What is monkeypox virus? How is it transmitted?

What is monkeypox, and how is it transmitted?

Monkeypox is a viral zoonosis, meaning it is a disease transmitted from animals to humans. It is caused by the monkeypox virus, a member of the Orthopoxvirus genus, which also includes the variola virus (smallpox). Transmission to humans can occur through direct contact with the blood, bodily fluids, or cutaneous or mucosal lesions of infected animals. Human-to-human transmission is possible, though less common, and occurs primarily through respiratory droplets, direct contact with an infected person's bodily fluids or lesions, and contaminated objects like bedding or clothing.

What are the symptoms of monkeypox?

Monkeypox symptoms are similar to those of smallpox but generally milder. The disease typically begins with fever, headache, muscle aches, and exhaustion. Lymphadenopathy (swollen lymph nodes) is a distinctive feature of monkeypox compared to smallpox. After the initial symptoms, a rash develops, usually starting on the face and spreading to other parts of the body. The rash progresses through several stages, from macules to pustules, before eventually forming scabs that fall off.

How severe is monkeypox, and what are the potential complications?

Most cases of monkeypox are mild and self-limiting, with symptoms lasting 2 to 4 weeks. However, severe cases can occur, particularly in children, pregnant women, and inpiduals with compromised immune systems. Complications can include secondary bacterial infections, respiratory distress, encephalitis, and corneal infections that can lead to vision loss. Overall, 1-6% of patients who fall ill, mostly young children, unfortunately, die. In the Central African subtype (strain 1), the fatality rate can reach up to 11%. The current outbreak in Congo associated with this strain has a death rate of around 5%. In the 2022 outbreak, the death rate was quite low, reported to be less than 1%.

It is known that there are two different genetic subtypes causing disease in Central and West Africa. The West African subtype (strain 2) causes milder disease compared to the Central African (Congo Basin) subtype (strain 1). In the 2022 outbreak, which affected countries outside Africa as well as our country, the virus strain called Strain 2, which causes milder infection, was involved. However, in the ongoing outbreak starting from Congo in 2023, the strain 1b subtype of the more severe Strain 1 is involved. There is concern that this strain may have acquired mutations allowing it to spread more easily among humans.

Where is monkeypox most commonly found?

Monkeypox is most commonly found in Central and West African countries, particularly in regions close to tropical rainforests where animals that carry the virus are more prevalent. The Democratic Republic of Congo (DRC) has the highest number of reported cases. However, in recent years, there have been outbreaks outside of Africa, often linked to international travel or imported animals, highlighting the potential for global spread.

How is monkeypox diagnosed?

Diagnosis of monkeypox is based on clinical presentation, particularly the characteristic rash, and can be confirmed through laboratory tests. Polymerase chain reaction (PCR) is the preferred method for diagnosis, as it is highly accurate and can differentiate monkeypox from other orthopoxviruses. Serology and antigen detection methods can also be used, but they are less specific and may cross-react with other orthopoxviruses.

What treatments are available for monkeypox?

There is no specific antiviral treatment approved for monkeypox, but supportive care can help manage symptoms. This includes keeping the patient hydrated, treating secondary bacterial infections, and addressing respiratory symptoms if they occur. Antiviral drugs such as tecovirimat (TPOXX) have been approved for smallpox and are being considered for monkeypox under compassionate use or clinical trial settings, as they may help reduce the severity of the disease.

Is there a vaccine for monkeypox?

Yes, the smallpox vaccine has been shown to be about 85% effective in preventing monkeypox. In countries where smallpox vaccination was widely administered, there is some level of immunity among the older population. However, routine smallpox vaccination was discontinued after the eradication of smallpox, leading to an increased number of people susceptible to monkeypox. A newer vaccine, specifically for monkeypox, has been developed and approved in some countries, but its availability is limited.

How can monkeypox be prevented?

Preventing monkeypox involves several strategies, including avoiding contact with animals that could harbor the virus, especially in endemic areas. Inpiduals should avoid handling or eating bushmeat and maintain good hygiene, such as regular handwashing. In healthcare settings, strict infection control measures should be implemented, including the use of personal protective equipment (PPE). Vaccination for those at higher risk, such as healthcare workers and laboratory personnel, is also recommended.

What should be done if someone is exposed to monkeypox?

If someone is exposed to monkeypox, they should monitor themselves for symptoms for 21 days, as the incubation period typically ranges from 5 to 21 days. If symptoms develop, they should seek medical attention promptly and avoid close contact with others to prevent potential spread. Post-exposure vaccination with the smallpox vaccine can be considered within 4 days of exposure to prevent onset or reduce the severity of the disease.

What are the public health implications of monkeypox?

Monkeypox poses a significant public health challenge, particularly in regions with limited access to healthcare. The potential for outbreaks in non-endemic areas underscores the need for global surveillance and response strategies. Public health efforts should focus on educating communities about the disease, improving diagnostic and treatment capabilities, and ensuring that vaccines are available to those at risk. The recent resurgence of monkeypox highlights the importance of preparedness and the need to address gaps in global health security.