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Monkeypox - An Ongoing Outbreak

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Monkeypox infection is a viral zoonotic disease that causes rash, fever, fatigue, and respiratory symptoms. Read more about this condition below.

Medically reviewed by

Dr. Balreen Kaur Bali

Published At March 1, 2023
Reviewed AtMarch 1, 2023

Introduction

In 1970, when smallpox was nearly eradicated, a previously unrecognized orthopoxvirus named monkeypox was identified in humans. The first known human case occurred in the Equateur province of Zaire, in a nine-year-old boy. Monkeypox was limited to the rain forests of central and western Africa until 2003, when the first cases in the Western Hemisphere were reported, where multiple individuals were identified as having fever, rash, and respiratory symptoms following exposure to ill pet prairie dogs.

In the most recent outbreak in May 2022, the United Kingdom reported nine cases of Monkeypox, with the first identified case traveling to Nigeria, which resulted in two confirmed transmissions within the patient's family to another adult and a toddler.

On May 18, 2022, the Massachusetts Department of Public Health announced a confirmed case of monkeypox in an adult male who had recently visited Canada. Monkeypox is a disease of global public health importance as it affects not only countries in west and central Africa but also the rest of the world. At the present date, 14th September 2022, there are 22,630 total cases of monkeypox in the U.S., two deaths, and 59,179 global cases. In recent times, the case fatality ratio has been around three to six percent.

What Is Monkeypox?

Monkeypox is a viral zoonosis (a virus transmitted to humans from animals). Monkeypox virus is an enveloped double-stranded deoxyribonucleic acid (DNA) virus that belongs to the Orthopoxvirus genus of the Poxviridae family. The symptoms are similar to smallpox, although it is clinically less severe. Monkeypox primarily occurs in central and west Africa, often near tropical rainforests. Various animal species, especially rodents, have been identified as natural hosts of the Monkeypox virus, including rope squirrels, tree squirrels, Gambian pouched rats, dormice, non-human primates, and other species, but still, further studies are needed to identify the exact reservoir.

How Is Monkeypox Transmitted?

Monkeypox is transmitted in the following ways:

1) Animal-to-Human Transmission:

  • This can occur from direct contact with the blood, bodily fluids, or the lesions of infected animals.

  • Eating inadequately cooked meat and other animal products of infected animals.

2) Human-to-Human Transmission:

  • This can result from close contact with respiratory secretions, skin lesions of an infected person, or recently contaminated objects (clothing, bedding, or towels) and surfaces.

  • Transmission can also be from mother to fetus via the placenta (congenital Monkeypox) or during close contact during and after birth.

  • Oral, anal, and vaginal sex or touching the genitals (penis, testicles, labia, and vagina) or anus of a person with Monkeypox.

  • Hugging, massaging, and kissing.

  • Prolonged face-to-face contact.

At present, data suggest that gay, bisexual, and other men who have sex with men make up the majority of cases in the current Monkeypox outbreak. People with Monkeypox have higher than expected rates of HIV as well as other concurrent sexually transmitted infections (STIs). Nearly two in five people with Monkeypox are HIV-Positive. However, regardless of sexual orientation or gender identity, anyone who has been in close, personal contact with someone who has Monkeypox is at risk.

What Are the Signs and Symptoms of Monkeypox?

The symptoms of Monkeypox usually start within about three weeks (can vary from 5 days to 21 days) of exposure to the virus and last for two to four weeks. Listed below are the symptoms:

  • A rash may be located anywhere on the body, near the genitals (penis, testicles, labia, and vagina) or anus, and could be on other areas like the hands, feet, chest, face, or mouth. Initially, it looks like blisters or pimples and can be itchy or painful. The rash tends to be more concentrated on the face and extremities rather than on the trunk. And then, it becomes a scab (crusty) before healing.

  • Fever.

  • Chills.

  • Swollen lymph nodes.

  • Fatigue.

  • Muscle aches and backache.

  • Headache.

  • Respiratory symptoms (e.g. sore throat, nasal congestion, or cough).

However, there is a variation in the development of the symptoms. Some people have flu-like symptoms before the rash. Some people get a rash first, followed by other symptoms. While others only get a rash.

Monkeypox is usually a self-limiting disease. Severe cases can occur more commonly among children and are related to the extent of virus exposure, patient health status, and the nature of complications. Any underlying immune deficiencies may play a role in having worse outcomes.

How Is Monkeypox Diagnosed?

Other similar illnesses should also be considered, including other rash illnesses, such as chickenpox, measles, bacterial skin infections, scabies, syphilis, and medication-associated allergies. Diagnosis of Monkeypox is made after studying the signs and symptoms, and the PCR result.

  • Polymerase chain reaction (PCR) is the preferred laboratory test because of its accuracy and sensitivity. For this purpose, samples are taken from skin lesions (skin swabs).

  • Patient specimens must be safely prepared for transport with triple packaging in accordance with WHO (world health organization) guidance for the transport of infectious substances.

How to Interpret the Test Results?

To interpret the test results, it is critical that some necessary information about the patient is provided with the specimens, including:

a) Age.

b) Date of onset of fever.

c) Date of onset of rash.

d) Date of specimen collection.

e) Current status of the individual (stage of rash).

Interpretation of Results:

  • If the test result is positive, it means that a person does not have Monkeypox disease. So necessary steps must be taken to protect oneself and others.

  • If the test result is negative, it means the person probably does not have Monkeypox. Continue to take steps to protect oneself and others.

  • If the test result is inconclusive, that means that the test will need to be conducted again.

What Is the Treatment for Monkeypox?

Most people infected with Monkeypox recover fully within two to four weeks without the need for medical treatment. No specific treatment is available for Monkeypox virus infections. However, antiviral drugs and vaccines developed to protect against smallpox can also be used to treat Monkeypox.

1) Antiviral Drugs - Antivirals like Tecovirimat (TPOXX) may be recommended for severely ill patients.

2) Vaccination - The Centers for Disease Control and Prevention (CDC) recommends smallpox or Monkeypox vaccination within two weeks of exposure, ideally within four days. It is 85 percent effective in preventing Monkeypox.

  • The JYNNEOS vaccine is approved for the prevention of smallpox and Monkeypox.

  • The ACAM2000 vaccine is an alternative to JYNNEOS.

In September 2019, the U.S. Food and Drug Administration (FDA) approved an attenuated, live, nonreplicating smallpox and Monkeypox vaccine (Jynneos) for the immunization of adults at high risk for smallpox or Monkeypox infection.

How Monkeypox Can Be Prevented?

  • Raising awareness and educating people about the disease.

  • Avoid close contact with infected persons or people having Monkeypox rash.

  • Reduce animal-to-human transmission by avoiding contact with infected wild animals.

  • Thoroughly cook the food before eating.

  • Disinfect the house with a strong disinfectant.

  • Standard clothing that fully covers the skin should be worn.

  • Proper hand hygiene should be maintained.

  • Proper methods of waste disposal should be adopted.

  • A person having Monkeypox disease should be isolated or quarantined.

  • Any infected animal who came in contact with another infected animal should be quarantined and observed for 30 days.

Conclusion

Monkeypox is a viral disease transmitted by either coming in contact with an infected animal or with an infected person. The symptoms began to appear about two to three weeks after exposure to the virus. Some people recover fully in two to four weeks without the need for any medical treatment. No specific treatment is available, but antiviral drugs and vaccines that were developed for smallpox can also be used for the treatment of Monkeypox.

Dr. Muntaqa Butt
Dr. Muntaqa Butt

General Practitioner

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monkeypox virus
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