zFind out what Monkeypox is all about, and whether it is a new viral infection we have to worry about!
Monkeypox : What You Need To Know
People are now worried about the rapid spread of monkeypox globally, with cases in at least 20 countries outside of Africa.
Here are some facts about monkeypox that you should know…
Monkeypox Is Different From COVID-19
First, let me just clearly state this – the monkeypox virus is completely different from the SARS-CoV-2 virus that causes COVID-19.
The monkeypox virus is a double-stranded DNA virus from the Orthopoxvirus genus in the Poxviridae family. It is closely related to the smallpox virus (variola)
The SARS-CoV-2 virus is a single-stranded RNA virus from the Betacoronavirus genus in the Coronaviridae family. It is closely related to the SARS virus (SARS-CoV-1).
Monkeypox Is A Zoonotic Disease
Monkeypox is a zoonotic disease that is primarily carried and spread by animals, especially primates.
It was first discovered in monkeys in 1958, giving rise to the name – monkeypox. The first human case was only reported in 1970.
Monkeypox Is Getting More Common
The monkeypox virus used to be a relatively rare zoonotic virus, with about 400 human infections reported from 1970 to 1986 that were mostly limited to Central and West Africa.
It is becoming more common though, with 2000 cases per year reported between 2011 and 2014. Several small outbreaks in the US (2003 and 2021), UK (2018 and 2021), and Singapore (2019) were also reported.
In the current 2022 outbreak, over 200 confirmed cases of monkeypox have been reported in 21 countries.
Monkeypox : Transmission, Mortality + Disease Progression
The monkeypox virus are generally transmitted through these methods :
- animal-to-human : close contact, scratches or bites, or direct contact with bodily fluids
- human-to-human : respiratory droplets or contact with bodily fluids or fomites (contaminated surfaces)
The virus enters the body through broken skin and the mucous membranes of the eyes, nose and mouth.
Risk factors for human transmission include sharing the same bed or room with an infected person, as well as having sexual intercourse or sharing utensils.
Monkeypox Mortality Rate
Monkeypox is not as easily transmitted as COVID-19, but has a significantly higher mortality rate depending on the strain :
- West African strain : 1% to 3%
- Central African strain : 10%
Fortunately, the infections in the 2022 monkeypox outbreak are of the less virulent West African strain.
How A Monkeypox Infection Progresses
After infection, the incubation period is usually 7-14 days, but can vary from 5-21 days.
The patient will start experiencing general symptoms like fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion.
Within 1-3 days though, the patient will develop lesions in the mouth, before they appear on the face and then spread to other parts of the body.
- The first lesions appear on the tongue and in the mouth
- A macular rash (flat, discoloured) then appears on the face, before spreading to the arms and legs and then hands and feet.
- The macular rash will typically spread to the entire body within 24 hours, but is most concentrated on the face, arms and legs.
- By the third day of the rash, the lesions will develop into elevated and palpable papules.
- By the fourth to fifth day of the rash, the lesions will become fluid-filled vesicles.
- By the sixth to seventh day, the vesicles will become pustular (filled with pus).
- The pustules will be round and firm, with a depression in the centre, for the next 5-7 days.
- By the end of the second week, the pustules will scab over for about a week before falling off.
Only after ALL of the scabs have fallen off is a person considered no longer contagious.
After the scabs have fallen off, the affected skin may appear pale before becoming dark marks, sometimes becoming pitted scars.
Monkeypox : Testing, Treatment + Prevention
Confirmation of a monkeypox infection is based on the detection of its viral DNA through real-time or conventional polymerase chain reaction (PCR).
The doctor will swab the lesions and/or exudate and/or crusts, which is different from how samples are collected for COVID-19 tests.
There is currently no proven treatment for monkeypox infections, which will generally resolve over 2-4 weeks.
Patient care is usually supportive in nature (antipyretic medicine, fluid balance and oxygenation), but in severe cases, several antiviral treatments can be attempted :
- Cidofovir and Brincidofovir (CMX001), which have proven activity against poxviruses in laboratory and animal studies.
- Tecovirimat (ST-246), which was shown in animal studies to be effective in treating orthopoxvirus-induced disease.
- Vaccinia Immune Globulin (VIG)
I should point out that none of these antiviral treatments have been proven to work against monkeypox.
Smallpox Vaccine Can Protect Against Monkeypox
The monkeypox virus is so closely related to the (eradicated) smallpox virus, that the smallpox vaccine can protect against monkeypox.
The smallpox vaccine called JYNNEOS (Imvamune / Imvanex) was earlier proven to be at least 85% effective in preventing monkeypox, and was thus licensed for use against monkeypox. Another smallpox vaccine called ACAM2000 may also be used.
The smallpox vaccine can also be given to those who were just exposed to the virus, to reduce its symptoms.
But please do NOT call up your local clinic to ask for the smallpox vaccine. It has not been available in many countries for decades because smallpox was effectively eradicated in 1980.
Other Preventive Measures
In the absence of the smallpox vaccine, the same measures used to avoid COVID-19 can be adopted to also avoid monkeypox :
- Avoid contact with animals that can harbour the virus, particular animals that are sick or have been found dead
- Avoid contact with infected monkeypox patients and their close contacts
- Avoid contact with objects or surfaces that have been in contact with a sick person / animal
- Use personal protective equipment (PPE) while caring for patients – N95 face mask, face shield, etc.
- Practice good hand hygiene, washing with soap and water, or an alcohol-based hand sanitiser
Monkeypox patients must be isolated either in a hospital or at home, until all lesions are clear with a fresh layer of skin.
Close contact with other people should be avoided until all scabs have dropped off, which usually takes 2-4 weeks.
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