about the reservoir of this virus or how it is circulated in nature. The virus can infect several animals, like rodents and non-human primates such as monkeys.
In humans, the virus is spread through direct contact with skin lesions, respiratory droplets, vesicular fluids, and recently contaminated items such as bedding and clothing. In addition, the virus can be transmitted by a pregnant woman to her fetus via the placenta. However, it is yet to be confirmed if the virus can be transmitted through sexual contact. Even then, the WHO has issued an advisory to not indulge in any sexual activity till fully cured. Eating inadequately cooked meat and other animal products of infected animals can increase the risk of contracting this disease.
Monkeypox is far less severe and contagious than smallpox. However, the longest chain of transmission by human contacts has risen from 6 to 9 in recent years, indicating a decline in the immunity levels of the general population. Hence, the infected patient should be treated in isolation till they are cured.
Most viral diseases, like smallpox, measles, etc., show symptoms like fever, skin lesions, and rashes. Monkeypox can be distinguished from these diseases, however, by the presence of lymphadenopathy during the early stage of the disease.
The laboratory results are not conclusive by themselves in diagnosing monkeypox. They must be correlated with the clinical findings to make a final diagnosis.
Since appropriate medicines and vaccines are not yet available for treating monkeypox, people should be made aware of risk factors and sources of infection of the monkeypox virus. Strict infection control measures and appropriate staff training in handling infected patients, samples, and materials can help in containing the spread of this virus, especially in a healthcare facility.
Monkeypox treatment is currently limited to relieving symptoms, managing complications, and preventing long-term sequelae in patients. It is critical to keep the patient’s fluid levels and nutritional status stable.
Tecovirimat (TPOXX) and Brincidofovir (Tembexa) have been licensed for treating monkeypox by the European Medicines Agency (EMA) in 2022. However, it is not widely available yet. Furthermore, patients on this drug must be monitored closely for any adverse effects.
A vaccine named IMVAMUNE® (also known as MVA-BN, JYNNEOS, and IMVANEX) is also being tested in the 3rd phase of a clinical trial.
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