Monkeypox: 2022 Outbreak

Public Health Emergency of International Concern

Monkeypox: What is it?

Monkeypox is a viral infection. It is a type of orthopoxvirus; viruses such as smallpox and cowpox also belong to this group. Despite its similar name, chickenpox is not a type of orthopoxvirus, rather it is caused by the varicella-zoster virus, a type of herpesvirus.

The monkeypox virus was first discovered in lab monkeys in 1958. This is how it got its name. The first human case was found in 1970. Despite its name, the origin of monkeypox is still undetermined although the virus is known to be a zoonotic disease, meaning it was passed on to humans from animals. Current evidence supports that the virus came from rodents.

Symptoms

Symptoms of monkeypox resemble those of smallpox. Yet, monkeypox fatalities are rare and its symptoms tend to be less severe. Swollen lymph nodes are a distinguishing difference between monkeypox and smallpox. An individual with monkeypox is contagious only at the onset of symptoms up until the rash has cleared. Asymptomatic people (i.e., people with no symptoms) cannot spread the virus. Illness typically lasts from 2-4 weeks. Symptoms of monkeypox include the following:

Fever
Headache
Muscle aches
Tiredness
Swollen lymph nodes
Rash that begins in the mouth then spreads to the skin of the face and the rest of the body

The monkeypox rash can be painful and itchy. The rash goes through various phases over the course of the illness. At first, the rash appears as pus-filled, pimple-like lesions. This lasts for 5-7 days. In the following 7-14 days, the lesions begin to develop a crust and then flake off.

How can you get it?

Monkeypox can be spread directly from person-to-person by the pus of the rash or respiratory droplets, or indirectly by contact with contaminated surfaces or objects. The virus can also be spread through bodily fluids. Sexual activity is a source of transmission. Monkeypox can be passed on from an infected mother to her

Treatment and Prevention

There is no real treatment for monkeypox. Treatment is typically given only for symptom management. In most cases, the infection resolves completely on its own by the end of 4 weeks. Apart from some potential skin scarring, most individuals make a full recovery with no persisting symptoms.

Since the virus cannot be spread by people who do not have symptoms, only individuals who have symptoms need to consider the following advice:

Self-isolate
Wear a mask
Keep rash/skin lesions covered until fully healed

Action is only required at symptom onset, not at exposure. Always follow local guidelines first.

The Centers for Disease Control and Prevention (CDC) states vaccination before or even after exposure can be helpful. The onset of illness can sometimes be prevented if a vaccine is administered within 4 days of exposure and if a vaccine is received within 14 days, it may help to reduce the severity of symptoms and reduce the chance of associated complications. Unfortunately, these monkeypox specific vaccines are currently not widely available.

Public Health Emergency of International Concern (PHEIC)

Monkeypox has been found in Central and West Africa for years (endemic), but in the last few months over 16,000 cases have been reported in 75 countries and territories. The virus is popping up in places like Europe and North America where it has never been seen before and in people with no history of recent travel to Central or West Africa.

On the 23^rd of July 2022, the World Health Organization's (WHO) Director-General, Tedros Adhanom Ghebreyesus, released a statement declaring the current monkeypox outbreak as a Public Health Emergency of International Concern (PHEIC). A PHEIC is the WHO’s highest call to action, whereby the disease is said to have global concern and requires a coordinated global effort to resolve. It is in response to how fast the virus is spreading and where and how the virus is spreading. Transmission is occurring quickly and through new ways which we need to understand more about. It does not necessarily relate to the virus’s level of danger nor the risk to an individual’s health. Monkeypox has a relatively low transmission and fatality rate.

References

Moore M, Zahra F. Monkeypox [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 Jul 24]. 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK574519/
Centers for Disease Control and Prevention (CDC). Signs and Symptoms [Internet]. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2022 Jun 24 [cited 2022 Jul 24]. Available from: https://www.cdc.gov/poxvirus/monkeypox/symptoms.html
Centers for Disease Control and Prevention (CDC). How it Spreads [Internet]. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2022 Jun 24 [cited 2022 Jul 24]. Available from: https://www.cdc.gov/poxvirus/monkeypox/transmission.html
Centers for Disease Control and Prevention (CDC). Considerations for Monkeypox Vaccination [Internet]. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2022 Jun 30 [cited 2022 Jul 24]. Available from: https://www.cdc.gov/poxvirus/monkeypox/considerations-for-monkeypox-vaccination.html
World Health Organization (WHO). WHO Director-General's statement at the press conference following IHR Emergency Committee regarding the multi-country outbreak of monkeypox - 23 July 2022 [Internet]. Geneva, CH: WHO; 2022 Jul 23 [cited 2022 Jul 24]. Available from: https://www.who.int/director-general/speeches/detail/who-director-general-s-statement-on-the-press-conference-following-IHR-emergency-committee-regarding-the-multi--country-outbreak-of-monkeypox--23-july-2022#:~:text=At the time, 3040 cases,and territories, and five deaths
World Health Organization (WHO). What do we know about the outbreak of monkeypox in several countries in 2022? [Internet]. Geneva, CH: WHO; 2022 Jul 12 [cited 2022 Jul 24]. Available from: https://www.who.int/news-room/questions-and-answers/item/monkeypox?gclid=EAIaIQobChMI3KzllI2T-QIVg4TICh1VbgckEAAYASAAEgKmOfD_BwE