The latest outbreak of monkeypox has, at the time of writing, reached 17 countries with 110 confirmed cases and a further 205 suspected cases. It’s a fast-moving story, so if you need to catch up on the latest, here are answers to some of the most pressing questions. By Ed Feil, University of Bath
How is monkeypox spreading?
The first patient in the current outbreak had returned to the UK from travels to Nigeria where monkeypox is endemic. (There have been similar cases of travellers from Nigeria ‘exporting’ Monkeypox to other parts of the world in previous years. Just last year – June 2021 – a person from Nigeria was identified with the disease in the US, and another person from Nigeria exported it to the UK where they infected two other members of the family.) However, cases are now spreading among people who have not travelled to west or central Africa, suggesting local transmission is occurring.
Monkeypox usually spreads by close contact and respiratory droplets. However, sexual transmission (via semen and/or vaginal fluid) has been posited as an additional possible route. The World Health Organization (WHO) says: “Studies are needed to better understand this risk.”
Most cases in the current outbreak have been in youngish men, but the virus can spread to anyone.
What are the symptoms?
Early symptoms are flu-like, such as a fever, headaches, aching muscles and swollen lymph nodes.
Once the fever breaks, a rash can develop, often beginning on the face and then spreading to other parts of the body – most commonly the palms of the hands and soles of the feet.
View pictures of the evolution of Monkeypox lesions here.
How deadly is monkeypox?
Monkeypox is mostly a mild, self-limiting disease lasting two-to-three weeks. However, in some cases, it can cause death. According to the WHO, the fatality rate “in recent times” has been around 3% to 6%. The west African monkeypox virus is considered to be milder than the central African one.
Monkeypox tends to cause more serious disease in people who are immunocompromised – such as those undergoing chemotherapy – and children. There have been no deaths from monkeypox in the current worldwide outbreak, but, according to the Daily Telegraph, one child in the UK is in intensive care with the disease.
Why is it called monkeypox?
Monkeypox was first identified in laboratory monkeys (macaques) in Denmark in 1958, hence the name. However, monkeys don’t seem to be the natural hosts of the virus. It is more commonly found in rats, mice and squirrels. The first case in humans was seen in the 1970s in the Democratic Republic of the Congo.
Is monkeypox related to smallpox and chickenpox?
Monkeypox is related to smallpox – they are both orthopoxviruses – but it is not related to chickenpox. Despite the name, chickenpox is a herpes virus, not a poxvirus. (How “chicken” got in the name is not entirely clear. In his dictionary of 1755, Samuel Johnson surmised that it is so named because it is “of no very great danger”.) Nevertheless, the vesicles (little pus-filled blisters) caused by monkeypox are similar in appearance to those of chickenpox.
Are cases likely to continue rising?
Cases are likely to continue to rise significantly over the next two-to-three weeks, but this is not another pandemic in the making. Monkeypox doesn’t spread anywhere near as easily as the airborne virus SARS-CoV-2 that causes COVID-19.
Has monkeypox evolved to be more virulent?
RNA viruses, such as SARS-CoV-2, don’t have the ability to check their genetic code for mistakes each time they replicate, so they tend to evolve faster. Monkeypox is a DNA virus, which does have the ability to check itself for genetic mistakes each time it replicates, so it tends to mutate a lot slower.
The first genome sequence of the current outbreak (from a patient in Portugal) suggests that the virus is very similar to the monkeypox strain that was circulating in 2018 and 2019 in the UK, Singapore and Israel. So it is unlikely that the current outbreak is the result of a mutated virus that is better at spreading.
(The WHO confirmed today it has no evidence that the monkeypox virus has mutated. The more than 100 suspected and confirmed cases in the recent outbreak in Europe and North America have not been severe, the WHO’s emerging diseases and zoonoses lead and technical lead on COVID-19, Maria van Kerkhove, said. “This is a containable situation,” she said.)
How is monkeypox diagnosed?
In the UK, swab samples taken from the patient are sent to a specialist laboratory that handles rare pathogens, where a PCR test is run to confirm monkeypox. The UK Health Security Agency has only one rare and imported pathogens laboratory.
Is there a vaccine for it?
Vaccines for smallpox, which contain the lab-made vaccinia virus, can protect against monkeypox. However, the vaccine that was used to eradicate smallpox can have severe side-effects, killing around one in a million people vaccinated.
The only vaccine specifically approved for monkeypox, Imvanex, is made by a company called Bavarian Nordic. It uses a nonreplicating form of vaccinia, which causes fewer side-effects. It was approved by the US Food and Drug Administration and the European Medicines Agency in 2019 – but only for use in people 18 years of age or older.
UK health secretary Sajid Javid said that the UK government will be stocking up on vaccines that are effective against monkeypox. The UK currently has about 5,000 doses of smallpox vaccine, which has an efficacy of around 85% against monkeypox.
Are there drugs to treat it?
There are no specific drugs to treat monkeypox. However, antivirals such as cidofovir and brincidofovir have been proven to be effective against poxviruses in animals and may also be effective against monkeypox infections in humans.
By Ed Feil, Professor of Microbial Evolution at The Milner Centre for Evolution, University of Bath
This article is republished from The Conversation under a Creative Commons license. Read the original article.
The Latest on Monkeybox from the World Health Organisation (WHO)
The World Health Organization said it expects to identify more cases of monkeypox as it expands surveillance in countries where the disease is not typically found.
“Available information suggests that human-to-human transmission is occurring among people in close physical contact with cases who are symptomatic”, the WHO added.
“What seems to be happening now is that it has got into the population as a sexual form, as a genital form, and is being spread as are sexually transmitted infections, which has amplified its transmission around the world,” WHO official David Heymann, an infectious disease specialist, told Reuters.
German Health Minister Says Monkeypox Outbreak is Cause for Concern
The worldwide outbreak of monekypox is so unusual that it’s a cause for concern, German Health Minister Karl Lauterbach said on the sidelines of a WHO meeting in Geneva on Monday (May 23).
Lauterbach, an epidemiologist, told reporters quick and decisive action was required in order to contain the spread of the virus.
“I urge all those who had anonymous sex with men to be vigilant and to pay attention to possible changes on their skin, to take a fever seriously and to quickly seek medical assistance in the case of a suspicion.”
UN Accuses Media Of Homophobic And Racist Monkeypox Reporting
The United Nations’ Aids agency has labeled some reporting on the monkeypox outbreak as racist and homophobic. “Some public reporting and commentary on Monkeypox has used language and imagery, particularly portrayals of LGBTI and African people, that reinforce homophobic and racist stereotypes,” said UNAIDS. They said “a significant proportion” of recent monkeypox cases have been gay, bisexual and other men who have sex with men However, they say transmission is most likely caused by close physical contact and can affect anyone.
Monkeypox: gay and bisexual men aren’t at greater risk from the disease – but they are from unfair stigma
The first case of monkeypox in the current outbreak was reported to the World Health Organization (WHO) on May 7. The person in question had recently returned to the UK from Nigeria, where they are believed to have contracted the infection. Since then, further cases have been reported in over a dozen countries where the disease is not normally present, including several European countries, Israel, the US and Canada, as well as Australia.
It has attracted a morbid interest from the public and media. Strange new infectious diseases that the public is unfamiliar with, such as monkeypox, can generate a disproportionate degree of fear in the population. In part, this is due to its “exotic” nature, the fear of contagion, and the perception that it is spreading quickly and invisibly in the population.
This “germ panic” is further heightened by the off-putting visible disfigurements caused by the infection, even if only temporarily. In addition, the public health measures required, such as isolation procedures, healthcare workers suited up in personal protective equipment, and rigorous investigations and contact tracing, are all reminiscent of interventions an authoritarian police-state might use for some crime. Misleading information in the media, and especially social media, could further fuel public anxiety, as was the case with Ebola in 2014.
The more recent monkeypox cases did not have travel links to countries where the disease is endemic, which raises the possibility that the disease may have been silently spreading in the population for some time before it was detected. Many cases, but not all, that were recently reported were in gay, bisexual and other men who have sex with men. This is unfortunate as there is a real danger here of further stigma being generated towards this group.
They have suffered tremendously over the years with the stigma attached to infectious disease, most notably with the HIV/Aids pandemic, and there is still a strong undercurrent of homophobia even in countries with strong LGBTQ+ rights. This is despite a lot of effort by the LGBTQ+ community, public education programmes and equal rights legislation to tackle stigmatisation.
There are lessons we need to learn from the HIV/Aids pandemic. Some of the stigma was driven by deeply held religious and cultural beliefs in society that unfairly equated their sexuality with notions of immorality and negative stereotypes of promiscuity. Gay and bisexual men were blamed as the source and cause of HIV spread, even though it was also spread through other routes such as heterosexual sex, from mother to child, needle-stick injuries and contaminated blood products. The situation was worse for men from an ethnic minority background, where racial prejudices and stereotypes added to the stigma.
This, in turn, had serious consequences for the people affected, especially on their mental and emotional wellbeing. It affected their social and sexual relationships, leading to rejection by their partners and social isolation. It resulted in some changing their health behaviour that led to delays in seeking healthcare. It meant some were not prepared to disclose who their contacts were – this would hinder outbreak investigations and control efforts by public health teams trying to track down the disease and stop its spread.
So how should we tackle this outbreak? First, public health initiatives, such as clear, timely and transparent public education about the disease, can help allay public fears. Increased public access to reliable health information sources would also help. But we need to get the message out there about monkeypox sensitively, without stoking fear and mistrust and inadvertently alienating men who have sex with men.
We need to help the public put the risk of this disease in perspective – it is usually a mild, self-limiting illness that usually goes away on its own within a few weeks, and it does not spread that easily. We need to reassure the public that this is not a new disease – scientists have studied it for years and have a good understanding of how it spreads and its health consequences. We can also reassure those who have been exposed that there is an effective vaccine against it.
We need to get across the message that monkeypox is not a disease of men who have sex with men. It is not about sexuality: people tend to be infected through close physical contact and it does not have to be sexual in nature. Infected people will tend to infect people they have close contact with, which is why the risk of spread is high in affected households.
So while a high proportion of cases have so far occurred among men who have sex with men, in part this reflects their social networks. It could just as easily have been an outbreak in a heterosexual friendship network, or a group of sports people, or occupational group, or other social groups. Would it have carried as much risk of stigma then?
Another danger of mis-portrayal of the monkeypox outbreak as a phenomenon that only affects men who have sex with men is that others who at risk – for example, household members – may not realise this and fail to protect themselves. We also need to alert and inform travellers to endemic areas in west and central Africa as they may not realise there is a risk there.
Our best chance of snuffing out this outbreak quickly is through early detection and quarantining people who are infected and protecting their close contacts through vaccination, to break the chains of transmission. As we know all too well from our experience with HIV, stigma won’t help.
Source: Reuters / The Conversation