A multi-country monkeypox outbreak is causing concern around the world, as more and more people get infected with the virus. According to the World Health Organization (WHO), 23 United Nations (UN) member states, across four different regions that are not endemic for the virus, have reported new monkeypox cases. At the end of May, there were 257 confirmed monkeypox cases in those non-endemic countries, with 127 more cases still being investigated. While scientists are now carefully examining the outbreak and hope to contain it before it becomes a critical global issue, many are left wondering what monkeypox really is, and how it’s connected to the now eradicated smallpox virus.
In fact, the monkeypox virus is closely related to the virus that causes smallpox, both being part of the four orthopoxviruses known to cause infection in humans: variola, vaccinia, cowpox, and monkeypox. According to Seth Blumberg, MD, PhD, an assistant professor of medicine at UC San Francisco, monkeypox is much less maiming and deadly than smallpox, and it is also easier to control than COVID-19 and other deadly viruses known to cause epidemics. Both diseases present serious symptoms like fever, swollen lymph glands, fatigue, headaches and a vesicular rash. Monkeypox is generally much milder—usually clearing up on its own within two to four weeks.
Public Health Risk
According to the WHO, scientists are still investigating the recent monkeypox outbreak to determine what the public health risks are. The agency goes on to say that most cases have no established travel links to an endemic region, and that the patients in question have been diagnosed after arriving at a primary care unit or sexual health clinic. The public health risk level is thought to be moderate. This is the first time a monkeypox outbreak has been simultaneously reported in different regions of the world and without links to non-endemic countries in West or Central Africa. Many of the confirmed cases have been reported among men who have sex with men (MSM).
“It’s important to recognize that the case reports we’re hearing about—transmission events between sexual partners—potentially is due simply to prolonged proximity or skin-to-skin contact,” Seth Blumberg says. Although cases have been confirmed primarily among MSM, the WHO states that the rapid appearance of the outbreak and its wide geographic range point to widespread human-to-human transmission of the virus. Moreover, the agency is concerned that the epidemic may have started several weeks ago, and that multiple cases remain undiagnosed. “The virus is not targeting people specifically because of their sexual practices,” Blumberg concludes.
Symptoms and Treatment
Monkeypox usually comes with fever, headaches, muscle aches and backache, swollen lymph glands, chills, and tiredness, according to the Centers for Disease Control and Prevention (CDC). In a few days, a rash begins to appear on the face. The rash then spreads to other parts of the body where the lesions continue to grow from macules to papules, vesicles to pustules, and later transform into scabs that will eventually fall off. The disease usually runs its course over two to four weeks, and while it has been known to cause death in 1/10 patients in Africa, no deaths have been reported elsewhere yet.
However, the CDC recommends multiple preventive measures, such as avoiding contact with animals that could carry the virus and items that have been in contact with sick persons or animals. As always, good hand hygiene is essential, especially after touching infected animals. The COVID-19 pandemic already proved that washing hands with clean water and soap, and using hand sanitizer can prevent people from getting sick. The health protection agency is currently evaluating an attenuated live virus vaccine for monkeypox prevention and reminds clinicians that approved antiviral treatments like Tecovirimat or TPOXX and Cidofovir or Vistide are also available in the United States. However, the disease is usually mild and most people infected with monkeypox recover on their own within two to four weeks.
Limiting Future Outbreaks
While the monkeypox virus is indeed related to the Variola major and Variola minor viruses—known to cause the much more dangerous smallpox infection—the disease it causes is milder by comparison. According to the WHO, “overall public health risk at global level is assessed as moderate,” as patients usually recover with just supportive clinical care. The agency advises policy-makers to provide the communities identified to be at risk with more information about the virus, but also suggests that measures should be taken to avoid unnecessary stigmatization of people and communities. Patients that present monkeypox symptoms should be offered testing, isolation, and supportive care.
For now, monkeypox seems to be a moderate healthcare issue in the United States and abroad, and the new threat seems to be much smaller when compared to past smallpox epidemics, and even to the ongoing COVID-19 pandemic. “We can be cautiously optimistic that the outbreak will be controlled,” Seth Blumberg says. However, the professor and many other scientists around the world already know that awareness and prevention are especially important now, and so is being “ready for the unexpected.”
