Now that the world is approaching an endemic with Coronavirus, we were shocked by yet another concern that’s keeping us on our toes. Believe it or not, monkeypox was already discovered in 2003, almost 19 years ago due to the importation of infected mammals in 2003 into the United States. This means, it’s not relatively new and since 2018, almost 12 cases of travel-associated MPXV cases have been reported outside Africa until the end of 2021. Fast forward to 2022, for the first time, many outbreaks were reported in the EU Member States and worldwide (in non-endemic countries) that had no epidemiological links to travel or imported mammals.
According to WHO, Monkeypox is an illness caused by the monkeypox virus, which is a viral zoonotic infection. Simply put, it can spread from animals to humans, mostly coming from rodents and/or primates. It can also spread from person to person. The reason it’s called monkeypox is that it was first discovered in colonies of monkeys used for research in 1958. But that doesn’t mean it originated with the animals as the source of the disease remains unknown, according to the Centers for Disease Control and Prevention.
The symptoms and signs may range from person to person. Although some might experience milder symptoms, others can develop more serious ones and would need extra care in health facilities. Pregnant women, children and persons that are immunocompromised are at higher risk to develop severe diseases or complications.
Most common symptoms:
- Muscle aches
- Back pain
- Low energy
- Swollen lymph nodes
These symptoms usually co-occur with the development of a rash that may last for two to three weeks. The most common area that is affected by the rashes is the face, palms of the hands, soles of the feet, eyes, mouth, throat, groin, and genital and/or anal regions of the body. The number of lesions may vary from one up to several thousand. Lesions begin flat, then fill with liquid before they crust over, dry up and fall off, with a fresh layer of skin forming underneath.
Symptoms typically last two to three weeks and usually go away on their own or with supportive care, such as medication for pain or fever. People remain infectious until all of the lesions have crusted over, the scabs fallen off and a new layer of skin has formed underneath.
Anyone with symptoms that could be monkeypox or who has been in contact with someone who has monkeypox should call or visit a health care provider and seek their advice.
How is monkeypox diagnosed?
Due to the rarity of this infection and only a few recent cases that occurred, your healthcare provider may first suspect other rash illnesses, such as measles or chickenpox. But the most important symptom that helps to distinguish monkeypox from other poxes is swollen lymph nodes.
Another way to properly diagnose monkeypox is by taking your tissue sample from an open sore (lesion) and sending it to a lab for polymerase chain reaction (PCR) testing (genetic fingerprinting). Your healthcare provider may also need your blood sample to check for the monkeypox virus or antibodies your immune system makes to it.
The incubation period (interval from infection to onset of symptoms) of monkeypox is usually from 6 to 13 days and ranges from 5 to 21 days.
How does monkeypox spread from person to person?
- Close contact with someone who has a monkeypox rash
Close contact may include face-to-face, skin-to-skin, mouth-to-mouth or mouth-to-skin contact, and sexual contact. Research is still ongoing on the infectious period of monkeypox, but normally it is considered infectious until all of their lesions have crusted over, the scabs have fallen off and a new layer of skin has formed underneath.
Contaminated environments, for instance, where an infectious person touches any surfaces including clothing, bedding, towels, objects and electronics can also be the cause of the spread. When another person comes in contact with these items, they may be infected as well. Another possibility to be infected is breathing in skin flakes or viruses from clothing, bedding or towels, also known as fomite transmission.
- Ulcers, lesions or sores in the mouth
The liquids inside the lesions can be infectious, as well as the ulcers and sores in the mouth. The virus can spread through direct contact with the mouth, respiratory droplets and possibly through short-range aerosols. There is no acknowledgement that transmission through the air could be one of the possible mechanisms for monkeypox as the studies are progressing.
- Pregnant women to the fetus, after birth through skin-to-skin contact, or from a parent with monkeypox to an infant or child during close contact
Although the asymptomatic infection has been reported, it is not clear whether people without any symptoms can spread the disease or whether it can spread through other bodily fluids. Pieces of DNA from the monkeypox virus have been found in semen, but it is not yet known whether infection can spread through semen, vaginal fluids, amniotic fluids, breastmilk or blood. Research is underway to find out more about whether people can spread monkeypox through the exchange of these fluids during and after symptomatic infection.
Symptoms of monkeypox will diffuse on their own within a few weeks. In spite of that, some people do experience medical complications and even death. Newborn babies, children and people with underlying immune deficiencies could possibly be at higher risk of more serious symptoms and death from monkeypox.
Among the complications may include secondary skin infections, pneumonia, confusion, and eye problems. Almost 1% to 10% of people with monkeypox have died in the past. However, the death rates may differ in different settings primarily due to a number of factors including access to health care. Based on the WHO article, the figures stated may be overestimated due to limited surveillance for monkeypox in the past. As for the newly affected countries where the outbreaks are happening, there are no death cases to date.
How can I protect myself and others against monkeypox?
- Avoid contact with people who have suspected or confirmed monkeypox, or with animals who could be infected.
- Make sure to clean and disinfect environments that could have been contaminated regularly.
- Keep yourself informed about monkeypox in your area and have open conversations with those you come into close contact (especially sexual contact) with about any symptoms you or they may have.
- If you showed symptoms of monkeypox, you can try to protect others by seeking medical advice and isolating yourself until you have been evaluated and tested by your healthcare provider.
- Once you are confirmed with monkeypox, you should isolate yourself from others until all of your lesions have crusted over, the scabs have fallen off and a new layer of skin has formed underneath. This will stop you from passing on the virus to others. Get advice from your health worker on whether you should isolate at home or in a health facility.
- Practice safe sex and use condoms as a precaution whilst having sexual contact for 12 weeks after you have recovered.
Is there a vaccine against monkeypox?
Yes. A vaccine was recently approved for preventing monkeypox. Some countries are recommending vaccination for persons at risk. Many years of research have led to the development of newer and safer vaccines for an eradicated disease called smallpox, which may also be useful for monkeypox. One of these has been approved for the prevention of monkeypox. Only people at risk (for example someone who has been in close contact with someone who has monkeypox) should be considered for vaccination. Mass vaccination is not recommended at this time.
While the smallpox vaccine was shown to be protective against monkeypox in the past, current data on the effectiveness of newer smallpox/monkeypox vaccines in the prevention of monkeypox in clinical practice and in field settings are limited. Studying the use of vaccines for monkeypox wherever they are used will allow for the rapid generation of additional information on the effectiveness of these vaccines in different settings.
The CDC says those who have been exposed to monkeypox and haven’t had a smallpox vaccine within three years should get one sooner than later. The agency recommends individuals get inoculated within four days of exposure and no later than two weeks to reduce symptoms.
Treatments for monkeypox
- Always refer to your healthcare provider and follow their advice accordingly.
- Take medication for pain (analgesics) and fever (antipyretics) if needed to relieve some symptoms.
- Drink plenty of water, practice a well-balanced diet and get enough sleep.
- Prioritize your mental health by doing things you love and enjoy and try staying connected to your loved ones for emotional support.
- Do some light exercising if you feel well enough while isolating.
- Avoid scratching your skin and always clean your hands before and after touching lesions.
- Make sure to always keep the skin dry and uncovered and clean the rashes with sterilized water or antiseptic.
Based on the research on therapeutics for smallpox, an antiviral that was developed to treat smallpox (tecovirimat) was approved in January 2022 by the European Medicines Agency for the treatment of monkeypox. However, there is limited experience with these therapeutics in the context of an outbreak of monkeypox. Due to this, their use is usually accompanied by a collection of information that will improve knowledge on how best to use them in future.
What is the difference?
Monkeypox vs. chickenpox
The main difference between the two is the type of viruses that cause it. Monkeypox is an orthopoxvirus, while chickenpox is a herpes virus. Both viruses can be spread through skin-to-skin or prolonged face-to-face contact, but chickenpox is very contagious and spreads more easily than monkeypox. One notable difference is that people with monkeypox are more likely to have swollen lymph nodes than people with chickenpox, and the rashes act individually. Chickenpox rash tends to appear in waves while monkeypox sores develop all at the same time. Chickenpox symptoms (including the rash) usually subsides within two weeks, in contrast with monkeypox that will take two weeks to resolve.
Monkeypox vs. smallpox
Since smallpox and monkeypox are parts of the orthopoxvirus family, they are caused by similar but distinct viruses. By the virtue of successful vaccines, smallpox was eradicated by 1980. Smallpox was very contagious and spread more easily than monkeypox, but monkeypox symptoms are milder.
World Health Organization. (2022, July 12). Monkeypox (Questions and Answers). https://www.who.int/news-room/questions-and-answers/item/monkeypox
World Health Organization. (2022, May 19). Monkeypox (Fact Sheets). https://www.who.int/news-room/fact-sheets/detail/monkeypox
European Centre for Disease Prevention and Control. (2022, June 14). Factsheet for health professionals on monkeypox. https://www.ecdc.europa.eu/en/all-topics-z/monkeypox/factsheet-health-professionals
ARKANSAS DEPARTMENT OF HEALTH. (2022, August 12). Monkeypox. https://www.healthy.arkansas.gov/programs-services/topics/monkeypox
Dustin Jones. (2022, August 5). Monkeypox explained: How to protect yourself and what to watch out for. Npr. https://www.npr.org/2022/07/24/1113197119/monkeypox-symptoms-prevention-vaccines-what-to-know
Cleveland Clinic. (2022, June 17). Monkeypox. https://my.clevelandclinic.org/health/diseases/22371-monkeypox
Centers for Disease Control and Prevention. (2022, June 2). Monkeypox and Smallpox Vaccine Guidance. https://www.cdc.gov/poxvirus/monkeypox/clinicians/smallpox-vaccine.html