General Overview of Monkeypox
Monkeypox is a rare illness, similar to smallpox, and caused by the monkeypox virus. This disease is a “viral zoonotic infection” which means it can be spread from animals to humans. It can also be transferred between humans. The disease has similar symptoms to those of the flu, such as chills, and fever; the most distinctive sign is a rash that can take weeks to clear.
What’s the Current Status of Monkeypox?
Monkeypox was first discovered in 1958. The two outbreaks in groups of monkeys showed a pox-like ailment. For decades, Africa was the only place where monkeypox was present; in fact, the disease there is considered endemic. In 2003 the first outbreak of monkeypox was reported outside of Africa when an animal shipment arrived in Texas coming from Ghana. The rodents infected dogs which subsequently transferred the virus to over forty people in the Midwest.
Globalization and more frequent international travels may explain why diseases that were once kept in certain areas are now spreading worldwide. In the summer of 2022, it was reported the first case of Monkeypox in the United States; was a resident who had recently traveled to Nigeria.
A British resident who also traveled to Nigeria presented symptoms on April 29, 2022. The current monkeypox outbreak was officially confirmed on May 06, 2022. There are two known strains of the virus: one originated in Central Africa, and the other one came from West Africa. The current 2022 world outbreak is caused by the West African virus, which is considered less severe.
The CDC currently reports 31,800 cases worldwide, out of those 31,425 in countries where the disease was never historically reported. The current outbreak is present in 89 countries. The United States has so far confirmed 9, 492 cases.
Tracking Monkeypox in The United States
On May 4, 2022, a Massachusetts resident developed a rash a few days after returning from international travel. On May 17, the patient received a diagnosis of confirmed Orthopoxvirus by the Massachusetts LRN laboratory, and CDC confirmed Monkeypox virus West African clade the following day.
It was the same day – May 04, 2022 – when a traveler from New York City developed an oral, painful rash. After the alert was launched by the Massachusetts case, the patient was tested for monkeypox and became isolated. Over the next five days, multiple states reported potential and confirmed cases of monkeypox. On May 31, nine states reported 17 confirmed cases.
We now have over 9,000 confirmed cases; Montana was the last state to report an infected patient in August 2022.
Treatment For Monkeypox
So far, there is no specific treatment or medication designed for monkeypox. Since it’s closely related to smallpox, health experts state that vaccines and drugs developed for smallpox can treat and prevent monkeypox disease.
The smallpox vaccine is considered to have 85% of efficacy in preventing the disease. A study made in 2006 concluded that, while the preventive use of the smallpox vaccine is well-documented, there’s scarce information about its effectiveness once the individual is exposed to the virus. Anti-viral treatment is considered more effective upon monkeypox virus infection. While most patients can recover on their own in a few weeks, doctors around the world are using the following treatment techniques for monkeypox:
- Supportive care or treating symptoms. Most patients will recover on their own without medical intervention. When gastrointestinal symptoms show (such as diarrhea, and vomiting) doctors may prescribe rehydration – oral or intravenous – to minimize fluid losses.
- Antivirals. Several antivirals are known to be effective in treating monkeypox disease. Among them are:
o Tecovirimat. This was the first antiviral prescribed to treat smallpox in adults and infants. Studies report improved survival from lethal monkeypox. Tecovirimat is available through the Strategic National Stockpile as an oral capsule formulation or an intravenous vial.
o Cidofovir and Brincidofovir. The latter was approved in the United States to treat smallpox in June 2021. Brincidofovir has a safer profile (less damage to the kidneys) compared to Cidofovir.
o Vaccinia Immune Globulin Intravenous (VIGIV) is licensed by FDA for treating complications from smallpox vaccination. CDC has permission to use VIGIV for the treatment of orthopoxviruses, including monkeypox, during an outbreak.
Treatment depends on the individual’s medical history and how sick they get. Most people recover within two to four weeks after the infection.
As of today, the global death toll reached ten cases related to monkeypox. Out of those, three happened in Nigeria, two in the Central African Republic. Ghana reported its first death. Out of the countries that have not historically had the disease, four deaths were reported; two in Spain, one in India, and one in Brazil. The WHO is still waiting on more information about these cases.
How is Monkeypox Spreading?
a) From animals to humans: the CDC reports that animals infected with the monkeypox virus can transmit the disease to humans The disease can be transferred through close contact such as hugging, cuddling, petting, licking, sharing food, or sharing sleeping areas.
b) From humans to animals: there is currently no evidence that infected humans can transmit the disease to animals.
c) Person to person: individuals showing the typical monkeypox rash can transmit the disease skin-to-skin, mouth-to-mouth, face-to-face, mouth-to-skin, and through sexual contact. So far, health specialists conclude that a person is no longer infectious until their skin lesions have crusted over and their scabs have fallen off.
d) Environmental. When infected individuals touch objects, surfaces, or items and other people touch them, they can become infected as well. There’s also a possibility of infection when a person breathes into bedding, towels, or clothing used by an infected individual.
e) Air transmission. Monkeypox transmitted through air droplets is not yet understood, and there are no conclusions concerning it so far.
f) Through pregnancy and birth. Pregnant women can transfer the virus to the fetus; monkeypox is also spread after birth through skin-to-skin contact.
g) Other ways. Although monkeypox DNA has been found in semen, there’s no conclusion whether the disease can be spread through bodily fluids such as vaginal fluids, amniotic fluids, blood, or breastmilk.
The most characteristic sign of monkeypox disease is a skin rash.
- The rash can initially resemble blisters or pimples.
- It is usually itchy or painful.
- The rash will go through several stages, including scabs. Once the scabs are fallen off and new skin underneath develops, it is considered cured.
Other common symptoms include:
- Chills and fevers.
- Swollen lymph nodes.
- Muscle aches.
- Gastrointestinal symptoms such as vomiting or diarrhea.
- Respiratory symptoms such as sore throat, cough, and nasal congestion.
Infected individuals may experience all or just a few symptoms.
How Do We Protect Ourselves From Monkeypox?
Smallpox got eradicated thanks to vaccination and an aggressive surveillance program. However, monkeypox cannot be eradicated because of the existence of an animal reservoir. This means, that the pathogen naturally lives and reproduces in animal hosts such as rodents. Nonetheless, the smallpox vaccine is still proven effective against monkeypox viruses.
The United States currently has three different smallpox vaccines in the National Stockpile: JYNNEOSTM (also known as IMVAMUNE, IMVANEX, MVA-BN) and ACAM2000® are licensed for smallpox; the Aventis Pasteur Smallpox Vaccine (APSV) could be used for smallpox under an investigational new drug (IND) protocol.
Following a strict protocol can also drastically reduce the possibility of infection. This includes:
- Avoid unprotected contact with an infected individual (or a person showing one or more symptoms). This includes, but is not limited, to all forms of sexual contact.
- Avoid being inside an infected person’s room (or within 6 ft from them) without wearing a respirator or N95, and eye protection.
- Avoid touching an infected individual’s clothing, linens, surfaces, and all personal belongings without gloves, and protective gowns.
Monkeypox, once considered a rare disease limited to African Countries, is quickly spreading worldwide. The growing lack of herd immunity since the discontinuation of routinary smallpox vaccination has led to general concern among Health Authorities. Being vaccinated, and following protocol drastically reduces the chances of getting infected.