The monkeypox virus causes monkeypox disease. This virus is of the same family of viruses as the variola virus, responsible for smallpox. Monkeypox symptoms are very similar to that of smallpox but milder. It is a rare disease and not fatal and it is not related to chickenpox.
It was first identified in 1958 after two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research purposes. The name “monkeypox virus” does not necessarily mean the source of the infection is the monkeys. It is believed that African rodents and non-human primates like monkeys might harbour the monkeypox virus and infect others.
In 1970, the first human case was recorded. The disease had been reported in several central and western African countries before the outbreak in 2022. Earlier all cases outside of Africa were linked to international travel to countries where the disease occurs or through imported animals.
The monkeypox symptoms are similar to smallpox symptoms, only milder, and it is rarely fatal. The incubation period is approximately 1 to 2 weeks. It is the time which takes to develop monkeypox symptoms after an exposure. Generally the infections start with flu-like symptoms.
Monkeypox Symptoms include:
- A rash that can look like blisters – Monkeypox Symptoms
- Fever – Monkeypox Symptoms
- Muscle aches and backache
- Swollen lymph nodes – Monkeypox Symptoms
A rash could appear on our face, inside the mouth, and on some other parts of the body, like the chest, hands, feet, etc. The rash has different stages before healing completely. The rashes appear on the face, in the oral cavity and on the palms and soles. They look like chickenpox rash caused by the Varicella zoster virus. Rashes begin as discoloured patches of skin. Then it transforms into blisters and more giant pus-filled pimples. In extreme cases, separate skin rashes can join and form one colossal lesion. The illness typically lasts 2-4 weeks. Sometimes, people get a rash first, followed by other symptoms. Others only experience a rash.
The virus is an enveloped double-stranded DNA virus that belongs to the Orthopoxvirus genus of the Poxviridae family. The monkeypox virus has two distinct genetic clades: the central African (Congo Basin) clade and the West African clade.
The natural host of the virus
Various animal species like rope squirrels, tree squirrels, Gambian pouched rats, dormice, and non-human primates like monkeys have been identified as vulnerable to the monkeypox virus.
Transmission of the disease
When disease transmission passes from animal to human, it is called zoonotic transmission. It can either occur from direct contact with infected animals’ blood, bodily fluids, cutaneous or mucosal lesions or eating undercooked meat or other products of infected animals. People living in or near forest land may have indirect and low-level exposure to the diseased animals.
Respiratory droplets or skin lesions of an infected person or recently contaminated objects can potentially cause human-to-human transmission of the virus. Transmission via respiratory droplet particles usually requires prolonged face-to-face communication. It puts health workers, household members and other close contacts of active cases at greater risk.
How to Diagnose?
In case of suspicion of monkeypox virus infection, health care providers can collect an appropriate sample and get it tested in a laboratory with proper testing capabilities. The confirmation of the disease depends on the type and quality of the specimen and the type of laboratory test. PCR or Polymerase chain reaction test is one of the most preferred laboratory tests as it is accurate and sensitive.
The orthopoxviruses are serologically cross-reactive antigens. The antibody detection methods do not provide specific confirmation. Therefore, serology and antigen detection methods are not recommended for diagnosis or case investigation where resources are limited.
What is the available Treatment?
Patients must get healthy, nutritious foods and stay hydrated. Medicines should be given for any secondary bacterial infection. An antiviral treatment known as tecovirimat was licensed by the European Medicines Agency (EMA) for monkeypox virus in 2022 based on animal and human studies data, but it is not yet widely available.
It is generally a mild disease, and most people start to recover within a few weeks after monkeypox symptoms appear, without any treatment.
If the monkeypox symptoms are severe, one needs treatment in the hospital.
The risk of treatment in a hospital is higher for:
- older people
- young children
- people with a medical condition that affects their immune system
As the infection passes through close contact, it is necessary to isolate patients diagnosed with the virus. One can self-isolate at home if they have mild monkeypox symptoms.
Vaccination against the virus
The European Commission approved a smallpox vaccine named Imvanex after WHO declared it a global health emergency. The approval is valid for all EU member states, including Iceland, Norway and Liechtenstein.
As per CDC or The Centers for Disease Control and Prevention
- U.S. Food and Drug Administration (FDA) licensed two vaccines to prevent the infection ACAM2000 and JYNNEOS, named Imvamune/ Imvanex.
- Though there is a limited supply of JYNNEOS, the stocks are supposed to be replenished in the coming weeks and months.
- There is sufficient stock of ACAM2000, but it should not be used in people with a weakened immune system, atopic dermatitis/eczema, or pregnant women.
- 2 weeks after the second shot of JYNNEOS and 4 weeks after receiving ACAM2000, people are considered fully vaccinated. But still, prevention protocols should be followed.
Prevention is very important
People need to be aware of different risk factors and measures to reduce exposure to the virus.
Reducing the risk of human-to-human transmission
Rapid identification and surveillance of new cases are critical for outbreak containment. The most significant risk factor for monkeypox virus is close contact with an infected person. Health care providers are at a greater risk of disease. Standard infection control precautions should be taken by health care professionals taking care of confirmed or suspected patients.
The outbreak of May 2022 surprises us with data of getting infected without ever being travelled to an endemic area. More data is being collected, and investigations are ongoing to find the source of infection and prevent further spread. It is vital to look into all possible ways of transmission to protect people.
Reducing the risk of zoonotic transmission
Most human infections have resulted from the direct, indirect animal-to-human transmission. Wild animals which are sick or dead, or their meat, blood and other parts, should be steered clear of. Furthermore, any foods which contain animal meat or parts must be thoroughly cooked before eating.
Prevention through restrictions on animal trade
Countries have put regulations and restrictions on the importation of rodents and non-human primates. Potentially infected captive animals must be separated from other animals and placed in quarantine.
Outbreak at a glance
Since 1 January and 22 June 2022, 3413 laboratory-confirmed cases and one death have been reported to WHO from 50 countries/territories in five WHO Regions. In several non-endemic countries, multiple cases were identified in May 2022. Research is ongoing to fully know the epidemiology, infection sources, and transmission patterns.
Since the previous Disease Outbreak News of 17 June was published, 1310 new cases and eight new countries have reported cases.
Most laboratories have confirmed that the WHO European Region reported 86% of cases. Other regions report cases like African Region, the American region, Eastern Mediterranean Region, and Western Pacific Region.
- An antiviral agent to treat smallpox has also been given approval for treatment.
- Smallpox vaccines are being used to provide protection against the virus.
- Vaccines are being developed, and one such has already been approved.
- The virus is of Orthopoxvirus genus and of family Poxviridae.
- Monkeypox symptoms include high fever, rash and swollen lymph nodes etc.
- Monkeypox symptoms usually last from two to four weeks. In the case of this disease, the fatality ratio is approximately 3–6%.
- It transmits from one infected animal or human to another.
- It transmits from one human to another by coming in contact with lesions, body fluids, respiratory droplets and contaminated materials.
What are the first signs of monkeypox virus or what are monkeypox symptoms?
Monkeypox symptoms include high fever, fatigue, headache, swollen lymph nodes etc. Lymphadenopathy or swollen lymph nodes is a distinguishing feature of monkeypox virus from smallpox.
Can it be fatal?
For most people, the answer is No. It only causes mild illness. It can cause severe issues in immune-compromised individuals, pregnant women or older adults.
How does it spread?
Suppose one touches an infected person’s rash, scabs, or body fluid and shares clothing and bedding. In that case, it can transform from one person to another. Pregnant women can pass the illness to the baby in the uterus.
How to treat it?
In general, there is no treatment necessary. Most people can be treated at home through self-isolation and taking analgesics for fever and pain by keeping the body hydrated. An antiviral therapy known as tecovirimat was licensed by the European Medicines Agency (EMA) but is not yet widely available.
How can I prevent myself from monkeypox virus?
It can be prevented in several ways, such as
- Avoid close contact with an infected person
- Do not touch the rash or scab of an infected person
- Must wear gloves and a mask while caring for an infected person
- Never share utensils, clothing, bedding, etc
- Wash hands with soap and water or use an alcohol-based rub
- Avoid crowded places
Are there any serious complications?
Some severe complications are corneal involvement, Encephalitis, Sepsis, Pneumonia, and secondary infection in skin lesions.
Are there tests available for diagnosis?
Yes, tests are available with government health agencies.
Are there medicines available for treatment?
Medicines are generally not given, but medicines developed to treat smallpox can be used in severe cases of monkeypox virus.
Is there a vaccine for prevention?
The European Commission approved a smallpox vaccine named Imvanex. U.S. FDA approved two vaccines to prevent the infection ACAM2000 and JYNNEOS, called Imvamune/ Imvanex.
- CDC. (2022a, July 29). Signs and symptoms. Centers for Disease Control and Prevention. https://www.cdc.gov/poxvirus/monkeypox/symptoms.html
- Episode #76 – Monkeypox virus: Who is at risk? (n.d.). Who.int. Retrieved August 3, 2022, from https://www.who.int/emergencies/diseases/novel-coronavirus-2019/media-resources/science-in-5/monkeypox-who-is-at-risk?gclid=Cj0KCQjwuaiXBhCCARIsAKZLt3npJmvGPcx6gTMD5Uzf1K6fD2600AuyKyp7Xh2EPvPcwYpFIZuVtEIaAk9tEALw_wcB
- Monkeypox. (n.d.-a). Who.int. Retrieved August 3, 2022, from https://www.who.int/news-room/fact-sheets/detail/monkeypox
- Multi-country monkeypox outbreak: situation update. (n.d.). Who.int. Retrieved August 3, 2022, from https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON393