Monkeypox

Origin

Monkeypox:  The ravenous disfigurer that you must have heard of.

This rare disease is caused by an infection of the monkeypox virus which is part of the same family as smallpox. Its symptoms are similar to those of smallpox but moderate and rarely fatal.

It was discovered in 1958 when two outbreaks of a pox like disease occurred in colonies of monkeys kept for research.

Human monkeypox was first identified in humans in 1970 in the Democratic Republic of the Congo in a 9 month old boy in a region where smallpox had been eliminated in 1968. Before the 2022 outbreak, monkeypox had been reported in people in several central and western African countries; Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Cote d’Ivoire, Liberia, Nigeria, the Republic of the Congo, Sierra Leone and South Sudan.

Monkeypox is a disease of global public health importance as it not only affects countries in west and central Africa but the whole world. 

In 2003, the first monkeypox outbreak outside of Africa was in the United States of America and was linked to contact with infected pet prairie dogs. These pets had been housed with Gambian pouched rats and dormice that had been imported into the country from Ghana. This outbreak led to over 70 cases of monkeypox in the U.S. 

Multiple cases of monkeypox were identified in several non endemic countries from September 2018   May 2022. And that's why there has been an increasing cause for concern.

Host And Transmission of Monkeypox 

Different animals have been identified as susceptible to the monkeypox virus. This includes; rope squirrels, tree squirrels, Gambian pouched rats, dormice, non-human primates etc. Further studies are needed to identify the exact reservoir(s) and how virus circulation is maintained in nature.

Animal-to-human (zoonotic) transmission;

1. can occur from direct contact with the blood, bodily fluids, or cutaneous or mucosal lesions of infected animals. 
2. Eating inadequately cooked meat and other animal products of infected animals is a possible risk factor. 
3. People living in or near forested areas may have indirect or low-level exposure to infected animals.

Human to human transmission; 

1. can result from close contact with respiratory secretions, skin lesions of an infected person or recently contaminated objects.
2. Transmission via droplet respiratory particles usually requires prolonged face to face contact, which puts health workers, household members and other close contacts of active cases at greater risk. 
3. Transmission can also occur via the placenta from mother to foetus (which can lead to congenital monkeypox) or during close contact during and after birth. 

While close physical contact is a well known risk factor for transmission, it is unclear at this time if monkeypox can be transmitted specifically through sexual transmission routes.

Signs and symptoms

The infection can be divided into two periods which are:

The invasion period (which lasts between 0-5 days) is characterized by;

1. Fever
2. Intense headache
3. Swelling of the lymph nodes
4. Back pain
5. Muscle aches and  

The skin eruption usually begins within 1- 3 days of the appearance of fever. The rash tends to be more concentrated on the face and extremities rather than on the trunk. It affects the face (in 95% of cases), palms of the hands and soles of the feet (in 75% of cases). Also affected are oral mucous membranes, genitalia and conjunctiva as well as the cornea. The rash evolves from macules (sore with a flat base) to papules (slightly raised firm sore), vesicles (sore filled with clear fluid), pustules (sore filled with yellowish fluid), and crusts which dry up and fall off. 

Severe cases are common among children.

Severity of monkeypox is based off on;

1. Extent of virus exposure
2. Patient health status 
3. Nature of complications
4. Underlying immune deficiencies.

Although vaccination against smallpox was protective in the past, today persons younger than 40 to 50 years of age (depending on the country) may be more susceptible to monkeypox due to the lack of smallpox vaccination campaigns globally in recent times.

Complications of monkeypox can include;

1. Bronchopneumonia
2. Sepsis
3. Encephalitis
4. Infection of the cornea etc.

Prevention

1. Avoid close, skin-to-skin contact with people who have a rash that looks like monkeypox.
2. Avoid contact with objects and materials that a person with monkeypox has used.
3. Wash your hands often with soap and water or use an alcohol-based hand sanitiser, especially before eating or touching your face and after you use the bathroom.
4. In Central and West Africa, avoid contact with animals that can spread the monkeypox virus, usually rodents and primates. Also, avoid sick or dead animals, as well as bedding or other materials they have touched.
5. Vaccination is recommended for people who have been exposed to monkeypox and people who may be more likely to get monkeypox.
6. People with monkeypox should avoid contact with animals, including pets, domestic animals, and wildlife to prevent spreading the virus

Treatment

There are no treatments specifically for monkeypox virus infections. However, monkeypox and smallpox viruses are genetically similar, which means that antiviral drugs and vaccines developed to protect against smallpox may be used to prevent and treat monkeypox virus infections.

Antivirals, such as tecovirimat (TPOXX), may be recommended for people who are more likely to get severely ill, like patients with weakened immune systems.

If you have symptoms of monkeypox, you should talk to your healthcare provider, even if you don’t think you had contact with someone who has monkeypox.

References

https://www.cdc.gov/poxvirus/monkeypox/about.html

https://www.who.int/news-room/fact-sheets/detail/monkeypox#:~:text=Outbreaks,had%20been%20eliminated%20in%201968.