Monkeypox. What You Should Know

Investigators believe the Monkeypox virus was brought to America from Ghana in 2003, when a shipment of 800 animals of various species - including rodents - arrived in Texas.

Monkeypox is similar to smallpox, but far less contagious and deadly. The first case of the virus was identified in monkeys that had been imported from Singapore to a research institute in Denmark in 1953.

The first human case of Monkeypox was linked to a child in the Democratic Republic of the Congo in 1970. The illness was limited to Central and Western Africa until 2003, when farm animals and pets in Texas became infected and passed the virus to humans.

Investigators now believe monkeypox may have originated with African rodents, not monkeys. As of June 13, 2022 there have been over 1000 cases of monkeypox reported worldwide, including ten confirmed cases in the U.S. Health authorities are investigating several suspected cases and how the individuals might have been exposed to the virus.

Outside the U.S. and Africa, 20 countries (mostly in Europe) have reported cases of monkeypox including Australia, Denmark, France, Germany, Italy, Portugal, Spain, Sweden, Switzerland, Israel, and the United Arab Emirates.

Monkeypox causes and modes of transmission

Monkeypox is caused by the monkeypox virus. The virus is a member of the Orthopoxvirus genus, which includes the variola virus that is responsible for smallpox.

Animal-to-human transmission may occur from a bite, scratch, skin lesions or respiratory droplets from an infected animal. Indirect contact with contaminated bedding and clothing may also transmit the virus.

Human-to-human transmission occurs through large respiratory droplets, however, transmission requires prolonged exposure to face-to-face contact. The virus may also infect someone through contact with the body fluids of an infected individual.

Most cases of monkeypox identified in Europe have been observed in young men who have sex with men. Although monkeypox is not considered a sexually transmitted disease, men were seeking treatment for a rash in the genital area, which may have spread through close contact, particularlyrespiratory droplets.

Monkeypox signs and symptoms

Monkeypox symptoms are similar to smallpox, but milder. Signs include headache, fever, muscle aches, and fatigue. Monkeypox can also cause enlarged lymph nodes. Once someone becomes infected with monkeypox, it could take one or two weeks (incubation period) before they exhibit symptoms. The virus normally runs full course in one or two weeks.

A person with monkeypox may initially experience fever, typically between 38.5-40.5°C, along with chills and sweats. These symptoms may be followed by headache, muscle aches, fatigue and back pain.

The lymph nodes typically swell about 2-3 days after the fever. During the 2003 outbreak, almost half of those infected experienced enlarged lymph nodes several centimeters in diameter in the neck and chin areas.

After the fever, a rash or lesions develop on the skin within 10 days, beginning with the face and spreading to other parts of the body like the trunk, hands and feet. They may start as small bumps that may fill with pus and scab over in a cycle that typically lasts between 2-4 weeks.

Monkeypox complications

While the virus usually resolves in 2-4 weeks, complications can include scars; serious bacterial infections;lung complications; eye problems and blindness; and brain inflammation (encephalitis).

The estimated mortality rate for monkeypox is between 1-10 percent, but mostly among people with poor health or pre-existing conditions in Africa. So far no one has died from monkeypox in the U.S.

Monkeypox treatment

Monkeypox usually resolves on its own with bed rest and supportive care, especially in the beginning stages of fever and fatigue.

As of today, there is no specific treatment approved for the monkeypox virus. Updates are provided by the CDC. A person infected with monkeypox should remain isolated until there are no more scabs and the last crust on the skin is shed.

If symptoms become severe or worsen, hospital treatment may be required. . Hospitals have specific protocols in place to avoid spreading the infection to healthcare workers,other patients, and the public.

As per CDC, the following medical countermeasures are offered by the Strategic National Stockpile (SNS) as therapeutic options for monkeypox:

  • Tecovirimat (POXX) - an antiviral drug approved by the The Food and Drug Administration (FDA) for adults and children weighing over 3 kgs.
  • Brincidofovir (Tembexa) an antiviral drug approved by the FDA in June 2021 for treating human smallpox in adults and children, including infants. The CDC is currently working to have this drug approved for monkeypox as well.
  • Cidofovir (Vistide) - an antiviral drug used for AIDS patients that has been approved by the FDA.
  • Vaccinia Immune Globulin Intravenous (VIGIV) - licensed by the FDA to treat complications related to vaccination.

Monkeypox Prevention

Monkeypox prevention includes following general health measures meant to reduce the spread of the virus along with two available vaccines.

General prevention measures include:

  • Avoiding contact with animals that have potential to transmit the disease (for example sick or dead animals in high risk areas)
  • Avoiding contact with materials that had been in contact with a sick animal
  • Practicing good hand hygiene by washing often and using hand sanitizers
  • Staying home when feeling unwell, and talking to a doctor if concerned about symptoms

Two vaccines currently on the market can help prevent monkeypox: ACAM200 and JYNNEOS. Both are licensed in the U.S. to prevent the smallpox virus, particularly JYNNEOS.

  • ACAM2000 is a live virus preparation. After the inoculation, a lesion will form at the site of the injection. It is important to avoid close contact after vaccination because the virus growing at the site of the inoculation can spread to other parts of the body and possibly to other people.
  • JYNNEOS is also a live virus preparation, but does not replicate at the site of the injection. It won’t cause a visible lesion or spread to other people. JYNNEOS is given in two doses, one month apart.
  • Vaccines are recommended for individuals at higher risk including research and healthcare professionals who may work around orthopoxviruses, and military personnel.

Resources

https://emedicine.medscape.com/article/1134714-overview

https://www.cdc.gov/poxvirus/monkeypox/treatment.html

https://www.cdc.gov/poxvirus/monkeypox/symptoms.html

https://www.ncbi.nlm.nih.gov/books/NBK574519/

https://www.cdc.gov/poxvirus/monkeypox/clinicians/smallpox-vaccine.html

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