MONKEYPOX

MONKEYPOX

Monkeypox is an illness caused by the monkeypox virus. It is part of the same family of viruses known as variola virus, the virus that causes smallpox. With the eradication of smallpox, monkeypox has emerged as the most important orthopoxvirus for public health.

NATURAL HOST OF MONKEYPOX

Mostly occurring in Central and West Africa, monkeypox is becoming more prevalent in urban areas. The disease is called monkeypox because it was first identified in colonies of monkeys kept for research in 1958. It was only later detected in humans in 1970. Despite its name, the source of the disease remains unknown. However, African rodents such as squirrels, rats, mice and other non-human primates might harbor the virus as well.

MODE OF TRANSMISSIO

1.  Animal to Human: This occurs from direct contact with bodily fluids such as blood or cutaneous / mucosal lesions of infected animals.

– Eating Inadequately cooked meat or other infected animal products.

2. Human to Human: Close contact with respiratory secretions, skin lesions of an infected person or recently contaminated objects, and sexual activities.

– Transmission can also occur via the placenta from mother to fetus which can lead to congenital monkeypox

SIGNS AND SYMPTOMS

Monkeypox is usually a self-limited disease with symptoms lasting from 2 – 4 weeks.

INCUBATION PERIOD

The incubation period of monkeypox is roughly 1-2 weeks. In this stage, the affected person is not symptomatic (does not show symptoms and may feel fine).

PRODROME

The affected person may sometimes be contagious during this period. Symptoms include:

1.  Lymphadenopathy (swollen lymph nodes) 
2. Fever
3. Malaise
4. Headache
5. Sore Throat
6. Cough
7. Myalgia
8. Fatigue

N.B: Lymphadenopathy is a distinctive feature of monkeypox compared to other diseases that may appear similar (chickenpox, measles).

SKIN ERUPTIONS

This 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 the trunk. It also affects the oral mucous membrane, genitals and conjunctiva.

The rashes evolve from

1. Macules (lesions with flat base)
2. Papules (slightly raised form lesions)
3. Vesicles (lesions filled with yellowish/ transparent fluid)
4. Crusts (vesicles that dry up and fall off)

DIAGNOSIS

Diagnosis is made by carrying out appropriate laboratory investigations using specimens from skin lesions (fluid from vesicles) and dry crust.

N.B Blood tests are usually inconclusive.

TREATMENT

1. Infected persons should follow the advice of their health care provider. Symptomatic relief can be offered if needed. Medication for pain (analgesics) and fever (antipyretics) can be used.
2. It is important for anyone with monkeypox to stay hydrated, eat well and get enough sleep.
3. People who are self isolated should take care of their mental health by doing things they find relaxing and enjoyable.
4. Infected persons should avoid scratching their skin and take care of their rash by cleaning their hands before and after touching lesions and keeping skin dry.

THERAPEUTICS

Many years of research on the therapeutics for smallpox have led to deployment of products that may also be useful for treating monkeypox. Eg Tecovirimat, an antiviral that was developed to treat smallpox was approved by the European Medicines Agency for the treatment of monkeypox.

PREVENTION

1. Avoid close skin to skin contact, bodily fluids and sexual activities with people who have a rash that looks like monkeypox.
2. Do not share eating utensils or cups with a person with monkeypox.

IS THERE A VACCINE AGAINST MONKEYPOX?

Yes, a vaccine was recently approved for preventing monkeypox but only for people who are at risk.

N.B Mass vaccination is not recommended at this time.

KEY FACTS

1. WHO recently declared monkeypox outbreak a global health emergency.
2. Monkeypox is a viral zoonotic disease that occurs primarily in tropical rainforest arrears of Central and West Africa and is occasionally exported to other regions.
3. Monkeypox virus is transmitted to humans through close contact with an infected person or animal or with materials contaminated with the virus.
4. Monkeypox is transmitted from one person to another by close contact with lesions, body fluids, respiratory droplets and contaminated material such as beddings.
5. The clinical presentation of monkeypox resembles that of smallpox, a related orthopoxvirus infection which was declared eradicated worldwide. Monkeypox is less contagious than smallpox and causes a less severe illness.
6. Monkeypox typically presents clinically with fever,rash, swollen lymph nodes and may lead to a range of medical complications. 
7. Monkeypox is usually a self-limited disease with symptoms lasting from 2-4 weeks. Severe cases can occur. In recent times, the case fatality ratio has been around 3-6%.
8. Vaccines used during the smallpox eradication programme also provided protection against monkeypox. Newer vaccines have been developed of which one has been approved for prevention of monkeypox.