Monkeypox: All That We Know So Far

There has been much written and spoken about a new threat to global health that emerged in the second week of May 2022 – MONKEYPOX. Coming close on the heels of the prolonged COVID-19 pandemic, there is growing concern that this may erupt into a global health event of consequence. Although there is no case reported from India as yet, the Ministry of Health and Family Welfare has already issued Guidelines for Management of Monkeypox Disease last evening. While world health authorities continue to investigate this outbreak further, it is also important to understand this on an individual level.

Monkeypox is a disease caused by a virus of orthopoxvirus family, whose other member includes the now-eradicated smallpox virus. For centuries, smallpox ravaged civilizations and claimed the lives of commoners and kings alike – the Egyptian Pharoah Ramses V is thought to have succumbed to smallpox.

However, monkeypox is a milder infection than smallpox was, even if the symptoms and progression are similar. Even in the countries where it is endemic (mainly in parts of the African continent), the fatality rate is low. Monkeypox is primarily a disease of animals that have become zoonotic –  has crossed species and can infect humans. 

First discovered in research monkeys in 1958 (which is how it got the name), a confirmed human infection was only reported in 1970, from the Democratic Republic of Congo (then Zaire), where a 9-year-old boy was affected with an illness confirmed later to be monkeypox. Since then, cases have mainly been confined to a few endemic African nations with occasional cases being reported from non-African countries, primarily due to animal trading and unsafe behaviour by visitors to endemic countries.

Apart from the animal-to-human transmission, human-to-human transmission can also occur.

Animal-to-human transmission is from the consumption of meat of an infected animal or by coming into contact with its body secretions, getting bitten or scratched. In humans, the disease spreads by:

▪ Close contact:

o Sexual contact or direct contact with the body fluids of an infected person

o Contact with rashes or pustules of an infected case

o Prolonged face-to-face contact with a sick person

▪ After touching virus-contaminated objects, such as shared bedding or clothing

It takes about 6 to 13 days for the virus to incubate once a person gets infected but it may take as long as 3 weeks. The initial symptoms are fever, body ache, swollen lymph nodes, chills, and extreme exhaustion. About 1 to 3 days later, as the fever begins to subside, patients develop a rash usually on the face, extremities, and genitalia. The rash progresses through several stages, forming pus-filled blisters, before crusting and falling off. People remain infectious until all the crusts have fallen off. Most people usually recover within about 2 to 4 weeks. During the rash phase, a secondary bacterial infection is also a significant risk. 

Hence, it becomes important to isolate suspected and confirmed cases so that further transmission can be arrested. Contact tracing definitely helps. The clinical picture guides the diagnosis and is confirmed by either an RT-PCR test or by visualizing the virus under a microscope using a swab from the rash. People who have been vaccinated against smallpox in the past appear to have 85% protection from monkeypox. A newer vaccine that protects against smallpox and monkeypox is available in a few locations, mainly for clinical research personnel in high-risk areas. 2 antiviral medications have also been studied to be of benefit but are not easily available as yet.

This is the first time that a large number of cases are being reported from non-endemic countries (400 cases across 24 countries as of 31 May 2022). There are 2 known variants of monkeypox and though cases being reported during the current outbreak belong to the milder variant among the two, there is a worry that a mutation may have occurred, affecting the transmissibility. Also puzzling is the finding that this time around, many cases have no direct contact with infected animals or humans.

So far, the outbreak remains just that – an outbreak. Global health bodies are working closely to share information and guidance to limit and prevent the spread. Companies and organizations already have measures in place against COVID-19. Some of these measures will also help prevent monkeypox outbreaks at work. During travel, additional precautions needed include masks, hand sanitization, and avoidance of contact with animals and sick persons.

Staying current on updated information from credible sources is critical to ensure that the evolving 

AUTHOR: DR. VIKRAM VORA, MEDICAL DIRECTOR, INDIAN SUBCONTINENT, INTERNATIONAL SOS

International SOS webinar Link:  All you need to know about the Monkeypox webinar

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