Traditionally, monkeypox infections have been rare in the United States. However, recent reports show that an unusual outbreak of monkeypox has occurred in a number of nations. Efforts must be made to limit the spread of this virus to prevent a new pandemic. A proactive approach to medical management will not only help stop the epidemic, but will also help determine its extent.
Opinion: A new international epidemic of monkeypox. Image credit: cometa geo / Shutterstock
The monkeypox virus is a member of the same family of viruses as the smallpox virus. It is a double-stranded deoxyribonucleic acid (DNA) virus that was first discovered in monkeys in the 1950s. This virus infects a wide range of hosts, including rodents. The smallpox eradication campaign has revealed human infections. The stake in the Congo Basin is more virulent than the stake in West Africa, which is a softer option. The latter is involved in most cases in this outbreak of monkeypox.
The outbreak currently covers Australia, Austria, Belgium, Canada, the Czech Republic, Denmark, England, Finland, France, Germany, Israel, Italy, the Netherlands, Portugal, Scotland, Slovenia, Spain, Sweden, Switzerland, the United Arab Emirates and the United States. confirmed cases of monkeypox. The virus is spreading in a pattern that does not resemble past outbreaks outside of Africa.
Outbreaks of monkeypox have been identified in 11 African countries in the last few years; the majority took place in the Democratic Republic of the Congo. This increase in the number of cases is due to the weakening immunity of the population to smallpox. The children formed a significant group of individuals who showed symptoms of monkeypox in Africa.
The monkeypox virus was first discovered on other continents after 2003. This viral spread can occur through direct contact, respiratory droplets or folitis. The incubation period is 5-21 days, after which the symptoms and the risk of transmission begin. Evidence of human-to-human transmission is scarce; hence reports of small isolated past outbreaks among humans.
However, airborne transmission is provided for by the Centers for Disease Control and Prevention (CDC) – which also recommends measures to control airborne infections. Infection control protocols emphasize the use of N95 masks and personal protective equipment for health professionals and the general public when visiting public places.
Complications associated with monkeypox are central nervous system (CNS) involvement and airway compromise due to lymphadenitis. Mortality can be between 1-10%, lower in regions with modern medical facilities.
Famous outbreaks of monkeypox
The most notable outbreak was in the United States in 2003, which spread from imported African rats to prairie dogs and then to humans. Of the four dozen documented cases, three have become seriously ill, but no deaths. There is a potential link between all cases of humans and infected animals. In response, prophylactic applications of smallpox vaccine are recommended.
The last two decades have seen a significant influx of monkeypox through international travelers exposed to the virus in endemic countries. The United States has registered two cases related to travel in 2021, but without secondary distribution.
Diagnosis of monkeypox
During the current episode, each episode of new-onset fever and rash should be suspected as monkeypox, especially in patients with lymphadenopathy.
The rash usually appears first in the mouth, then spreads to the face and limbs – in a centrifugal distribution. The polymerase chain reaction (PCR) test for skin lesions or fluid is a confirmation of this infection.
Treatment of monkeypox
A standard for the treatment of monkeypox has not yet been set. Antiviral drugs against smallpox, such as cidofovir, brintsidofovir and tecovirimate, may be effective. Brincidofovir and tecovirimat are approved by the US Food and Drug Administration (FDA) for smallpox. These agents should be reserved for the treatment of severe cases of monkeypox and for the treatment of immunocompromised individuals.
Prevention of monkeypox
Smallpox vaccines have been shown to be effective in preventing monkeypox and as a post-exposure prophylaxis measure. That’s why the FDA has suggested that a new generation smallpox vaccine, JYNNEOS (Bavarian Scandinavian), could be used to prevent monkeypox. In addition, off-label use of ACAM2000, the older generation measles vaccine, is also an option.
Experience from past outbreaks has shown that vaccinating close contacts of an infected person can help reduce the transmission of monkeypox. In addition, prophylactic vaccines administered immediately after possible exposure can significantly weaken and even discontinue it. Vaccine immunoglobulin may serve as an alternative post-exposure prophylactic measure for individuals with contraindications to the smallpox vaccine.
The current epidemic
Dozens of cases of monkeypox have been reported in Europe, the United Kingdom and North America – all outside of endemic areas. During the current epidemic, most of these countries have documented human-to-human transmissions in unrelated clusters that cannot be traced to endemic country trips. Thus, undiscovered transmission circuits are already apparent.
In addition, a significant proportion of cases have been identified in homosexual men. However, this virus is not only sexually transmitted; it is also likely to infect other people after skin-to-skin contact or when exposed to respiratory droplets by an infected person.
The unfolding of the epidemic of smallpox that has caused the current epidemic remains a challenge and may have global significance in explaining the emergence of newer pathogens. There is an urgent need for a deeper understanding of the cause of this outbreak, which has geographically spread further than previous outbreaks of apes in humans. Discoveries like these can prevent outbreaks of such microbes in the future.
Genetic analyzes do not identify viral mutations as a reason for greater tolerability. In this regard, many random speculations have been made, for example – spread through human clusters and social networks. Case studies and case-control studies could help to understand the emergence of the wider scope of the monkeypox virus in the current scenario.
In the meantime, virus control protocols should be in place, which may include case detection, isolation, contact tracing, preventive measures and close contact vaccination and post-exposure vaccination. Healthcare professionals, especially those involved in primary care, are most exposed to monkeypox and have the greatest opportunity to identify new cases.
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