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THE CONVERSATION
This article was originally published in The Conversation, an independent and non-profit source of news, analysis and commentary by academic experts. Disclosure information is available on the original site.
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Author: Sameer Elsayed, Professor of Medicine, Pathology and Laboratory Medicine and Epidemiology and Biostatistics, Western University
With cases reported in a number of countries, human monkeypox infection is causing global interest and concern as an emerging threat of infectious disease even in the midst of the slowly declining COVID-19 pandemic.
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What is the monkeypox virus?
Monkeypox is a member of a closely related group of viruses of the genus Orthopoxvirus, which includes smallpox, bovine smallpox and camel smallpox. The monkeypox virus was first discovered in the summer of 1958 as a non-fatal, smallpox-like skin disease of captive monkeys at a research institute in Denmark.
The name monkeypox is incorrect, as terrestrial African rodents (rats and squirrels) serve as a natural reservoir for the virus, while monkeys and other primates are thought to be random hosts.
When was monkeypox first reported in humans?
The first known case of human monkeypox infection was reported by the Democratic Republic of the Congo in 1970 in a nine-month-old boy with a non-fatal smallpox-like disease.
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Since then, sporadic cases of humans have occurred in many countries in Central and West Africa, with infections being more common in children and young adults. In countries where smallpox is endemic (where it is common), recent increases are thought to be linked to climate change, deforestation, wars, increased population mobility and declining immunity of the herd from smallpox vaccination.
How is monkeypox transmitted?
Transmission occurs through close physical contact with animals or humans, their body fluids, contaminated droplets of respiratory secretions or infected skin lesions and indirectly through “fomiti” (inanimate objects such as bedding, towels and hard surfaces that can be loaded with infectious viral particles).
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Animal bites and the consumption of animal meat are common modes of transmission in endemic areas. Secondary infections among unvaccinated close contacts occur in about 12.3% of household contacts and 3.3% of others.
When was monkeypox first reported in non-African countries?
The first cluster of human monkeypox infections outside Africa occurred in the United States in 2003. An outbreak in several states involving 87 children and young adults has been attributed to close contact with infected prairie dogs acquired as pets by an animal distributor. The main source of infection was found to be imported Gambian rats, which transmitted the infection to prairie dogs. There were no human deaths, although three children suffered from a serious illness.
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Prior to 2022, several travel-related cases were reported in the United Kingdom, Israel, Singapore and the United States among people who visited Nigeria.
What do we know about the global smallpox epidemic in non-endemic countries?
On 7 May 2022, the public health authorities in the United Kingdom were informed of a case of an imported human monkeypox infection in a traveler returning from Nigeria. Since then, more than 550 confirmed human cases have been reported in the United Kingdom and 29 other countries. The incidence is extremely high among men who have sex with men, although it is not known that the virus is sexually transmitted.
What are the symptoms of monkeypox?
The clinical manifestations of human monkeypox infection mimic those of smallpox, but are usually much milder. Unlike monkeypox, smallpox is an eradicated disease, has no animal reservoir, and usually does not affect the lymph nodes.
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The incubation period of apes in humans varies from four to 21 days and is followed by one to five days of fever, chills, sweating, fatigue and enlarged, sensitive lymph nodes in the neck and groin.
The next phase involves a multi-stage rash that progresses from small skin patches to papules (small bumps on the skin), followed by vesicles (small bumps filled with clear fluid) and then pustules (small bumps filled with pus). They are most noticeable on the face, palms and feet. The pustules are removed by scarring or crusting over the next two to four weeks.
Exposed people may also develop a sore throat, cough and / or a rash on the mucous membranes of the mouth.
How severe is monkeypox infection?
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The disease is usually mild, although severe illness and death can occur. There are two common genetic variants of the monkeypox virus: the Central African variant and the West African variant. Mortality rates of 3.6% for the West African variant and 10.6% for the Central African variant have been reported in endemic regions.
However, so far no deaths have occurred in any of the cases reported outside Africa. All confirmed cases of the outbreak in 2022 in the 30 non-endemic countries are due to the West African version.
Are there other public health recommendations for monkeypox?
People who are infected with monkeypox should wear surgical masks, and skin lesions should be covered until they heal. Items for personal use such as towels and sheets should not be shared. Frequently touched surfaces should be disinfected regularly, contaminated clothing should be washed, and contact with households and non-household members should be avoided until the disease has resolved.
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Healthcare professionals should wear gloves, gowns and respiratory protection with N95 masks and face shields and maintain excellent hand hygiene while caring for patients with monkeypox. Hospitalized patients with confirmed or suspected monkeypox should be isolated with precautionary measures for airborne and contact transmission until they are no longer contagious.
Does the smallpox vaccine protect against monkeypox?
The smallpox vaccine – given before or after exposure to monkeypox – can prevent or reduce the effects of human measles infection. However, rare but serious side effects have been reported by older generations of smallpox vaccines. A newer generation live vaccine is now available that is not replicable and is considered safe for use by all populations, including those with compromised immune systems.
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The Advisory Committee on Immunization Practices of the US Centers for Disease Control and Prevention recommends pre-exposure prophylaxis (vaccination before exposure to the virus) with a newer generation vaccine for laboratory workers performing monkeypox diagnostic tests, as well as for health professionals, administering smallpox vaccine or caring for monkeypox patients. (The trade name is Jynneos in the United States, Imvamune in Canada, and Imvanex in Europe.)
In Canada and other developed countries, people born before 1972 may have been vaccinated against smallpox. Although post-vaccination immunity tends to decline with age, lifelong immunity appears to be the norm after smallpox vaccination in otherwise healthy individuals, and its cross-protective efficacy against monkeypox is estimated to be 85 percent.
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Is smallpox the next viral pandemic?
The emergence of infectious diseases such as smallpox in non-endemic areas has created great concern in light of our experience with COVID-19.
Monkeypox has been a neglected tropical disease until the current outbreak in the developed world. But the trajectory of these cases, combined with the model of transmission in Africa, suggests that the virus will not become a pandemic.
The basic number of reproductions (R0), a measure of viral infectivity, where R0 is equal to the number of secondary infections transmitted from a single case in a non-immune population, is 0.6 to 1.0 for the Central African variant and much lower for West African version.
In contrast, R0 for the Omarron variant of SARS-CoV-2 is approximately 10 and R0 for measles ranges from 11 to 18. R0 for the West African variant of monkeypox virus may be too low to be maintained by humans. transmission from people outside endemic areas.
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Sameer Elsayed does not work for, consult with, hold any shares in or receive funding from any company or organization that would benefit from this article, and has not disclosed any relevant links outside of their academic assignment.
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This article was republished by The Conversation under a Creative Commons license. Disclosure information is available on the original site. Read the original article:
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