The monkeypox outbreak is currently raising concerns across the world. So far, around 100 cases of this new disease have been reported, while 28 suspected cases are currently under surveillance. The disease is not endemic to the 12 countries that reported monkeypox cases.

Australia, France, Belgium, and Germany reported their first case on the 20th of May 2022. So far, no one has died due to the disease.

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Dr Hans Kluge, World Health Organization’s Europe director, has described the monkeypox outbreak as ‘atypical,’ stating that the outbreak’s appearance in several countries across continents suggested that ‘transmissions were going on for quite some time’. According to Dr Kluge, the cases in Europe are milder compared to other regions.

What is the Monkeypox Outbreak?

Monkeypox is a viral zoonosis- a virus that can pass on from animals to humans. It has symptoms similar to those seen in previous years in smallpox patients, although it is clinically less brutal. Monkeypox virus is a part of the Orthopoxvirus genus in the family Poxviridae. The Orthopoxvirus genus includes variola virus (which causes smallpox), vaccinia virus (used in smallpox vaccines), and cowpox virus.

In 1958, the monkeypox disease first appeared when two outbreaks of pox-like disease occurred in the colonies of monkeys kept for study and research. Hence, the disease gets its name ‘monkeypox’. 1970 witnessed the first human case of monkeypox. It appeared in the Democratic Republic of Congo (DRC) in a 9-year-old boy during a phase of intensified efforts to remove smallpox. The disease has spread further, and more cases have been reported in people in several other western and central African countries.

The disease mainly occurs in Africa, often close to tropical forests. However, monkeypox cases in people have appeared outside of Africa in connection with international travel and imported animals, including cases in the United Kingdom, the United States, Israel, and Singapore. The disease is increasingly spreading in urban areas. As of now, the natural reservoir of monkeypox is unknown. However, African rodents and non-human primates such as monkeys may harbour the virus and infect people.

The monkeypox outbreak is a serious concern for public health as it affects countries in Africa and the rest of the world. The first monkeypox outbreak outside Africa was recorded in the United States and was linked to contact with infected pet prairie dogs. The Gambian pouched rodents, imported into the country from Ghana, transmitted the virus to the dogs.

What are the Symptoms of Monkeypox?

The incubation period for monkeypox (interval from infection to the start of symptoms) is generally from 6 to 13 days but can stretch from 5 to 21 days.

The infection occurs in two phases:

• The occupation or invasion phase (ranges between 0 to 5 days): This phase is characterized by intense headache, fever, back pain, intense asthenia (lack of energy), lymphadenopathy (swelling of the lymph nodes), and myalgia (muscle aches). Lymphadenopathy is a unique feature of monkeypox compared to other diseases that may initially appear similar (smallpox, chickenpox, measles).

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• The second phase is characterized by severe skin eruptions that generally begin within 1 to 3 days of the appearance of fever. The rash or eruptions tends to be more focused on the face. The face is affected in 95 percent of cases, and the soles of the feet and palms of the hands in 75 percent of cases. Oral mucous membranes are affected in 70 percent of cases, genitalia in 30 percent, and conjunctivae and cornea in 20 percent of cases. The rash develops sequentially from macules to papules, vesicles, pustules, and crusts which eventually dry up and fall off. The number of lesions differs from a small amount to a hundred.

Monkeypox is generally a self-limited disease with symptoms usually ranging from 2 to 4 weeks. Extreme cases mainly occur among children and young adults; they are related to the extent of virus exposure, the nature of the difficulty, and the patient’s health status. Underlying immune deficiencies sometimes result in severe outcomes.

Smallpox vaccinations were protective in the past. However, younger people today below the age of 40 or 50 (depending on the country) may be more vulnerable to monkeypox due to the global elimination of smallpox vaccine campaigns after the eradication of smallpox.

How Can This Disease be Treated?

Smallpox vaccines act as an effective agent against the monkeypox virus. The vaccine, examined through several observational studies, is approximately 85 percent effective in preventing monkeypox. Vaccinating people exposed to monkeypox with smallpox vaccines will reduce the effects of the virus.

Currently, the original (first generation) smallpox vaccines are not available to the public. Certain laboratory workers and health personnel have received a more recent vaccine to protect them in an outbreak or exposure to the virus in the workplace. A newer vaccine was developed based on a modified attenuated vaccinia virus and was approved in 2019 for the prevention of monkeypox. The new vaccine- a two-dose vaccine- is limited.

Several antiviral drugs are currently in the stage of development. The European Medical Association (EMA) recently licensed an antiviral agent known as ‘tecovirimat‘ in 2022, originally developed for smallpox. However, the vaccine is not widely available. The European Centre for Disease Prevention and Control has suggested complete isolation for all reported and suspected cases, while health personnel can offer high-risk cases the smallpox vaccine. Observation and rapid identification of new cases are essential for outbreak containment. Patients infected with monkeypox should be offered food and fluids to maintain sufficient nutritional status.

Close contacts with infected persons are the most significant risk factor for infection during monkeypox outbreaks. Health personnel or organizations should implement standard infection control measures for health workers dealing with infected patients and specimens.

Countries Most Affected

According to the World Health Organization (WHO), at least thousands of monkeypox infections are recorded across Africa every year. The majority of infections are in Congo- around 6,000 cases per year. Few of the earliest countries to report the outbreak include DRC, Cameroon, Gabon, Central African Republic, Nigeria, Republic of the Congo, Cote d’Ivoire, Liberia, and Sierra Leone.

Almost 47 people in the United States had confirmed or probable cases of monkeypox in 2003. According to the WHO, Nigeria reports around 3,000 cases per year. The monkeypox outbreaks are generally in rural areas where people are most likely to be in close contact with infected rodents and squirrels.

The sudden increase in cases outside Africa has several world leaders distressed. United States President Joe Biden stated that the recent outbreak of monkeypox identified in the United States and Britain is something ‘to be concerned about’. He adds that it would be consequential if the infection were to spread. The level of exposure to the disease is unknown to world leaders yet; however, it is still something to worry about.

British health officials are currently examining the transmission of the disease. According to health officials, while the risk to the general population is low, doctors and health personnel still need to be alert for potential cases. The WHO has given its support to member states with preparedness, surveillance, and outbreak response measures for monkeypox in affected countries.