An abstract representation of the monkeypox virus.
An abstract representation of the monkeypox virus.

What is the Human Monkeypox Virus?

Until July 2022 when the World Health Organization declared the monkeypox outbreak a public health emergency of international concern, monkeypox received little attention. Our understanding of the monkeypox virus remains limited. The lack of attentiveness was due to the belief that it is an uncommon illness that went away without intervention.1 

The growing concerns surrounding monkeypox are especially valid in locations like Africa, where humans frequently have contact with wild animals.Clinical studies have previously not been done despite monkeypox being an endemic disease in Africa for decades.3  

Although the exact mechanisms of how the virus enters the body remain unclear, scientists believe that initial human monkeypox cases originated from humans interacting with monkeypox-infected animals.1

With reported worldwide cases being 73 000 as of October 2022 and the effects of the virus being more severe than previously thought, it is time to act.4

How is monkeypox spread?

Direct skin-to-skin contact with infectious monkeypox lesions is the primary method of virus transmission.3 The nose, mouth, eyes, and broken skin are thought to be the main entry points for the monkeypox virus into the body.1 

Most cases reported during the current outbreak have involved sexual intercourse or other intimate contacts.3  Transmission of the virus could occur if one comes into contact with clothing and personal objects that someone with monkeypox used.5

What are the clinical features of monkeypox?

Monkeypox is can range from non-life-threatening to life-threatening with either causing unpleasant symptoms that can additionally cause social stigma.3 Monkeypox has milder clinical symptoms than smallpox, yet it can still be lethal, with mortality rates between 1% to 10%.1 

It may take 5 to 21 days to experience symptoms after contracting the virus.1 The symptoms may last 2 to 5 weeks. Before rashes form, the disease starts with non-specific symptoms such as

  • headaches
  • chills 
  • fever
  • swollen lymph nodes back pain
  • and muscle aches.1 

Monkeypox patients should stay isolated for the course of the illness, which generally lasts for 2 to 4 weeks.3

Given the current global outbreak, it is essential to look into any unusual skin lesions, especially those in areas surrounding the genitals.3 Monkeypox rashes may present as a single skin lesion or several lesions. Access to testing for monkeypox is improving and has recently expanded to 5 commercial laboratories where results may take 2 to 3 days to process.3

Monkeypox has symptoms and lesions that are difficult to distinguish from smallpox.6 Swollen lymph nodes are seen in 90% of monkeypox cases, and scientists believe this is a clinical feature that distinguishes human monkeypox from smallpox.1 

Rashes of different sizes typically appear 1 to 5 days after the fever starts.1 These rashes first appear on the face, then spread to the rest of the body, particularly the hands, legs, and feet. 

Other complications of monkeypox include pneumonia, encephalitis, and eye infections, which are most common in children under the age of 8, in those with compromised immune symptoms, or in persons who are pregnant.3 

How is monkeypox treated?

Recent data suggest that hospitalizations due to monkeypox are uncommon with pain management being the primary reason behind hospital admissions.3 The majority of patients only need symptomatic therapy. There are currently no antiviral drugs approved for the treatment of monkeypox.3 Those at risk for severe monkeypox disease are advised to seek treatment.3

What vaccines are available for monkeypox?

Two vaccines are now available to prevent monkeypox. These vaccines are the Bavarian Nordic JYNNEOS vaccine, which is FDA-approved for both smallpox and monkeypox, and ACAM2000, which is only FDA-approved for smallpox but is permitted for use against monkeypox.3 It has been reported either vaccine may prevent at least 85% of monkeypox.

Both vaccines may also be administered after being infected with the human monkeypox virus. Immunization can reduce sickness when given up to 4 days after exposure.3 When inoculated up to 2 weeks after exposure, the vaccines can lessen the severity of monkeypox symptoms.3 It is advised that you contact your healthcare provider for more information on monkeypox vaccines and take preventative measures against the virus. 

References

  1. Petersen E, Kantele A, Koopmans M, et al. Human monkeypox: Epidemiologic and clinical characteristics, diagnosis, and prevention. Infect Dis Clin North Am. 2019;33(4):1027-1043. doi:10.1016/j.idc.2019.03.001
  2. Petersen E, Abubakar I, Ihekweazu C, et al. Monkeypox — Enhancing public health preparedness for an emerging lethal human zoonotic epidemic threat in the wake of the smallpox post-eradication era. Int J Infect Dis. 2019;78:78-84. doi:10.1016/J.IJID.2018.11.008
  3. Del Rio C, Malani PN. Update on the Monkeypox Outbreak. JAMA. 2022;328(10):921-922. doi:10.1001/jama.2022.14857
  4. 2022 Monkeypox Outbreak Global Map | Monkeypox | Poxvirus | CDC. Accessed October 14, 2022. https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html
  5. Guarner J, Del Rio C, Malani PN. Monkeypox in 2022-What clinicians need to know. JAMA. 2022;328(2):139-140. doi:10.1001/jama.2022.10802
  6. Di Giulio DB, Eckburg PB. Human monkeypox: an emerging zoonosis [published correction appears in Lancet Infect Dis. 2004 Apr;4(4):251]. Lancet Infect Dis. 2004;4(1):15-25. doi:10.1016/s1473-3099(03)00856-9
  7. Mucker EM, Shamblin JD, Raymond JL, Twenhafel NA, Garry RF, Hensley LE. Effect of monkeypox virus preparation on the lethality of the intravenous cynomolgus macaque model. Viruses. 2022;14(8):1741. Published 2022 Aug 9. doi:10.3390/v14081741
  8. Center for Disease Control. Monkeypox and Smallpox Vaccine Guidance | Monkeypox | Poxvirus | CDC, 2022. https://www.cdc.gov/poxvirus/monkeypox/clinicians/smallpox-vaccine.html.
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