Know more about Monkeypox – Jesse Santiano M.D.

Yesterday, the first case in the United States was documented in Massachusetts. There have been seven suspected cases in Montreal, Canada. There were seven confirmed and one probable case of monkeypox in the United Kingdom and eight patients in Spain and Portugal. In the UK, the four cases were among men who have sex with men raising the possibility of community transmission.

Update: 10:30 am. Monkeypox is rapidly spreading. Italy has reported its first case of monkeypox, with two more suspected. Sweden has its first report of monkeypox too.

Update: 4:30 pm. One suspected case of monkeypox in New York City.

Update May 20, 2022. 7:30 am EST. Germany confirms one person with monkeypox.

What is monkeypox?

Monkeypox is an infection usually found in animals (zoonosis) that can affect humans. The skin manifestations are similar to smallpox.

Smallpox vaccination provides immunity against the monkeypox, but the protective immunity is gone since the smallpox vaccination is not done anymore.

The virus that causes monkeypox is from the family Poxviridae. It was first discovered among monkeys in 1958, which explains the name. It was diagnosed among humans in 1970. It is endemic to central and western Africa and most concentrated in the Democratic Republic of Congo.

On electron microscopy, the monkeypox virus is relatively large (200-250 nanometers). Poxviruses are brick-shaped, surrounded by a lipoprotein envelope with a linear double-stranded DNA genome.

http://www.uwlax.edu/clinmicro/clinicalmicro.htm. the University of Wisconsin-La Crosse, Microbiology program, Public Domain, https://commons.wikimedia.org/w/index.php?curid=4638050

The monkeypox virus relies on the host’s ribosomes for mRNA translation. Other than that, poxviruses include all necessary replication, transcription, assembly, and egress proteins in their genome.

The natural reservoir is African rodents. Infections have occurred in squirrels, rats, mice, monkeys, and prairie dogs.

There are two strains the

How can someone get infected with monkeypox?

Animal to human

Direct contact with the body fluids of infected animals
An animal bite
Living in heavily forested and rural areas of central and western Africa
Handling and preparing bushmeat.

Risk factors for human to human transmission include:

The virus can be airborne and can be acquired by breathing. Examples will be sharing a bed or room
Using the same utensils as an infected person.
Caregiving to someone infected with monkeypox virus
Not being vaccinated against smallpox.
An increased transmission risk is associated with factors involving the introduction of a virus to the oral mucosa. (Don’t kiss someone infected with monkeypox)

Natural Course of Monkeypox

Once the virus enters the nose, mouth, or the skin, the monkeypox replicates at the entry site and travels to the local lymph nodes.

Next, the viruses will spread thru the blood (viremia) and seed other organs. This represents the incubation period and typically lasts 7 to 14 days with an upper limit of 21 days.

Symptoms start with a secondary viremia leading to 1 to 2 days of early symptoms such as fever and enlarged lymph nodes (lymphadenopathy) before lesions appear. Infected patients may be contagious at this time. Lesions start inside the mouth and then appear on the skin.

After 1 to 2 days, lesions develop in the mouth, followed closely by skin lesions of the face and extremities (including palms and soles) and are centrifugally concentrated. That means the rash spreads outwards.

The rash may or may not spread to the rest of the body, and the total number of lesions may vary from a small amount to thousands. The rash will become pustular and later on develop crusts. Once the crust dries and falls off, the person is no longer infectious. The condition resolves in about three to four weeks in most cases.

The image below shows monkeypox lesions.

CDC Public Health Image Library Media ID #2329, Public Domain, https://commons.wikimedia.org/w/index.php?curid=6314378

How deadly is Monkeypox?

The case fatality rate for monkeypox is 0 to 11%, with children being more affected.

How will you know if it is monkeypox and not smallpox?

According to the CDC, monkeypox has the same symptoms but is milder than smallpox. The main difference is that monkeypox causes lymph nodes to swell (lymphadenopathy) while smallpox does not.

Monkeypox infection can be confirmed via isolation in viral culture or PCR for monkeypox DNA

Is there treatment for monkeypox?

Symptomatic treatment is used at this time, but if there is an outbreak, the smallpox vaccine, cidofovir, ST-246, and vaccinia immune globulin (VIG) can be used.

The smallpox vaccine is to develop active immunity, while the vaccinia immune globulin provides antibodies to bind the viruses.

The Centers for Disease Control and Prevention (CDC) recommends isolation in a negative pressure room and standard, contact, and droplet precautions in the healthcare setting with escalation to airborne precautions if possible.

How to avoid monkeypox?

If you are not a health care worker, avoid people with skin rash similar to monkeypox. Even if they have another disease like chickenpox, they are still contagious. Avoid physical contact, and better yet, don’t be in the same room with them to prevent airborne transmission.

If you work in health care, observe the precautions recommended by the CDC and your institution.

Will the monkeypox spread and cause an epidemic?

In COVID-19, infected people with mild symptoms can spread the infection. It is hard to isolate from them because they may appear well until they start coughing and sneezing. That is why COVID-19 can spread fast.

Monkeypox is infectious when the person has skin and oral lesions. This makes them easier to identify and isolate. Plus, they have other symptoms like fever, and they will feel weak.

That is why I wrote this article. Knowing how monkeypox spreads and its signs and symptoms will help prevent another round of quarantines, lockdowns, and another epidemic.
Don’t Get Sick!

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Reference:

Moore M, Zahra F. Monkeypox. [Updated 2022 Feb 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK574519/
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