Monkeypox – Symptoms and Prevention

• Monkeypox is caused by the Orthopoxvirus, which is related to the smallpox family of disorders native to the African continent. However, this virus has recently spread throughout Africa and to some countries in Europe. 
• Monkeypox is capable of human-to-human transmission through contact with secretions containing the virus, which can originate from the respiratory system, wounds, or contaminated objects, while infection via prolonged exposure to aerosol particles is also possible. 
• The smallpox vaccine is approximately 85% effective in helping to prevent a monkeypox infection. 

Monkeypox is a disease native to the African continent, but it has recently spread throughout not just throughout Africa but also Europe, resulting in scientists and the World Health Organization issuing warnings and trying to identify the factors behind the outbreak. 

Monkeypox was first discovered in 1958 during studies of infectious diseases in monkeys, while the first human case was reported in 1970 in the Republic of the Congo. After that, cases were mostly confined to countries in central and western Africa, with most cases reported in the Republic of the Congo and Nigeria. 

Monkeypox is caused by the Orthopoxvirus, which belongs to the Poxviradae family, of which smallpox is also a member. 

Monkeypox has previously been confined to countries on the African continent, but in 2003 there began to be more cases reported in countries outside of the region, although these cases could be traced back to contact from infected patients originating in Africa. Despite the true case numbers being hard to pinpoint, an outbreak in Nigeria in 2017 led to 500 suspected cases, 200 of which were confirmed, with a mortality rate of 3%. 

Since 2018, there have been greater numbers of monkeypox cases outside of Africa, and since May 2022, there have been numerous reported cases outside of the region. Although there are yet to be any confirmed deaths from this current outbreak, it has caused a spike in interest among those studying the disease, who are working hard to prevent the outbreak from broadening its range. 

Animal-to-human transmission 

Animal-to-human transmission stems from contact with the blood, secretions, or open wounds of infected animals, as well as through eating raw meat from an infected specimen. In Africa, such transmission can generally be linked to the consumption of rodents, including squirrels and rats, as well as some types of monkeys. While scientists are still unsure of the disease’s true origins, it is most likely that rodents are where the disease first originated. 

Human-to-human transmission 

Human-to-human transmission occurs when a person comes into contact with secretions from the respiratory system, open wound, or contaminated objects used by an infected patient. Additionally, it is possible that prolonged exposure to aerosols originating from an infected patient can cause an infection, which is why medical staff and those residing with infected patients are at greater risk. It is also possible that the virus can be transmitted from mother to baby after birth or during the pregnancy. 

Can monkeypox be sexually transmitted? 

There has been no confirmation as to whether this virus can be sexually transmitted, but recent reports of increased cases among sexually active homosexual males with disease indicators found on their genitalia and nearby has led to the hypothesis that monkeypox can be transmitted via intercourse or during sexual activity. 

From studies into the transmission of the disease, it has been found that those most at risk are people who live in areas in close proximity to an outbreak or those who have traveled to African countries. People who have had close contact with infected animals or patients, medical staff, researchers studying the condition, those living with an infected patient, people engaging in activities with an infected patient, and those living nearby forested areas are all more likely to become infected. However, the rates at which the virus spreads through other means are still very low. 

Monkeypox has an incubation period of between 6–13 days, after which symptoms start to present. The symptoms can be split into 2 main phases, as follows: 

Phase 1: Days 0–5 

• A fever 
• Headaches 
• Aches and pains 
• Back pain 
• Fatigue 
• Swollen lymph nodes 

Swollen lymph nodes are the symptom that distinguishes monkeypox from smallpox and chickenpox because the latter do not cause this symptom. 

Rash phase: Days 1–3 following the onset of fever 

A rash tends to form on the face and arms rather than on the patient’s abdomen. However, a rash can also occur on hands, feet, mouth, and in and around the eyes. It begins as a red rash and hives, but these soon develop into clear pustules that turn yellow after time, and finally dry up and fall away. In severe cases, these pustules can become quite large and remove areas of skin when they peel off, although all symptoms generally go away without treatment after 2-4 weeks. 

Serious complications associated with the disorder are repeat infections, pneumonia, hematological infections, nerve system infections, and loss of sight caused by eye infections. 

Despite symptoms being similar to smallpox, the symptoms of monkeypox are actually less dangerous, with most patients recovering without treatment within 2–4 weeks of contracting the virus. Mortality rates for this disease are approximately 0–11%, with most deaths occurring in children. Moreover, recent figures show that the mortality rate has dropped to between 3–6%, with children, adolescents, and those with immune system deficiencies shown to be most at risk because most of the adult population have received a smallpox vaccine, which can play a part in protecting them against monkeypox. 

Patients presenting a rash should undergo diagnosis to rule out other associated conditions, such as smallpox, chickenpox, scabies, syphilis, skin allergies, and medication allergies. Additionally, the presence of swollen lymph nodes is an indicator that the patient may have monkeypox rather than smallpox or chickenpox. Nevertheless, medical staff will usually attempt to confirm their diagnosis with additional screening (screening of skin particles or pustule fluids are advised), including a polymerase chain reaction (PCR) test, which involves removing a tissue sample from the patient and sending it away for laboratory testing. Patients should also be sure to communicate their symptoms and timeframe, as well as informing their doctor if they have received any vaccinations related to this type of disease that may cause a false positive result. 

The smallpox vaccine can play a part in reducing the likelihood of contracting monkeypox by approximately 85%, but there are also vaccines being developed specifically to provide protection against monkeypox. Aside from these, there are certain habits that can help people to reduce their risk of infection, as follows: 

• Regularly wash hands with soap or alcohol-based gel 
• Avoid contact with infected patients 
• Avoid consumption of raw meat 
• Avoid contact with wildlife and the secretions of animals suspected of carrying the disease, such as monkeys and rodents 

Those working in research facilities and medical staff should use PPE to reduce their risk of infection. 

Most patients who contract monkeypox recover without the need for treatment, so most care is targeted at treating symptoms, such as the use of intravenous saline and nutrient solutions to reduce the risk of complications occurring and to prevent any long-term side effects. However, some countries also utilize antiviral drugs, including tecovirimat and cidofovir. 

Although the current monkeypox outbreak has not reached a dangerous level, nor are mortality rates currently anything to worry about, the constantly changing nature of such viruses means we must remain vigilant and be sure to follow the latest news surrounding the disease. 

Reference 

• https://www.nytimes.com/article/what-is-monkeypox.html 
• https://www.cdc.gov/poxvirus/monkeypox/index.html 
• https://www.who.int/news-room/fact-sheets/detail/monkeypox  
• https://www.gov.uk/guidance/monkeypox 
• https://www.nhs.uk/conditions/monkeypox/